PEDICLED PERFORATOR FLAPS IN NASAL RECONSTRUCTION: A REVIEW

The use of perforator flaps in face reconstruction is becoming increasingly common. They are particularly useful in nose reconstruction, where they can be tailored to match the complex three-dimensional structure of the nasal concave and convex subunits. In this paper, we present a review of the literature on the use of pedicled perforator flaps in nose reconstruction, discussing current indications and outcomes. Literature on this topic is still limited, with only 12 studies reporting data on 129 reconstructions. Reconstruction of nasal defects with pedicled perforator flaps is a novel and expanding field. It allows for the achievement of good aesthetic results, with a single operation and…

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…

Use of the Diabetes Risk Score for Opportunistic Screening of Undiagnosed Diabetes and Impaired Glucose Tolerance

OBJECTIVE—To evaluate an opportunistic screening strategy addressed to individuals with one or more cardiovascular risk factor, based on the Diabetes Risk Score (DRS) as the initial instrument, for the identification of individuals with type 2 diabetes or impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS—The DRS, a simple self-administered questionnaire, was completed by individuals identified by general practitioners and presenting with one or more cardiovascular risk factor. All patients underwent a 2-h oral glucose tolerance test (OGTT). The optimal DRS cutoff was calculated by applying the receiver-operating characteristic curve. RESULTS—Overall, 1,377 individuals aged betwe…

Reply: Time to Reconsider a Gold Standard of Lymph Flow Imaging: Importance of Reliability to Detect Abnormal Lymphodynamics in Lymphedema Screening after Cancer Treatments

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Spectroscopic and X-ray structural characterization of complexes of lead(II)

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Male breast cancer: Reconstructive surgery

The conventional treatment for male breast cancer consists of modified radical mastectomy with axillary sentinel node biopsy and/or axillary lymph node dissection in case of lymph node-positive disease. However, breast-conserving surgery (BCS) is gaining popularity also among men. In both cases, surgery leaves an aesthetic disfigurement that impacts patient well-being and quality of life. Thus, even if male breast has a different social and emotional role than female’s one, male breast reconstruction deserves the same importance. The aim of this chapter is to give a comprehensive review on latest indications and strategies for the post-oncological reconstructive surgery of the male breast.

Freestyle-Like V-Y Flaps of the Eyebrow: A New Outlook and Indication of an Historical Technique

The eyebrow region is of utmost importance for facial movement, symmetry, and the overall cosmetic appearance of the face. Trauma or tumor resection often leave scars that may dislocate the eyebrow producing an alteration both in static symmetry of the face and in the dynamic expressivity. The authors present a technique for eyebrow’s defects repair using the remaining eyebrow advancement by means of a “freestyle-like” V-Y flap. In the past two years a total of eight consecutive patients underwent excision of skin lesions in the superciliary region and immediate reconstruction with this technique. On histology, six patients were affected from basal cell carcinomas, one from squamous cell ca…

ALGORITHM OF PARTIAL BREAST RECONSTRUCTION WITH PEDICLED PERFORATOR FLAPS

INTRODUCTION: The authors present an algorithm of partial breast reconstruction following quadrantectomy that allows to restore the breast volume defect with the use of pedicled perforator flaps. MATERIAL AND METHODS: Between March 2009 and May 2010, at the Plastic and Reconstructive Institute of University of Palermo, pedicled perforator flaps were used to integrate volume and/or breast skin in 12 patients after benign and malignant breast tumors. The flaps used were based on perforators of the thoraco-dorsal artery (TDAP) and of the intercostal arteries (ICAP). TDAP flaps were used to reconstruct defects in any breast quadrant, while ICAP perforator were used to reconstruct lateral and ce…

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…

An algorithm to improve outcomes of radial forearm flap donor site

Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site compli- cation rates. Methods: The authors analyzed retrospectively 31 patients who underwent free radial fore- arm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was…

Cooperatives' performance relative to investor-owned firms: a non-distorted approach for the wine sector

