Aim: To report the author’s experience in augmentation phalloplasty by studying a retrospective series of patients who underwent fat grafting for girth enhancement or a composite technique based on suspensory ligament release plus fat grafting performed simultaneously.

Methods: The author analyzed retrospectively the outcomes of 275 augmentation phalloplasty procedures performed in 259 patients until November 2013. Of these, 127 correspond to girth augmentation with fat grafting and 148 to composite augmentation phalloplasty (girth augmentation with fat grafting and length improvement by suspensory ligament release). In 16 patients girth and length enhancement were performed in two separate procedures.

Results: Of this 259 patients, 87 underwent postoperative follow-up for at least 12 months and 160 patients underwent follow-up for at least 6 months. The average increase in circumference at 6 months was 1.7 cm (1.57 cm at 12 months) and the average increase in length of 3.2 cm (3.1 cm at 12 months). Twenty-two patients showed minor complications that were treated without sequelae and without influencing the final result.

Conclusion: By judicious use of currently available techniques, it is possible to achieve stable increases in penis size. The use of composite techniques provides better final results than the use of individual techniques performed alone due to the increase of the actual volume of the penis. An adequate informed consent is essential in all patients due to the unrealistic expectations expressed by the majority of them.

Nerve transfer surgery, also referred to neurotization, developed in the mid 1800s with the use of animal models, and was later applied in the treatment of brachial plexus injuries. Neurotization is based on the concept that following a proximal nerve lesion with a poor prognosis, expendable motor or sensory nerves can be re-directed in proximity of a specific target, whether a muscle or skin territory, in order to obtain faster re-innervation. Thanks to the contribution of several authors including Oberlin, MacKinnon and many others, the field of nerve transfer surgery has expanded in treatment of not only the brachial plexus, but also the arm, forearm and hand. This article reviews the recent literature regarding current concepts in nerve transfer surgery, including similarities to and differences from tendon transfer surgery. Moreover, indications and surgical techniques are illustrated for different types of nerve injury affecting the extrinsic and intrinsic musculature of the hand as well as sensory function.

Wound healing requires a complex interaction and coordination of different cells and molecules. Any alteration in these highly coordinated events can lead to either delayed or excessive healing. This review provides an overview of adult wound healing physiology. A review of the literature focused on wound healing physiology and current advances in wound healing was conducted using the online Medline/PubMed database. The aim of this review was to inspire further investigation into wound healing physiology that will ultimately translate into improved patient care.

Hemifacial microsomia and Goldenhar syndrome pose unique challenges to the craniofacial surgeon. The O.M.E.N.S. classifcation provides a description of the craniofacial features. For the “M” of O.M.E.N.S. (the mandible), the Pruzansky-Kaban classifcation provides therapeutic guidelines for joint and face reconstruction. A sequence of standard procedures, including temporomandibular joint reconstruction, facial rotation surgery, gluteal fat grafting, and patient-specifc titanium implantation, each have their intricacies. The author provides his expert opinion, acquired over thirty years of experience, with an emphasis on descriptions of and solutions for ten problematic issues.

Aim: The indication of neck dissection in oral squamous cell carcinoma (OSCC) is a problem of risk-benefit evaluation between probability of neck metastases, the problem of complications associated with neck dissection and the prognostic influence of delayed diagnosis of metastasis during follow-up. There is no consensus on the elective treatment of the neck in early oral cancer patients with a clinically N0 (cN0) neck.

Methods: The author performed a search of PubMed articles with the words "elective neck dissection vs. observation", "node negative neck" and "early stage oral squamous cell carcinoma". The author selected those articles that studied the early OSCC (T1-T2), and elective neck treatment was compared with clinical observation.

Results: Many studies have compared the outcome of elective neck dissection (END) to observation of the neck in early OSCC. The results of them are described. The biologic aggressiveness of oral cavity squamous cell carcinoma, particularly in the early stages, is reflected in its ability to metastasize to regional lymph node chains. Many pretreatment imaging techniques to diminish the incidence of occult metastases haven been studied, and comparative studies have shown ultrasound guided fine needle aspiration cytology (USgFNAC) to be the most accurate.

Conclusion: A few non-randomized studies have shown no advantages of END when strict USgFNAC follow-up was employed. Thus, if routine strict follow-up using USgFNAC by a well-trained ultrasonographer cannot be assured, END is the safest strategy.

