Interleukin-4-Loaded Gelatin Methacryloyl Hydrogel Promotes Subcutaneous Chondrogenesis of Engineered Auricular Cartilage in a Rabbit Model.

Tissue engineering technology offers a promising solution for ear reconstruction; however, it faces the challenge of foreign body reaction and neocartilage malformation. This study investigates the impact of interleukin-4 (IL-4), an anti-inflammatory factor, on cartilage regeneration of hydrogel encapsulating autologous auricular chondrocytes in a rabbit subcutaneous environment. Initially, we assessed the influence of IL-4 on chondrocyte proliferation and determined the appropriate concentration using the CCK-8 test in vitro. Subsequently, we loaded IL-4 into gelatin methacryloyl (GelMA) hydrogel containing chondrocytes and measured its release profile through ELISA. The constructs were then implanted autologously into rabbits' subcutis, and after 3, 7, 14, and 28 days, cartilage matrix formation was evaluated by histological examinations, and gene expression levels were detected by qRT-PCR. Results demonstrated that IL-4 promotes chondrocyte proliferation in vitro, and maximum release from constructs occurred during the first week. In the rabbit subcutaneous implantation model, IL-4-loaded constructs (20 ng/mL) maintained a superior chondrocytic phenotype compared to controls with increased expression of anti-inflammatory factors. These findings highlight IL-4 as a potential strategy for promoting chondrogenesis in a subcutaneous environment and improving ear reconstruction.

Treatment Algorithm for Surgical Correction of Lower Eyelid Bags and Tear Trough Deformity Based on Barton Grading System.

Facial rejuvenation procedures for lower eyelid bags and tear trough deformity have recently gained increasing attention. This study introduced a treatment algorithm tailored to the severity of tear trough deformity, categorized using the Barton grading system, to tackle this concern effectively. One hundred seventy-six patients with combined lower eyelid bags and tear trough deformity underwent lower lid blepharoplasty at our center between 2018 and 2023. Preoperative assessment utilized the Barton grading system to categorize the severity of tear trough deformity, guiding personalized surgical approaches for each patient. Postoperative outcomes, including satisfaction levels, complications, and tear trough deformity improvement, were evaluated. Following surgery, 175 out of 176 patients achieved a reduction to Barton grade level of 0. Postoperative satisfaction scores averaged 4.4, with a satisfaction rate of 96.6%. Complications were minimal, including mild postoperative ectropion in patients and single occurrences of postoperative hematoma, infection, insufficient improvement, and recurrence. Our treatment algorithm offers a straightforward and effective approach for addressing tear trough deformity and lower eyelid bags. Further research is warranted to validate these findings.

Assessment of facial autologous fat grafts using Dixon magnetic resonance imaging.

Background: Autologous fat grafting is a procedure that treats soft tissue defects by reallocating fat to improve a patient's physical appearance. Imaging methods may be used to evaluate and monitor the grafted fat after transplantation. The goal of imaging is to examine the signal and volume of the grafted fat after autologous fat grafting during the adipose tissue recovery. However, researchers have yet to examine the feasibility of using fat-only imaging to assess the autologous fat graft. Methods: In this prospective and observational study, 46 injected sides in 23 female patients (age 35±7.8 years) were included in the image evaluation. The patients underwent autologous fat grafting surgery with filtered and washed fat. A total of 16, 18, and 12 sides were scanned 7 days, 3 months, and 1 year after fat grafting, respectively. Fat-only images were obtained using Dixon imaging, and then the image quality and contrast of the T1W and T2W were rated to evaluate the application of this method when imaging the autologous fat. The signal and volume of the autologous fat graft were recorded to assess the retention during recovery of the autologous fat tissue. Results: Fat-only T1W magnetic resonance imaging (MRI) was used to identify and delineate grafted fat because this method had better image quality and image differentiation than did T2W MRI. The average signal contrast and retention rate measured 7 days postoperation (28.8%±4.7%; 94.1%±5.8%) was the highest and then decreased at 3 months (16.3%±2.1%; 48.7%±17.3%) and 1 year (3.3%±1.3%, 33.1%±12.9%) after surgery. There were statistically significant differences between the signal and volume retention measurements at each postoperative recovery phase. Conclusions: The T1W fat-only images produced by Dixon MRI is a feasible approach for identifying grafted fat and measure postoperative changes during clinical evaluation. We found a significant decrease in signal contrast and volume of the grafted fat from the surgery date to 3 months postoperation and from 3 months to 1-year postoperation.

