Tecnica Co.Di per la produzione di cartilagine solida umana

Abstract English Tissue or organ transplantation is severely limited by the problems of donor shortage and immune rejection from the patients. The cartilage defects are difficult to reconstruct. In head and neck surgery, as in septal reconstruction, auricular reconstruction for injury or malformation, in laryngotracheal reconstruction, surgeons harvest autologous cartilage from a donor site (of the patient) in order to reconstruct the defect. Today's current therapies to reconstruct cartilage defects involve the use of autologous cartilage grafts or biocompatible implants, but these seem inadequate to restore form and function, have many limits and are related with many complications. Due t…

One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation

Letter to Editor

ANTITHROMBOTIC PROPHYLAXIS IN MICROSURGERY

Background. The most common complication of microsurgical reconstruction is graft failure secondary to thrombosis. It is clear that thromboprophylaxis is helpful for a successful microsurgery. However, it's also obvious that thrombosis can't be avoided in cases of poor microsurgical technique. There is no consensus regarding the use of anticoagulation therapy during and after microsurgery. The authors compared two different antithrombotic prophylaxis protocols used in the past ten years, and analyzed the effectiveness and risks of different pharmacological protocols. Materials and methods. The authors performed a retrospective review of microsurgical patients operated between 2005-2014 by t…

TRATTAMENTI LASER IN CHIRURGIA PLASTICA

Poliphasic protocol for keloid scar

Magnetic Resonance Imaging and Ultrasound Evaluation after Breast Autologous Fat Grafting Combined with Platelet-Rich Plasma

Trattamento delle fistole oro-nasali recalcitranti con lembi endo-orali

VENOUS THROMBOSIS IN FREE FLAPS: A STUDY OF THE PHENOMENOLOGY, HISTORY AND CLINICAL SIGNS IN AN EXPERIMENTAL MODEL OF RATS.

Non-Hodgkin B-cell lymphoma involving the palate.

Vascularized dermal flap for abdominal wall reconstruction after bariatric surgery

A rare case of malignant transformation of endometrioma

Lembi ALT nella ricostruzione del distretto testa-collo

Surgical repair of acute Achilles tendon rupture with an end-to-end tendon suture and tendon flap.

Abstract Background Achilles tendon ruptures are becoming more common. Complications after open or minimally invasive surgery are: recurrent rupture (2–8%), wound breakdown, deep infections, granuloma, and fistulas. The authors expose their experience with a personal technique. Materials In 8 patients with acute rupture of Achilles tendon the surgery was performed at least 25 days after trauma. Clinical exam and MR demonstrated in all case a total lesion of tendon. After a posterolateral skin incision the tendon stumps were debrided and suture in end-to-end fashion. A tendon flap was harvested from the proximal part of the tendon, in order to protect and reinforce the suture itself. A plast…

Impiego della tossina botulinica nella preparazione agli interventi di microchirurgia ricostruttiva del cavo orale

anatomia vascolare e mucosasomi del cavo orale.

Nonostante il concetto di perforante o propeller mucosale non sia stato ben standardizzato e definito, gli studi anatomici dei territori vascolari del cavo orale, hanno dimostrato come la anatomia vascolare della mucosa orale sia costante ed affidabile. 8 i territori vascolari identificati utili per l'allestimento di lembi locali.

Reconstruction of full thickness scalp defects after tumour excision in elderly patients: our experience with Integra dermal regeneration template.

Summary Background Scalp reconstruction after wide tumor excision is particularly challenging. Free tissue transfers, local flaps, or skin grafts can be used but present some disadvantages especially with old patients with local advanced cancers, systemic diseases and in patients with a prior history of recurring scalp skin cancers in which the risk of burying a recurring tumor with a flap is likely. The Authors expose their early experience with Integra ® dermal regeneration template for scalp reconstruction after scalp tumor excision. Methods Eight patients with primary or secondary scalp tumor underwent a first surgical procedure under local anaesthesia for tumor removal and Integra ® po…

Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy

Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy. Cordova A, Corradino B, Pirrello R, Di Lorenzo S, Dispenza C, Moschella F. Source Dipratimento di Discipline Chirurgiche ed Oncologiche, Divisione di Chirurgia Plastica e Ricostruttiva, Facolta di Medicina, Universita di Palermo, Palermo, Italy. chirplas@unipa.it Abstract CONCLUSION: Our experience confirms that pectoralis major flap is the first-choice technique for repairing recurrent hypopharyngeal fistulae in previously irradiated patients in whom microsurgical techniques are not indicated, and that hyperbaric oxygen therapy helps to solv…

Propeller flap for treatment of a poststernotomy sternal fistula: A case report.

