Aim:The objective was to compare the use of autologous dermal and temporalis fascia grafts in the treatment of acquired penile curvatures.Materials and Methods:It was a prospective observational study of 33 cases, conducted in Sher-i-Kashmir Institute of Medical Sciences, Srinagar from March 2007 to September 2013. All the patients had stable Peyronies disease (PD). Dorsal, dorsolateral and vental curvatures with good preoperative erections were included. PD index with visual analog scales for curvature was used preoperatively. An informed written consent was taken from all the patients with main emphasis on erectile dysfunction.Results:After an average follow up of 2 years, complete straightening of penis was observed in all patients with satisfactory sexual intercourse in 30 patients (90%). Three patients (10%) required frequent use of type 5 phosphodiesterase inhibitors for adequate erections. Overall 91% of patients and partners were satisfied with the procedure and cosmetically donor site was better in temporalis fascia graft site. No rejection of any graft was noted and glans hypoesthesia was noticed in 4 patients (12%). None of the patients required penile prosthesis. Total operative time for harvesting and application of the graft was more in dermal grafts (>3 hrs) than for temporalis fascia graft (2 hrs).Conclusion:Tunical lengthening procedures by autologous free grafts represents a safe and reproducible technique. A good preoperative erectile function is required for tunical lengthening procedure. Temporalis fascia graft is thin, tough membrane and effective graft for PD with good cosmetic and functional results.

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Background: Omental flap has the distinction of being the foremost flap to be applied in the field of reconstructive microsurgery. Despite the keen initial interest, the drawback of a harvest laparotomy led to gradual loss of favour in this flap. It was the path breaking application of minimal access surgery for flap harvest, which led to a renewed interest in omental flap in its new incarnation. In this case series of laparoscopically harvested microvascular omental transfers, we explore the flap's unique immunologic and tissue regenerative properties and resulting outcomes in challenging reconstructive situations and limb salvage. Patients and Methods:A retrospective analysis of microvascular reconstructions with laparoscopically harvested omental flaps in ten challenging situations. The study evaluated the indications, procedural details such as operative technique and time, length of flap vascular pedicle achieved, complications and outcome.Results: Provision of vascularized and stable soft tissue cover with swift resolution of infection in chronic wounds was achieved in all cases leading to reduced long term morbidity with negligible complications. Conclusion:Microvascular omental flap provides large pliable tissue with characteristic vascular anatomy and unique set of immune and stem cells that has immense application in situations of complex three-dimensional reconstruction and limb salvage. Together with the laparoscopic-assisted harvest to avoid the morbidity of laparotomy, it presents an effective solution for those challenging situations that demand more than the routine options.