PurposeThis study aims to investigate whether significant performance differences between cooperatives and investor-owned firms (IOFs) may exist.Design/methodology/approachBased on data from a sample of Italian wine firms for the period from 2009 to 2018, an adjusted measure of performance called earnings before interests, taxes, depreciations and amortizations gross the raw materials cost was adopted to consider the different objectives of cooperatives relative to those of IOFs.FindingsEmpirical evidence shows that in the context under analysis, cooperatives have performed better than IOFs.Originality/valueDespite the theoretical literature suggesting that the cooperative form of organizat…

Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls

Background Current research on the upper limb lymphatic system mainly studies breast cancer patients with unilateral lymphedema. Without preoperative lymphoscintigraphy, the contralateral limb is used as a control, assuming that it is functionally intact. Few lymphoscintigraphic studies investigate patients before any axillary surgery. The purpose of this study was to evaluate, through lymphoscintigraphy, the preoperative condition of the upper limb lymphatic system in melanoma patients and healthy controls. Methods Two groups were studied: the study group (16 patients with trunk/upper limb melanoma candidates for axillary sentinel lymph node biopsy) and the control group (10 healthy volunt…

The summit part of Mount Etna revealed by High Resolution DC Electrical Resistivity Tomography coupled with complementary geophysical and soil gas techniques

Between 25 June and 13 July 2015 a very deep ERT profile (Pole-Dipole configuration, 40m spacingbetween electrodes and a remote electrode located at ~10km from the acquisition points) has been performedin the framework of the “MED-SUV” Project. Self-potential, soil gas concentrations (CO2, 222Rn, 220Rn, He,H2 and CH4) and soil temperature measurements were coupled to the ERT profile with a spacing of 20m(except for Rn: 40m). The NE-SW profile crossed Etnas summit craters in the middle of the 5720m ERTtotal length. Six roll along protocols of . of the dispositive (600m out of 2520m tot) have been carried outand, for the first time, a high resolution DC ERT profile reached the noticeable inve…

The role of the vastus lateralis flap in head and neck reconstruction

The Vastus lateralis flap is a very versatile flap, easy to harvest and with a long pedicle. It can be harvested as a muscle, musculo-cutaneous or chimeric flap. It is particularly suit-able for head and neck reconstruction, as it allows for a two-team approach and can be tailored to the complex three-dimensional structure of this district. In this paper, we discuss our experience and a review of the literature on the use of the free Vastus lateralis flap in the head and neck region, analyzing its indications, advan-tages and limitations. We also provide technical tips to minimize donor site morbidity.

The determinants affecting the internationalisation of the Italian SMEs producing sparkling wines: An empirical study on the RBV of the firms

In the last few years, wine industry has been characterised by profound changes that have determined an intensification of competition on a global scale. The aim of this study is to identify the firms’ internal factors that most influence the export intensity and the ability to fit into the international market of the Italian wineries producing sparkling wines through a resource-based view (RBV) approach. Results of our study supporting the findings of previous empirical researches presented in this paper. In particular, the main factors affecting export intensity are: innovation degree and intensity of investment in advertising and promotion, among firms’ characteristics, and abroad experi…

Hydrothermal fluid flow structures at Solfatara volcano, Somma-Vesuvius volcanic complex and Mt. Etna

Solfatara (Campi Flegrei):We present the first detailed 3-D Resistivity model of the Solfatara-Pisciarelli area, obtained from numerousERT surveys during the “MED-SUV” Project. This inversion was performed by taking into account 44 000ERT data points, as well as surface e-m resistivity measurements and the magneto-tellurics model from A.Siniscalchi et al. respectively as surface and bottom boundary conditions. The 3-D resistivity structure wellmatches with the CO2 flux, temperature and self-potential variations at the crater surface. This model clearlyhighlights the main geological units of the area (Monte Olibano, Solfatara crypto-dome, layers of eruptivedeposits), and the structures of hy…

The impact of corporate characteristics on the financial decisions of companies: Evidence on funding decisions by Italian SMEs