Aim: Traditional donor site closure from radial forearm free flap (RFFF) has been associated with esthetic and functional morbidity. To avoid complications, such as color mismatch and secondary donor site morbidity, a new technique named ‘‘Iberic graft’’ for covering the RFFF donor site was described previously by our team.

Methods: A study of patients who underwent reconstruction of head and neck defects using a RFFF was conducted to assess postoperative complications of the RFFF donor site and also to evaluate the morbidity in terms of aesthetics and function following the use of the “Iberic graft”. The donor site was covered by the use of a combined local triangular full-thickness skin graft. Color match, quality of the scar, presence of necrosis, dehiscence of the suture or tendon exposure were recorded and analyzed.

Results: One hundred and twenty-five consecutive patients undergoing RFFF harvesting were included. RFFF donor site defects ranged from 15 cm² to 70 cm²; 9 patients (7%) had small dehiscences of the forearm skin graft, whereas 2 cases (1.6%) presented tendon exposure. Otherwise, partial skin graft loss occurred in a few patients. In all cases, these sites healed secondarily by conservative management, with no final impairment of function. Assessment of the forearm donor site at 1 to 3 months after the primary surgical procedure showed complete defect coverage, good color match, and no scarring along the graft line.

Conclusion: The “Iberic graft” is a reliable method for closing most of RFFF donor site defects as it provides excellent color match and pliability, while obviates the need for a second surgical site.

Aim: The correction of nasal tip defects presents many challenges. Zitelli’s bilobed flap has been widely used for such repairing defects, but may be complicated by interrupted scars on the nasal dorsum. Our study evaluates the design principles, results, and advantages of a modified bilobed flap for repairing nasal tip defects.

Methods: The primary lobe was located between the defect and the cheek, and the second lobe was located in the cheek. The width of the primary lobe was equal to that of the primary defect. The length of the primary lobe was 10% longer than the distance of the distal defect edge to the pivot point of the flap. The length of the second lobe was 30% longer than the distance of the distal defect edge to the pivot point of the flap. The width of the second lobe was 90-100% of that of the primary lobe. The ability to close the defect under minimal tension, the cosmetic appearance, and any complications were evaluated.

Results: This technique was performed in 34 cases; defect size ranged from 0.8 cm × 0.9 cm to 1.2 cm × 1.8 cm. All defects were closed under minimal wound tension, all scars were inconspicuous, no obvious complications occurred, and the aesthetic outcomes were considered favorable.

Conclusion: The modified bilobed flap can provide satisfying outcomes with lower morbidity and inconspicuous scarring. It is simple and suitable for repairing small- to medium-sized defects in the nasal tip.

Aim: Auricular seroma is a cystic swelling with a collection of serous fluid between the perichondrium and cartilage. The successful treatment of auricular seromas remains a challenge because this disease has a high propensity for recurrence.

Methods: A total of 20 patients with auricular seromas were treated by remodeling a corrugated rubber drain.

Results: All patients tolerated the procedure well. No patient had any collection of fluid after the removal of the splint. No patient experienced pain, fever, or edema after treatment. The seroma disappeared without disfigurement. There were no recurrences on further follow-up.

Conclusion: Aspiration and splint application by remodeling a corrugated rubber drain provides very simple, minimally invasive, and effective management of seromas. It is a cost-effective treatment that prevents patient distress from fluid recollection and social embarrassment.

The dynamic process of wound healing has various phases, knowledge of which is essential for identification of the pathology involved in a chronic intractable wound. Various instruments for the assessment of wound healing have been described, primarily for clinical assessment of the wound. However, very few instruments are currently available for histological grading of the wound. The aim of this article is to review all available literature from 1993 to 2014 on the objective histological scoring of the state of wound healing. This review article emphasizes the importance of histological grading of wounds based on the different parameters from each phase of wound healing, and the need for an ideal grading system in order to help assessment of wound status. The parameter chosen in an experimental model should be defined by the scientific question, the underlying hypothesis and the pathogenesis of the disease.

The ever-increasing interest in retaining a youthful physical appearance has facilitated the development of various minimally invasive dermatological techniques. The use of intradermal fillers can be incorporated into dermatological practices with minimal overhead costs. This strategy addresses facial volume loss and dynamic lines, which are the main features of facial aging. Moreover, intradermal fillers provide an array of flexible treatment options for a balanced and holistic result to dermatological practitioners. This paper reviews the different intradermal fillers categorized by biodegradable and non-permanent fillers including collagen based materials, hyaluronic acid and autologous fat, semi-permanent fillers including poly methyl methacrylate, poly-L-lactic acid and calcium hydroxyapatite microspheres, and permanent fillers including silicone. A discussion is provided of the commercial products made of these materials and their clinical efficacy in the treatment of facial aging.

