Breast cancer, a pervasive malignancy affecting women worldwide, continues to be a subject of extensive research and clinical exploration. Modern oncoplastic techniques have provided alternatives for managing centrally located breast cancers. The Grisotti flap technique offers a practical approach, employing a local rotational dermoglandular flap to fill the central defect. The aim of this study is to evaluate the short-term outcomes of Grisotti flap oncoplastic technique as a breast-conserving surgical approach for centrally located breast cancer in Bangladeshi patients. This prospective study included 23 female patients with central quadrant breast cancer who underwent Breast-Conserving Surgery (BCS) followed by immediate reconstruction using the Grisotti oncoplastic technique at Bangladesh Medical University (BMU) and Anower Khan Modern Hospital; Dhaka, Bangladesh from January 2019 to March 2023. The study findings offer promising insights, suggesting that the Grisotti flap technique not only presents a viable and oncologically safe option but also yields satisfactory aesthetic outcomes for patients dealing with central quadrant breast cancer. However, it is important to note that this study primarily investigates short-term outcomes, and further research encompassing a larger patient cohort and an extended follow-up period is essential to comprehensively assess the long-term survival implications of this surgical procedure.

Outcomes of gastrocnemius flap coverage during treatment of periprosthetic joint infection of the knee: Planned versus unanticipated flap timing.

Reconstructive options for skin defects in the distal lower extremity are limited. Propeller flaps (PF) represent an important option due to their practicality and wide applicability. Planning the flap in a rational and practical manner facilitates reconstruction in this area. PF was performed in 52 patients with distal lower extremity soft tissue defects. The patients had an age range of 23 to 58 years, with a male preponderance (45 males and 7 female). The flap size ranged from 8 × 4 to 18 × 7cm. This study was conducted retrospectively to examine the salvage procedure in cases of venous congestion, which is frequently encountered with PF. Total necrosis was not occured in any of the patients. Partial necrosis developed in three patient, accounting for 1/5 of the flap. Moderate venous congestion (MVC) occurred in 10 patients, all of whom received leech therapy. One patient developed an infection on postoperative day 4. Venous supercharging was performed in 23 patients during surgery. No complications occurred in 42 patients. In statistical analysis, increasing artery diameter significantly increases the frequency of supercharging (p = 0,001), and also increasing the degree of flap rotation significantly increases the risk of MVC (p = 0,001). In distal lower extremity tissue defects where the use of local flap is limited, PF can potentially become the first choice. Complications such as venous congestion, which most commonly occur with these flaps, can be readily addressed using salvage procedures such as leech therapy and venous supercharging.

Catastrophic pelvic and perineal trauma with associated traumatic hemipelvectomy is extremely rare and carries a high mortality risk. These injuries often involve multisystem destruction, including genitourinary, anorectal, musculoskeletal, and vascular structures, presenting extraordinary challenges for surgical management and reconstruction. Reports of survivors, particularly from resource-limited settings, remain limited. A 52-year-old man presented in 2022 with devastating pelvic-perineal trauma following a high-energy motorcycle crash. He received initial first aid at a district hospital before being urgently transferred to our tertiary care center in Vietnam. Upon arrival, he was in profound hemorrhagic shock, with non-palpable pulses and unrecordable blood pressure. Operative findings revealed complete avulsion of the left hemipelvis, severe crush injury of the left lower limb, full-thickness rectal transection, bladder rupture, and complete loss of the external genitalia. He underwent prompt resuscitation, left hemipelvectomy, and fecal and urinary diversion, followed by staged reconstruction. Definitive wound coverage was achieved using a combination of local rotational flap, right profunda artery perforator (PAP) flap, and autologous skin grafting. The patient recovered well and was discharged after 112 days with stable vital signs and functioning urinary and fecal diversion. This case demonstrates the survivability of catastrophic pelvic-perineal trauma with traumatic hemipelvectomy. It emphasizes the importance of multidisciplinary care, early hemorrhage control and surgical intervention, as well as adaptable reconstruction strategies in low-resource settings. Not applicable.

