Split lateral iliac crest chimera flap: utility of the ascending branch of the lateral femoral circumflex vessels.

BACKGROUND: Complex head and neck reconstruction often requires multiple tissue components to restore form and function to the traumatized area. Here, the authors describe the split lateral iliac crest chimera flap and demonstrate the utility of the ascending branch of the lateral femoral circumflex system to provide vascularized bone for complex head and neck reconstruction. METHODS: A retrospective case series analysis was performed for patients undergoing complex head and neck reconstruction utilizing the split lateral iliac crest chimera flap to provide vascularized bone and soft tissue. The blood supply to the lateral iliac crest was via the ascending branch of the lateral femoral circumflex system, and the soft tissue was supplied by the transverse and descending branches of the circumflex system. RESULTS: Four patients with advanced recurrent head and neck cancer undergoing split lateral iliac crest chimera reconstruction between November of 2007 and April of 2009 were included. Three patients required reconstruction of segmental mandibulectomy defects, and one required reconstruction of a maxillectomy defect. All components of the chimeric flaps in each patient survived. Bone vascularity was confirmed with triphasic bone scans within the first week postoperatively in two patients. CONCLUSIONS: The split lateral iliac crest chimera flap employs distinct branches of the lateral femoral circumflex system to supply the split lateral iliac crest and soft tissue of the thigh, each isolated on separate vascular leashes connected to a common source vessel. Through inclusion of a vascularized bone component, the flap extends the versatility of the lateral femoral circumflex flap for complex head and neck reconstruction requiring both hard-tissue and soft-tissue replacement.

Novel technique for proximal anchoring of penile prostheses in female-to-male transsexual.

OBJECTIVES: To present our initial experience with a novel technique for fixation of an inflatable penile prosthesis in the female-to-male transsexual in 2 patients. METHODS: Proximal fixation of an inflatable penile prosthesis is challenging in the female-to-male transsexual because of the lack of normal corporal bodies. This technique uses a bone drill to create a fixation chamber in the symphysis pubis. A rear tip extender is then secured into bone, providing a stable fixation point for the proximal aspect of the penile cylinder. RESULTS: Two patients successfully underwent placement of a 2-cylinder inflatable penile prosthesis using this technique without any complications. At 8 and 13 months postoperatively, their Sexual Health Inventory for Men score was 23 and 25 of a possible 25 points, respectively. CONCLUSIONS: With modest follow-up, bone anchoring appears to provide improved support and better performance of the inflatable penile implant in the female-to-male transsexual patient.