Wound healing requires a complex interaction and coordination of different cells and molecules. Any alteration in these highly coordinated events can lead to either delayed or excessive healing. This review provides an overview of adult wound healing physiology. A review of the literature focused on wound healing physiology and current advances in wound healing was conducted using the online Medline/PubMed database. The aim of this review was to inspire further investigation into wound healing physiology that will ultimately translate into improved patient care.

The dynamic process of wound healing has various phases, knowledge of which is essential for identification of the pathology involved in a chronic intractable wound. Various instruments for the assessment of wound healing have been described, primarily for clinical assessment of the wound. However, very few instruments are currently available for histological grading of the wound. The aim of this article is to review all available literature from 1993 to 2014 on the objective histological scoring of the state of wound healing. This review article emphasizes the importance of histological grading of wounds based on the different parameters from each phase of wound healing, and the need for an ideal grading system in order to help assessment of wound status. The parameter chosen in an experimental model should be defined by the scientific question, the underlying hypothesis and the pathogenesis of the disease.

Pathologies comprising more than half the length of the trachea are a challenge to the reconstructive surgeon. Innovative tracheal transplantation techniques aim to offer the patient a curative solution with a sustained improvement in quality of life. This review summarizes the authors’ experience with the rabbit as a versatile model for research regarding tracheal transplantation. Because of the segmental blood supply of the trachea, it is not feasible to transplant the organ together with a well-defined vascular pedicle. As such, the key element of successful tracheal transplantation is the creation of a new blood supply. This vascularized construct is created by prelaminating the rabbit trachea heterotopically, within the lateral thoracic fascia. After prelamination, the construct and its vascular pedicle are transferred to the orthotopic position in the neck. This model has become gold standard because of the advantages of working with rabbits, the anatomy of the rabbit trachea, and the reliability of the lateral thoracic artery flap. In this paper, the key elements of surgery in the rabbit are discussed, as well as the tracheal anastomosis and the harvest of the lateral thoracic artery flap. Practical tips and tricks are presented. The data described in this review represent the fundaments of ongoing translational research in the center over the past twenty years.

The ever-increasing interest in retaining a youthful physical appearance has facilitated the development of various minimally invasive dermatological techniques. The use of intradermal fillers can be incorporated into dermatological practices with minimal overhead costs. This strategy addresses facial volume loss and dynamic lines, which are the main features of facial aging. Moreover, intradermal fillers provide an array of flexible treatment options for a balanced and holistic result to dermatological practitioners. This paper reviews the different intradermal fillers categorized by biodegradable and non-permanent fillers including collagen based materials, hyaluronic acid and autologous fat, semi-permanent fillers including poly methyl methacrylate, poly-L-lactic acid and calcium hydroxyapatite microspheres, and permanent fillers including silicone. A discussion is provided of the commercial products made of these materials and their clinical efficacy in the treatment of facial aging.

Angiogenesis plays a crucial role in wound healing by forming new blood vessels from preexisting vessels by invading the wound clot and organizing in to a microvascular network throughout the granulation tissue. This dynamic process is highly regulated by signals from both serum and the surrounding extracellular matrix (ECM) environment. Vascular endothelial growth factor, angiopoietin, fibroblast growth factor and transforming growth factor beta are amongst the potent angiogenic cytokines in wound angiogenesis. Specific endothelial cell ECM receptors are critical for morphogenetic changes in blood vessels during wound repair. In particular integrin (αvβ3) receptors for fibrin and fibronectin, appear to be required for wound angiogenesis: αvβ3 is focally expressed at the tips of angiogenic capillary sprouts invading the wound clot, and any functional inhibitors of αvβ3 such as monoclonal antibodies, cyclic RGD peptide antagonists and peptidomimetics rapidly inhibit granulation tissue formation. Inspite of clear knowledge about influence of many angiogenic factors on wound healing, little progress has been made in defining the source of these factors, the regulatory events involved in wound angiogenesis and in the clinical use of angiogenic stimulants to promote repair.