Eyebrow Reconstruction With Temporal Hairline Relay Flap.

ABSTRACT: Eyebrow is one of the most important features of the face; the absence of eyebrows will cause a heavy psychological burden to patients. Existing brow reconstruction techniques are not perfect for every case of eyebrow defect. In this study, a patient who suffered from eyebrows loss after radiotherapy for hemangioma underwent eyebrow reconstruction with the relay transfer of a temporal hairline flap. The entire procedure was performed in the outpatient operating room. The temporal hairline flap was transferred to the eyebrow region in a relay and survived well without necrosis. In the 2-month follow-up, the shape and density of the reconstructed eyebrows were satisfactory. The operation showed this technique was innovative, economic, and recommended as a suitable choice for eyebrow reconstruction, especially in those patients with poor hair transplantation recipient area.

Orbicularis-levator-tarsus fixation suturing in buried suture double-eyelid blepharoplasty.

BACKGROUND: In buried suture methods, the levator aponeurosis is fixed to the subcutaneous tissue in the pretarsal region using a suture. However, loosening of the suture occurs frequently and causes regression or disappearance of the double-eyelid folds. To avoid potential loosening of the suture after surgery, we modified the horizontal suture technique commonly used in buried suture double-eyelid blepharoplasty. METHODS: In our procedure, the levator aponeurosis was sutured horizontally, and then the subcutaneous tissue in the pretarsal region was sutured vertically by the same suture. After the two ends of the suture were tied, three tissue layers, namely, the levator aponeurosis, pretarsal fascia, and orbicularis oculi muscle, were fixed together in the pretarsal region. RESULTS: A total of 873 Asian patients underwent double-eyelid blepharoplasty during the past 8 years. No loss of the double-eyelid folds occurred in 563 patients who were followed up for more than six months, and 531 patients, accounting for 94% of the sample, were satisfied with the postoperative results. CONCLUSION: Since the suture was perpendicular to both the levator aponeurosis and the pretarsal orbicularis oculi muscle, pulling on the suture fixation site during blinking was effectively reduced. As a result, regression or disappearance of the double-eyelid folds due to loosening of the suture along the orientation of the muscle fibers was avoided, and the long-term stability of the double-eyelid folds was ensured.

Use of Buried Guide Needle to Fix Inferior Eyelid Orbital Septum Fat for Tear Trough Depression Filling.

ABSTRACT: Fat fixation is a key step in filling tear trough depression with inferior eyelid orbital septum fat. The ideal position for inferior eyelid fat fixation is to cross the tear trough ligament causing tear trough depression and the orbicularis retaining ligament, with the distal end fixed at the farthest end of the dissected lacuna deep down the inferior orbicularis oculi muscle. Traditional suturing is difficult in the deep narrow lacunae, but a buried guide needle can be used to suture and fix the fat in the deepest lacuna. In this study, 264 patients who underwent tear trough filling using a buried guide needle to fix the released inferior eyelid orbital septum fat from 2017 to 2020 were followed up. The preoperative and postoperative imaging findings were compared to evaluate the effectiveness of the operation and postoperative complications. The inferior eyelid bulging, loose skin, and tear trough depression significantly improved than that before the operation. None of the patients had any severe complications, such as inferior eyelid ectropion, lagophthalmos, scar hyperplasia, and diplopia, in the long term (6 months) postoperatively. Five patients showed mild eyelid-eyeball separation and recovered in 1 month. Four patients had diplopia, and 3 patients had chemosis; all recovered in 7 days. The tear trough depression was not corrected completely in 2 patients. The operation showed satisfactory results in the improvement of tear trough depression in addition to alleviation of inferior eyelid bulging and loose inferior eyelid skin that is caused by the traditional inferior eyelid pouch removal.

Chondrogenic Characteristics of Auricular Chondrocytes Cocultured With Adipose-Derived Stem Cells are Superior to Stromal Vascular Fraction of Adipose Tissue.