Summary The treatment of post-operative deep sternal wound infections is a real challenge for surgeons. Conservative treatment with debridement and vacuum-assisted closure (VAC) therapy is not always successful. In the most severe and chronic cases, a surgical debridement and reconstruction of the defect is mandatory. In this report, the authors present a case of a 61-year-old female patient with a chronic cutaneous fistula in the sternal region following a median sternotomy after coronary artery bypass. The patient had already undergone treatment with antibiotics, drainage of an abscess and local debridement, but the infection continued to relapse periodically. The authors decided to treat…

U-stitches in microvascular anastomosis in an animal model.

Dupuytren,s contractrure: an update of biomolecular aspects and therapeutic perspectives

Melanoma nei BRCA mutation carriers

Melanoma Extirpation with Immediate Reconstruction

Letter to Editor

Absence of germline CDKN2A mutation in Sicilian Patients with Familial Malignant Melanoma: could it be a population-specific genetic signature?

Germline CDKN2A mutations have been described in 25% to 40% of melanoma families from several countries. Sicilian population is genetically different from the people of Europe and Northern Italy because of its historical background, therefore familial melanoma could be due to genes different from high-penetrance CDKN2A gene. Four hundred patients with cutaneous melanoma were observed in a 6-years period at the Plastic Surgery Unit of the University of Palermo. Forty-eight patients have met the criteria of the Italian Society of Human Genetics (SIGU) for the diagnosis of familial melanoma and were screened for CDKN2A and CDK4 mutations. Mutation testing revealed that none of the families car…

The "COMMA-flap": a new technique for inner canthus reconstruction.

Transdermal Nitroglycerine Patch: An Optional Device to Reduce Flap Venous Congestion? A Case Report

ABSTRACT Sometimes in free flap there is a venous congestion without an obstruction of the venous anastomosis or other organic causes of reduction venous drainage (haematoma, seroma compressing the pedicle). In these cases the authors suggest the application of nitroglycerine patch in the congested area of the flap few hours before the surgical exploration of the anastomosis. If there is a fast improvement of the clinical feature of the flap, the surgical exploration could be avoided. The authors underline that applying the nitroglycerin patch should not be regarded in any way as a therapy of a free flap venous thrombosis but only as an useful device, an option to be taken only when the sur…

Botulinum Toxin A for Oral Cavity Cancer Patients: In Microsurgical Patients BTX Injections in Major Salivary Glands Temporarily Reduce Salivary Production and the Risk of Local Complications Related to Saliva Stagnation

Abstract: In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid b…

A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap

Patient: Female, 82 Final Diagnosis: Giant basal cell carcinoma Symptoms: Anemia Medication: — Clinical Procedure: — Specialty: Plastic Surgery Objective: Rare disease Background: Basal cell carcinoma (BCC) greater than 5 cm in diameter is called giant basal cell carcinoma (GBCC), or super giant basal cell carcinoma if it has a diameter larger than 20 cm. Giant BCC only accounts for 0.5% of BCCs and super giant BCC is exceedingly rare. On account of their rarity, there are no established guidelines for GBCC treatment. Case Report: We describe a peculiar case of an 82-year-old woman with a GBCC carcinoma of the lower abdominal wall. The tumor was surgically removed with ipsilateral inguinal …

"Downward steps technique" with CO2 ultrapulsed laser for the treatment of rhinophyma: our protocol.

Abstract BACKGROUND: The rhinophyma is an important soft-tissue hypertrophy of the nose. In literature a wide range of surgical approaches to rhinophyma has been described such as dermoabrasion, scalpel shave, cryosurgery, electrocautery, near total excision with skin grafting, and laser excision. PATIENTS AND METHODS: The authors describe their experience with CO(2) ultrapulsed laser in 14 elderly male patients, using their personal approach, the Downward steps technique. With this technique they removed the pathological hypertrophic tissue using a progressive reduction of the laser power during the treatment. They obtained good results from morphological and aesthetic point of view, in a …

Treatment of stages IIIIV of the Dupuytrens Disease using a personal approach: percutaneous needle fasciotomy (PNF) and minimal invasive selective aponeurectomy.

Abstract The authors present their experience in treating 23 fingers on 20 patients affected by Dupuytrens Disease in stages III and IV of the Tubiana classification with their personal technique that involves the percutaneous needle fasciotomy followed 40 days after by a selective open aponeurectomy on the previously treated cord, by making a small cutaneous incision. The treatment requires careful selection of the patients. In fact, patients suffering from the disease for more than 5 years and all the cases with a suspicion of joint rigidity are excluded from the study. The average follow up period was approximately 48 months. 18 out of the 20 patients had excellent functional recovery. S…

Botulinum toxin in preparation of oral cavity for microsurgical reconstruction.

