Background: Finger tip injuries are one of the most common types of injury. Destruction of the skin in this area leads to destruction of sensory receptors. As hand function is closely related to sensibility of the finger tips, selecting the best procedure of reconstruction that provides the highest degree of sensation is very important. As V-Y FLAP and Neurovascular Island FLAP are more common used, the aim of this study is comparison of these two methods for restoration of finger tip sensation.Methods: This is a clinical trial study of 70 patients with traumatic finger tip injury who were randomly divided into two groups. Finger tip injuries reconstructed by V-Y FLAP were placed in group A and neurovascular Island FLAP in group B. Sensation of the reconstructed finger tip was checked in all patients by two point discrimination test 1 year after operation.Results: Each group was included 35 patients. Incidence of necrosis, flexion contracture and discomfort of the patients was similar in the two groups. Sensibility of the fingers was 54.8% in group A, and 93.5% in group B, which is statistically significant. (P=0.0005).Conclusion: Restoration of sensibility to the finger tip is significantly more successful by neurovascular Island FLAP in comparison to V-Y FLAP method for finger tip reconstruction.

Introduction: BLADDER Exstrophy (BE) is a congenital anomaly in which the BLADDER and abdominal wall and external genitalia are pathologically open. Incidence of this anomaly is one in 50000. Treatment of this anomaly is complicated and, the old method of treatment was pelvic osteotomy. The aim of this study was offering a new surgical approach, which is closure of the BLADDER in BLADDER exstrophy-epispadiasis complex using rectus muscle FLAP without pelvic osteotomy.Methods: From Nov 2008 to Nov 2011 15 cases of BE containing 10 boys (70%) and 5 girls (30%) were under 3 steps of surgical operation. Patients were followed up in this period and outcomes and complications of this new surgical approach were recorded.Results: Mean volume of BLADDER after first operation was 58.2±3.71 milliliter (ml). There were 4 cases of wound infection (26.6%), 3 wound dehiscence (20%) and 2 BLADDER dehiscence (13.3%). After the second step of surgery there were 3 cases of wound infections (20%), 4 cases of uretero-vesical fistulas (26.6%). After third step of surgery there were 2 cases of wound infections (13.3%) and 4 cases of BLADDER dehiscence's (26.6%). The shape and size of external genitalia in 60% of boys and in 80% of girls were acceptable. The mean time of the urinary continency was 25 min.Conclusion: Outcomes of the new surgical technique, based on our study, were acceptable and complications with little and controllable complications. So we recommend the new surgical technique for BLADDER exstrophy repair.

Purpose: To report visual and anatomical outcome of FLAP loss after LASIK surgery for correction of high myopia. Materials & Methods: Retrospective evaluation of FLAP loss in two eyes of two patients, a rare complication of LASIK Surgery. Case No. 1: 27 y/o woman with Ref. OD -9.75; 2.75*177 VA. CC: 20/60 KR OD: 41.86*77 39.86 * 168 & partial amblyopia due to anisometropia. Case No. 2: 38 y/o woman with Ref OD. -9.50 1.0*177 VA CC: 20/30 KR OD: 42.06*77 40.99 * 167. Results: In both patients during LASIK surgery free cap complication occurred and after Laser therapy free cap positioned over the stromal bed, but the next day after operation FLAPs were lost. For case NO.1only medical management performed and after 4.5 years F/U cornea has 2° central haziness. For case NO.2 another corneal FLAP from donor globe cut and sutured with Nylon 10/0 and after 18 months F/U cornea is clear. Conclusion: In patients with flat keratometry less than 41.0 Diopter rate of free cap are high and after laser therapy for high myopia the keratometry became more flat. If surgeon doesn't suture FLAP the rate of FLAP loss increase so for prevent of corneal haziness and corneal ectazia this evaluation suppose to perform donor corneal FLAP graft.      

To consider the different ideas on performing one-FLAP versus two-FLAP DCR surgery, this study carried out in L.M.C Hospital during the year 1989 to 1994.This study was done according to the existing data available in patient's medical history file in two groups: First: one-FLAP group. Second: Two-FLAP. group, then the statistical results were compared by using chi square test.153 patients including 130 patients with one-FLAP DCR and 23 patients with two-FLAP method were assessed. There was no prominent difference between the success rate of two groups which was 82.3% versus 82.6% respectively.Regarding to no difference between the success rate of two methods we recommend a practical study in matched groups to verify our findings.