Periorbital defects following Mohs micrographic surgery (MMS) require precise reconstruction to preserve both function and aesthetics. To evaluate reconstructive outcomes for periorbital nonmelanoma skin cancers treated with MMS and assess the influence of defect size and subunit localization on surgical decisions. Sixty-eight patients treated between 2014 and 2022 were retrospectively reviewed. Data on tumor characteristics, defect dimensions, reconstructive techniques, and complications were analyzed across 4 periorbital subunits. Basal cell carcinoma was the most frequent malignancy (95.6%), primarily involving the lower eyelid (61.8%). Complex repairs (56%)-predominantly transposition flaps for lower eyelids and glabellar rotation flaps for the medial canthus-slightly outnumbered simple repairs (44%). Statistical analysis revealed no significant association between defect size and reconstruction method (P=0.679) or anatomic subunit (P=0.143). Complications occurred in 7.4% of cases, mainly including ectropion and hypertrophic scarring. Notably, ectropion was associated with inadequate vertical tension management rather than defect size alone. The retrospective, single-center design and the relatively small sample size for certain subunits, such as the upper eyelid, are the primary limitations of this study. Nevertheless, our findings demonstrate that periorbital reconstruction following MMS should prioritize individualized, subunit-specific strategies over rigid size-based protocols. A flexible approach focused on vertical tension management and anatomic integrity ensures optimal functional and cosmetic outcomes while minimizing malposition risks.

Superiorly based facial artery musculomucosal flap with maxillary sinus access for palate defects.

Flattening of the hip with masculinization and lack of buttock projection are common consequences of buttock lift procedures in women. Rotational axial flaps provide central and lower buttock volume but often lack enough remaining tissue to provide hip and upper buttock projection. We describe a buttock lift technique, utilizing a well-vascularized, broadly-based "sliding" adipofascial flap to preserve and enhance hip and upper buttock projection, while using autologous fat grafting for central and lower buttock volume. A retrospective analysis was performed of all female patients who underwent buttock lift surgery with an autologous adipofascial flap by the senior surgeon between January 2015 and December 2020. A total of 145 female patients underwent buttock lift surgery with a sliding adipofascial flap; 132 (91%) receiving concomitant fat grafting of the central and lower buttocks. Average follow-up was 9.7 months (2-48 months). Average patient age was 46 (23-68), and average BMI was 28.3 (17-39.6). The overall patient complication rate for all procedures performed was 17.2%, while the complication rate for the buttock lift procedure alone was 8.3%. No instance of adipofascial flap necrosis occurred. The sliding adipofascial flap provides an alternative for volume enhancement in buttock lift surgery, prioritizing use of the valuable hip-flank adipose tissue for more proximal upper buttock and hip projection while relying on autologous fat grafting for the more distal central and lower buttock. This retrospective review demonstrates a strong safety profile with predictable aesthetic outcomes.

Basal cell carcinoma (BCC) of the upper lip poses significant reconstructive challenges due to the need to restore both function and aesthetics in a highly visible area. This case series presents four patients with upper lip BCC that underwent Mohs micrographic surgery followed by individualized local flap reconstruction. Flap selection was tailored to each defect, utilizing rotational, advancement, O-to-Z, and transpositional flaps to address variations in size, location, and tissue availability. All patients experienced satisfactory healing, restoration of lip contour, and preservation of oral competence, with no major complications or recurrences during follow-up. These results highlight the importance of careful preoperative planning and personalized surgical approaches in achieving optimal outcomes for upper lip reconstruction. Our findings support the use of versatile local flaps as effective options for managing complex upper lip defects following BCC excision.

