Hypospadias present with a wide array of meatal position and curvature. Choosing an operative technique for the different types of hypospadias has been challenging and controversial among the plastic, urologic, and pediatric surgeons. Regardless of the selected techniques, primary hypospadias repair still frequently results in complications requiring further surgery, such as fistula, residual chordee, and stricture. Owing to its practicality, the single stage urethroplasties are more-popular and widely used at present. However, our experience found higher rates of postoperative complications with the one-stage procedure compared to the two-stage for repair of non-glanular hypospadia. This article details the operative techniques of the two-stage Sidik-Chaula urethroplasty, a technique that we have implemented in our institution over two decades. It is applicable for the primary repair of any distal, middle, and proximal hypospadias. We also introduce the Manset Flap, a simple modification to the first stage of urethroplasty, which ease neourethra creation in the second stage. However, due to prior insufficient medical recordkeeping, we are yet unable to produce a quantified rate of success and complications by utilizing this technique. A study is currently being done to produce the numbers.

Background: In the era of surgical advances where institutional pride and status resonates with their progress in the minimal invasives, latest technologies, stem cells, and supermicrosurgeries; some things in plastic surgery never change. The extended lateral forehad flap (ELFF) was first introduced by Ian McGregor in 1963 to reconstruct an intraoral defect, he called it the temporal flap. Gillies and Millard each modified and utilized the flap for patching various facial and intraoral defects and published their experience a year later. Until today in 2012, the ELFF is still largely useful for the reconstruction of wide defects post neoplasms ablation in the face or oral region, which would otherwise require distant flaps or free flaps.Patients and Methods: Three cases of oral and perioral carcinoma were resected and reconstructed using the ELFF to cover for: a full-thickness cheek defect including the lip commisure, an inner oral lining, and a hemipalatal defect.Results: In all, the flaps were tunneled subcutaneously, and donor area grafted by full-thickness skin. All flaps survived and functional outcomes are attained in all patients, with acceptable aesthetic results.Summary: A flap once introduced 49 years ago, is today as consistent and applicable in plastic surgery. This article is an appraisal to the ELFF, and a reminder to the general plastic surgeons, of the simple yet versatile role of ELFF in the reconstruction of facial and intraoral defects.

Background: Patients and clinicians experience the frustration of cutaneous viral warts due to human papilloma virus (HPV) infection. Verruca vulgaris, the common warts, appear in various forms at different body sites. Over 118 types of papilloma virus have been identified. The most common cutaneous warts are caused by types 1, 2, 4, 27, 57, and 19 HPV. The rare cases of generalized warts around the world are suspected to be caused by type 2 HPV. There are many treatment modalities for this disease but none is 100% effective yet. Patient and Method :We report a 39-year-old male with generalized warts on various body parts (scalp, forehead, trunk, arms, lower leg and foot). The team consist of plastic surgeons, dermatologist, psychiatrist, pathologist, medical rehabilitationist, and internist. The treatment goals were to remove all warts, prevent recurrence of the disease, and improve the immunological status of the patient. Serial excisions were performed and closure attained using a combination of primary sutures, skin grafts (split- and full-thickness), and skin flaps. 5 Fluorouracil was administered on the raw surfaces before closure. Staged excisions were performed 11 times, with 3-4 weeks interval over a1-year period. Interferon and cimetidine injection were also given to augment the immune system.Results : All lesions were successfully excised and reconstructed. On a few fingers, hypertrophic scar and minor contracture ensued after closure by skin graft. Patient is able to carry out daily living activities independently. Patient was profoundly delighted and his quality of life improved.Summary : Management of a rare generalized verruca vulgaris through a team approach, by multiple staged excision, 5-FU application before defect closure, combined with antiviral therapy, proved effective in a case.

Background: In reconstructing challenging defects, surgeons are considered fairly fortunate when they are able to obtain a similar donor tissue quality to that of the missing tissue; in regards to their color, texture, size, and the ease of donor transfer to the defect. Several methods may be used, which frequently include the free tissue transfers using microvascular anastomoses bearing their specific consequences. We report a select of challenging cases which were successfully reconstructed using the Keystone flaps and avoid microvascular anastomoses, where otherwise the free tissue transfers would be the typical option for closure in such defects. Patient and Method: Nine cases of relatively large defect in various locations were reconstructed using the Keystone flaps supplied by either non-identified perforators or identified reliable perforators. Result: Out of the 9 defects located on various region of the body (lumbar, thorax, dorsum of the foot, plantar of the foot, posterior leg, sacrum, and cervicofacial) only the first 2 cases had identifiable perforators. All flaps survived completely without problem of vascularization. Summary: The Keystone flap is a useful and reliable random perforator-based flap even when the perforator vessels are not identified.

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