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BACKGROUND: Radial forearm free flap phalloplasty (RFFF) is a set of complex reconstructive procedures aimed at creating an aesthetic and functional penis in transgender patients. Sensory recovery in the neophallus and donor site is crucial for optimizing outcomes, but the few prior studies that exist assess neophallus sensation at limited locations and time points. The purpose of this study was to prospectively quantify sensory outcomes in the neophallus and donor site following RFFF phalloplasty. METHODS: Sensation testing occurred prospectively over February 2019-January 2021 on Stage 1 RFFF phalloplasty patients using the Pressure Specified Sensory Device (PSSD). On the neophallus, one-point discrimination (1PS) pressure threshold and lengthwise sensory recovery were measured at six circumferential locations proximally to distally. On the donor site, 1PS was measured at three locations on the donor hand. RESULTS: Nineteen patients were included (average age 34.0 years old, range 18-53 years). Among patients that received neophallus testing (n = 13), eight had at least two follow-up appointments. Six of these patients had sensation as of their most recent measurement (75.0%), with an average of 73 days to regain sensation. There was a significantly greater proportion of patients with sensation at the right ventral (80.0% after 3 months vs. 11.1%-60.0% before 3 months, p = 0.024) and right lateral (100.0% after 3 months vs. 11.1%-60.0% before 3 months, p = 0.004) aspects of the neophallus over time. Pressure required to elicit sensation decreased by 18.0% from 1 week-1 month postoperatively to 3-7.7 months postoperatively in the right ventral neophallus (96.2 g/mm2 ± 11.3 g/mm2 to 56.6 ± 39.9 g/mm2, p = 0.037). Among patients that received donor site testing (n = 11), mixed effects regression analysis with random intercepts demonstrated significant changes in the thumb (3.4 g/mm2 ± 1.4 g/mm2, p < 0.05) and webspace (13.5 g/mm2 ± 4.9 g/mm2, p < 0.01) that returned to baseline at 3 months postoperatively (1.7 g/mm2 ± 1.0 g/mm2, p > 0.05, and 2.3 g/mm2 ± 4.0 g/mm2, p > 0.05, respectively). CONCLUSION: This pilot study demonstrates that quantitative sensory testing can be used to monitor post-phalloplasty sensory changes. Recovery was significantly associated with contralateral (i.e, right side in a left forearm RFF) aspects of the neophallus, suggesting a possible pattern of circumferential sensory innervation via RFFF sensory nerves. Future studies with a larger sample size and longer follow-ups are necessary to fully characterize sensory recovery in phalloplasty patients.

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INTRODUCTION: Keloids are the result of abnormal tissue scarring that occur after skin injuries leading to pain, psychological distress, and impaired quality of life. Despite the high recurrence rate after surgical treatment, excision is often inevitable for symptom control. PATIENT CONCERNS: A 32-year-old female presented with a huge keloid on the pubic area accompanied by severe pain, pruritus, and infectious discharge. She also had multiple keloids on her chest and shoulders, indicating a strong predisposition to keloid formation. INTERVENTIONS: While high potential for recurrence was anticipated, surgical excision was inevitable for symptom control. Complete keloid excision followed by split-thickness skin graft was performed. DIAGNOSIS: Pathological report revealed keloid accompanied by ruptured epidermal inclusion cyst. OUTCOMES: Although postoperative care was highly recommended for prevention of keloid recurrence, the patient refused any additional management due to her financial difficulties. At postoperative 8 months, mild degree of keloid or hypertrophic scar at marginal area of the graft was observed, suggesting the potential sign of keloid recurrence. The patient voluntarily discontinued the outpatient follow-up for 2 years, and then returned with huge keloid not only at the graft site but also at the donor site. CONCLUSION: Keloid with inflamed epidermal inclusion cyst can cause severe pain where surgical excision is unavoidable, regardless of the high potential for recurrence. Additional postoperative care is necessary to prevent recurrence. Furthermore, attempts to minimize new keloid formation at the donor site after split-thickness skin graft, such as thin skin harvest or selecting the scalp as the donor site, should be considered.