BACKGROUND AND OBJECTIVE: The most common cause of ureterovaginal fistula is pelvic surgery. Approximately 10% of urinary fistulas may involve ureters. It was not found ureterovaginal fistula associated with pelvic fused kidneys in English literature. Fistula repair technique is significant in this case because of kidney position. CASE: An 18-year-old female with continuous urinary incontinence five days following cesarean section referred after one month. IVU showed fused pelvic kidney with left hydroureteronephrosis. Cystoscopy and dye test, under anesthesia did not show vesicovaginal fistula. Double-J catheter did not pass into the left ureter. With regard to these findings, ureterovaginal fistula was diagnosed. For repair, mid line lower abdominal incision was made. Repair procedures such as direct ureteroneocystostomy and psoas hitch was difficult because the ureteral length was short and psosas muscle was behind the pelvic fused kidneys but BLADDER FLAP was the convenient procedure that we could do in this patient. The patient was dry and IVU became normal fallowing repair. CONCLUSION: Repair techniques for ureterovaginal fistulas depend on the ureteral length proximal to the fistula such as direct ureteronecystostomy, psoas muscle hitch and BLADDER FLAP. BLADDER FLAP is the convenient procedure in pelvic fused kidneys because of short ureter and kidneys position.

Background & Objectives: Hypospadiasis is a common congenital genitourinary malformation which has various surgical procedures for its reconstruction. Tabularized incised plate (TIP) is the most common technique and this study compares the use of buccal mucosal graft combined to double dartos FLAP with tunica vaginalis FLAP as second layers in TIP procedure.Material & Methods: In a prospective study 43 patients with hypospadiasis underwent TIP. Patients were randomly assigned into two groups. In the first group, 21 patients undergo buccal mucosal graft combined to double dartos FLAP and in the a second group, tunica vaginalis FLAP were used as second layer in 22 patients. Patients were followed and development of complications such as wound infections, meatal stenosis, and urethrocutaneous fistula formation were recorded. Failure was defined as need for repeated surgery.Results: The overall success rate was 87.5% (100% in first group and 60% in the second). 12 patients had complications (3 in the first group and 9 in the other group) which half of them needed surgical operation. In 5 patients of tunica vaginalis FLAP group developed urethrocutaneus fistula; nevertheless, no fistula was recorded in buccal mucosal graft combined to double dartos FLAP (P=0.048). Other complications were not significantly different in the 2 groups. The surgical success rate of patients undergoing buccal mucosal graft combined to double dartos FLAP was significantly higher than tunica vaginalis FLAP (P=0.021).Conclusion: Buccal mucosal graft combined to double dartos FLAP as a second layer is a good technique with reasonable results in hypospadiasis surgery.

Nose is the most common site of facial skin cancer because of its continuous sun exposure. 1 Soft tissue tumors such as basal cell carcinoma (BCC) are the most common tumors of this region. The choice of treatment for BCC is surgical demolitions. Since these tumors grow more aggressively and are so likely to recur from the involved surgical margins, the surgery requires often wide resection of the midfacial region’s structures to obliterate adequate margin. 2 Thus reconstruction surgery of defected regions plays an important role in the integrity of complex facial expressions, facial functions and the aesthetic outcome. In the present study, we described an eccentric case of a recurrence of a BCC managed by a para median forehead FLAP in an unusual condition.

Introduction &,Objective: Soft tissue coverspecially in lower extremity and leg is a challenag for all reconstructive surgeons. Many methods and FLAPs have been introduced and used in this area. In this study we discussed about some unusual FLAPs that we used in our cases in 15 khordad hospital. Materials &,Methods: In this study according to ourresults in our cases, the leg divides into three subarea. We used Distal &,lateral thigh FLAP in proximal third, free gracilis FLAP for the middle third and Medial plantar FLAP andmedial pedis FLAP for lower third defect. Results: Our results suggest that these less common FLAPs have comparable results VS common FLAPs, and can be used as first step for leg reconstruction. Conclusions: In some cases, this study showed that the desired flops have received less attention,their results are comparable to the more common flops in terms of performance and appearance. This study emphasizes that the common methods should not necessarily be recognized as the best method and the best decision should be made for each disease based on the existing conditions.