Inveterated Facial Palsy Correction with Endoscopically Assisted Multiple Muscle Transposition and Lifts: The EMTL Procedure.

Introduction The aim of the present analysis was to study the safety and efficacy associated with reanimation in facial nerve palsy by the endoscopically assisted multiple muscle transposition and lifts (EMTL). Patients and Methods The study sample included all patients who had undergone a facial reanimation by EMTL procedure from September 2015 to May 2019. The patients were analyzed retrospectively, with more than 1 year of follow-up, and were evaluated in terms of functional-aesthetic results and postoperative complications. The outcome was evaluated with the Sunnybrook scale. Results Fourteen patients were included in the present study. They were all inveterate palsies with minimum 4 years from the initial injury. The preoperative Sunnybrook score ranged from 0 to 5 and the postoperative ranged from 30 to 65. Spontaneous smile achievement was obtained in 10 patients and only mild restoration in one patient. The scar and static correction were satisfactory in all patients. Eye protection was improved in all cases with some form of active blinking in six cases. Conclusion This study showed that facial palsy correction with EMTL procedure offers a promising alternative treatment for patients with facial palsy not suitable for microsurgical muscle transposition.

"On demand" posterior tibial artery perforator flaps: a versatile surgical procedure for reconstruction of soft tissue defects of the leg after tumor excision.

Relatively small soft-tissue defects of the lower leg following tumor excision are usually treated, especially in older patients, by split-thickness skin grafting. On specific sites where periosteum or paratenon is exposed, as well as when a skin graft is best avoided for cosmetic reasons, an excellent alternative option is the use of posterior tibial artery perforator flaps.Such flaps are designed and elevated "on demand," ie, according to the defect location and on whichever perforator is best found suited to supply the flap and allow adequate transposition.However, operative time is longer, and the surgeon needs to be judicious in dissection, as well as versatile in choosing the best flap design after identifying a suitable perforator.Between 2003 and 2008, 24 patients underwent this procedure, with uniformly successful result except for 2 partial flap necrosis.The advantages of posterior tibial artery perforator flaps are a quick and usually safe procedure, which provides good contour with excellent color, texture, and thickness match, with long-term stability of the reconstruction at the expense of minimal donor-site morbidity.

Bone regeneration after pedicled periosteal dorsal metacarpal flap. Reconstructive technique.

The dorsal metacarpal artery (DMCA) flap is considered as one of the working horses to cover exposed extensor tendon or bone of dorsal digits. The periosteal composite DMCA reverse flap (pcDMCAr flap) is described as a fast and safe solution to manage this kind of trauma. A 35-year-old male had a trauma to his left hand from a circular saw. The resultant injury was localized to the proximal middle finger with a dorsal bone loss. A vascularized composite flap, including 3th metacarpal periosteum, was elected as the most appropriate option. Postoperative follow-up at 6 months confirmed bony regeneration. There are no documented cases to the best of our knowledge demonstrating the use of pcDMCAr flap to treat fractures with bone loss in the proximal digits. This report suggests that technique may be employed as regenerative bone flap in reconstructive surgery for proximal fingers trauma with bone loss and open fracture. KEY WORDS: Bone regeneration, Dorsal metacarpal flap, Periosteum.

Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection.

BACKGROUND: The risk of infection continues to be a subject of discussion within the field of implant-based breast reconstruction. Studies have shown the feasibility of immediate single-stage procedures with acellular dermal matrix (ADM), yet 2-stage tissue expander techniques continue to be the procedure most often performed. The purpose of this study was to evaluate postoperative infections and to identify associated predictors. METHODS: A retrospective study at Papa Giovanni XXIII Hospital was conducted between 2013 and 2017. Patients' demographic data were compared between single-stage and 2-stage procedures. Rate of infection and predictors were examined. Minor infections could be treated by oral antibiotics only, major infections required inpatient treatment. Healing was considered a successful treatment with antibiotics only, whereas any supplementary surgical intervention resulting in the preservation of an implant device was considered salvage. Breast reconstruction was defined a failure in case of implant loss or need for autologous reconstruction. RESULTS: Three hundred ninety-three patients underwent 336 monolateral and 57 bilateral implant-based breast reconstruction. Ninety-two patients had a submuscular direct-to-implant reconstruction with ADM with an infection rate of 11.4% compared with an infection rate of 7.8% among the 268 patients with a 2-stage tissue expander procedure. Beta-binomial regression showed obesity and preoperative radiotherapy as significant predictors for infection (OR, 4.65, P = 0.038, and OR, 7.13, P = 0.015, respectively). Average time of onset of infection among the submuscular direct-to-implant with ADM group was 67.1 days compared with 80.1 days among tissue-expander group with postoperative chemotherapy and preoperative radiotherapy having a significant effect on time of infection onset (P = 0.014, P = 0.034, respectively). CONCLUSIONS: Direct-to-implant breast reconstruction with ADM is a procedure with acceptable risks of infection in comparison to tissue expander procedures. A profound patient selection pre- and intraoperatively is the basis of successful breast reconstruction.

Aesthetic role of the surgically rebuilt inframammary fold for implant-based breast reconstruction after mastectomy.

The inframammary fold (IMF) represents one of the most important anatomic landmarks in defining a woman's breast ptosis and inferior quadrant shape. Therefore it is important to preserve it, if this is oncologically safe, at the time of excisional surgery. If it is sacrificed, dislocated cranially or caudally, or there is a thick panniculus adiposus with a poor definition of the fold, it is necessary to recreate it. We present our experience in the reconstruction of the IMF in patients suffering from post-oncologic mastectomy, reconstructed with silicone implants. From January 2000 to May 2004 at the Plastic Surgery Department of the University of Turin, 74 reconstructions of the IMF were performed through Nava's technique, partially modified by us. We believe that IMF reconstruction, through fixation of cutis, subcutis and fascia superficialis to VI rib, along with capsulectomy of periprotesic pocket inferior quadrants, is a milestone for achieving, in selected cases, a good aesthetic result in terms of shape, ptosis and projection of inferior pole. The comparison between patients' opinions (obtained through questionnaires) and surgeon's, at 1 year after the reconstruction, shows that both are satisfied with the achieved outcome in terms of shape, projection, symmetry, ptosis and IMF definition. Another comparison was made between cases of fold preservation and cases of fold reconstruction, with a remarkable similarity of aesthetic satisfaction. The technique proposed here appears to be the current method of choice for IMF reconstruction in all cases where it is necessary to recreate or redefine it.