ABSTRACT: Reconstruction of craniofacial cartilage defects is among the most challenging operations in facial plastic surgery. The co-culture system of partial replacement of chondrocytes by stem cells has been confirmed effective in the repair of cartilaginous defects. The aim of this study is to compare chondrogenic properties of expanded adipose-derived stem cells (ADSCs) and stromal vascular fraction (SVF), including ADSCs/SVF monoculture and coculture with rabbit auricular chondrocytes (ACs). Analysis of morphology, histology, real-time polymerase chain reaction and glycosaminoglycans (GAG) quantification were performed to characterize the chondrogenesis of pellets. The triple differentiation potential of ADSCs had been confirmed. Further, using flow cytometry, the authors demonstrated that ADSCs and SVF have different characteristics in cell surface markers, and ADSCs are more enriched in cells from the mesenchymal lineage than SVF. GAG production of ADSCs is significantly higher than that of SVF in pellet monoculture, and pellet coculture of ADSCs and ACs are better in depositing cartilage matrix than the mixture of SVF and ACs. Our study suggests that ADSCs may be more suitable seed cells for craniofacial cartilage defect or deformity repair.

Human decellularized adipose tissue hydrogels as a culture platform for human adipose-derived stem cell delivery.

Adipose-derived stem cells (ADSCs) have been widely researched and used as a drug therapy in many fields like disease treatment and tissue engineering. However, ADSCs are susceptible to the surrounding environment. The emergence of acellular extracellular matrix provides a solution, which can serve as biomaterial scaffold as well as original ecological niche for the stem cells. Therefore, we propose the hypothesis that human decellularized adipose tissues (hDAT) are processed into injectable hydrogels and then mixed evenly with ADSCs. So that the ADSCs embedded-hydrogels could directly carry the stem cells to the appropriate sites. The hDAT hydrogel could provide microenvironmental protection for ADSCs. In this study, we successfully made human decellularized adipose tissue hydrogel (hDAT-gel), which was temperature-sensitive, liquid at 4°C and semi-solid at 37°C. When the ADSCs were embedded in hDAT-gel, they survived well and continued to grow well in layers. When the pre-gel containing ADSCs was injected subcutaneously into nude mice, the sample results after 15 min showed gelation occurred in situ. These results suggested that hDAT-gel could provide a culture platform for ADSCs delivery.

Rapid generation of functional hepatocyte-like cells from human minor salivary gland-derived stem cells.

Liver failure is one of the major risk factors for death worldwide, and the only effective liver transplantation is currently very limited. Adult stem cells can be induced into hepatocytes in vitro and implanted into the body to repair damaged liver. However, most of the induction time in vitro is relatively long, which is not suitable for practical application. Therefore, search for new seed cells that can rapidly differentiate into functional hepatocytes is crucial for the clinical application of cell transplantation therapy. In this study, we explored a three-step protocol to rapidly induce human minor salivary gland mesenchymal stem cells (hMSG-MSCs) into hepatocytes in vitro, and finally obtained hepatocyte-like cells within 6 days. After a series of relevant detection from gene, protein and functional levels, we confirmed that the finally induced cells were mature hepatocyte-like cells with certain hepatocyte functions to some extent. Besides, we injected the preliminary induced cells into mice with acute liver injury, showing a good repair effect on the damaged liver. All these results indicate that the hMSG-MSCs have potential to be a kind of seed cells for rapid hepatic differentiation.

Corrective Strategies for a Complex Deformity Caused by "European-Style Double Eyelid" Blepharoplasty in Asians.

BACKGROUND: "European-style double eyelid" blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity. METHODS: During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. The authors classified this complex deformity as mild, moderate, or severe based on the extent of adhesion and tissue insufficiency, and we performed preaponeurotic fat flap transfer in 47 eyes (44.3%), free fat graft in 35 eyes (33%), and free dermis-fat graft in 24 eyes (22.6%), respectively. RESULTS: The outcomes in 87 eyelids were judged as excellent; and the grading was excellent in 41 eyes (87.2%) that underwent preaponeurotic fat flap transfer, 30 eyes (85.7%) that received a free fat graft, and 16 eyes (66.7%) that received a free dermis-fat graft. The outcomes in only 3 eyes (2.8%) were evaluated as unsatisfactory. CONCLUSIONS: The fundamental reasons behind this deformity were adhesion and tissue insufficiency above the supratarsal crease. The purpose of correction was to reconstruct the gliding system and restore the volume. The authors performed preaponeurotic fat flap transfer, free fat graft, and free dermis-fat graft and achieved satisfactory results. Great improvement in ptosis was achieved by releasing the adhesion and lowering the fold in patients with normal levator muscle function. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An Islanded Rabbit Auricular Skin Flap Model of Hyaluronic Acid Injection-Induced Embolism.

