The purpose of this article is to evaluate the potential role of a protective colostomy after reconstructive plastic surgery in individuals with spinal cord injury and neurological bowel, where pressure injuries are a serious complication. This began as a case‐control observational study. From 2019, the therapeutic protocol was modified, and colostomy was proposed to all individual. 45 people with spinal cord injuries and grade 3 or 4 of pressure injuries were recruited. The experimental group underwent colostomy, while the control group received direct lesion reconstruction. Fisher's exact test and Student's t‐test were utilized for group comparison. Primary outcomes included the number of healed ulcers and post‐operative infections. The number of lesions healed within 30 days and the rate of flap infections showed significant differences between the two groups. A crucial statistical difference was found (p < 0.05). The complication rate was 44.44% in the control group and 17.65% in the experimental group (p‐value < 0.05). Quality of life also showed encouraging results. Protective colostomy may prevent local complications after surgery, reducing long‐term hospitalization and healthcare costs. It also may improve individuals’ quality of life.

Background: Autologous breast reconstruction after chest-wall radiotherapy (RT) remains challenging because radiation-induced vascular injury may impair flap perfusion and wound healing. Bipedicled deep inferior epigastric perforator (DIEP) flaps anastomosed to two separate recipient systems may provide greater vascular redundancy in this setting. Methods: This retrospective single-center case series, reported according to the PROCESS 2025 guideline, included 26 consecutive women who underwent unilateral bipedicled DIEP flap breast reconstruction in the setting of chest-wall RT between September 2024 and March 2026, with a minimum follow-up of 6 months. Outcomes were total flap loss, flap-related complications, donor-site morbidity, and BREAST-Q scores. Results: One pedicle was anastomosed to the internal mammary vessels and the other to an axillary branch, most often the circumflex scapular artery (18/26; 69.2%). Mean operative time was 7 h 9 min ± 47 min. No total flap loss occurred. One arterial complication (3.8%) involved the internal mammary pedicle, and the flap survived. Abdominal bulge occurred in 5 patients (19.2%). Mean BREAST-Q scores were ≥90 in all domains. Conclusions: In this case series, bipedicled DIEP flap reconstruction was associated with no total flap loss after chest-wall RT, without an apparent increase in early donor-site morbidity. The biological condition of the recipient bed may deserve consideration when selecting flap configuration; larger prospective studies are required to confirm these findings.