[Computer-based preoperative planning for breast reconstruction in the woman with unilateral breast hypoplasia]. / Pianificazione computerizzata per la ricostruzione mammaria in donne affette da ipoplasia mammaria unilaterale.

BACKGROUND: Aim of this paper is to describe a computer program which can provide objective and quantitative data useful for the selection of the proper implant in order to obtain the symmetry with the contralateral breast in case of unilateral breast reconstruction by tissue expansion, especially for the surgeon without experience or for the occasional operator. METHODS: Our C++ program provides the final implant volume using the measurements of the semi-circumference and projection of the contralateral breast performed on the supine patient. The aim is the symmetry of the two breasts. RESULTS: According to our experience in breast reconstruction by tissue expanders, this program allows non invasive and simple measurements of the breast volume, useful to obtain the mammary symmetry. CONCLUSIONS: In case of breast reconstruction by tissue expansion, the preoperative evaluation is usually based on the surgeon's experience and on empirical observations without knowing the correct volume to reach. For this reason our program is useful to know the necessary volume for breast reconstruction, and therefore it allows the surgeon to obtain a better plastic result.

[Experimental model for the evaluation of topical application of a solution to help myocutaneous flap transposition]. / Modèle expérimental pour l'évaluation d'une solution topique améliorant la survie des lambeaux myocutanés.

The aim of this article is the evaluation of the topical application of a solution of hydrogen peroxide (H2O2) 8% and dimethyl sulphoxide (DMSO) 50% in order to reduce ischaemic failure in random skin flaps. This study was performed using a rabbit model. Two parallel, cephalad-based para-midline random cutaneous flap (10 cm x 2.5 cm) were elevated and resutured in place on the dorsum of 40 New Zealand rabbits. The 80 flaps thus obtained were then randomly divided into one control group and three experimental groups of 20 flaps each. Flaps from the control group (group A) were topically treated with saline, while flaps from experimental group B were treated with H2O2 8%, flaps from experimental group C with DMSO 50%, and flaps from experimental group D with a solution of 50% DMSO + 8% H2O2. Each solution was topically applied, 20 cc per three times a day, on the flaps for seven days, starting on the immediate postoperative period. Transcutaneous oxygen tension (Ptc O2) measurements were carried out in all flaps, 72 h after flap elevation. The percentage of surviving skin area of each flap was determined by planimetry 7 days after flap elevation. The mean surviving area of the group A (control) flaps was 71%. The mean surviving area of the group B (H2O2-treated) flaps was 72%. The mean surviving area of the group C (DMSO-treated) flaps was 76%, and that of the group D (DMSO + H2O2-treated) flaps was 92%. While no statistically significant differences were found between the survival rates of both the flaps treated with H2O2 or DMSO alone and that of the control group, the mean surviving rate of the DMSO + H2O2 treated flaps (+20%) was statistically higher than that of the control flaps. Similarly, a statistically significant difference has been found between the mean Ptc O2 values of the DMSO + H2O2 flaps and those of the other three groups of flaps.

Local recurrence of breast cancer around a prosthesis dome.

We report a patient who, 2 years after mastectomy and breast reconstruction using a permanent expander, developed metastatic carcinoma around the filling port of the prosthesis. We believe this is the first description of such a condition, the differential diagnosis of which includes a silicone granuloma.

Solitary fibrous tumor of the inguinal region: a clinicopathological, light-microscopic, immunohistochemical, electron microscopic and flow-cytometric DNA study.

Solitary fibrous tumors (SFTs) are rare neoplasms with a probable mesenchymal origin that were first reported in the pleura but can occur in different sites. We report a case of SFT arising in the inguinal region of a 55-year-old woman. The patient presented with a mass in the left groin; she underwent wide excision of the lesion which was well-circumscribed and without evidence of adjacent soft tissue involvement. The histological, immunohistochemical and electron microscopic criteria for SFT were found. She had an uneventful recovery and she is alive without evidence of disease five years after operation. To our knowledge, this neoplasm has never been reported in this location.

Ineffectiveness of acute scalp expansion.