BACKGROUND: Hyaluronic acid (HA) injection-induced embolism is a rare but severe complication. This article is aimed to introduce an islanded rabbit auricular skin flap model of HA injection-induced embolism and to study its pathophysiological progress. METHODS: An islanded skin flap was elevated based on the proximal central auricular artery/vein. Eighteen rabbits were randomized into three groups. Ten, twenty, and forty microliters of HA were injected into the central auricular artery in each group, respectively. Flap fluorescence angiography was performed. One-way ANOVA was used to compare fluorescence area at different time points and between dose groups. Two rabbits in each group were randomly chosen for histology examination. In addition to regular HE staining, Alcian Blue staining was performed to better show the existence of HA in the vessel lumen. RESULTS: The mean calculated fluorescence area was 64.41 % on POD 1, 79.77 % on POD 3, 88.20 % on POD 5, and 92.03 % on POD 7 in 10 µl group; 60.51 % on POD 1, 58.84 % on POD 3, 71.20 % on POD 5, and 76.54 % on POD 7 in 20 µl group; 21.60 % on POD 1, 3.08 % on POD 3, 2.91 % on POD 5, and 7.52 % on POD 7 in 40 µl group. In all three groups, infiltration of eosinophilic granulocytes was observed in the muscular layer of both artery and vein. CONCLUSION: Our study successfully created a rabbit auricular skin necrosis model of HA embolism, which provided a valuable animal model for further investigation of the pathophysiological progress and the efficacy of potential treatments. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of facial post-burn hyperpigmentation using micro-plasma radiofrequency technology.

Management of facial post-burn hyperpigmentation is a common and challenging problem for dermatologists and plastic surgeons. The recent development of micro-plasma radiofrequency technology, which allows precise and rapid treatment with controlled thermal injury, can be an effective treatment of post-burn hyperpigmentation. This study aimed to evaluate the effectiveness and complications of micro-plasma radiofrequency treatment of post-burn hyperpigmentation. The study included 35 patients with Fitzpatrick skin type III or IV and facial post-burn hyperpigmentation. Patients received three to five treatments at 8-week intervals. A roller tip was used with the power setting at 60-90 W, and 3-4 passes were made in different directions. The degree of improvement and complications were recorded. Improvement of hyperpigmentation was evaluated by patient self-assessment and by plastic surgeons who compared digital photographs taken before treatment and 2 months after the last treatment. The results showed that post-burn hyperpigmentation responded favorably to micro-plasma radiofrequency treatment with very few complications. The average pain score using a visual analog scale from 0 to 10 was 6.7 ± 0.7. After a series of treatments, 32 of the 35 patients had achieved a >51% improvement of their hyperpigmentation, and 3 patients had achieved a fair improvement. The mean score for improvement of hyperpigmentation was 4.28. Patient self-evaluations indicated good satisfaction with the cosmetic outcomes, and some softening of the scars. Micro-plasma radiofrequency technology is appropriate, effective, and safe for the treatment of facial post-burn hyperpigmentation, and provides a promising noninvasive treatment for superficial facial injuries.

Forty-five cases of chest keloids treated with subcutaneous super-tension-reduction suture combined with postoperative electron-beam irradiation.

BACKGROUND: Chest keloids are challenging to surgeons because of their high recurrence rate. OBJECTIVE: To investigate the effectiveness of the subcutaneous super-tension-reduction suture technique with postoperative electron-beam irradiation in the treatment of chest keloids. MATERIALS AND METHODS: Forty-five patients with chest keloids underwent excision. To minimize the wound-closing tension, subcutaneous super-tension-reduction suture was used. The maximum tension reduction was placed on both dermis and subcutaneous tissue, which were far away from the incision. The consequence of such suturing was that the wound edges were moved centrally to elevate them like a bump after tying the buried knot. All patients received fractionated electron-beam radiation therapy starting within 24 hours after surgery, in a 5-Gy dose daily for 3 to 4 consecutive days, to a total dose of 15 to 20 Gy. RESULTS: The wounds healed primarily in all 45 cases. The bump at the incision began to flatten out after 2 to 3 months and was almost completely flat by 12 months postoperatively. Only 1 case of relapse (2.2%) was observed within 2 years of follow-up examination. CONCLUSION: The use of subcutaneous super-tension-reduction suture after chest keloids excision can greatly decrease tension on the dermis and the subcutaneous tissue and can, in combination with postoperative electron-beam irradiation, decrease the rate of relapse.

