Autonomization is a physiological process allowing a flap to develop neo-vascularization from the reconstructed wound bed. This phenomenon has been used since the early application of flap surgeries but still remains poorly understood. Reconstructive strategies have greatly evolved since, and fasciocutaneous flaps have progressively replaced muscle-based reconstructions, ensuring better functional outcomes with great reliability. However, plastic surgeons still encounter challenges in complex cases where conventional flap reconstruction reaches its limitations. Furthermore, emerging bioengineering applications, such as decellularized scaffolds allowing a complex extracellular matrix to be repopulated with autologous cells, also face the complexity of revascularization. The objective of this article is to gather evidence of autonomization phenomena. A systematic review of flap autonomization is then performed to document the minimum delay allowing this process. Finally, past and potential applications in bio- and tissue-engineering approaches are discussed, highlighting the potential for in vivo revascularization of acellular scaffolds.

Abdominoperineal amputation (AAP) is a gold standard procedure treating advanced abdominal and pelvic cancers. The defect resulting from this extensive surgery must be reconstructed to avoid complications, such as infection, dehiscence, delayed healing, or even death. Several approaches can be chosen depending on the patient. Muscle-based reconstructions are a reliable solution but are responsible for additional morbidity for these fragile patients. We present and discuss our experience in AAP reconstruction using gluteal-artery-based propeller perforator flaps (G-PPF) in a case series. Between January 2017 and March 2021, 20 patients received G-PPF reconstruction in two centers. Either superior gluteal artery (SGAP)- or inferior artery (IGAP)-based perforator flaps were performed depending on the best configuration. Preoperative, intraoperative, and postoperative data were collected. A total of 23 G-PPF were performed—12 SGAP and 11 IGAP flaps. Final defect coverage was achieved in 100% of cases. Eleven patients experienced at least one complication (55%), amongst whom six patients (30%) had delayed healing, and three patients (15%) had at least one flap complication. One patient underwent a new surgery at 4 months for a perineal abscess under the flap, and three patients died from disease recurrence. Gluteal-artery-based propeller perforator flaps are an effective and modern surgical procedure for AAP reconstruction. Their mechanic properties, in addition to their low morbidity, make them an optimal technique for this purpose; however, technical skills are needed, and closer surveillance with patient compliance is critical to ensure success. G-PPF should be widely used in specialized centers and considered a modern alternative to muscle-based reconstructions.

Background: Lymphedema is a chronic condition for which accurate imaging evaluation of the lymphatic system can contribute to diagnosis, disease assessment, and treatment planning. Non-contrast magnetic resonance lymphangiography (NCMRL) is an imaging technique that enables morphological visualization of lymphatic abnormalities without contrast agent administration. This technical report aims to describe the NCMRL protocol routinely implemented at our institution, with particular emphasis on lower-extremity imaging. Methods: The institutional NCMRL workflow performed on a 3 Tesla (3T) magnetic resonance imaging (MRI) system is described, including patient positioning, three-station anatomical coverage, pulse sequence selection, acquisition parameters, geometric alignment, and image post-processing using segmental and panoramic maximum intensity projection (MIP) reconstructions. Results: The report documents the acquisition and post-processing workflow and illustrates its imaging output through representative clinical images. No systematic assessment of diagnostic accuracy, quantitative image quality, or examination success rates was performed. Conclusions: This technical report provides a structured description of an existing institutional NCMRL workflow for lower-extremity imaging. The documented approach may serve as a reference for future protocol optimization and standardization, while its reproducibility and broader clinical applicability require further evaluation.