Search Our Scientific Publications & Authors

Surgery 2021 Jun 16. Epub 2021 Jun 16.

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. Electronic address:

Background: Perineal wound complications after extralevator abdominoperineal resection for cancer are common with no consensus on optimal reconstructive technique. We compared short- and long-term results of laparoscopic abdominoperineal resection with open surgery ± vertical rectus abdominis myocutaneous flap.

Methods: This is a single-institution retrospective observational study of 204 consecutive patients with advanced low rectal cancer who underwent extralevator abdominoperineal resection from January 2010 to August 2020. Read More

BMC Pediatr 2021 06 16;21(1):283. Epub 2021 Jun 16.

Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden.

Background: Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics.

Methods: Ethical approval was obtained. Read More

Am J Obstet Gynecol MFM 2021 Jun 12:100421. Epub 2021 Jun 12.

Department of Obstetrics, Gynecology, and Neonatology, Sydney Medical School Nepean, University of Sydney, Kingswood, New South Wales, Australia.

This review presents the available data on the diagnosis of obstetric anal sphincter injury (OASI) by postnatal ultrasound imaging. There is increasing evidence that anal sphincter tears are often missed after childbirth and, even when diagnosed, often sub- optimally repaired, with a high rate of residual defects after reconstruction. Even after postpartum diagnosis and primary repair, 25-50% of patients will have persistent anal incontinence (AI). Read More

Plast Reconstr Surg Glob Open 2021 Jun 10;9(6):e3621. Epub 2021 Jun 10.

Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

The lotus petal flap can be applied for reconstruction of extensive defects in the vulvoperineal area. Studies on aesthetic outcomes are lacking. This study aimed to fill this gap. Read More

Urol Int 2021 Jun 11:1-5. Epub 2021 Jun 11.

Laboratório de Investigação Médica-Urologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

Introduction: Transposition of the gracilis has been used in a large number of reconstructive procedures. Its advantage is its proximity to these defects and a good blood supply. Traditionally, the gracilis mobilization is performed by open surgery with one or more incisions. Read More

Int J Surg Case Rep 2021 Jun 10;84:106086. Epub 2021 Jun 10.

Urogynecology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Electronic address:

Introduction: Modified Passerini-Glazel feminizing genitoplasty is typically performed in children with atypical genitalia. In our article, we have performed the procedure in adults with genital anomalies.

Case Presentation: The first case was a 22 years old woman who was planning to get married. Read More

Ann Plast Surg 2021 Jun;86(6S Suppl 5):S571-S574

From the MorsaniCollege of Medicine.

Background: The vertical rectus abdominis myocutaneous (VRAM) flap has been frequently used for perineal reconstruction given the high potential for wound complications associated with direct closure of this area. However, the relationship between defect size and postoperative complications remains undefined.

Methods: A retrospective chart review of the last 20 years for VRAM flaps was performed. Read More

ANZ J Surg 2021 Jun 1. Epub 2021 Jun 1.

Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia.

Background: This study aimed to assess the risk factors, management, imaging validity, Laboratory Risk Indicator for Necrotising infection (LRINEC) score and outcomes of necrotising soft tissue infection (NSTI) at a western Sydney tertiary hospital.

Methods: A retrospective study was conducted of all patients with NSTI from 2012 to 2019 at our institution. Patient characteristics, imaging, microbiology and site, LRINEC score, surgical management and outcomes/disposition were collected. Read More

JBJS Essent Surg Tech 2020 Oct-Dec;10(4). Epub 2020 Dec 24.

Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.

Background: Endoscopic repair of a proximal hamstring avulsion promotes precise anatomical repair and lowers the risk of neurovascular injury.

Description: Indications for proximal endoscopic repair of the proximal part of the hamstrings include acute tears of 2 tendons with >2 cm of retraction in young active patients, acute complete tears of 3 tendons with >2 cm of retraction, or failed conservative treatment of tears of ≥2 tendons with ≤2 cm of retraction. Repair of a proximal hamstring avulsion is performed using 2 portals. Read More

J Pediatr Surg 2021 Apr 30. Epub 2021 Apr 30.

Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Primary Children's Hospital, 100N. Mario Cappecchi Dr., Suite 3800, Salt Lake City, UT 84113, United States.

Background/purpose: the timing of endorectal pull-through for Hirschsprung disease (HD) is controversial. Neonatal primary endorectal pull-through theoretically prevents preoperative enterocolitis. Delayed primary endorectal pull-through offers the surgeon the benefit of more robust perineal anatomy and allows primary caregivers the time to emotionally process the diagnosis and to gain experience with rectal irrigations. Read More

J Surg Case Rep 2021 May 18;2021(5):rjab111. Epub 2021 May 18.

Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima 730-8518, Japan.