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INTRODUCTION: Peroneus longus has proved to be a promising graft for ACL reconstruction due to its high tensile strength, and ease of harvesting. While multiple studies have assessed the functional outcomes of the knee after ACL reconstruction using peroneus longus autograft, we aimed to evaluated donor site morbidity among the Indian population. MATREIALS AND METHODS: This was a prospective, longitudinal, descriptive study conducted at a tertiary care hospital. Preoperative AOFAS and Karlsson-Peterson scores were obtained, and patients were followed up after surgery for a period of 6-months using the same scoring systems and strength testing with a hand-held Chatillon MSE-100-M dynamometer. Pedobarographs were done using Diers Pedoscan Plantar Pressure Measurement System on a subset of seven patients. RESULTS: 20 patients participated in the study. Mean AOFAS and Karlsson-Peterson scores pre-operatively were 99.7 ± 1.34 and 98.5 ± 4.62 respectively. On completing 6- months of follow-up these scores were found to be 95.6 ± 9.43 and 88.75 ± 18.42 respectively. Deterioration of mean evertor strength was noted at all follow-ups compared to the opposite side. Static pedobarographs showed significant decreased in total surface area of contact and pressure over the posterior aspect of the operated side by 3-months which improved later at 6-months. Dynamic pedobarographs showed decreased mean average plantar pressure while walking on the operated side and significant increase in mean surface area of contact of the operated side (191.886±22.678 cm2) at 6-months of follow-up compared to the opposite side (184.471 ± 22.218 cm2). Five patients showed deviation of the point of maximum pressure while walking on the operated foot making it lateral to the COP with increased lateral plantar/ medial plantar pressure ratio. CONCLUSION: While the use of peroneus longus tendon autografts in arthroscopic ACL reconstruction does not seem problematic on short-term subjective assessment, there is objective evidence in keeping with evertor weakness, weakness of first ray plantar flexion and possible ankle instability. LEVEL OF EVIDENCE: Level lll.

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OBJECTIVE: Anterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location. We sought to correlate flap thickness at different donor sites with patient BMI to determine optimal donor site selection. METHODS: Patients with CT scans of the oral cavity, thorax and lower extremity were identified and included. The volumes of the anterior 2/3rds of the tongue were measured and recorded using computed tomography-generated modeling. Pre-muscular tissue thicknesses at anterolateral thigh (ALT), deep inferior epigastric artery (DIEP), latissimus dorsi, and parascapular donor sites were measured. The donor site adequency was defined as reconstructing the tongue volume within 10% of the ideal volume required and stratified based on patient BMI. RESULTS: In 144 patients, the average anterior 2/3rds glossectomy defect was 100.3 cm3. Glossectomy defect size was highly correlated with BMI (p < 0.001). The DIEP flap had the largest volume (155.4 cm3), followed by latissimus (105.6 cm3), parascapula (97.8 cm3), and ALT (60.5 cm3). For patients with BMI ≤ 30, the DIEP flap best reconstructed native tongue volume (up to 113 % of native tongue volume). In patients with BMI > 30.1, native tongue volumes were approximated by the latissimus flap (89-92 % of native tongue) and parascapular flap (85-95 % of native tongue volume). In BMI > 30.1 the DIEP flap provided excess tissue bulk (129-135 % of native tongue volume). CONCLUSION: The DIEP flap more closely approximates the volume needed to reconstruct anterior two-thirds tongue defects for BMIs ≤ 30. The subscapular system flaps provided the best volume match for BMIs > 30 and the DIEP flap provided excess tissue bulk which could be adjusted in the reconstruction process.

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BACKGROUND: Hair transplantation, particularly through follicular unit extraction (FUE), can lead to postoperative complications, such as numbness, itching, and pain in donor areas, primarily because of delayed wound healing. Efficient management of donor-site healing is crucial to mitigate these complications and improve overall patient outcomes. OBJECTIVE: This study aimed to assess the efficacy of hair follicular-derived microtissue (HFMT) in promoting wound healing and alleviating postoperative complications in donor areas after FUE hair transplantation. METHODS: Perifollicular tissue obtained during the trimming phase of hair transplantation was processed into HFMT and analyzed for its properties using histological and molecular techniques. In a single-blind, split-scalp study involving 98 participants, Group A received HFMT or mupirocin, whereas Group B received HFMT or no treatment. Dermatoscopic images were captured postoperatively, and visual analog scale scores were used to evaluate pain, itching, and numbness. RESULTS: HFMT-treated donor sites in Group A demonstrated a significantly higher wound closure ratio on postoperative day 3 than mupirocin-treated sites. Pain scores for HFMT-treated sites were consistently lower on postoperative days 3, 5, and 7. Similar trends were observed for itching scores. Group B exhibited outcomes comparable with Group A. CONCLUSION: The application of HFMT homogenates effectively accelerated wound healing and alleviated donor-site complications after FUE hair transplantation.