CONCLUSIONS: Infiltration of botulinum toxin in the major salivary glands allows a temporary reduction of salivation that begins 8 days afterwards and returns to normal within 2 months. The inhibition of salivary secretion, carried out before the oral cavity reconstructive surgery, could allow a reduction of the incidence of oro-cutaneous fistulas and local complications. OBJECTIVES: Saliva stagnation is a risk factor for patients who have to undergo reconstructive microsurgery of the oral cavity, because of fistula formation and local complications in the oral cavity. The authors suggest infiltration of botulinum toxin in the major salivary glands to reduce salivation temporarily during th…

Laser treatment of giant xanthelasma palpebrarum

Xanthelasma palpebrarum is the most common cutaneous xanthoma. It typically presents in middle-aged and older adults, most often around the eyelids. The diagnosis is made clinically. Giant xanthelasmas palpebrarum are xanthelasmas that extensively affect the superior and inferior bilateral eyelids. Many techniques have been put forward for treating these lesions (surgical, laser, and chemical techniques), but we describe our experience in the treatment of giant xanthelasmas by ultrapulsed CO2 laser. Between 2009 and 2012, in the Division of Plastic and Reconstructive Surgery at the University of Palermo, 12 patients with giant xanthelasmas were treated using a CO2 laser. The laser parameter…

Surgical Treatment of Extravasation Injuries

The authors present their experience of treating anti-cancer drug extravasation by means of a composite surgical technique that consists of infiltration with physiological solution and hyaluronidase and subsequent manual aspiration of solutes alternated with profuse irrigation of the infiltrated area. In the immediate post-op we carry out a medical therapy that consists of calciparine and topic antibiotic and/or steroid creams. Since the year 2000 this technique has been used on 25 patients. We have had neither complications nor scars. Copyright 2005 Wiley-Liss, Inc Surgical treatment of extravasation injuries. Napoli P, Corradino B, Badalamenti G, Tripoli M, Vieni S, Furfaro MF, Cordova A,…

Comparing the Outcomes of Different Agents to Treat Vasospasm at Microsurgical Anastomosis during the Papaverine Shortage.

Letter to Editor

Dupuytren's contracture: an update of biomolecular aspects and therapeutic perspectives.

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren’s contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren’s disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.

A rare case of malignant trasformation of endometrioma

Histology of the Oral Mucosa in Patients With BRONJ at III Stage: A Microscopic Study Proves the Unsuitability of Local Mucosal Flaps.

Background: Bisphosphonate Osteonecrosis of the Jaw (BRONJ) is a newly recognized condition reported in patients treated with aminobisphosphonates (BF). BRONJ is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates who has not had radiotherapy to the jaw. Treatment protocols have been outlined, but trials and outcomes of treatment and long-term follow-up data are not yet available. In 2004 an expert panel outlined recommendations for the management of bisphosphonate-associated osteonecrosis of the jaws. Through the histological study of the oral mucosa over the bone necrosis and around the osteonecrosis …

A Difficult Case of Necrotizing Fasciitis Caused By Acinetobacter baumannii

This study reports the case of a 55-year-old woman with diabetes with a necrotizing fasciitis of the right lower limb and the perineum, first admitted at the emergency department for septic shock with cardiac arrest, and later transferred to the department of surgery. Microbiological and histopathological examination confirmed the diagnosis of necrotizing fasciitis caused by Acinetobacter baumanii. A broad-spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture. Intensive hemodynamic support was required. Wounds were dressed daily with a 3 percent boric acid solution and a silver sulfadiazine-impregnated dressing. An extensive s…

Poland’s Syndrome

Poland’s syndrome is a sporadic, congenital thoracic deformity, mostly unilateral, with a wide spectrum of presentation. The thoracic malformations are distinguished on the basis of the anatomical site in which an embryological development alteration has occurred after the fourth week of gestation (Table 3.1) [1]. Poland’s syndrome is a rare congenital and complex anomaly of the development of thoracic muscles, characterized by hypoplasia of the breast and nipple, scarcity of subcutaneous tissue, absence of the costosternal portion of the pectoralis major muscle, lack of the pectoralis minor muscle, aplasia or deformity of the costal cartilages or ribs II to IV or III to V, alopecia of the …

Blood Congestion Can Be Rescued by Hemodilution in a Random-Pattern Skin Flap

Can sentinel node biopsy be safely omitted in thin melanoma? Risk factor analysis of 1272 multicenter prospective cases

Background: The indication to sentinel node biopsy (SNB) for thin melanomas (Breslow <1 mm) is still subject to controversies. The aim of this paper is to review all SNB performed for thin melanoma and to analyze factors related to lymphatic metastasis. Moreover, the diagnostic performance of the 5th, 6th, 7th and 8th AJCC classifications for cutaneous melanoma were investigated. Methods: All sentinel node biopsies performed for thin melanomas were selected from a multicentre prospectively-collected database. For each patient the following was collected: age, sex, date of treatment, site of primary melanoma, histopathologic features (Breslow, Clark, number of mitoses/mm2 , presence of ul…