A clinical study of various buccinator musculomucosal flaps for palatal fistulae closure after cleft palate surgery.

This retrospective study describes various buccinator musculomucosal flaps for the repair of palatal fistulae. Twenty-two palatal fistulae were repaired at our institution between 2002 and 2012 by buccinator musculomucosal flaps with superior-anterior or posterior pedicles. Seventeen patients were treated with posteriorly pedicled flaps, 7 of whom had lengthening of the soft palate and 10 of whom had simultaneously repaired severe lateral palatal scarring. Five patients with anterior or midpalatal fistulae were treated with superior-anteriorly pedicled flaps. All but 4 of the 22 patients had satisfactory results. Four patients had recurrent fistulae, 2 resulting from flap tip necrosis and 2 from wound dehiscence. Follow-up was from 5 to 72 months. None of the patients had facial nerve injury, limited mouth opening, or difficulty chewing. We evaluated the factors that could cause complications, such as flap pattern, location of fistula, and size of palate defect. No statistically significant differences were found in the complication rates among different groups. In conclusion, the buccinator musculomucosal flap is reliable and versatile, with rich vascularity and flexible design. The flap is a good option for fistula repair, especially for larger fistulae at the anterior portion of the hard palate or at the junction of hard and soft palate, where surrounding soft tissues are stiff, scarred, and difficult to mobilize.

'Expansion in-situ' concept as a new technique for expanding skin and soft tissue.

Techniques for expanding skin and soft tissue are widely used to repair damaged areas since they facilitate the provision of new, additional skin tissue with similar quality, texture and color to that surrounding the defective area. Conventional expansion techniques involve placing expanders under the normal skin adjacent to a lesion. However, these techniques may involve additional incisions, complications with blood supply and 'dog-ear' deformities and may result in a low utilization rate of the expanded tissue. When reconstructing small defects that may not be sutured directly, these shortcomings, particularly the requirement to make additional incisions, limit the application of conventional techniques. The current study presents a novel approach to expansion called the 'expansion in-situ' technique. In this technique, the lesion is used as the center for expansion and expanders of optimal size are implanted under the lesion and surrounding normal soft tissue. Following expansion, the damaged area is excised directly. In order to avoid poor healing of the incision made during expander implantation, the overlapping suturing of both cut sides is conducted. This enlarges the contact area of both sides of the incision, thereby avoiding incision dehiscence and increasing wound healing during the expansion process. Between August 2006 and July 2011, the expansion in-situ technique was applied in 10 cases involving either nevus excision or scar removal. All 10 cases were treated successfully. Five of the cases were followed up over 1-3 years. The 'expansion in-situ' technique is likely to be useful for avoiding additional incisions and improving the utilization rate of expanded skin flaps.

Angular vessels as a new vascular pedicle of an island nasal chondromucosal flap: Anatomical study and clinical application.

Successful eyelid reconstructions have been reported when using an axial nasal chondromucosal flap based on the dorsal nasal artery. The present study aimed to present a detailed anatomical description of the blood supply of the lateral nasal region and the angular artery, in order to propose the angular vessels as a new vascular pedicle for the island nasal chondromucosal flap. A total of 11 cadavers (22 hemi-faces) were examined. Observations with regard to the origin, course and distribution patterns of the angular artery were recorded. Based on the anatomical study findings, the angular vessels were proposed as a vascular source for the island nasal chondromucosal flap. Observations with regard to the varying origins of the angular artery were categorized into four types. The course of the angular artery along the nasojugal fold was constant. The angular artery branched off into the upper two-thirds of the lateral nasal region and anastomosed with the other vascular branches on the nasal dorsum. Clinically, reconstruction of a full-thickness defect of the lower eyelid was successfully performed by using this composite flap based on the angular vessels and an adjacent orbicularis oculi myocutaneous flap. Satisfactory esthetic outcomes were obtained for the donor and recipient sites. The angular artery is a good vascular source for an island nasal chondromucosal flap. The flap may be created safely and successfully in clinic. Island nasal chondromucosal flaps and nasolabial groove skin flaps based on the angular vessels may be designed simultaneously for use on full-thickness defects of the eyelid.

