The supra-auricular arterial network: anatomical bases for the use of superior pedicle retro-auricular skin flaps

Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap

Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap. Cordova A, D'Arpa S, Pirrello R, Brenner E, Jeschke J, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro, 129-90127, Palermo, Italy. adriana.cordova.unipa@gmail.com Abstract BACKGROUND: Vessels in the supraclavicular area and their contribution to skin vascularization have always been studied for flaps planning in head and neck reconstruction and many pedicled flaps have been des…

PRP E LATANOPROST:​ GRUPPI A CONTROLLO

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, r…

Additional file 1: Figure S1. of Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients

showing AD-MSCs from both healthy subjects and SSc patients with increased levels of CD271 expression. Representative dot plot showing the expression of CD271 corresponding isotype match control in freshly isolated SVF and long-term propagated AD-MSCs from healthy subjects (upper panels) and SSc patients (lower panels), performed by flow cytometry. (PDF 205Â kb)

Principi di ricostruzione della palpebra inferiore e tecniche principali

LIfting tradizionale versus lifting omotetico

Multimodal surgical and medical treatment for extensive rhinocerebral mucormycosis in an elderly diabetic patient: a case report and literature review

Diabetes is a well-known risk factor for invasive mucormycosis with rhinocerebral involvement. Acute necrosis of the maxilla is seldom seen and extensive facial bone involvement is rare in patients with rhino-orbital-cerebral mucormycosis. An aggressive surgical approach combined with antifungal therapy is usually necessary. In this report, we describe the successful, personalized medical and surgical management of extensive periorbital mucormycosis in an elderly diabetic, HIV-negative woman. Mono- or combination therapy with liposomal amphotericin B (L-AmB) and posaconazole (PSO) and withheld debridement is discussed. The role of aesthetic plastic surgery to preserve the patient’s physical…

Re: Correlation between tissue-harvesting method and donor-site with the yield of spheroids from adipose-derived stem cells

Hyaluronic acid and platelet-rich plasma, a new therapeutic alternative for scleroderma patients: a prospective open-label study

Abstract Background Systemic sclerosis is a systemic connective tissue disease characterized by endothelium damage, fibrosis, and subsequent atrophy of the skin. Perioral fibrosis produces a characteristic microstomia together with microcheilia, both of which cause severe difficulties and affects patients’ daily life, such as eating and oral hygiene. Since there are no effective and specific therapies, we have aimed at evaluating the response to filler injections of hyaluronic acid together with platelet-rich plasma. Methods Ten female patients aged between 18 and 70 were included in this study. Each patient was treated with three filler injections of hyaluronic acid and platelet-rich plasm…

Propeller Flaps: A Review of Indications, Technique, and Results

In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequate…

Intestinal malrotation in a female newborn affected by Osteopathia Striata with Cranial Sclerosis due to a de novo heterozygous nonsense mutation of the AMER1 gene

Abstract Background Osteopathia Striata with Cranial Sclerosis (OS-CS), also known as Horan-Beighton Syndrome, is a rare genetic disease; about 90 cases have been reported to date. It is associated with mutations (heterozygous for female subjects and hemizygous for males) of the AMER1 gene, located at Xq11.2, and shows an X-linked pattern of transmission. Typical clinical manifestations include macrocephaly, characteristic facial features (frontal bossing, epicanthal folds, hypertelorism, depressed nasal bridge, orofacial cleft, prominent jaw), hearing loss and developmental delay. Males usually present a more severe phenotype than females and rarely survive. Diagnostic suspicion is based o…

IL RINGIOVANIMENTO FACCIALE: ANALISI, PROBLEMI E SOLUZIONI

Correlation between tissue-harvesting method and donor-site with the yield of spheroids from adipose-derived stem cells

Fat Transplantion: Different Clinical Applications to Achieve Symmetry in Face and Body Contouring

Introduction: Fat autograft was first described in 1893 by Neuber for cosmetic and congenital defects. Nowadays its use is becoming widespread for soft tissue augmentation to improve simmetry and contour in all areas of the face and body. The authors present their experience with face and body contouring by fat autograft in post-oncological, post-traumatic and cosmetic settings. Materials and Methods: Between 2005 and 2008 31 patients underwent fat autografting in the plastic surgery unit of the university of palermo. There were 10 cases of breast asimmetry after reduction mammaplasty, breast augmentation and breast recostruction; 3 cases of post-traumatic and 1 congenital deformities in th…

Profilassi perioperatoria del sanguinamento in pazienti affetti da palatoschisi associata a deficit di fattore VII

A new reverse dorsal metacarpal flap for the thumb

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…

L'utilizzo di un lembo di derma vascolarizzato per la riparazione della parete addominale dopo chirurgia bariatrica

Reply: vascular anatomy of the supraclavicular area revisited

Reply to Letter to Editor

Additional file 2: Figure S2. of Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients

showing AD-MSCs from SSc patients with decreased levels of mesenchymal stem cell markers. Representative dot plot showing the expression of CD44, CD90, CD271, CD29, CD73, and CD9 in AD-MSCs from healthy subjects (upper panels) and SSc patients (lower panels). Small boxes show isotype match control staining. (PDF 316Â kb)

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 da…

Retroauricular skin: a flaps bank for ear reconstruction.

