Christopher J. Salgado

Immediate application of vacuum assisted closure dressing over free muscle flaps in the lower extremity does not compromise flap survival and results in decreased flap thickness

Background Free muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC) dressing after a free muscle flap to the lower extremity. Methods Over a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival. Immediate application of a VAC dressing was performed in 9 patients, while the flap was left exposed for monitoring in 8 patients. Results There was no statistically significant difference in flap survival between both cohorts. Mean flap thickness at postoperative day 5 for the VAC group was 6.4±6.4 mm, while flap thickness for the exposed flap group was 29.6±13.5 mm. Flap thickness was significantly decreased at postoperative day 5 for the VAC dressing group. Conclusions Immediate application of VAC dressing following free muscle flaps to the lower extremity does not compromise flap survival or outcomes and results in decreased flap thickness and a better aesthetic outcome.

Preferences in the Aesthetic Appearance of the Female External Genitalia

Objective: In recent years, women have become more dissatisfied with the appearance of their labia minora, in particular their width, shape, and symmetry, prompting increased requests for labiaplasty. This has been attributed to the popular depiction of female genitalia in media outlets as homogenously hairless, symmetrical, and without protruding labia minora. Over-reduction of labia minora, although requested by patients, should not be performed due to their physiologic importance. Methods: We designed a survey to better understand preferences for the aesthetic appearance of female external genitalia. Survey Monkey was used to distribute an online questionnaire to a convenience sample of authors’ contacts. Respondents were asked to refer to three images of female external genitalia-varying in labia minora width but all still physiologically normal-and select the image that they felt to be most normal and most attractive, respectively. Pearson’s chi square test with significance level of 5% was used for statistical analysis. Results: Overall 95.8% (767/800) selected non-visible or slightly visible labia as the most “normal” variants, and 96.6% (773/800) selected either A or B for the most “attractive” variants of labia minora. Respondents selected images most consistent with popular culture depictions of genitalia, which seem to be driving genital plastic surgery requests. Conclusion: Given these findings, we recommend a discussion with patients about preferences and a belief regarding what is truly normal and encourages more wide spread media visibility and education about normal physiologic variability in female external genitalia.