Background The combined pedicled pectoralis major‐latissimus dorsi (PM–LD) and free extended anterolateral thigh (ALT) myocutaneous flaps provide well‐vascularized tissues for extensive sternal wound reconstruction. However, the outcomes and postoperative complications between the two surgical techniques are different. Thus, the aim of this study is to evaluate the feasibility of these two reconstructive options. Methods This single‐center, retrospective study was conducted between August 2011 and May 2019. Forty‐four patients diagnosed with deep sternal wound infection (DSWI) and presented with grade four complications (sternal instability and necrotic bone tissue) were enrolled. Two reconstructive strategies, namely, combined pedicled PM–LD (n = 24) and free extended ALT (n = 20) myocutaneous flaps, were used according to the patients' hemodynamics. Data including age, gender, body mass index (BMI), hospital stay, follow‐up, defect/flap size, number of surgical procedures before reconstruction, duration from the last debridement to flap coverage, comorbidities, and postoperative complications, were obtained for statistical analysis. Results The mean defect size in the combined PM–LD myocutaneous flap group was 188.4 (5*17–10*23) cm2, and the mean flap size was 150.0 (8*12–15*15) cm2 and 205.0 (8*15–10*25) cm2 in PM and LD flap, respectively. The mean defect size in the free extended ALT myocutaneus flap group was 202.5 (6*16–10*21) cm2, and the mean flap size was 285.2 (9*30–12*25) cm2. No significant differences were observed between the free extended ALT and the combined pedicled PM–LD myocutaneous flaps in relation to age, gender, BMI, hospital days, follow‐up, defect size, preoperative procedures, and comorbidities, except for the average operative time (443.2 ± 31.2 vs. 321.3 ± 54.3 mins, p = .048). The combined pedicled PM–LD myocutaneous flap had significantly more donor site complications, including seroma (21% vs. 0%, p = .030), bilateral nipple–areolar complex asymmetry (100% vs. 0%, p < .0001), and skin graft loss with infection (33% vs. 0%; p = .044) than the free extended ALT myocutaneous flap. Conclusion The free extended ALT and the combined pedicled PM–LD myocutaneous flaps were both feasible and effective options for sternal wound reconstruction. Our findings suggested that the free extended ALT myocutaneous flap may be a better alternative for a comprehensive and extensive reconstruction of sternal wounds. Further studies based on these findings can be conducted.

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In surgical procedures involving the penopubic junction, there are significant risks associated with postoperative scar traction. Scar traction may result in a short penis and other deformities, which may cause discomfort during erections and interfere with the patient's sexual performance. The article describes the case of a 27-year-old male who had undergone a penis lengthening procedure four years earlier. After the surgery, the skin around the penopubic junction was scarred and became severely contracted. This led to a short penis and a high hanging scrotum as a consequence of the scarring. The purpose of this case report is to describe how we repaired the penopubic junction with a pedicled superficial circumflex iliac artery perforator flap. At the penopubic junction, there was a defect measuring 4 x 3 cm following the removal of the contracture scar. The affected region was repaired using a left pedicled modified superficial circumflex iliac artery perforator flap based on its medial superficial branch. Moreover, a hybrid technique was developed to harvest the superficial circumflex iliac artery perforator flap in a safe and effective manner. Using the hybrid technique, a proximal-to-distally flap elevation approach was combined with a pedicle elongation strategy to lengthen the pedicle. It is our experience that the pedicled superficial circumflex iliac artery perforator flap may provide an effective alternative method of reconstructing the postoperative scar traction at the penopubic junction.