Mental Health, and Eating Disorders in Patients After Roux-en-Y Gastric Bypass Surgery (RYGB).

<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.

The impact of lifestyle, measured with the HLPCQ questionnaire on the prevalence of metabolic syndrome in Poland: a multicenter study.

Metabolic syndrome is one of the most common health problems for people around the world. The aim of our study was to assess the prevalence of metabolic syndrome among adults without prior diagnosis of cardiovascular disease, diabetes, and chronic kidney disease. We also plan to assess the influence of certain lifestyle components on prevalence of metabolic syndrome. The study involved cardiovascularly healthy patients undergoing lab tests, measurements, and the HLPCQ questionnaire (The Healthy Lifestyle and Personal Control Questionnaire). The data were used to diagnose metabolic syndrome. Out of 1044 patients from 10 primary care facilities, 23.3% met the metabolic syndrome criteria, showing a strong link with increased blood pressure, cholesterol, and fasting glucose. Lower scores in the Organized physical exercise subscale of the HLPCQ questionnaire were noted in those with metabolic syndrome. Comparing the subscale of HLPCQ questionnaire, the lower results in Organized physical exercise subscale were found among the participants with metabolic syndrome, both male and females. Metabolic syndrome, a significant risk factor for cardiovascular disease, should be screened for actively, even in apparently healthy populations. Results obtained in our study from analysis of HLPCQ show that screening for metabolic syndrome should be preceded by prevention based on regular physical activity and proper eating habits.

Plasma Treatment of PDMS for Microcontact Printing (µCP) of Lectins Decreases Silicone Transfer and Increases the Adhesion of Bladder Cancer Cells.

The present study investigates silicone transfer occurring during microcontact printing (µCP) of lectins with polydimethylsiloxane (PDMS) stamps and its impact on the adhesion of cells. Static adhesion assays and single-cell force spectroscopy (SCFS) are used to compare adhesion of nonmalignant (HCV29) and cancer (HT1376) bladder cells, respectively, to high-affinity lectin layers (PHA-L and WGA, respectively) prepared by physical adsorption and µCP. The chemical composition of the µCP lectin patterns was monitored by time-of-flight secondary ion mass spectrometry (ToF-SIMS). We show that the amount of transferred silicone in the µCP process depends on the preprocessing of the PDMS stamps. It is revealed that silicone contamination within the patterned lectin layers inhibits the adhesion of bladder cells, and the work of adhesion is lower for µCP lectins than for drop-cast lectins. The binding capacity of microcontact printed lectins was larger when the PDMS stamps were treated with UV ozone plasma as compared to sonication in ethanol and deionized water. ToF-SIMS data show that ozone-based treatment of PDMS stamps used for µCP of lectin reduces the silicone contamination in the imprinting protocol regardless of stamp geometry (flat vs microstructured). The role of other possible contributors, such as the lectin conformation and organization of lectin layers, is also discussed.

Bladder Cancer Cells Interaction with Lectin-Coated Surfaces under Static and Flow Conditions.

Aberrant expression of glycans, i.e., oligosaccharide moiety covalently attached to proteins or lipids, is characteristic of various cancers, including urothelial ones. The binding of lectins to glycans is classified as molecular recognition, which makes lectins a strong tool for understanding their role in developing diseases. Here, we present a quantitative approach to tracing glycan-lectin interactions in cells, from the initial to the steady phase of adhesion. The cell adhesion was measured between urothelial cell lines (non-malignant HCV29 and carcinoma HT1376 and T24 cells) and lectin-coated surfaces. Depending on the timescale, single-cell force spectroscopy, and adhesion assays conducted in static and flow conditions were applied. The obtained results reveal that the adhesion of urothelial cells to two specific lectins, i.e., phytohemagglutinin-L and wheat germ agglutinin, was specific and selective. Thus, these lectins can be applied to selectively capture, identify, and differentiate between cancer types in a label-free manner. These results open up the possibility of designing lectin-based biosensors for diagnostic or prognostic purposes and developing strategies for drug delivery that could target cancer-associated glycans.