The aim of this review is to extrapolate evidence regarding the use of vascularized nerve grafts (VNGs) in peripheral nerve reconstruction and summarize available data on their indications, if any, and clinical applications. A review of the literature via the PubMed database was performed with analysis of ninety-five articles on the experimental and clinical studies of VNGs. Eight relevant questions were selected to be answered about VNGs. VNGs allow faster nerve regeneration and convey a functional advantage under certain clinical conditions such as large nerves, proximal lesions, and nonvascularized recipient beds. Several donor sites are available which have been being divided by body region in this manuscript. VNGs perform better than non-VNGs and provide an advantage in selected cases. However, limited availability and donor site morbidity still limit their application. We foresee a wider application of vascularized nerve allografts to overcome these problems.

Aim: The aim was to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of chronic nonhealing ulcers.

Methods: A nonrandomized, uncontrolled study was performed on 24 patients with 33 nonhealing ulcers of various etiologies. All patients were treated with PRP at weekly intervals for a maximum of 6 treatments. At the end of the 6-week period, reduction in size of the ulcers (area and volume) was assessed.

Results: The mean age of the patients was 42.5 years [standard deviation (SD) 12.48]. Of 33 ulcers, there were 19 venous ulcers, 7 traumatic ulcers, 2 ulcers secondary to pyoderma gangrenosum, 2 diabetic ulcers, 2 trophic ulcers, and 1 vasculitic ulcer. The mean duration of healing of the ulcers was 5.6 weeks (SD 3.23). The mean percentage of reduction in area and volume of the ulcers was 91.7% (SD 18.4%) and 95% (SD 14%), respectively. About 100% resolution in the area was seen in 25 (76%) of the ulcers and 100% reduction in volume was seen in 24 (73%) of the ulcers at the end of the 6th treatment.

Conclusion: Conventional therapies do not provide satisfactory healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors (GFs) (platelet-derived GF, epidermal GF, vascular endothelial GF, etc.) which are essential for the healing process. PRP is a safe, affordable, biocompatible, and simple office-based procedure for the treatment of nonhealing ulcers.

Aim: To explore the characteristics of normal hair distribution in Han Chinese.

Methods: A total of 146 healthy Han Chinese and 41 patients with androgenetic alopecia (AGA) were selected as research subjects. Digital photographs of the vertex, temporal, and occipital regions were taken after their hair was trimmed. An image analysis software was used to compute the number of follicular units (FUs) and hairs.

Results: The mean FU density of the 146 healthy Han Chinese was 74.36 ± 13.33 units/cm² and their mean hair density was 143.33 ± 28.08 hairs/cm². There was no significant difference between males and females (P > 0.05). The mean FU density in the occipital region of AGA patients was 77.78 ± 2.99 units/cm² and their mean hair count was 148.12 ± 6.98 hairs/cm². Both were lower than those of healthy Han Chinese, and the differences were statistically significant (P < 0.001). Two-hair FUs (52.62%) were the predominant type found in Han Chinese.

Conclusion: The FU and hair densities of healthy Han Chinese are lower than those of whites and Africans. the study provides hair transplantation surgeons with information on hair distribution in Han Chinese. It also provides a quantitative basis for the area of donor site and transplantation density necessary for hair transplantation surgeries. the research findings provide some theoretical data for the hair distribution characteristics of Han Chinese. These data can contribute to the preoperative assessment, surgery planning, and postoperative outcome evaluation by hair transplantation surgeons.

Aim: To evaluate possible results with the stimulation use of minoxidil and the strengthening of hair roots with nutritional cyclical supplements, resulting in increased hair regrowth, without the use of anti androgens and enzyme blockers.

Methods: This prospective controlled clinical trial compares the current acknowledged form of treatment for hair loss within two controlled groups for both men and women against the use of cyclical nutritional therapy and minoxidil 2%. One hundred patients in each of the 4 groups, a total of 400 patients, were followed for 1 year. The progress was evaluated every 2 months with computerised measurements of hair density, hair calibre, global photography and uniquely designed self-assessment scores.

Results: The use of nutritional supplements showed consistent improvements in both treatment groups of men and women against the controlled groups with a correction of hair fall and minimum 18% increased density within 2 months with further improvement to a maximum of 156% over 1 year.

Conclusion: Hair loss occurs when weak, sensitive, follicles are affected by multiple causes. Hair regrowth can be achieved consistently and safely by strengthening the hair roots and promoting hair growth without necessarily depending on the use of anti androgens.

The design and application of hyaluronic acid (HA)-based scaffolds to control cell response and construct ideal tissue engineering products have been of great interest in the past few decades. This review provides an overview of the biological properties of HA to better understand how to engineer a cell-scaffold composite that is qualified in tissue engineering; important tissue engineering applications of HA including cartilage tissue engineering; and lastly, the problems of the current research on HA. All the data described above were collected and analyzed from PubMed, EMBASE and Medline.

