Background: Reconstruction surgery for skin and soft tissue defects of the penis would ideally secure sufficient volume, be safe in procedure, and involve a simple surgical technique. Among the wide variety of techniques that have been employed, the groin flap-based technique is considered a relatively simple option for volumetric reconstruction. In this retrospective study, the authors report cases of penile reconstructive surgery using a groin flap.Methods: We performed a retrospective chart review of patients with penile defects treated in our department. Reconstructive surgeries were carried out using pedicled groin flaps. Charts were reviewed to investigate duration of the surgeries, recovery and follow-up periods, and bulkiness at one and 10 months after surgery. Patients were observed postoperatively for complications, urination, and erectile function.Results: Six patients hospitalized from March 2009 to September 2013 for penile defects underwent surgery in our department. All patients recovered without any flap loss. The most common complication after surgery was wound dehiscence. Circumferences of penile shafts were measured at 1 and 10 months after surgery, and penile bulkiness at rest were found to be maintained at >86%. There were no patients with contracture, and in all patients, urination and erectile functions were satisfactory.Conclusion: Reconstructing penile defects using groin flaps was found to be favorable in terms of volumetric reconstruction and postoperative patient satisfaction. Furthermore, the surgery and recovery periods are short, and rates of complication and donor site morbidity are also low.

Necrotizing fasciitis is an infection of the subcutaneous tissue that results in destruction of the fascia and is disproportionately common in patients with chronic liver disease or diabetes. Necrotizing fasciitis of the head and neck is rare, but has a high fatality rate. A 50-year-old man with a past medical history of diabetes reported a chief complaint of a wound in the posterior neck due to trauma. The wound had grown and was accompanied by pus and redness, and the patient had a fever. When the patient was referred to department of plastic & reconstructive surgery, the sternocleidomastoid muscle, semispinalis capitis muscle, splenius capitis muscle, and trapezius muscles were exposed, and the size of the defect was about 25×20 cm. Dead tissue resection was performed before negative-pressure wound therapy, followed by a split-thickness skin graft (STSG). After a 2-week course of aseptic dressing post-STSG, the patient recovered completely. No postoperative complications were observed for 1 year. Necrotizing fasciitis is a life-threatening, rapidly spreading infection, requiring early diagnosis and active surgical treatment. In addition, broad-spectrum antibiotics are required due to the variety of types of causative bacteria. Broad necrotizing fasciitis of the posterior neck is rare, but can quickly progress into a life-threatening stage.

Malignant tumors of the hand are rare. Squamous cell carcinoma (SCC) is the most common tumor that can develop at the nail bed. However, its prevalence is extremely rare. We report a male patient with SCC in the middle finger and provide a review of related literature. A 70-year-old male patient presented with subungal exudate of the right middle finger for 2 years. The lesion was treated by the patient himself without any relief. He visited the other hospital and underwent removal of the affected fingernail followed by histopathological examination. An extended excision was performed to remove the lesion located in close proximity with the distal phalanx along with a portion of the phalangeal soft tissues. The tumor shows malignant squamous sheets and nests with invasive growth pattern and pleomorphism. At the 6-month postoperative follow-up, neither symptom relapse nor other complications were observed. Various types of skin cancers, such as SCCs and malignant melanomas, can develop in the hand. However, their incidence is extremely rare. In particular, subungal lesions, which may be mistaken as fungal nail infections, require histopathological examination if they respond only slowly to treatment.

Follicular occlusion triad (FOT) is a complex chronic inflammatory skin disease comprising hidradenitis suppurativa (HS), acne conglobata (AC), and dissecting cellulitis of the scalp (DCS; Hoffman’s disease or perifolliculitis capitis abscedens et suffodiens). While pathological mechanisms are responsible for common skin manifestations, the exact underlying causes of follicular occlusion have not yet been clearly identified. Therefore, the diagnosis and treatment of FOT remain challenging. A 31-year-old man on conservative treatment for previously diagnosed HS and AC presented to our clinic with multiple masses on his posterior neck and face. Excisional biopsy of the masses revealed epidermal cysts. Four months after the surgery, he presented with a painful palpable mass around the occipital region of the scalp with characteristic skin manifestations such as cicatricial alopecia and comedones and was diagnosed with DCS. Incision and drainage of the lesion were performed, and histopathology revealed pathological findings of follicular occlusion. The patient was diagnosed with FOT. Following the procedure, the patient has been on regular follow-up and is on oral isotretinoin; there have been no complications for the last 6 months.

Prosthetic joint infection is a rare but serious complication of total shoulder replacement. After infection control, shoulder reconstruction is also required to repair the shoulder defect. The shoulder is a complex structure consisting of mechanical soft tissue and the joint, making reconstruction challenging. A 78-year-old female patient was diagnosed of wound necrosis and exposed prosthesis due to prosthetic joint infection after reverse total shoulder replacement. The infection was controlled with appropriate antibiotic treatment, and the necrotic tissue was removed by radical debridement. To reduce the size of the massive shoulder defect and minimize exposure of the prosthesis, negativepressure wound therapy (NPWT) was administered for 8 weeks and shoulder reconstruction was performed using a pedicled latissimus dorsi (LD) flap and split-thickness skin graft. The patient recovered without any complications, and no reinfection of the surgical site or other complications were observed during follow-up visits. This report demonstrates that antibiotic treatment, radical debridement of necrotic tissue, NPWT, and shoulder reconstruction using a pedicled LD flap can be an effective method of treatment for prosthetic joint infection with exposed prosthesis, tissue necrosis, and massive shoulder defect.