Igor Stupka

New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals

From December 2001 to September 2005, the technique of total penile reconstruction with a reinnervated free latissimus dorsi myocutaneous flap was used in 22 patients (24–38 years old) with gender dysphoria. These patients were followed up for at least 11 months (range, 11–44 months). All flaps survived. Complications include hematoma (7 cases), vascular thrombosis (2 cases), partial necrosis (1 case), excessive swelling of the neophallus (3 cases), and skin graft loss at the donor site (1 case). Of the 19 patients included in the final evaluation, the transplanted muscle was able to obtain contraction in 18 (95%) cases and 8 patients (42%) had sexual intercourse by contracting the muscle to stiffen and move the neopenis. The described technique of neophalloplasty proved to be a reliable technique and the muscle movement in the neophallus can be expected in almost all cases. The muscle contraction in the neophallus leads to “paradox” erection—stiffening, widening, and shortening of the neopenis, which allows for sexual intercourse in some patients. Subsequent reconstruction of the urethra is possible.

Primary vein grafting in treatment of ring avulsion injuries : A 5-year prospective study

Out of 262 hands with total finger amputations treated by replantation of finger/fingers from January 2001 until January 2006, there were only 6 cases of type III ring avulsion injuries, all of which were replanted. Radical resection of the damaged part of the artery with primary vein grafting was used in each case; only 1 artery and 2 veins were anastomosed for each finger. The survival rate was 100%. Mean total active motion was 195° (ranging from 175° to 220°). Mean 2-point discrimination was 8.6 mm static (ranging from 4 to 11 mm) and 6.2 mm moving (ranging from 3 to 9 mm), and mean grip strength was 37.4 kg. We believe that liberal resection of the “zone of contusion” of vessels and primary vein grafting for arterial repair can improve the overall survival rate of replantation in type III ring avulsion injuries, and replantation can be attempted in majority of the cases; good hand function can be expected.

The bilobed arterialized venous free flap for simultaneous coverage of 2 separate defects of a digit.

We report a case of a 17-year-old patient who sustained multiple finger contusions on the left hand. After thorough debridement, the volar and dorsal defects of the middle finger were covered simultaneously with bilobed arterialized venous free flap from the left forearm. The flap was composed of 2 paddles, which were connected by a subcutaneous bridge containing a subcutaneous venous network. The subdermal plexus in the bridge was interrupted with no impairment of blood supply to the second cutaneous paddle. The flap survived completely with only temporary mild venous congestion. Excellent functional and cosmetic result was reached. We consider bilobed arterialized venous free flap as a useful option for coverage of concomitant volar and dorsal digital defects.

Reconstruction of a Nose Bitten and Eaten by a Dog: A Ten-Year Follow-up of a Bitten-Off Nose Replantation Performed on an Eleven-Year-Old Boy.

The nose is one of the most important aesthetic units of the face. After a traumatic amputation, replantation is undoubtedly the procedure of choice, although, technically, very challenging. We report the 10-year follow-up of a partially digested nose replantation after a dog-bite in an 11-year-old boy using supermicrosurgery technique. Our report confirms that the microsurgical replantation of the nose can lead to an acceptable aesthetic result, with the sufficient growth of the replanted part in the following years. Besides the patient did not report sensibility disorders. The nose replantation in our opinion is the best reconstructive option to achieve an optimal aesthetic and functional outcome.

Foot morbidity following toe to hand transfers

Toe-to-hand transfers to replace missing fingers have become a common reconstructive practice in our clinic. The purpose of this article is to evaluate morbidity of the donor site on the foot following the transfer. A group of 72 patients were assessed; 95 feet were examined post-transfers, i.e., 23 patients had transfers from both feet. The groups were arranged according to the numbers of patients as follows: group A (37 cases), second toe from one foot; group B (17 cases), second toes from both feet; group C (6 cases) with wrap-around flap; and group D (5 cases), the whole big toe. This was followed by group E (7 patients), who had the combination of the second and third toes harvested simultaneously, the great toe or wrap-around flap in combination with harvesting the second toe from the same or contralateral foot. Scar quality of the donor site, standing on tiptoe and tiptoeing, discomfort after prolonged walking, stair climbing, need to change the shoe size, and participation in special activities, such as sports and overall patient satisfaction, were evaluated. The least significant problems occurred in patients with the second toe harvested, they had minimum complaints with static loading and minor complaints with dynamic loading. Patients with the second toes harvested from both feet also had minimum complaints with static loading and minor complaints in dynamic loading. More problems were observed with both static and dynamic loading in the patients with the great-toe transfer. The biggest troubles were reported by the patients with the wrap-around flap or in case of multiple toe transfers. Only one patient from the sample had to seek medical help of a specialist due to some problems following the toe harvest. In the retrospective subjective evaluation of patient satisfaction and benefits of the operation, all patients declared that they would undergo the reconstruction again despite the problems encountered at the donor site.