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PUSPOSE OF THE STUDY. Many studies have investigated the efficacy of peroneus longus tendon (PLT) in anterior cruciate ligament (ACL) reconstruction, and donor site morbidity has not been adequately studied. MATERIAL AND METHODS: Fifty patients who underwent ACL reconstruction using PLT were included. Ankle strengths of the patients evaluated with an analog dynamometer. Ankle range of motion (ROM) was measured with a smart phone inclonometer application. RESULTS: There was no significant difference between the postoperative ankle strength(eversion, plantar flexion) in the donor area and the preoperative period (p=0.6 and p=0.7, respectively) and contralateral healthy side (p=0.6, p=0.6, respectively). Ankle ROM angles (dorsiflexion, plantar flexion, eversion, inversion) were significantly lower in the post-operative period compared to the preoperative period and contralateral healthy side (p<0.05, p<0.05, p<0.05, p<0.05, respectively). There was no significant difference between pre-operative and post-operative AOFAS scores (p=0.2). CONCLUSIONS: Although PLT can affect ROM angles, it is a promising alternative for ACL reconstructions without causing functional morbidity. KEY WORDS: peroneus longus tendon, autograft, anterior cruciate ligament reconstruction, donor site morbidity.

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Patients with severe alveolar ridge defects cannot be directly implanted and repaired, which seriously affects their quality of life. Onlay bone grafting is the main solution for severe alveolar ridge bone defect reconstruction, among which autogenous block bone grafting is the most widely used and is also the focus of clinical research on bone tissue reconstruction. This article expounds the characteristics and basic principles of autogenous bone block grafting, and comprehensively analyzes the selection of autogenous bone donor site, the principles of surgical operation, and the progress of bone graft techniques. In order to help surgeons make correct clinical decisions, increase the predictability of surgical effects, and improve the level of clinical diagnosis and treatment.

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OBJECTIVES: Dermal substitutes are classically used in a 2-stage procedure followed by skin graft for wound healing. This study aims to evaluate the possibility to use an alternative technique for radial forearm and fibula donor sites coverage using one-stage Pelnac reconstruction. MATERIALS AND METHODS: 21 patients who underwent radial forearm and fibula flaps harvest for reconstruction of head and neck defects after oncological surgery were enroled in the study. 13 patients were treated by one-stage Pelnac reconstruction of the donor site defect, 8 patients underwent full thickness skin graft. The Vancouver Scar Scale was used to evaluate the scar quality. RESULTS: Most patients treated with one-stage Pelnac reconstruction showed good healing of the flap donor site, with minor complications, scar quality comparable to other treatment options and unimpaired function of the implicated limb. One patient had wound dehiscence at the radial forearm site, which was treated with secondary full thickness skin graft. In the group treated with FTSG we had three patients that developed complications, such as dehiscence of the graft and seroma. Overall, we reported comparable satisfaction with donor sites both for aesthetic and functional outcomes, in both groups of patients. CONCLUSION: The use of Pelnac without a following skin graft provides a viable method for the reconstruction of radial forearm and fibula flaps donor site. A longer postoperative care is needed, but the long-term aesthetic and functional results are satisfactory in comparison with full thickness skin graft.

