A comparative study of surgical outcomes using a Colorado microdissection needle versus standard-size needle electrocautery in one-stage hypospadias repair using a transverse preputial island flap.

BACKGROUND: The purpose of this study was to compare the surgical outcomes of a Colorado microdissection needle (CMN) with that of a standard-size electrocautery needle in one-stage hypospadias repair using a transverse preputial island flap (TPIF). METHODS: The records of patients who received hypospadias repair from September 2012 to October 2013 were retrospectively reviewed. Patients were divided into a group that received repair using a CMN and those in which a standard-size electrocautery needle was used. Data collected and compared included age, types of hypospadias, duration of surgery, intraoperative blood loss, and postoperative edema and complications. RESULTS: There were 51 patients in the CMN group and 44 in the standard needle group, and the groups were similar with respect to age and type of hypospadias. The median surgery time for the CMN group was significantly shorter than that of the standard group (15.7 minutes vs. 20.6 minutes, respectively, P<0.001). At postoperative day 7 and day 30, the CMN group had significantly less patients with edema than the standard needle group (31.4% vs. 65.9%, P<0.01; and 37.3% vs. 79.5%, P<0.001, respectively). The overall complication rate has no significant difference between two groups. CONCLUSIONS: The use of CMN for tissue dissection and separation in hypospadias repair can facilitate foreskin degloving, shape the flap in a more efficient way, and help maintain adequate blood supply for the new urethra and its skin coverage.

[A comparative study of the skin expansion rate and instantly expanded skin retraction rate between implantation of double overlapping expanders and implantation of one single expander].

OBJECTIVE: To comparatively study the difference of the skin expansion rate and instantly expanded skin retraction rate between implantation of double overlapping expanders and implantation of one single expander. METHODS: From Mar. 2009 to Mar. 2012, 22 cases with 39 sites for skin expansion, received double overlapping expanders in 24 sites, single expander in 15 sites. The area of original skin and expanded skin was measured by "wet-cloth sampling". Then the skin expansion rate was calculated. A distance of 5 cm at the center of expanded skin was re-measured after taking out the expanders. Then the instantly skin retraction rate was calculated. RESULTS: During the same expansion period, the skin expansion rate was (3.5 +/- 0.9)% with the double overlapping expanders and (2.6 +/-0.6)% with one single expander, showing a significant difference between the two groups (P = 0. 002), while the instantly skin retraction rate was not statistically different [(30.3 +/- 0.8)% vs (32.3 +/- 0.9)%; P = 0.47)]. There was a negative relationship between the instantly skin retraction rate and the expansion period (r = -0.768). CONCLUSIONS: The skin expansion rate can be increased with double overlapping expanders, while the instantly skin retraction rate doesn' t decrease. So the skin expansion efficiency is increased to reduce the re-expansion times for the patients with large lesions.

Implant double tissue expanders superposingly in mastoid region for total ear reconstruction without skin grafts.

OBJECTIVE: To present our clinical experience in using two skin soft-tissue expanders implanted superposingly in the mastoid region and Medpor ear framework for congenital microtia reconstruction. METHODS AND MATERIALS: The process of our technique is divided into three stages. In the first surgical stage, a 50 cm(3) and 80 cm(3) kidney-shaped expander is implanted under the fatty layer in mastoid region. Overlay the big expander on the small one. After the first surgery stage they are inflated alternately. In the second surgical stage, we remove two skin soft-tissue expanders and fix the Medpor ear framework to the fascial tissue which is covered by the expanded skin flap wholly without application of fascial flap. In the third stage, we perform the transposition of the auricular lobule to the designated position, construction of the tragus and refinement the new reconstructed ear. From January 2009 to December 2010, 27 patients were treated by this method of total ear reconstruction. RESULTS: 27 patients acquired symmetrical, subtle contour, prominent reconstructed auricles. The new reconstructed ear had a good contour and its skin color and texture were nearly the same as the normal surrounding skin. The postauricular sulcus was stable and satisfactory. The postoperative follow-up time ranged from 1 to 3 years. The expanded skin flap took well without necrosis. Exposure of the skin expander occurred in 2 patients (7.4%). The Medpor ear framework was extrused in one patient (3.7%). In addition, the hematoma was observed in 3 patients (11.1%). No other severe complications happened. CONCLUSION: Overlying implantation of two skin-soft skin expanders solves the problem of insufficient amount of the skin flap, avoids postauricular skin grafting, simplifies the surgical procedure and shortens the operation time significantly.

[Penile augmentation using acellular dermal matrix].

OBJECTIVE: Penile enhancement was performed using acellular dermal matrix. METHODS: Multiple layers of acellular dermal matrix were placed underneath the penile skin to enlarge its girth. Since March 2002, penile augmentation has been performed on 12 cases using acellular dermal matrix. RESULTS: Postoperatively all the patients had a 1.3-3.1 cm (2.6 cm in average) increase in penile girth in a flaccid state. The penis had normal appearance and feeling without contour deformities. All patients gained sexual ability 3 months after the operation. One had a delayed wound healing due to tight dressing, which was repaired with a scrotal skin flap. CONCLUSIONS: Penile enlargement by implantation of multiple layers of acellular dermal matrix was a safe and effective operation. This method can be performed in an outpatient ambulatory setting. The advantages of the acellular dermal matrix over the autogenous dermal fat grafts are elimination of donor site injury and scar and significant shortening of operation time.