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Background Nasal reconstruction is one of the most challenging procedures for plastic surgeons, and whether it should be performed using the subunit principle versus the defect-only principle remains a matter of debate. Skin grafting and local flaps such as dorsal nasal, bi-lobed, V-Y advancement, glabellar, nasolabial, forehead, and para-median forehead flaps have been used in nasal reconstruction. Another style of flap that has also been used for nasal reconstruction is the perforator flap. In this work, we will evaluate the utility of unilateral or bilateral freestyle infra-orbital perforator flaps in the reconstruction of nasal skin defects. Methods This prospective clinical study was conducted in the plastic surgery department of Tanta University Hospital, Egypt, between February 2015 and April 2019. A total of 34 patients who presented with nasal skin tumours that did not invade the nasal bones or cartilage were ultimately enrolled in the study. Results The age of the patients ranged from 43 to 78 years, with a mean of 53 years. Clinical assessment was performed by three plastic surgeons who did not share in this study using a four-point scale. The assessment indicated excellent results in 22 (64.7%) patients, good results in 7 (20.6%) patients, fair results in 5 (14.7%) patients, and no poor results. No significant complications were observed in our experience. Conclusions We believe that unilateral and bilateral infra-orbital perforator flaps may provide an alternative reconstruction method for different nasal defects. Level of Evidence: Level IV; therapeutic study.

Summary: The anterioabdominal wall is the most common site for low molecular weight heparin administration for anticoagulation, either for prophylactic or for therapeutic indications. Occasionally, this could be associated with damage of the abdominal pannus microvasculature, which could possibly jeopardize the reliability of free abdominal flaps as deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle, especially with therapeutic anticoagulation therapy. These flaps are reliant on a highly intricate complex vascular anatomy and perforasomes for their adequate perfusion and survival. The authors report a case of nonobstructive microvascular failure of a free muscle sparing transverse rectus abdominis muscle utilized for soft tissue coverage following resection of a chest wall breast cancer recurrence on a background of portacath-induced deep venous thrombosis of the axillary and subclavian vein whilst on chemotherapy. History of long-term therapeutic low molecular weight heparin administration in the abdomen resulted in microangiopathic densities evident on computerized tomography scan with subsequent flap failure due to possible jeopardization of the flap microvasculature and perfusion. Following exclusion of common local and systemic factors that can cause vascular compromise, a debridement and salvage re-reconstruction procedure utilizing a contralateral free latissimus dorsi flap was performed. Reconstructive surgeons should be cautious when planning to utilize free abdominal-based flaps on the background of long-term therapeutic low molecular weight heparin administration in the abdomen and may possibly explore other alternative options of using non-abdominal free flaps from the reconstructive armamentarium within this unique context.

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Modern interdisciplinary concepts with involvement of various surgical specialties can considerably reduce perioperative morbidity after sacroperineal resection of locally advanced primary or recurrent anorectal malignancies. Resultant defects can represent a major challenge for reconstruction particularly with chemoradiotherapy. The aim is to assess the long-term outcomes of sacroperineal reconstruction using inferior gluteal artery perforator flaps.We performed a retrospective data analysis on 31 patients who were treated with inferior gluteal artery perforator flaps (n = 61) over the period 2009-2021. The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection and dehiscence were recorded.The median age was 42 year (range, 25-82 years) with preponderance of males (n = 21). The follow-up period ranged from 6 to 80 months. Early minor complications included superficial wound dehiscence (3), which was managed conservatively, whereas the major (2) included deep wound collection and infection (1), which required surgical drainage, and perineal hernia, which required repair. All flaps survived completely.Inferior gluteal artery perforator flaps are safe, robust, and reliable with less donor side morbidity and positive impact on quality of life. It should be considered as a valuable tool in the reconstructive armamentarium of sacroperineal defects within a multidisciplinary setting.