The PIVA flap revascularises the scarred milieu, adds a dynamic component to improve function and may reach up to the xiphoid process. Donor-site morbidity is limited.

Although seldom dangerous to life, these degloving injuries are all potentially infected and, unless treated as acute surgical emergencies, inevitably lead to serious complications. Diagnostic is done according to a standardized protocol, which eventually must be integrated in the standard polytrauma management. Multidisciplinary (orthopedic surgery, plastic surgery, dermatology, physiotherapy) defect management is of utmost importance and requires an "integrated therapy concept". The success or failure of primary treatment of degloving injuries is determined by an adequate primary care including debridement, osteosynthesis (if necessary) and soft tissue and skin management. If the skin is no more vascularised, it should be thinned out and refixed as a full thickness skin graft at the day of injury. Still vascularised skin flaps should be replaced and fixed with few stitches. A second look operation 24 to 72 hours later should be planned. Secondary surgery is necessary in almost every patient in order to improve the functional or aesthetic result. Adjuvant procedures such as physiotherapy, standardized scar treatment, orthesis, orthopedic shoes, etc. may be useful at any time of treatment.

The SEAP flap provides a useful approach for reconstruction of defects of the anterior chest, or of the abdominal wall. As a perforator or adipocutaneous flap, the flap is reliable and easy to raise, and spares donor site morbidity.

No abstract

Salvage surgical procedures after failed reconstruction for an extrophy-epispadias complex are extremely challenging. The goals are to restore continence and improve aesthetic appearance in order to provide quality of life and an improved body image to the patient. We describe the surgical steps in an adult patient who presented anal urinary incontinence and a poor body image due to the absence of an umbilicus and the presence of hypertrophic scars. He underwent a modified Mainz II reconstruction of the lower urinary tract at childhood for an extrophy-epispadias complex. Restoration of continence was achieved by the construction of a modified Mainz I pouch with a continent stoma in a neo-umbilicus. Body image improved dramatically by the construction of a neo-umbilicus, a surgical revision of the hypertrophic abdominal scars and an abdominoplasty. It is mandatory that such demanding surgery should only be attempted as a combined multidisciplinary effort with urologists and plastic/reconstructive surgeons.