Immunoexpression of Bmi-1, CK15, Bcl-2 in different types of basal cell carcinomas.

Introduction: Basal cell carcinoma (BCC) occurs in aggressive and non-aggressive forms. The expression of immunohistochemical markers varies in different types of BCC. Aim: Immunohistochemical analysis of selected proteins in BCCs. Material and methods: The immunohistochemical method was used to examine the immunoexpression of Bmi-1, CK15 and Bcl-2 in 56 cases of BCC divided into four groups. Results: Positive Bmi-1 staining 3-4+ level (nodular type) was seen in 91.3% of samples, 4+ (infiltrative) in 92.3%, 4+ (nodular/infiltrative) - 69.2%, 3+ - 30.8%, in BSC 3+ - 42.8%, and 28.6% each for 2+ and 4+. Low grade positivity (0-1+) in CK15 staining was present in 52.1% of nodular BCC, 46.2% - nodular/infiltrative, 92.3% - infiltrative, and 100% - BSC, but levels 2-3+ in nodular BCC in 47.8%, nodular/infiltrative BCC - 53.8%, infiltrative - 7.7%. Bcl-2 positivity (3-4+) was revealed in nodular BCC in 95.6%, (1-2+) in 100% of BSC, infiltrative and infiltrative/nodular BCC, but the lowest (0-1+) in 76.9% of nodular/infiltrative BCC, 71.4% of BSC, and in 38.4% of infiltrative BCC. Conclusions: Positive Bmi-1 staining was the highest in the aggressive infiltrative subtype of BCCs, whereas the lowest in basosquamous cell carcinomas (BSC). Infiltrative BCC was characterized by a lower level of CK15 expression than nodular BCC and nodular/infiltrative BCC. Differentiation of Bcl-2 expression depended on the type of tumour; the highest level was found in nodular BCC, low grade in nodular/infiltrative and infiltrative BCCs, and BSC.

Changes in nanomechanical properties of single neuroblastoma cells as a model for oxygen and glucose deprivation (OGD).

Although complex, the biological processes underlying ischemic stroke are better known than those related to biomechanical alterations of single cells. Mechanisms of biomechanical changes and their relations to the molecular processes are crucial for understanding the function and dysfunction of the brain. In our study, we applied atomic force microscopy (AFM) to quantify the alterations in biomechanical properties in neuroblastoma SH-SY5Y cells subjected to oxygen and glucose deprivation (OGD) and reoxygenation (RO). Obtained results reveal several characteristics. Cell viability remained at the same level, regardless of the OGD and RO conditions, but, in parallel, the metabolic activity of cells decreased with OGD duration. 24 h RO did not recover the metabolic activity fully. Cells subjected to OGD appeared softer than control cells. Cell softening was strongly present in cells after 1 h of OGD and with longer OGD duration, and in RO conditions, cells recovered their mechanical properties. Changes in the nanomechanical properties of cells were attributed to the remodelling of actin filaments, which was related to cofilin-based regulation and impaired metabolic activity of cells. The presented study shows the importance of nanomechanics in research on ischemic-related pathological processes such as stroke.

Epidemiology and clinical characteristics of hospitalized patients with heart failure with reduced, mildly reduced, and preserved ejection fraction.

