The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed Large sural flap from the proximal and middle third of the leg for Large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had Large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in 13 patients who had Large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in Large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and Large distally based sural flap is an alternative to free tissue transfer for Large defect reconstruction of the foot.

Objective- Decision making for closure of Large ventricular septal defect (VSD) with increased pulmonary vascular resistance (PVR) sometimes is difficult. In this prospective study, we report our experience in patients undergoing closure of Large VSD with a valve-patch.Methods- Between March 1998 and December 2004, acyanotic patients with Large VSD and pulmonary artery hypertension were selected for surgery. In all the patients, Cortex patch material was used, and a longitudinal slit (5-8 mm) was made in the middle part of it. A pericardial piece was sewn around the slit on one side of the Cortex patch except in the upper part. Usually via the right atrial approach, the VSD was closed with trimmed Cortex patch with the pericardial valve-patch located on the left ventricular side, allowing it to open for probable right to left shunt.Results- Sixteen patients with a mean age of 7±5.7 years and PVR of 9.6±3.8 Wood units underwent operation. All the patients were weaned off cardiopulmonary bypass successfully and sedated for at least 18-24 hours. Echocardiography on the same day of operation revealed right to left shunt in 6 cases. Two patients died in the early postoperative period. One child died due to frequent episodes of pulmonary hypertensive crisis and the other with persistent severe pulmonary hypertension and systemic low oxygen saturation. In three years' follow-up, PVR gradually regressed except in one case, in which PVR increased with right-to-left shunt and cyanosis.Conclusion- Valve patch technique in severe pulmonary artery hypertensive cases is a promising technique to decrease morbidity and mortality; however, in sustained or elevated PVR it may have deleterious effects in the early and late postoperative periods.

Purpose: Vasectomy is one of the most common urological operations performed, and provides permanent contraception. Many vasectomized men ultimately seek vasectomy reversal because of unforeseen changes in lifestyle. Vasovasostomy has varying rates of success. In this study, we utilize vas deferens (VD), artery, and vein grafts to reconstruct 30% and 50% defects of the total vas deferens length. Materials and Methods: Forty two male Wistar rats were divided into three groups as VD graft, carotid artery and external jugular vein transplantations. Each group was equally divided into 2 different subgroups according to the length of transplant material as 1. 0 cm (n = 7) and 1. 5 cm (n = 7). To evaluate whether these materials may be used for long segment vas deferens reconstruction, the patency rate, partial or total graft occlusion, and histologic examination of all specimens were examined. Results: No patency was found in any of the grafts and many of them suffered destructive changes in anatomic structure. Sperm granulomas were determined around the testicular side anastomosis due to accumulated semen fluid which was in our belief, a result of aperistaltic zone caused by the grafts Conclusion: When the poor results obtained in our study are put into perspective, vasoepididymostomy is the only treatment method to date for reconstruction of Large segment vas deferens defects.

Background. Large mandibular defects are considered difficult reconstructive challenges for oral and maxillofacial surgeons. Cell therapy, as an alternative technique, might increase the speed of bone regeneration. This study aimed to investigate bone regeneration in Large defects of dog mandibles using allogenic adipose-derived stem cells on gelatin foam as a cell carrier. Methods. The tissue engineering phase consisted of the sampling of adult dogs’ adipose tissue that can easily be isolated from adipose stem cells (ASCs) of the dogs, ASCs were cultured in Dulbecco’ s Modified Eagle’ s Medium (DMEM, Gibco, USA) with low glucose, containing 10% fetal bovine serum (FBS) (Sigma, USA) and 1% penicillin-streptomycin (Gibco, USA), with the characterization of dog ASCs and gelatin-transplanted ASCs. Six dogs were included in this experimental study in the next step and randomly assigned to the treatment and control groups. The samples in both groups underwent surgery under general anesthesia to create uniform 3-cm bony defects. The samples in both groups were reconstructed with titanium reconstruction plates and screws. A Large bone gap filled with ASCs (5×106) was seeded on gelatin (ASCs) in the treatment group. In the control group, bony defects were filled with a cell delivery carrier without ASCs. Six months after transplantation, the animals’ mandibles were evaluated by CT scan imaging, and the results were quantified through the Hounsfield unit (HU). The data were analyzed with t-test. Results. Before transplantation, the nature of the stem cells was confirmed by the expression of CD44 and CD105 cell markers at 71. 9% and 89. 3%, respectively, and a lack of the CD45 cell marker expression at 2. 2%. Evaluation of CT scan images showed significantly higher bone repair in the ASCs group (920. 25 ± 572. 92 HU) than in the control group (-94. 746 ± 08. 42). Conclusion. The bone regeneration of the ASCs group was significantly higher than that in the control group.