Here we represent a report of 31 patients treated for increasing the distance between two points on skin surface by using two triangular and one square flaps. Theoretically, best skin lengthening is made by using one triangular with right - angled position. Squared - flap procedure as compared with other procedures for increasing the distance between two points of skin surface including Z - plasty and all its other modified procedures and also in comparison with Limberg procedure is more effective.We performed square - flap procedures for 31 patients with post- burned contractive scars and clefts in ear lobules and nasal alar rim in Poorsina Teaching Hospital (Guilan - 1989) with excellent results. And we found that square flap procedure is an effective procedure and has many practical applications.

The coverage of soft– tissue defects of the hand specially volar side needs special consideration. Although certain local flaps have been described and used for resurfacing the palm, Extensive injury requires distant or free flaps for coverage. abdominal pedicle flap has been traditionally used for extensive hand injuries, however there is no doubt that one of the ideal tissues for resurfacing the volar of hand is plantar tissue. We reconstructed the hand with a new procedure of combined medial plantar and medial pedis free flap, and compared it with 15 cases, whom their extensive palm injuries reconstructed with abdominal pedicle flap. The result was significantly better in respect to sensation, Texture of the Hand and patient satisfaction in compare of Abdominal flap.

Objectives: To overcome the drawbacks of the conventional flap surgery, newer surgical techniques like minimally invasive surgery were evolved to optimize the primary closure of the flap. Using a surgical operating microscope is one such technique, enhancing precession with clinical benefits. The current study aimed to compare the efficacy of a surgical operating microscope versus surgical loupes regarding periodontal treatment outcomes. Materials and Methods: In this split-mouth randomized controlled clinical trial, flap surgery was planned for sites with a pocket probing depth (PPD)≥5mm under a surgical operating microscope and surgical loupes. All clinical periodontal parameters were recorded at baseline, and 3, and 6 months. The patients’ perception of postoperative pain and wound healing were also assessed. Results: The study comprised of 20 participants with mild to severe periodontitis. The reduction in the mean PPD was significantly greater at the test site than the control site at 3 months (P=0. 05) and 6 months (P=0. 005). At 3 months, there was a statistically significant difference in clinical attachment level (CAL) between the test and control sites (P=0. 001). Flap surgery performed under a surgical operating microscope significantly enhanced early wound healing and caused less postoperative pain compared to flap surgery performed under surgical loupes (P<0. 05). Conclusion: All parameters improved at the test and control sites after the procedure. Nonetheless, the clinical parameters were noticeably better at the test site. Also, the test site had lower postoperative pain and enhanced wound healing compared with the test site.

Background: Selection of a surgery method with best outcomes and least complications in hypospadias repair is of prime importance. Objective: To determine the advantages and disadvantages (complications) of Snodgrass procedure using vascularized Dartos method in the repair of hypospadias. Methods: Through an interventional study, 31 patients with mid shaft to distal hypospadias were operated using Snodgrass method supported with vascularized flap. All patients were operated once and by only one surgeon. Results of repairs were analyzed statistically. Findings: Out of 31 patients, 6 were under 3 years old, 19 between 3 to 7 years old and the rest were more than 7 years old. Results of hypospadias repair showed that there was no meatal stenosis & other complications except a fistula which was corrected surgically. Conclusion: Based on the data obtained from the present study, Snodgrass method using vascularized Dartos flap for repair of hypospadias is strongly recommended.

Background: Perianal fistula is a complicated disorder and most difficult to manage. New treatment methods would help surgeons to achieve a better outcome in patients with perianal fistula. Human amniotic membrane (HAM) has positive effects on wound healing in several conditions. The present study aimed to further determine the effect of HAM on wound healing of perianal fistula in rabbits. Methods: In a prospective experimental study, 14 male rabbits (aged 4-6 months and weighing 3-4 kg) were randomly divided into 2 groups. After 12 weeks, the high type perianal fistula was repaired with endorectal flap (ERF) and ERF plus HAM in the control and case groups, respectively. In all rabbits of the case group, a 1×1 cm width wrap of HAM was applied and fixed around the ERF site. Three weeks later, the repaired site of the perianal fistula was sent for pathologic wound healing scoring. The results were analyzed with the SPSS 21. 0 software using Mann-Whitney test. Results: Six rabbits of each group survived the study period. There was a statistically significant difference in wound healing between the case and control groups (P<0. 001). Wound healing process in the case group occurred better and faster than the control group. Conclusion: HAM has an effective role in enhancing the ERF procedure and considered appropriate. A combination of HAM with other methods is recommended.

Background: A reverse sural flap is an available surgical technique because it provides robust axial blood circulation to flaps with a substantially larger surface area. We aimed to assess Ilizarov frames outcome after reverse sural flaps among patients with traumatic injuries to the distal portion of the leg. Methods: Patients with traumatic distal injury of leg in Shoha-e Tajrish Hospital in 2022-2021 were recruited and treated with reverse sural flaps. Interventional group was followed by Ilizarov frames application (group A). For the second group, just conventional dressings and proper positioning were done after surgery (group B). Between the two groups, the duration of surgery, the degree of flap swelling, the time from surgery to discharge and flap failure, surgical site infection, deep vein thrombosis (DVT), and other complications were compared using SPSS 25 software. Results: Of 26 recruited patients, twenty consented to participate in this study. The average time from initial injury to reconstruction surgery, the mean duration of surgery, the mean time from surgery to discharge and the degree of swelling of the flap was compared between these two groups. The results showed better outcome in Ilizarov group, but the flap swelling grade was the only statistically significant factor between groups (P value= 0. 03). Conclusions: The use of “, offloading Ilizarov frames”,to protect reverse sural flaps resulted in a considerable reduction in the flap swelling. It is a safe, quick, easy, and effective technique.

Background: Abdominoperineal resection (APR) is the standard surgical treatment for low-lying anorectal malignancies. It seems that immediate flap reconstruction has fewer complications compared to primary closure. There are several options for local flap reconstruction of perineal wound closure, and each specific flap method has its own advantages and disadvantages. Case presentation: In this case report, a new method of reconstruction is presented which contains only the inferior part of the rectus abdominis muscle in 2 patients, one with unilateral and the other with bilateral involvement and they both underwent APR. Both patients were referred to the colorectal surgery clinic for APR by an oncologist. Both patients had severe constipation and both reported pain on defecation and rectorrhagia. Patient 1 received a unilateral inferior part of rectus abdominis muscle flap and patient 2 received a bilateral flap. Conclusion: Immediate flap reconstruction after APR has fewer complications than primary closure and the inferior part of rectus abdominis muscle flap seems to be a possible means of reconstruction after APR.

Boari flap construction and ureteroneocystostomy is an appropriate technique for repairing the injuries in the distal ureter that result in shortening of the ureter. We report the use of laparoscopic distal ureterectomy consisting resection of the bladder cuff and Boari flap construction in a patient with low-grade transitional cell carcinoma of the distal ureter.