[Treatment of the congenital exstrophy of bladder].

OBJECTIVE: To sum up the methods repairing the congenital bladder exstrophy, and to evaluate the value of the abdominal fascial flap and the lower abdominal skin flap, the tensor fascia lata musculocutaneous flap treating the bladder exstrophy. METHODS: The abdominal rectus sheath and the fascia flap of obliquus externus abdominal and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap were used to repair the abdominal wall defection, meanwhile repair the epispadias. The maximum field of the musculocutaneous flaps was 8 cm x 10 cm. RESULTS: 12 cases were cured. The bladder exstrophy and the abdominal wall defection were repaired very well. The musculus sphincter bladder neck was reconstructed. After the second operation, the cases could urinate under self-control. 2 skin flaps of 8 musculocutaneous flaps were necrosis and cured by skin grafting. CONCLUSIONS: Using the abdominal fascial flap and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap, is feasible for repairing the bladder exstrophy and the lower abdominal wall defection. The continuous of the musculus sphincter bladder were renewed, and then the patients could urinate under self-control. When the ischemia of the musculocutaneous flaps had occurred, the tensor fascial was survived well.

[The clinical application of acellular urinary bladder submucosa to reconstructive the urethral duct of hypospadias patients].

OBJECTIVE: Attended to apply the acellular urinary bladder submucosa in the operation of the urethral duct reconstruction of penile hypospadias. METHODS: In 2 cases, the urethral ducts were reconstructed by using the acellular urinary bladder submucosa as dorsal half of the urethra, while the preputial island flap as ventral side. In the other patient, the urethral plate was incised, similar to Snodgrass operation, the matrix was fixed to the corpora cavernosa beneath. RESULTS: Uroflowmetry and the urethroscopy were been performed in the one year follow up. A bell-shaped flow curve was obtained in the patient after urethroplasty using matrix graft combined with a local flap, and no fistula, stricture was found after a year or half a year follow-up. CONCLUSIONS: The freeze-dried acellular urinary bladder submucosa had three-dimensional network structure, and the acellular urinary bladder submucosa graft combined with preputial flap for hypospadias repair provided satisfactory functional results.

Penile reconstruction by the free scapular flap and malleable penis prosthesis.

BACKGROUND: : Penile reconstruction has always been a challenging problem for plastic surgeons while facing patients with severe congenital deformities and gender dysphoria and those who have suffered penile loss because of trauma, self-amputation, malignancy, and so on. Since 1936, when Bogoras first constructed a total penis, attempts have been made by different techniques, including skin flaps or myocutaneous flaps. And with development of free tissue transfer and microsurgical techniques, various free skin flaps, such as the radial free forearm flap, the superficial inferior epigastric artery flap, the superficial circumflex iliac artery flap, have been attempted for phallic construction, with the goal of functional (including a competent neourethra that allows voiding while standing and sexual intercourse) and cosmetic result. The purpose of our study was to evaluate the scapular free flap and implantation of malleable penile prosthesis for penile reconstruction. PATIENTS AND METHODS: : Since March 2000, 20 patients with penile loss were reconstructed in a 1-stage procedure by transferring scapular flap and implantation of a malleable penile prosthesis. The age of the patients ranged between 21 and 36 years old. Of these patients, 12 had penile amputation resulting from an electric accident; the other 8 were self-amputated. RESULTS: : All the flaps remained 100% viable postoperatively. Follow-up ranged from 1 to 5 years. There were no cases of urethral fistula, urethral stenosis, prosthesis extrusion, or infection. The reconstructed penis yielded satisfactory function and esthetic appearance. CONCLUSION: : The scapular free flap is an ideal flap that achieves satisfactory function and esthetic appearance for penile reconstruction because of its adequate amount of tissue, reliable vascularity, acceptable donor-site morbidity, and reliable blood supply.