Pediatric lower extremity lawnmower injuries are high-energy traumas that often result in severe composite tissue loss and require advanced reconstruction. Compared with other mechanisms of pediatric lower extremity trauma, these injuries have a higher incidence of amputation and complex reconstruction. This case series describes 3 pediatric patients, aged 2.5-10 years, who sustained severe lower extremity lawnmower injuries that were managed with free tissue transfer (FTT). Reconstructions included a tensor fasciae latae perforator flap, a latissimus dorsi myocutaneous flap, and an anterolateral thigh perforator flap. These cases demonstrate the practical importance of early escalation to FTT, judicious reconstructive timing, appropriate flap selection between fasciocutaneous and musculocutaneous options, recognition of the indications and limitations of preoperative vascular imaging, and consideration of the unique perioperative challenges associated with FTT.

Autologous breast reconstruction depends on intact wound healing. Chronic granulomatous disease (CGD) results from nicotinamide adenine dinucleotide phosphate oxidase dysfunction and predisposes patients to opportunistic infections; acquired forms can transiently mimic the congenital disorder. We report a case of transient phagocytic dysfunction that complicated delayed transverse rectus abdominis myocutaneous flap reconstruction. A 43-year-old woman with Stage IIB breast cancer underwent delayed reconstruction 18 months after cytotoxic chemotherapy. A delay procedure (inferior epigastric vessel ligation) was performed 14 days before flap elevation to reduce ischemic risk. When atypical wound failure developed postoperatively, deep tissue biopsies grew opportunistic pathogens (Pseudomonas putida, Staphylococcus epidermidis, and Candida tropicalis) and immune workup was initiated. Neutrophil oxidative function was assessed by dihydrorhodamine (DHR) 123 flow cytometry. Initial DHR testing showed absent oxidative burst (oxidation index <1.0; reference >5.0), indicating severe phagocytic dysfunction. Targeted antimicrobials (levofloxacin, fluconazole) and negative pressure wound therapy were started. Repeat DHR at 6 weeks was fully normal (oxidation index 58.80), excluding genetic CGD. The patient healed completely by secondary intention without further surgery. Phagocytic dysfunction can emerge as a late sequela of cytotoxic therapy and complicate autologous reconstruction, mimicking genetic CGD. When flap failure is unexplained and opportunistic organisms are recovered despite intact perfusion, DHR testing should be part of the workup. Serial assays distinguish transient acquired dysfunction from a permanent genetic defect and determine how aggressively to intervene.

Reconstruction of extensive chest wall skin defects following mastectomy remains challenging, and a variety of reconstructive options have been reported. Although skin grafts, local flaps, and pedicled musculocutaneous flaps are widely used, these approaches may result in suboptimal cosmetic or functional outcomes, carry a relatively high risk of partial flap necrosis, and require sacrifice of muscle tissue. Additionally, achieving stable wound closure without delaying the initiation of postoperative radiotherapy or chemotherapy is particularly important in such cases. Here, we report five patients who underwent immediate reconstruction with a free superficial circumflex iliac artery perforator flap for extensive postmastectomy skin defects. Complete flap survival and timely wound healing were achieved in all cases. Postoperative radiotherapy and chemotherapy were initiated as scheduled in every patient. During the follow-up period, no cases of local recurrence or significant functional impairment were observed. Free superficial circumflex iliac artery perforator flap reconstruction provides reliable coverage for extensive postmastectomy skin defects with minimal donor-site morbidity, enabling early wound healing while preserving the option of future autologous breast reconstruction. The approach represents a valuable addition to reconstructive strategies for breast cancer patients.

Asian facial anatomy is often characterized by flatter midfaces, wider zygomatic arches, and reduced projection, leading to diminished contour definition. Aesthetic goals therefore emphasize smooth transitions and balanced facial proportions. The V-line concept represents a structured approach integrating point-, line-, and plane-based augmentation to enhance facial support and contour. This preliminary case report describes a 39-year-old woman who underwent facial rejuvenation using a polycaprolactone (PCL)-based filler with a 3-stage V-line layered injection technique. The protocol targeted the jawline, midface, and T-zone in a single treatment session using a layer-specific approach. Improvements were observed immediately and maintained at 1-, 3-, and 6-month follow-ups. Lower facial contour and jawline definition improved, midface support was restored with smoother transitions, and upper facial projection was enhanced. No complications were observed. This preliminary report suggests that the 3-stage V-line technique using PCL filler may provide effective and natural facial rejuvenation tailored to Asian facial morphology. Further studies with larger sample sizes, objective outcome measures, and longer follow-up are warranted.

This case report presents a novel technique for reconstructing posttraumatic asymmetrical labia majora using a deep external pudendal artery tubular flap. A 20-year-old woman experienced deviation of the urinary stream during micturition as a result of vulvar sequelae following a motorcycle accident. To address atrophy of the unilateral labia majora, we designed a de-epithelialized deep external pudendal artery tubular flap measuring 3 cm in width and 10 cm in length. The flap was delayed for 2 weeks before transposition, during which the lateral borders were incised down to the crural fascia, and the flap bed was partially undermined. During the second stage of the procedure, we de-epithelialized the external epidermal layer, sutured the flap edges in a tubular configuration, and positioned it within the atrophic labia majora pocket. The distal end of the flap was sutured inside the internal labial space for fixation, and the donor site was closed primarily. At the 6-month follow-up, the patient demonstrated satisfactory symmetrization of the labia majora and correction of the deviated urinary stream during urination. The technique achieved both functional improvement and aesthetic restoration of vulvar symmetry and proved to be promising for managing similar posttraumatic deformities in the genital region.

Galactorrhea after reduction mammoplasty is a rare postoperative complication, usually associated with hormonal dysregulation or pituitary abnormalities. A 43-year-old woman with symptomatic macromastia underwent bilateral superomedial pedicle reduction mammoplasty. Three days postoperatively, she developed high-volume bilateral milky drainage through her surgical drains. Laboratory evaluation revealed elevated prolactin (96 ng/mL; reference value 5-23 ng/mL). Imaging demonstrated a partially empty sella without pituitary mass. Endocrinology initiated cabergoline therapy, resulting in suppression of prolactin and resolution of the galactorrhea. The patient's drains were maintained until the galactorrhea ceased, and she went on to heal well without complication. Galactorrhea after breast reduction surgery secondary to transient hyperprolactinemia is a rare but clinically significant complication. Prompt recognition and multidisciplinary management including drain maintenance, lactation suppression, and exclusion of prolactinoma are important steps in preventing wound healing complications and achieving optimal outcomes.