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BACKGROUND: Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes from a donor site into a limb affected by lymphedema to restore the normal flow of lymphatic fluid. Despite the increasing clinical experience with VLNT, there remains insufficient data to support its routine use in clinical practice. Here, we aim to evaluate the effectiveness and safety of VLNTs for upper limb lymphedema and compare clinical outcomes when using different donor sites. METHODS: We carried out a systematic search of the literature through PubMed and Scopus databases for studies on VLNT for upper limb lymphedema. Primary and secondary outcomes included circumference reduction rate (CRR) and infection reduction rate by postoperative cellulitis episodes for the efficacy and safety of VLNT. Pooled analysis was performed using the inverse variance weighting meta-analysis of single means using the meta package in R software. Subgroup analyses were performed for donor and recipient sites, age groups, follow-ups, and symptom durations. Quality assessment was performed using the Newcastle-Ottawa Scale for nonrandomized studies. RESULTS: A total of 1089 studies were retrieved from the literature, and 15 studies with 448 upper limb lymphedema patients who underwent VLNT were included after eligibility assessment. The mean CRR was 34.6 (18.8) and the mean postoperative cellulitis episodes per year was 0.71 (0.7). The pooled analysis of CRR was 28.4% (95% confidence interval, 19.7-41.1) and postoperative cellulitis episodes showed a mean of 0.59 (95% confidence interval, 0.36-0.95) using the random-effect model. Subgroup analyses showed significant group differences in recipient site for CRR and postoperative cellulitis episodes with the wrist comprising the highest weights, and patients younger than 50 years showing a lower postoperative infection. CONCLUSIONS: Vascularized lymph node transfer using gastroepiploic flaps at the wrists has shown a significant difference in reductions of limb circumference and cellulitis episodes in upper limb lymphedema patients when compared with other donor sites. However, further prospective studies are needed to consolidate this finding.

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BACKGROUND: The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated. METHODS: Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72 hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group. RESULTS: NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72 hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4 weeks) between groups.  CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.

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OBJECTIVES: Autologous tenocyte implantation (OrthoATI™) therapy has demonstrated efficacy in treating patients with tendinopathy at various anatomical sites. This study evaluates the effect of patient age, gender, and tendon biopsy site on morphology, growth, and gene expression of autologous tendon cells used to treat chronic tendinopathy. METHODS: Patients undergoing OrthoATI™ for tendinopathies between 2020 and 2022 were initially treated by biopsies taken from patella tendon (PT) or palmaris longus tendon (PL). The biopsies were sent to a Good Manufacturing Practice (GMP) cell laboratory where tendon cells were isolated, cultured, and expanded for four to six weeks. Cell morphology was assessed using phase contrast microscopy. Droplet digital PCR (ddPCR) was utilized for gene expression analysis. Dichotomous results were compared between groups using x2 or Fisher's exact tests with no adjustment for multiple comparisons. The nonparametric Mann-Whitney U and Kruskal-Wallis tests were utilized for the sex and age (<35y, 35-44y, 45-54y, >55y) analyses, respectively. All analyses were performed using IBM SPSS v27, and a two-tailed P-value of <0.05 was considered statistically significant. RESULTS: 149 patients were included in the analysis. The PT was biopsied in 63 patients, and PL in 86 patients. There were no observer effects for age and gender between the PT and PL groups. There was no statistical significance between the PT and PL tendons for cell morphology, average cell population doubling time (PDT) (PT 83.9 vs PL 82.7 â€‹h, p â€‹= â€‹0.482), cellular yield (PT 16.2 vs PL 15.2 â€‹× â€‹106, p â€‹= â€‹0.099), and cell viability (PT 98.7 vs PL 99.0%, p â€‹= â€‹0.277). Additionally, ddPCR analyses showed no statistical significance found in tenogenic gene expression, including collagen type I (COL1, p â€‹= â€‹0.86), tenomodulin (TNMD, p â€‹= â€‹0.837) and scleraxis (SCX, p â€‹= â€‹0.331) between PT- and PL-derived tendon cells. An age stratification analysis found no effect on growth and gene expression. COL1 was found to be higher in males when compared to females (P â€‹< â€‹0.001), but otherwise no difference was seen in growth and gene expression in the gender analysis. No postbiopsy clinical complications were reported for either group. CONCLUSION: This study has shown that the growth and bioactivities of tendon cells from tendon biopsies for OrthoATI™ are not affected by tendon donor site and age. LEVEL OF EVIDENCE: IV.