Retroauricular skin: a flaps bank for ear reconstruction. Cordova A, D'Arpa S, Pirrello R, Giambona C, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro 129, 90127 - Palermo, Italy. adriana.cordova@excite.com Abstract BACKGROUND: The retroauricular skin has always been given much attention by the reconstructive surgeon for ear and face reconstruction because it is richly vascularised, as many anatomical investigations show, it is hidden behind the ear, its skin is very similar to that of ear and face. All these reasons make it an ideal donor site for ear reconstruction.…

NECK DISSECTIONS: MISCONCEPTIONS, MALPRACTICE AND COMMON CONTROVERSIES

B a c k g ro u n d. Neck metastases are the single most important prognostic factor in Head and Neck Squamous Cell Carcinoma. Wise approach to neck treatment is then mandatory to give a chanche for cure. Still, there are some issues about neck dissection that need to be clarified. M e t h o d s. Through a review of the literature and of everyday clinical observations, the following issues are discussed: Functional Neck Dissection, biopsies, nodal levels, Selective Neck Dissections, Spinal Accessory Nerve, neck dissection classification. R e s u l t s. Integration of historical, anatomical, clinical and surgical concepts and up-to-date knowledge can allow to understand how to behave in diver…

Vascular Anatomy of the Supraclavicular Area Revisited: Feasibility of the Free Supraclavicular Perforator Flap

Vascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap. Cordova A, Pirrello R, D'Arpa S, Jeschke J, Brenner E, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. adriana.cordova.unipa@gmail.com Abstract BACKGROUND: The supraclavicular skin has been studied extensively and used as a pedicled flap for face and neck reconstruction. Its use as a free flap has not paralleled its use as a pedicled flap. The authors performed an anatomical investigation to assess the possibility of harvesting a free supraclavicular flap …

Free style facial artery perforator flap for one stage reconstruction of the nasal ala.

Summary The nasolabial skin is the ideal donor site for nasal ala reconstruction. The classic techniques involve a two-stage procedure to reconstruct an aesthetically pleasing nasal ala. A one-stage technique for reconstruction of the nasal ala with a free style nasolabial perforator flap is presented in this article. Patients and methods The technique has been used in eight patients between November 2004 and June 2007. In most of the cases (seven out of eight) the whole alar subunit was reconstructed. Results Besides a small distal 2mm necrosis in one flap – which healed without further treatment – all the flaps healed uneventfully with aesthetically pleasing results using the one-stage te…

One-stage reconstruction of the nasal ala: the free-style nasolabial perforator flap.

no abstract

Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients.

Background The use of stem cells, including mesenchymal stem cells (MSCs), for regenerative medicine is gaining interest for the clinical benefits so far obtained in patients. This study investigates the use of adipose autologous tissue in combination with platelet-rich plasma (PRP) to improve the clinical outcome of patients affected by systemic sclerosis (SSc). Methods Adipose-derived mesenchymal stem cells (AD-MSCs) and PRPs were purified from healthy donors and SSc patients. The multilineage differentiation potential of AD-MSCs and their genotypic–phenotypic features were investigated. A cytokine production profile was evaluated on AD-MSCs and PRPs from both healthy subjects and SSc pat…

Posterior compartment of the lower leg reconstruction with free functional rectus femoris transfer after sarcoma resection.

A 72-year-old man with the third recurrence of a low-grade liposarcoma of the right lower leg came to our attention seeking limb-salvage surgery. The tumour was removed en bloc with all the superficial posterior compartment of the leg. Appropriate foot flexion was restored by means of a free-functional rectus femoris musculocutaneous flap harvested from the ipsilateral thigh. The patient was kept on a postoperative splint for 6 weeks. Three months after the operation, clinical and elecromyographic signs of reinnervation were observed. The patient was able to walk, run and climb stairs and no donor-site morbidity was observed. Thigh extension was rated M4, comparable to the contralateral thi…

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 …

Anatomic basis for the dorsal radial flap of the thumb: clinical applications

The pattern of the dorsal arterial supply of the thumb was studied by the dissection of 25 thumbs of fresh cadavers. A constant vascular axis was found, originating at the radial a. and communicating at the level of the middle third of the proximal phalanx with the arterial palmar circuit. The constant presence of this vascular axis and its connection with the palmar circuit permits the mobilisation of a dorsal metacarpal skin flap, with a distal pedicle and a reversed flow, that can be used for covering dorsal and palmar losses of substance in the thumb.