Facelift surgery is becoming increasingly common in men. Certain male- specific characteristics necessitate a tailored approach to achieve a natural, stigma-free outcome. The sideburn area in men requires special attention to avoid visible scars and to maintain its position, preventing an unaesthetic and feminized appearance. The author describes his personal approach to managing the sideburns in men undergoing facelift surgery and provides a literature review of techniques used in this region to avoid postoperative stigmas. The technique used by the author allows for the maintenance of both the width and position of the male sideburns, with scars camouflaged within the hair and beard regions. Temporal flap rotation and excess skin resection in the male sideburn area have proven effective in maintaining a natural, stigma-free result. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

This single-center prospective cohort study evaluated the clinical outcomes of thick acellular dermal matrix (ADM) for partial volume correction in breast reconstruction. Small-to-moderate volume deficits commonly occur after partial or total mastectomy in Asian women with relatively small breasts and may not justify additional major flap surgery. This study aimed to evaluate the safety and efficacy of thick ADM (≤5 mm) for intraoperative partial volume correction across oncoplastic and reconstructive settings. Between July 2022 and June 2023, thick ADM was applied as a deep onlay beneath glandular reshaping flaps, rotation flaps, or latissimus dorsi (LD) flaps in 20 prospectively enrolled cases, while 124 cases without thick ADM (67 partial mastectomy, 57 total mastectomy) served as a reference cohort; clinical variables, complications up to 6 months, and patient-reported satisfaction using a modified KNU Breast-Q were analyzed using appropriate statistical tests. The thick ADM group more frequently underwent oncoplastic volume displacement or replacement and received postoperative radiotherapy. However, rates of seroma, hematoma, dehiscence, fat necrosis-like firmness, infection, and reoperation were comparable between groups. No reconstruction failures or implant removals occurred in the thick ADM cohort. Both groups reported high satisfaction across all domains. Thick ADM is a safe, practical option for targeted partial volume correction following partial or total mastectomy, enabling restoration of contour and symmetry without increased short-term complications.

Despite advantages of titanium mesh, hardware exposure affects up to 25% of cases reported in the literature. We aim to identify risk factors associated with titanium mesh exposure following cranioplasty and characterize early wound changes that may signal impending hardware exposure. A review of 34 patients who underwent titanium mesh cranioplasty between 2015 and 2025 was performed. Seventeen patients with hardware exposure were matched 1:1 with 17 controls. Data on demographics, comorbidities, operative details, and postoperative complications were collected. Statistical analysis included Fisher exact test and t tests, with significance set at P<0.05. Significant risk factors for titanium hardware exposure included a history of metal allergy and reconstruction with advancement flaps. Significant protective factors included patients undergoing postoperative radiation therapy and reconstruction with rotational flaps. Titanium mesh exposure risk increases with metal allergy history, postoperative radiotherapy, and use of advancement flaps for reconstruction. Recognition of early wound changes is crucial for timely intervention. These findings support individualized surgical planning and highlight the need for close postoperative monitoring to reduce complications and improve reconstructive outcomes.

Background:Wounds of the posterior elbow present a reconstructive challenge due to the need for durability to withstand the bony prominences while allowing for a large arc of tension-free motion. A variety of options have been described along the entire spectrum of reconstructive surgery. We explore a more straightforward antegrade extended lateral arm flap for its effectiveness in covering these difficult to treat wounds.Methods:Over the course of August 1, 2020, to May 1, 2024, we selected 3 different patients, with posterior elbow wounds that required flap coverage, to investigate an innovative technique for elbow defects. We present these patients in a case series to demonstrate our technique of antegrade extended lateral arm rotation flaps for posterior elbow and olecranon coverage.Results:This reliable flap has a lower degree of technical difficulty and closes wounds in a tension-free manner. It does not require identification or dissection of perforating vessels. Redundant tissue is intentionally inset over the olecranon to allow for motion free of tension on the skin, and the donor site is covered with a split thickness skin graft. All 3 of our patients’ wounds healed, with only 1 complication of prolonged serous drainage from a small wound that resolved with local wound care.Conclusions:This flap technique for covering posterior elbow wounds is safe, fast, and technically less challenging; has low donor-site morbidity; and provides durable coverage that allows for expedited elbow range of motion.

Kiss flap in middle leg reconstruction: A technical note.