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INTRODUCTION: Total nose reconstruction is demanding as it is a 3-dimensional structure that needs lining, support and external coverage. Usually, several stages are needed to achieve a satisfactory result. The authors present 2 cases of prelaminated radial forearm and 2 prelaminated forehead nose reconstructions and compare both methods. According to our review of the literature, this is the first report of prelaminated forehead for total nose reconstruction. MATERIALS AND METHODS: The last 5 years the authors have treated 4 patients with prelaminated flaps for total nose reconstruction. The age ranged from 50 to 75 years. There were 3 male patients and one female. Three patients underwent total nose amputation due to squamous cell carcinoma and one due to melanoma. RESULTS: Two patients were treated with prelaminated radial forearm reconstruction and 2 with prelaminated forehead reconstruction. Both patients that were treated with prelaminated radial forearm reconstruction had the collapse of the nasal pyramid and had salvage procedures with replacement of the cartilaginous framework with iliac bone graft framework. CONCLUSIONS: Prelaminated nose reconstruction with either the radial forearm or forehead flap needs several stages. There is the possibility of infection-collapse of the cartilage framework, therefore, the authors recommend reconstruction of the nasal skeleton with an iliac bone graft. The flaps are stiff and difficult to handle. The authors don't think that prelaminated nose reconstruction with the radial forearm flap has advantage compared with the classic several stages nose reconstruction with radial forearm flap. Possibly, prelaminated forehead reconstruction can be applied for aged patients who cannot undergo microsurgical reconstruction.

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OBJECTIVES: This study compared the effects of leukocyte platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) on patients' quality of life and the healing of palatal wounds after free gingival graft harvesting. METHOD AND MATERIALS: After free gingival graft harvesting, palatal donor sites of 36 patients were assigned to one of three groups: L-PRF group, A-PRF group, or palatal stent + periodontal pack group (control group). Wound healing was evaluated by H2O2 test. Pain was evaluated by visual analog scale and number of analgesics consumed. For patient quality of life, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was utilized. RESULTS: Complete epithelialization was higher in the control group on day 7 than in the test groups (P < .05). Complete epithelialization was achieved in all groups 14 days postoperatively. Visual analog scale scores for pain and the number of analgesic tablets consumed were similar in all groups (P > .05). OHIP-14 total scores were similar in all study groups at 7 days postoperatively (P > .05). OHIP-14 total and physical pain score was lower in the L-PRF group than the A-PRF group at 14 days postoperatively (P < .05). CONCLUSION: Aside from the slight superiority of L-PRF over A-PRF, it can be concluded that both PRF procedures have similar effects on palatal wound healing and quality of life.

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Full-thickness skin grafts are essential tools for reconstructive surgery. Rectangular or square secondary defect usually occurs after performing a cross-finger flap or homodigital island flap. With the traditional fusiform ellipse design, trimming out excess graft tissue is necessary. Double right triangular shape full-thickness skin grafts are designed to correct the problem.

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BACKGROUND: Autologous costal cartilage has gained widespread acceptance as an important material for ear reconstruction in patients with microtia. Despite its recognition as being "worth the trade-off," attention should be directed toward donor-site deformities. This systematic review focused on existing English literature related to microtia reconstruction and aimed to reveal the incidence of chest wall deformities and assess the effectiveness of the various proposed surgical techniques aimed at reducing donor-site morbidities. METHODS: A comprehensive search was conducted on Pubmed and OVID using the keywords "microtia," and "chest deformity" or "rib harvest." Articles were screened based on predefined inclusion and exclusion criteria. Data acquisition encompassed patient demographics, employed surgical techniques, methods for evaluating chest deformity, and incidence of associated complications. RESULTS: Among the 362 identified articles, 21 met the inclusion criteria. A total of 2600 cases involving 2433 patients with microtia were analyzed in this review. Perichondrium preservation during cartilage harvesting led to a significant reduction in chest deformities. However, the wide incidence range (0% to 50%) and the lack of specific assessment methods suggested potential underestimation. Computed tomography revealed reduced chest wall growth in the transverse and sagittal directions, resulting in decreased thoracic area. Innovative surgical techniques have shown promising results in reducing chest deformities. CONCLUSIONS: Although a quantitative analysis was not feasible, objective evidence of deformities was established through computed tomography scans. This analysis highlighted the need for dedicated studies with larger sample sizes to further advance our understanding of chest wall deformities in microtia reconstruction.

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