Anal canal neuroendocrine carcinoma (NEC) with pagetoid spread (PS) is a rare disease, and its treatment strategy remains unclear. The prognosis of anal canal NEC with PS is poor. Resection margin status is very important for anorectal carcinoma because it affects survival. Read More

BMC Surg 2021 May 18;21(1):245. Epub 2021 May 18.

Département d'oncologie Chirurgicale, Institut Curie, PSL Research University, 35, Rue Dailly, 92210, Saint-Cloud, France.

Background: Acquired perineal hernia is a rare complication following extensive pelvic surgery. Radiotherapy is also a predisposing factor. Perineal hernia can cause chronic perineal pain, bowel obstruction, urinary disorders and a cosmetically disfiguring defect. Read More

Plast Reconstr Surg 2021 Jun;147(6):1420-1435

From the Departments of Surgery and Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center; the Department of Plastic Surgery, Leiden University Medical Center; and the Department of Gastrointestinal Surgery, Ghent University Hospital.

Background: The treatment of locally advanced or recurrent anorectal cancer requires radical surgery such as extralevator abdominoperineal resection and pelvic exenteration. Larger defects require flap reconstruction. The authors evaluated outcomes of different perineal reconstruction techniques. Read More

J Perioper Pract 2021 May 6:1750458920959565. Epub 2021 May 6.

Queen Victoria Hospital, East Grinstead, UK.

There is extensive discussion regarding method of perineal defect closure extralevator abdominoperineal excision, but little consideration of optimal postoperative management of the flaps, or use of Enhanced Recovery After Surgery in flap reconstruction. Literature review revealed little discussion of optimum postoperative care of perineal flaps following extralevator abdominoperineal excision. We have developed a protocol for postoperative care of perineal flaps for use in conjunction with colorectal Enhanced Recovery After Surgery pathways, easily followed in units not specialising in plastic surgery. Read More

J Plast Reconstr Aesthet Surg 2021 Mar 30. Epub 2021 Mar 30.

Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, UK; Department of Anatomy, Norwich Medical School, University of East Anglia, Norwich, UK.

The result of an extra-levator abdominoperineal excision of the rectum (ELAPE) is a composite three-dimensional defect. This is performed for locally advanced anorectal cancer, and may involve partial excision of the vagina. The aim of reconstruction is to achieve wound healing, restore the pelvic floor and to allow micturition and sexual function. Read More

Int Urogynecol J 2021 Apr 29. Epub 2021 Apr 29.

Colorectal Surgery Department at Clínica Santa Elena, Madrid, Spain.

Introduction And Hypothesis: Deficient perineum is a disruption of the perineal body and distal rectovaginal septum presenting with anal incontinence and a range of urogenital symptoms. There is scarce reported outcome of this condition with management often delayed and with a variety of surgical alternatives. This study aims to determine faecal continence outcomes after long-term surgical repair. Read More

Chirurg 2021 Apr 27. Epub 2021 Apr 27.

Plastisch- und Handchirurgische Klinik und Labor für Tissue Engineering und Regenerative Medizin, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Krankenhausstraße 12, 91054, Erlangen, Deutschland.

In addition to the progressive development of surgical oncological techniques for malignant tumors of the rectum, anal canal and vulva, reconstructive procedures after oncological interventions in the perianal region represent a cornerstone in the postoperative quality of life of patients. Modern treatment modalities for rectal cancer with neoadjuvant chemoradiotherapy increase the survival rate and simultaneously reduce the risk of local recurrence to 5-10%, especially by cylindrical extralevatory extirpation of the rectum. The price for increased surgical radicality and improved oncological safety is the acceptance of larger tissue defects. Read More

Urol Case Rep 2021 Sep 29;38:101667. Epub 2021 Mar 29.

Moi University, Department of Surgery and Anesthesiology, Kenya.

Klingsor Syndrome is an infrequent Surgical and Psychiatric emergency. We present such a case of self-penile amputation with delayed presentation precluding re-plantation. A 48 year-old man on follow-up for Schizophrenia presented 16 hours after peripubic self-penile amputation. Read More

Int Urogynecol J 2021 Apr 24. Epub 2021 Apr 24.

Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA.

Introduction And Hypothesis: We aimed to develop and validate a new MRI-based perineal membrane reconstruction and morphological measurement technique, and test its feasibility on nulliparous and parous women to determine the effects of pregnancy and childbirth on the perineal membrane.

Methods: The perineal membrane was traced on high-resolution MRI using 3D Slicer® and analyses performed using Rhinoceros 6.0 SR23®. Read More

Plast Reconstr Surg 2021 May;147(5):801e-811e

From the Division of Plastic Surgery, Oregon Health and Science University; the Department of Plastic Surgery, University of Ghent; The Buncke Clinic; and G.U. Recon.

Summary: The creation of a sensate, aesthetic, and functional phallus for transmasculine individuals has high reported complication rates. Neourethra reconstruction is the most challenging aspect of this surgery, with widely varying techniques and staging between providers. In an operation of this complexity, surgeons should not be expected to offer all the options, but rather the specific variation that works in their given setting. Read More

J Burn Care Res 2021 Apr 23. Epub 2021 Apr 23.