Aim: Autologous tissue transfer to salvage breast reconstruction following a previously failed or unsatisfactory reconstruction has been described by previous studies to be an effective strategy to optimize outcomes. The purpose of this systematic review is to assimilate the relevant literature to evaluate surgical and aesthetic outcomes following autologous breast reconstruction in the setting of a prior unsuccessful reconstruction.

Methods: A systematic review of the English literature was performed on Pubmed/MEDLINE to identify all manuscripts reporting surgical outcomes, aesthetic outcomes, or patient satisfaction of autologous breast reconstruction in the setting of a previously failed or unsatisfactory breast reconstruction.

Results: Nineteen studies met the criteria for inclusion. Of these, 15 studies reported outcomes following autologous conversion of unsuccessful prosthetic reconstruction (778 breasts). Pooled-analysis of these studies demonstrated total flap loss in 1.6%, microsurgical revision in 3.2%, total complications in 21.7%, and revision surgery in 26.5%. Review of these studies demonstrated high rates of positive aesthetic outcomes and patient satisfaction. Five studies (54 patients) evaluated outcomes following autologous salvage of prior unsuccessful autologous breast reconstruction. Pooled-analysis of these studies demonstrated no instances of microsurgical revision, total complications in 42.2%, and revision surgery in 70.0%. Total flap failure following tertiary reconstruction utilizing microsurgical free flaps occurred in 9.5%. Data describing aesthetic outcomes or patient satisfaction was lacking in these studies.

Conclusion: Autologous conversion in the setting of unsuccessful prosthetic breast reconstruction appears to be valuable option to improve outcomes. There is little evidence to suggest that prior prosthetic reconstruction negatively impacts outcomes of autologous breast reconstruction. Data describing autologous breast reconstruction following prior flap loss is limited but suggests it is viable method to salvage breast reconstruction in appropriate patients.

Aim: Propeller flaps provide excellent reconstructive options for defects of many etiologies. Trunk wounds are a commonly encountered issue for the plastic surgeon and multiple techniques to address them should be prepared for implementation. Propeller flaps are a subject rarely brought up as an option to address these wounds. The authors sought to elucidate this topic in the current plastic surgery literature available.

Methods: A PubMed search was conducted based upon the defined inclusion and exclusion criteria and publications reviewed in detail. Search terms included "trunk wound propeller flap", "trunk propeller flap", and "freestyle trunk wound flap". Duplicate studies were excluded. Data was extracted from each study pertaining to trunk wounds and reconstructions with propeller flaps.

Results: The electronic search yielded 49 results with 21 studies ultimately meeting inclusion criteria. A total of 365 flaps were described collectively amongst the included studies. Among them, 190 propeller flaps addressing trunk defects were performed across all studies reviewed to address a total of 165 defects of the trunk: 14 abdomen, 101 back, 50 chest defects and adjacent respective flaps were utilized for surgical reconstruction. Overall, cancer excision wounds were by far the most prevalent with 105 cases (59.0%). Defect sizes of those specified in the articles ranged from 2 cm × 5 cm to 30 cm × 24 cm. Of the 190 propeller flaps identified, 63 total complications were identified. The most common complication was 48 total cases of transient venous congestion (25.3%). The second most common complication was partial flap necrosis (6.3%). No total flap loss was noted. There were 2 cases of seroma (1.1%) and 1 case of wound breakdown (0.5%).

Conclusion: Propeller flaps are a viable reconstructive option for trunk wounds and should be in the armamentarium of plastic and reconstructive surgeons. Few studies are available in the literature regarding propeller flap reconstruction in trunk wounds. More aggregate data is needed in order to further review, evaluate, and refine propeller flap techniques and results.

Periarticular reconstruction of appendicular bones in skeletally immature patients after tumor resection is a surgical challenge that requires a multidisciplinary approach. The authors present a case of Ewing sarcoma of the proximal femur in an 8-year old girl treated with wide resection of the primary tumor and reconstruction using a vascularized fibula epiphyseal autograft within a cadaveric femoral allograft. The native femoral head was preserved to restore articular anatomy. Postoperative course was without complications. This report demonstrates the use of a vascularized fibula autograft within a cadaveric femoral allograft to optimize growth potential and joint durability in a pediatric patient.