Small and medium enterprises (SMEs) represent a large percentage of the corporate tissue of developed countries, but they do not have adequate attention. In fact, various researchers have focused their studies on larger and well-known companies. This paper aims to investigate the impact of corporate characteristic on the financial choices of SMEs, with a specific focus on agro-food micro companies. Access to finance is vital in business start-up, development and growth for SMEs, all with very different needs and facing different challenges in terms of finance compared to large companies. The lack of equity invested in small enterprises makes them more dependent on other external sources (e.…

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Solitary Fibrous Tumor of the Lower Leg: A Rare and Difficult Diagnosis

Summary: Solitary fibrous tumor (SFT) is a rare neoplasm that commonly originates in the pleura. Extrapleural locations are rare and for this reason sometimes difficult to diagnose. Malignant forms with local recurrence or distant metastases have been reported, also as a consequence of inappropriate treatment. In this article, we report the case of an SFT of the lower leg in a 37-year-old man. Leg SFT is a rare occurrence, and differential diagnosis may be difficult because they can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin, and Bcl-2 is necessary. Misdiagnosis carries a significant risk of inadequate removal with subse…

Advancement Perforator Cheek Flap for Aesthetic One-Stage Reconstruction of Postoncological Extended Split-Thickness Defects of the Nasal Sidewall

Aesthetic reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. The unique character of this subunit and the complex relationships with a number of different facial or nasal subunits make the excision of large tumors difficult to manage. Numerous techniques are described in the literature, but a primary reconstruction with a final good result is not often possible. The authors develop an advancement cheek flap for an aesthetic one-stage reconstruction of postoncological extended nasal sidewall defects. Between January 2009 and July 2012, 16 patients (mean age, 63.3 yr) underwent excision of skin tumors of nasal sidewall and immediate rec…

Chest fistula repair

Chest wall plays a fundamental role in the human body, as it represents a protective cage around vital organs such as heart and lungs. Chest wall fistula is a rare and insidious condition that could lead to severe functional and aesthetical consequences, and thus represents a serious surgical challenge. Goals of reconstructive surgery are to preserve the respiratory function, to provide visceral protection, and to assure the best possible cosmetic outcome. In this chapter, we present an overview of all key principles in chest wall fistula management and repair.

Lower urinary tract symptoms in male-to-female transsexuals: Short terms results and proposal of a new questionnaire

Presented at the 64th Annual Meeting of the SICPRE, September 17–19, 2015, Milan, Italy. SICPRE: La SICPRE, Societa Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, national meeting, in Milano, Italy on September 17–19, 2015. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was supported by a grant of family Dioguardi, in memory of Professor Domenico Dioguardi, MD.

ADVANCEMENT CHEEK FLAP FOR A SINGLE STAGE RECONSTRUCTION OF POST-ONCOLOGICAL NASAL SIDEWALL LARGE DEFECTS 

Objective: Reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. Numerous techniques are described in the literature but a primary reconstruction with a final good result is not often possible. The authors present an advancement cheek flap for a single-stage reconstruction of post-oncological nasal sidewall large defects. Methods: Between January 2009 and July 2012, sixteen patients with age ranged between 54 and 74 years underwent excision of skin tumors of the nasal sidewall and immediate reconstruction with an advancement cheek flap nourished by perforators from the facial branch of the superficial temporal artery. The defects size ra…

Male breast cancer: Modified radical mastectomy or breast conservation surgery? A case report and review of the literature

INTRODUCTION: Male breast cancer (MBC) is a rare disease that accounts for <1% of breast cancer cases. The most common treatment is modified radical mastectomy (MRM). Recently, breast conservative surgery (BCS) is getting popular for MBC treatment. We report a case and reviewed the literature to investigate whether emerging BCS can be considered as an alternative of a more radical surgery. PRESENTATION OF CASE: A 46 y.o. patient, presented with a painless left breast lump over a period of six months. The patient underwent a quadrantectomy at another institution. Pathology revealed an intraductal carcinoma in close proximity to the margins of excision. Adjuvant hormonal therapy was proposed …