Reversed distal laterodigital adipofascial flap for nail-bed reconstruction.

BACKGROUND: Lesions of the distal phalanges of the fingers frequently involve the nail bed. There are few therapeutic options for nail-bed reconstruction and they often lead to painful scars and onychodystrophy. We present our experience with the distal adipofascial laterodigital reverse flap. METHODS: Fifteen patients (average age 46.33 years, range 28-73) with tumors or traumatic injuries (crush injuries, nail avulsion, and partial fingertip amputations) of the nail bed, underwent digital reconstruction through the distal adipofascial laterodigital reverse flap from June 2018 to August 2019. The size of the fingertip defect covered with the flap was ranged between 1.1 × 1.1 and 1.6 × 1.2 cm (average size 1.4 × 1.2 cm). The flap was harvested enrolling subcutaneous tissue from the lateral aspect of the middle and distal phalanx from the less damaged side. RESULTS: The average size of the harvested flaps was 1.3 × 1.2 cm (range 1.1 × 1.0 to 1.4 × 1.1 cm). All adipofascial flaps survived entirely and the nail bed healed in all patients, with an average healing time of 21 days and a subsequent regrowth of the nail. The follow up ranged from 6 to 12 months, with a mean of 7 months. CONCLUSIONS: The distal reverse adipofascial flap provides a very versatile and reliable coverage of the distal finger and its nail bed. It is a rapid and reproducible surgical procedure with poor morbidity for the donor site. LEVEL OF EVIDENCE: IV.

Breast reshaping with dermaglandular flaps after giant lipoma removal: versatility of oncoplastic techniques.

Lipomas of the breast are benign lesions that do not raise great interest in the literature and their incidence is unclear. They usually are small, benign soft tissue tumors of fat cells that can be treated by simple excision. Although lipoma is a banal condition, it often causes diagnostic and therapeutic uncertainty. The first reason for this is the normal fatty composition of the breast. Second, it may be difficult to distinguish a lipoma from other benign or malignant lumps. This report presents a rare case involving giant lipoma of the breast that compromised most of the mass of the breast. After resection, the remaining breast was reshaped using multiple dermaglandular flaps to restore the breast mound, and contralateral breast mammaplasty was performed for symmetry. This case is a good illustration of the oncoplastic reconstruction options available after wide local excision.

Current indications for and comparative analysis of three different types of latissimus dorsi flaps.

BACKGROUND: Free tissue transfer with lower abdominal flaps for autologous breast reconstruction is not suitable for all patients. The latissimus dorsi (LD) musculocutaneous flap is an alternative, effective method for both immediate and delayed breast reconstruction. OBJECTIVES: The authors assess their experience with LD flaps for breast reconstruction, including indications for patient selection, donor site choice, aesthetic outcomes, complications, and patient satisfaction. METHODS: Charts for all patients who underwent breast reconstruction with one of three types of LD myocutaneous flaps during a three-year period at a single institution were retrospectively reviewed. Patients (n = 82) were divided into three groups: (1) 35 patients received a standard LD myocutaneous flap with implant, (2) 18 patients underwent a muscle sparing LD flap procedure with implant, and (3) 29 patients had an autologous LD flap. A questionnaire was administered to assess flap and donor site complications, aesthetic outcomes, patient satisfaction, and shoulder function. RESULTS: Flap complications occurred in 13 patients (15%). Donor site complications occurred in 24 patients (28%), mostly consisting of back seroma with the autologous LD flap. There was no significant difference in shoulder range of motion or muscle strength between the operated and unoperated sides. Patient satisfaction was high in all three study groups. CONCLUSIONS: The LD is a safe, versatile, and reproducible technique for breast reconstruction. The procedure benefits from ease of flap harvesting and setting and may provide satisfactory results in diverse patients, including those for whom an abdominal flap is neither indicated nor feasible. .

An adapted suction technique to aid removal of ruptured silicone implants.

Implant rupture is a common complication of breast implant surgery. Removal of silicone gel after breast implant rupture can be difficult and time-consuming. In the medical literature, a few other methods attempt to solve this challenge. We propose a simple and efficient technique to maximize its removal by suction. This method bypasses the problem, given the disadvantages of silicone's high viscosity. Moreover, the necessary equipment is inexpensive and readily available in any operating room.

Study to determine whether intraoperative frozen section biopsy improves surgical treatment of non-melanoma skin cancer.

Skin cancers are the most common types of cancer and their incidence has shown an increase of ∼4 to 8% per year over the last 40 years. The majority of skin cancers (∼97%) are non-melanoma skin cancers, mainly represented by basal cell (80%) and squamous cell carcinomas (20%). The use of intra-operative frozen section remains controversial in the surgical treatment of non-melanoma skin cancer, being commonly considered an optional tool, the reliability and effectiveness of which remain questionable. A large retrospective study was conducted to examine 670 surgical excisions of non-melanoma skin cancers of the head and neck in 481 patients over a period of nine years, between May, 2002 and December, 2011, at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy. Results demonstrated the paradoxical ineffectiveness of an intra-operative frozen section biopsy in pursuing higher rates of radical excision in non-melanoma skin cancers. Nevertheless, a more detailed analysis on the use of frozen sections focusing on the various anatomical sites of the body demonstrated a reverse trend in the eyelids and canthi, where a higher success rate (87.50 vs. 69.77%) in the surgical treatment of non-melanoma skin cancers was obtained with the use of an intra-operative frozen section biopsy. Results of the present study suggested that intra-operative frozen section biopsy be routinely used in the surgical treatment of nonmelanoma skin tumors involving the eyelids and canthi.

Inferiorly based parenchymal flap mammaplasty: a safe, reliable, and versatile technique for breast reduction and mastopexy.

BACKGROUND: Breast reduction and mastopexy are among the most frequent procedures in aesthetic breast surgery. Many approaches have been described, and various types of dermaglandular pedicles for the nipple-areola complex have been used. The authors present a technique suitable for either mastopexy or breast reduction whereby the superior or superomedial pedicle supplying the nipple-areola complex is combined with an inferior dermaglandular flap to restore the upper pole fullness, thereby improving breast shape and projection. METHODS: From January of 2008 to January of 2010, 83 patients underwent inferiorly based parenchymal flap mammaplasty. Patients' ages ranged from 23 to 65 years. The mean follow-up period was 27 months. The inferior breast tissue that is usually removed in a superior/superomedial pedicle technique is spared and shaped as a small implant and stitched to the pectoralis major muscle. The superior/superomedial pedicle is used for the nipple-areola complex. RESULTS: All the procedures were successful. No major complications were reported. All the patients were very satisfied with the shape, size, projection, and upper pole fullness of their breast postoperatively as reported by the questionnaire. Comparative evaluation test scores of a four-member jury were significantly higher regarding breast shape (p = 0.007), projection (p = 0.0041), and upper pole fullness (p = 0.0028). CONCLUSIONS: The inferiorly based parenchymal flap mammaplasty is a safe, versatile, and reproducible technique. It demonstrates ease of pedicle shaping and breast remodeling in patients undergoing mastopexy and breast reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.