Background: Breast reconstruction became a dynamic continually progressing group of procedures. These procedures are aiming to provide the patients after mastectomy more symmetrical and an aesthetically pleasing recreated breast in the cases which are fulfilling multiple basic oncologic goals. The reconstruction must not impede the oncological safety or cause a delay in detection of local recurrence or adjuvant cancer management. The aim of the current study is to evaluate the surgical outcomes of the immediate breast reconstruction by latissimus dorsi flap in patients after nipple sparing mastectomy regarding the aesthetic results, post-operative complications and patient satisfaction.Patients and Methods: Eight consecutive patients having invasive breast cancer (7 patient have invasive duct carcinoma and a patient has invasive lobular carcinoma) underwent nipple sparing mastectomy. All patients had immediate breast reconstruction by latissimus dorsi flap at Zagazig University hospitals within three years. Surgical outcomes in terms of post-operative complications including hematoma, wound infection, scarring, dorsal seroma, skin necrosis, back pain, and aesthetic outcomes such as breast symmetry, visual difference of bilateral breasts, breast contour, and nipple cosmoses were assessed.Results: Surgical outcomes including post-operative complications; hematoma, wound infection were not detected. Marked back scarring (25%), dorsal seroma (12.5%) were reported. Aesthetic outcomes were satisfactory and 75% of patients reported excellent satisfaction with (2 cases) 25% were not satisfied due to the back scar or volume asymmetry.Conclusion: Following nipple sparing mastectomy, purely autogenous immediate breast reconstruction by latissimus dorsi flap is a valuable reconstructing technique in selected type of patients. It has low incidence of complications, considerable aesthetic outcomes with high patient satisfaction relieving the psychological postmastectomy trauma.

Background: For managing of upper brachial plexus palsy in adult patients, many strategies should be discussed with the patient. Primary plexus repair, nerve transfer, functional muscle transfer and other musculoskeletal approaches may be followed according the suitability, merits and disadvantages of each. Time factorsare very crucial for the sound management for these patients as time delay can result in a non-achievable chance loss with the neuromuscular end plates loss within two years following muscle denervation and progressive musculoskeletal changes as well. Conclusion: Multimodal association between distal nerves transfer and combined transfer of trabezius, latissimus dorsi and teres major muscles provides an effective and relatively a short management scenario for upper brachial plexus injuries in adult patients.

Background: Soft tissue reconstruction of thumb defects is of paramount importance to keep the safety of deeper structures and preserve the function of thumb. Proper selection of flap coverage must provide a versatile, pliable coverage with restored thumb motor function and sensibility in pulp area, in one stage procedure with acceptable aesthetic outcome in both donor and defect areas. The aim of this study was to compare the use of two regional flaps 1 st dorsal metacarpal artery flap versus the reverse homodigital dorsoradial artery flap in reconstruction of partial soft tissue defects in the thumb as regard the function, sensibility and aesthetic outcome. Patients and Methods: Eighteen patients had been included in this prospective study was divided randomly in two groups A and B, they undergone the procedures. In the two groups; the flap dimensions, and operative time were recorded intraoperatively. Postoperatively; the motor function, two point discrimination testing for sensibility, the complications, and the aesthetic outcome were assessed during the follow-up period. Results: All flaps in both groups were survived, venous congestion was the main complications, which was more occurring in group B (3 cases) than group A (one case). There was statistically significant difference regarding the flap dimensions and operative time between the two groups. Restored motor function and sensibility were satisfactory in both groups. Aesthetically; the redial scars were more appealing in group B than A. Conclusion: Beside the well-known 1 st DMCA flap, the RHDDRA flap could be a useful alternative in thumb reconstruction with less operative time, larger skin island dimensions and more attractive residual scars.

Introduction: Facial disfigurement or cutaneous defect reconstruction might not be feasible without the aid of either skin grafts or local flaps, but they might have poor color and character match. Although chronic tissue expansion has succeeded to achieve an additional new skin with good match but it is not suitable in many cases. Acute Intraoperative Sustained Expansion (AISE) (rapid expansion) has been introduced as an alternate technique to aid in wound closure following the same strategy of preservation of a good tissue matching but in a single procedure, also when it is combined with fat grafting in case of contour irregularities, it enhance the aesthetic outcome. Patients and Methods:This study included 27 patients with different facial disfigurements or facial cutaneous defects [post tumor excision, post-burn contracture release] located on nose, cheek, temple, or forehead, divided in two groups: Group A (Expansion group) included 13 patients those were treated with (AISE) by using total 21 intraoperative expansion by Foley catheters, five of these patients were managed with additional fat injection when associated with contour irregularities. In the other group, B (Flap/Graft group), 14 patients were managed by local flaps (11 patients) and skin grafts (3 patients). Results: AISE showed success to gain additional skin surface area with each expansion site by dissection, expansion, or both with means of 14.2%, 16.5% and 30.7% of the involved basic relaxing skin surface area respectively with more aesthetic reliability if associated with fat grafting in cases with contour defects. However, expansion sites showed blood collection in 9,6%, closure under tension in 9,6%, partial wound dehiscence in 4.8%. Also, the incidence of patients' dissatisfaction with the results was 23% of cases. Also, the group of local flaps and grafts cases showed poor color and texture matching to the surrounding area 25% in local flap cases and 100% in cases reconstructed by skin grafts, additional facial scars 100% in cases of local flaps, donor site complications and unsatisfactory imaging in 80% of cases, unnatural facial distortion 65%, need for second procedure 28%, wound dehiscence 22%, partial graft loss 33% and flap viability problems 12%.Conclusion: Acute intraoperative sustained expansion could be considered as a reliable reconstructive tool in facial disfigurement, although it doesn't add skin as much as chronic 375 expansion, but it is helpful in assisting closure of wounds without tension, that might otherwise be problematic, it suits small to moderate surface area cutaneous defects, it generates a good matched skin in single procedure, and gives more aesthetic outcome if combined with autologous fat grafting in cases with contour irregularities.

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