Matrix rotation flap: A simple technique for tumors in the upper inner quadrant of the breast

Oncologic and non-oncologic cutaneous defects represent a frequent challenge in clinical practice, particularly when they are located in facial regions of high aesthetic and functional relevance. Proper management of these lesions requires careful integration of dermatologic criteria that guide oncologic resection and reconstructive principles that allow restoration of anatomy and function. Basal cell carcinoma is the most common cutaneous malignant neoplasm and, although it has low metastatic potential, it may generate significant defects when it involves photoexposed areas such as the cheek. This article presents a narrative review of the management of oncologic and non-oncologic cutaneous defects, emphasizing dermatologic criteria and reconstructive strategies, accompanied by a clinical case report of a 38-year-old female patient with basal cell carcinoma located in the right malar region. The patient was treated with surgical excision using adequate oncologic margins and immediate reconstruction with a Mustardé cheek rotation flap, achieving satisfactory functional and aesthetic outcomes with no evidence of tumor recurrence during follow-up. Through the integration of the clinical case and the literature review, epidemiologic factors, dermatologic evaluation criteria, and reconstructive principles influencing decision-making are highlighted. This comprehensive approach underscores the importance of individualized planning and an interdisciplinary strategy to optimize clinical and aesthetic outcomes in the management of facial cutaneous defects.

Large cutaneous defects of the trunk and extremities are frequently encountered in dermatologic surgery and often exceed the limits of primary closure. Local flaps remain a strong reconstructive option because of their robust perfusion, excellent skin match, and ability to be performed under local anesthesia in the office setting. This experience-based narrative overview outlines the authors' preferred local flap techniques for the reconstruction of large truncal and extremity defects. Each approach is illustrated with representative cases. In our experience, local flaps provide dependable coverage for large truncal and extremity wounds while maintaining natural contour and mobility. Depending on anatomic site and defect characteristics, preferred options include A-T advancement, single- and double-arm (O-Z) rotation flaps, rhombic flaps, keystone flaps, and peri-areolar mobilization techniques. Local flaps remain versatile options for closure of large truncal and extremity defects.

Promising Clinical Outcomes Using Rotational Achilles Autograft for Knee Arthroplasty Terrible Triad.

When opting for reconstruction, every dermatosurgeon should consider several key aspects of the defect being managed - firstly the location and size of the defect, particularly when it is situated in a challenging anatomical region with rich vascularity and innervation. It is also important to consider the potential tension that may be generated and how and in which direction it should be redistributed, as well as the expected aesthetic and functional outcomes. Classical techniques, although not new, have proven to be safe and reliable over time and should always be considered when selecting the most appropriate reconstructive approach. The double (bilateral) opposing rotation (Yin-Yang) flap is a versatile reconstructive technique used primarily in the scalp region for the reconstruction of small-to-medium-sized defects. We present another case of a successfully reconstructed with a Yin-Yang flap, a small-to-medium-sized circular scalp defect following excision of a squamous cell carcinoma. Although the final aesthetic outcome may be suboptimal, this approach remains a preferred option compared with other techniques in terms of effective tension distribution, maintenance of functional anatomy, and preservation of surrounding tissue.

Comprehensive classification of cloacal malformation provides a useful guide for individualized targeted reconstruction.

&lt;p&gt;A long-term chronic infection can undergo malignant transformation. This article presents a clinical case of concurrent chronic clavicular osteomyelitis and basosquamous carcinoma XH4C18 (ICD 11) T4bN0M0 Stage II - a non-melanoma skin cancer that developed secondary to a more than nine-year course of a purulent process with spread to the bone tissue and subsequent malignization. Radical sanitation of the lesion in combination with staged reconstruction using local skin flaps (keystone, rotational full-thickness flap) and VAC therapy ensured effective wound healing and aesthetic restoration. This clinical case confirms the effectiveness of combining reconstructive treatment methods for a complex tissue defect resulting from invasive purulent and neoplastic lesions.&amp;nbsp;&lt;/p&gt.