Adult Burns Unit and Skin Engineering Laboratory, Royal Adelaide Hospital, South Australia, Australia.

This case report details our experience using two-stage Biodegradable Temporizing Matrix (NovoSorb® PolyNovo Ltd) and autograft for acute reconstruction of a complex perineal burn wound in an elderly co-morbid patient. A 77-year old man sustained 42% full thickness burns extending circumferentially from bilateral thighs and buttocks, across the entire perineal and genital regions up to his mid-trunk, following self-immolation using an accelerant. Early total burn wound excision was carried out with acute application of Biodegradable Temporizing Matrix to all affected sites. Read More

Am Surg 2021 Apr 22:31348211011146. Epub 2021 Apr 22.

Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.

Background: Gracilis flap reconstruction (GFR) following abdominoperineal resection (APR) or proctocolectomy (PC) can reduce pelvic wound complications but has not been adequately assessed in the setting of immunosuppression, fistulous disease, and neoadjuvant chemoradiation.

Methods: Patients undergoing APR/PC with GFR were retrospectively analyzed with regard to perioperative characteristics, and morbidity was assessed.

Results: Patients underwent GFR for rectal cancer ( = 28), anal cancer ( = 3), inflammatory bowel disease ( = 13), or benign fistulizing disease ( = 1). Read More

Cureus 2021 Mar 19;13(3):e13992. Epub 2021 Mar 19.

Plastic and Reconstructive Surgery, Surgery Department, King Abdulaziz Medical City, National Guard's Health Affairs, Riyadh, SAU.

An ectopic scrotum (ES) represents a rare developmental anomaly of the male genitalia. The condition usually represents a part of a wide spectrum pathology associated with other anomalies. The different locations in which an ectopic scrotum is found include inguinal, suprainguinal, infrainguinal, and/or perineum. Read More

Front Neurol 2021 18;12:635894. Epub 2021 Mar 18.

Department of Pediatrics Orthopedics and Traumatology, University of Medical Sciences, Poznan, Poland.

Pain appearance is one the most common complication of spastic hip disease in children with cerebral palsy (CP). It determines child and caregiver quality of life and life priorities. Reconstruction hip surgery should be considered as a treatment of choice. Read More

Int J Surg Case Rep 2021 May 1;82:105848. Epub 2021 Apr 1.

Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Electronic address:

Introduction: The initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture's location and length as well as the accompanying trauma.

Case Presentation: A 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. Read More

BMJ Case Rep 2021 Apr 15;14(4). Epub 2021 Apr 15.

Plastic Surgery, Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, USA.

The patient is a 45-year-old man diagnosed with Fournier's gangrene and underwent treatment for septic shock, broad-spectrum antibiotic therapy and extensive surgical debridement of perineum, including total scrotectomy, ischiorectal fossa, abdomen and left superior thigh and flank. The patient required multiple staged complex reconstruction of the scrotum utilising prelaminated superior medial thigh flaps with use of dermal matrix, split-thickness skin grafting and pedicled gracilis muscle flap for coverage of the ischiorectal wound. The patient had full recovery and followed up 1 year postoperatively. Read More

J Am Vet Med Assoc 2021 May;258(9):1007-1010

Case Description: A 12-year-old Friesian stallion was examined because of a 1-year history of preputial injury and urination through a urethrocutaneous fistula located at the midbody of the ventral aspect of the penis.

Clinical Findings: Physical examination revealed an opening with a clearly apparent mucocutaneous junction 12 cm from the distal opening of the urethra on the ventral left side of the penis. Endoscopic examination of the distal portion of the urethra confirmed a blind pouch with no communication with the fistula or proximal portion of the urethra. Read More

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Background:  Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. Read More

Transl Androl Urol 2021 Mar;10(3):1040-1047

Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.

Background: To present our experience of transposing the penis to the perineum, with penile-prostatic anastomotic urethroplasty, for the treatment of complex bulbo-membranous urethral strictures.

Methods: Between January 2002 and December 2018, 20 patients with long segment urethral strictures (mean 8.6 cm, range 7. Read More

J Pediatr Urol 2021 Mar 26. Epub 2021 Mar 26.

Division of Pediatric Urology, Hasbro Children's Hospital, Warren Alpert School of Medicine at Brown University, 593 Eddy St, Providence, 02905, Rhode Island, USA. Electronic address:

Introduction: From 2000 to 2019, the De Castro's neo-phalloplasty was used in 47 patients with congenital and acquired penile loss.

Purpose: Herein, the technical aspects of penile reconstruction and the outcomes in 17 children and adolescents treated for total or sub-total acquired penile loss are reported.

Material And Methods: The median age at the time of injury was 3 months (range: 2 days-15 years). Read More