Lipofilling and platelet rich plasma, Hyaluronic acid and platelet rich plasma: new perspectives for scleroderma patients

Perioperative antibiotic prophylaxis in plastic surgery: A prospective study of 1100 adult patients.

Summary Background Although guidelines for antibiotic prophylaxis to prevent surgical site infections (SSIs) exist, specific guidelines for plastic surgery are missing and there is a tendency towards excessive administration of antibiotics. A total of 1100 patients were prospectively studied according to an evidence-based protocol to investigate if limiting antibiotic prophylaxis to high-risk cases does increase the infection rate. Methods Between April 2009 and April 2010, 1100 consecutive patients undergoing elective reconstructive or cosmetic procedures were enrolled. Procedures were classified into four groups, and prophylactic antibiotics were only administered perioperatively in 23.4%…

Zachelase e infiammazione

Bleeding prophylaxis in a child with cleft palate and factor VII deficiency: a case report.

Bleeding prophylaxis in a child with cleft palate and factor VII deficiency: a case report. Pirrello R, Siragusa S, Giambona C, D'Arpa S, Cordova A, Moschella F. Source Dipartimento di Discipline Chirurgiche ed Oncologiche, Sezione di Chirurgia Plastica e Ricostruttiva, Università di Palermo, Palermo, Italy. Abstract The association between factor VII deficiency and cleft palate has never been described. The case of a child with cleft palate and factor VII deficiency who successfully underwent palatoplasty is described in this article. To allow surgical treatment, through maintenance of a normal prothrombin time, the patient was given 15 microg/kg of recombinant factor VIIa every 12 hours, …

Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries.

"Orthoplastics" is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches.Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospect…

The face lift SMAS plication flap for reconstruction of large temporofrontal defects: reconstructive surgery meets cosmetic surgery.

Background: Reconstruction of large defects in the temporal region can be performed with skin grafts or pedicled or free flaps. Results are often not optimal because of the patch of a skin graft, lack of availability of local flaps, and distant skin from free flaps. A technique for reconstruction of these defects with local tissue is presented in this article that uses superficial musculoaponeurotic system (SMAS) plication to allow wide advancement of a cervicofacial flap. Methods: Once the defect is outlined, a face-lift–like skin incision is used to raise the flap. The SMAS is plicated with two purse-string sutures that relieve tension on the flap and allow maximal advancement. Thirteen f…

STATIC TREATMENT OF PARALYTIC LAGOPHTALMOS WITH AUTOGENOUS TISSUES

Static treatment of paralytic lagophthalmos with autogenous tissues. Pirrello R, D'Arpa S, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Universitá di Palermo, Via del Vespro, 129, 90138 Palermo, Italy. Abstract BACKGROUND: Long-standing facial paralysis is frequently seen in patients who have undergone surgical procedures with sacrifice of the facial nerve and have never been counseled about limiting its consequences. Lagophthalmos must always be treated in these patients to protect vision. The authors describe their techniques of static treatment for lagophthalmos using autologous tissues and their classification…

Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series.

Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series. Cordova A, Pirrello R, D'Arpa S, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. adriana.cordova@excite.com Abstract BACKGROUND: On the basis of a previously published anatomic study on the superior auricular artery (SAA) and on a series of 52 consecutive cases, the authors propose a new superior pedicle retroauricular island flap (SP-RIF) for defects of the upper half of the ear and for temporal region or superficial helical defects. ME…

Applicazioni e vantaggi del PRP

Paralytic Lagophthalmos:grading sistem and surgical management

Vascular Grafts and Flow-through Flaps for Microsurgical Lower Extremity Reconstruction

Background The use of vascular grafts is indicated in case of insufficient pedicle length or for complex defects involving both soft tissues and vessels. Venous grafts (for both venous and arterial reconstructions) and arterial grafts (arterial reconstruction) can be used. This study retrospectively evaluated the needs for vascular reconstruction and its results in a clinical series of lower limb reconstructions with microsurgical free flaps. Materials and Methods From 2010 to 2015, a total of 16 vascular grafts or flow-through flaps were used in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction (8%). Arterial reconstruction was performed in seven cases (si…

Reconstruction of Nasal Alar Defects with Freestyle Facial Artery Perforator Flaps

In 2009, we have described the use of freestyle facial artery perforator flaps for one-stage nose reconstruction. Since then, several articles have reported the use of facial artery perforator flaps for nose reconstruction. The purpose of this article is to provide an update of the published technique after 10 years of experience. Since 2004, 21 patients have been treated with a freestyle facial artery perforator flap for one-stage reconstruction of the nasal ala. The flaps were 16 propellers, 4 V-Y, and 1 island transposition. A single venous congestion leading to a minor flap tip necrosis and a wound dehiscence was observed. All other flaps healed uneventfully. The V-Y design and multiple…

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