The aim of this study was to test the ex vivo biomechanical properties of acutely expanded scalp flaps to quantitatively assess the efficacy of acute scalp expansion. A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (4 x 10 cm), laterally based flap was designed on each side of the scalp, starting from the superior margin of the external auditory canal. One randomly selected flap per scalp underwent acute intermittent expansion (a 3-minute expansion/3-minute rest cycle was performed three times with the maximum expansion achievable); the contralateral flap served as a control. After the expansion process, the acutely expanded flaps were measured to assess whether applied biomechanical stress caused any changes in flap dimensions. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force transducer. The obtained data showed that the biomechanical benefits provided by acute scalp expansion were not statistically different (p < 0.05) from those obtained by simple subgaleal undermining. No change of length nor gain in compliance was observed in the acutely expanded flaps as compared with control scalp flaps. In the authors' opinion, a possible explanation (to be further validated) for the lack of effect of acute scalp expansion might be that the inelastic galea aponeurotica did not allow mechanical creep to exploit the inherent elastic properties of the overlying scalp skin.

Two modified techniques for flexor tendon repair.

The aim of this article is to present two new techniques for digital flexor tendon repair: a modification to the conventional Kessler technique (wrap core suture) and tendon splints (H-shaped splint). These techniques were aimed at enhancing the biomechanical properties of such repairs as related to resistance to both gap formation and repair failure. Comparing (in an ex vivo study) the tensiometric properties (gap formation and failure strengths) of 24 flexor digitorum profundus tendons repaired with the described techniques (12 repairs per each technique) and the conventional Kessler repair (24 repairs), we found that the former provided significantly stronger repairs than the latter in vitro. A statistically significant difference (p < 0.001) was found between each of the two presented techniques and the Kessler repair. The wrap core suture increased the load at which a visible (1 mm) gap formed by 22.6 percent when compared with the conventional Kessler suture. The mean gap strength of the wrap core repair was 6.5 N, whereas that of the conventional Kessler was 5.3 N. The failure loads (ultimate strength) of the wrap core suture were 33.8 percent higher than those of the conventional Kessler. The mean breaking load of the wrap core repair was 19.4 N, whereas that of the conventional Kessler was 14.5 N. The H-splint repair increased the load at which a visible gap formed and the failure loads (ultimate strength) by 158.5 and 333.1 percent, respectively, when compared with the conventional Kessler suture. The mean gap strength of the H-splint repair was 13.7 N, and its mean breaking load was 62.8 N.

Cleft lip: a histochemical and ultrastructural analysis of lip muscles.

AIMS: In order to evaluate the pathogenesis of cleft-lip in relation to both the anatomical and structural anomalies of the mesenchymal tissues, the authors concluded that the presence of structural anomalies in the examined tissues could not explain the malformation, but might be a consequence of it. Delayed muscular development, asymmetrical distribution of the muscular fibres and their anomalous insertion suggest that the anatomical/functional loss clinically detectable in the orbicular muscle could be the result of a perinatal dysmorphological process rather than of a simple mesenchymal hypoplasia. METHODS: Schendel et al. suggested that a metabolic defect in the mitochondrial function could cause a deficiency in cell migration and proliferation responsible for the malformation in question. To establish whether the pathogenesis of the cleft-lip is associated with an alteration in mitochondrial functionality, eight patients affected by unilateral cleft-lip were subjected to a biopsy of the orbicular muscle during the course of reparative surgery. RESULTS: The results obtained showed: 1) a great variation in the size of muscle fibres; 2) the absence of ragged red fibres; 3) a normal oxidative function in the muscle fibres examined; 4) the absence of typologically significant groupings positive for myofibral ATPases. Furthermore, the morphology of the mitochondria was preserved in all cases and neither inclusions nor morphological or volumetric changes were detected. CONCLUSIONS: This preliminary data did not confirm the constant presence of mitochondrial pathology responsible for the malformation in question. In our opinion, the growth deficiency of the maxillary segment could be ascribed to the cicatrization of the surgical repair of the cleft-lip.