INTRODUCTION: There is still little information regarding a detailed description and predictors of different subtypes of heart failure (HF) in the Polish population. OBJECTIVES: This study sought to characterize the differences between hospitalized patients with HF divided into HF with preserved ejection fraction (HFpEF; EF ≥50%), mildly reduced EF (HFmrEF; EF 40%-49%), and reduced EF (HFrEF; EF <40%), and to identify factors related to each HF subtype. PATIENTS AND METHODS: Patients from the hospital database whose hospitalization was coded as HF­related between 2014 and 2019 were included in the analysis. RESULTS: A total of 2601 patients were included, of whom 62% had HFrEF, 13% had HFmrEF, and 25% had HFpEF. The patients with HFpEF, as compared with those with HFrEF and HFmrEF, were older (70.5 vs 61.6 vs 66.5 years, P <0.001), less often male (44% vs 68.3% vs 81.3%, P <0.001), and less likely to have an ischemic etiology of HF (19.3% vs 49.8% vs 34.4%, P <0.001) but they were more likely to have hypertension (87.3% vs 78.2% vs 78.2%, P <0.001), atrial fibrillation (64.5% vs 55.6% vs 59.5%, P <0.001), cancer (32.2% vs 19.6% vs 28.7%; P <0.001), and anemia (25.5% vs 15.9% vs 20.5%, P <0.001). Of 3 multivariable models, the one predicting HFpEF was the strongest (P <0.001, area under the curve, 0.79), and included age, sex, aortic stenosis, hypertension, anemia, cancer, thyroid abnormality, atrial fibrillation, longer history of HF, ischemic etiology, coronary artery disease, diabetes mellitus, and liver failure. CONCLUSIONS: HFrEF and HFpEF differed significantly in terms of baseline characteristics, while HFmrEF was in the middle of the HF spectrum, tending to be a mixture of HFpEF and HFrEF characteristics.

External ear carcinoma: evaluation of surgical and reconstructive management with postauricular island flap.

Introduction: Cancers of the auricle and the external auditory canal (EAC) remain a relevant oncological problem. Aim: Presentation of the results after resections of conchal bowl and EAC carcinoma (with or without radical mastoid surgery) and after reconstructions (postauricular island flap - PIF). Material and methods: We analysed results of 37 patients with cancers of the auricular conchal bowl and EAC after tumour resection and reconstruction (2000-2017). Results: The cancers were completely excised in all patients, with no recurrences within at least 5 years after surgery. We noted venous congestion in 22 (59.4%) cases, pinning of the operated ear in 18 (48.6%), prominent earlobe in 14 (37.8%), and EAC constriction in 6 (16.2%) cases treated without radical mastoid surgery. Conclusions: Retroauricular approach in cancer of the auricular concha and EAC allowed for accurate evaluation of the tumour extent and proper surgical access, which facilitated complete removal of the tumour. Use of radical mastoid operation with conchal bowl resection and PIF reconstruction in patients with aquamous cell carcinoma or infiltrating basal cell carcinoma of auricular concha and osseous EAC resulted in cancer extirpation and good aesthetic outcomes, despite minor functional consequences. In these cancers mastoidectomy offered a wider access to determine the radicality of oncological resection.

100 years of Thorek method - is this technique of breast reduction still actual?

In 1922, Max Thorek described the method of breast reduction with the transfer of the nipple-areola complex as free grafts. Initially, this method met with quite a lot of criticism. Therefore, the search for solutions guaranteeing better aesthetic results of breast reduction have been evolved.The aim of the study is to present our own experiences related to the Thorek method of breast reduction in patients with gigantomastia and to consider whether this technique is still relevant in the 21st century.The study included women operated on for large breasts at the Plastic, Reconstructive and Aesthetic Surgery Clinic between 2012-2021. In the analysis 95 women aged 17 to 76 were involved.In the analyzed group of 95 women, 14 patients underwent breast reduction with transfer of the nipple-areola complex as a free graft (modified Thorek's method). In the remaining 81 cases, breast reduction was performed with the transfer of the nipple areola complex on the pedicle (upper-medial - 78, lower - 1, upper-lower - McKissock's method - 2).The usage of Thorek's method is still actual in a selected group of women. This technique seems to be the only safe one in patients with gigantomastia, with a high risk of nipple-areola complex necrosis related to the distance of nipple transfer, as well as after the end of the reproductive period. Its main disadvantages (tendency to breasts being too wide and flat, unpredictable nipple projection and nipple pigmentation) can be minimized by modification of the Thorek method or minimally invasive follow-up techniques.

Transcatheter pulmonary denervation in patients with left heart failure with reduced ejection fraction and combined precapillary and postcapillary pulmonary hypertension: A prospective single center experience.

OBJECTIVES: The present study was a prospective, single-center, single-arm study to investigate the efficacy of transcatheter pulmonary artery denervation (TPADN) in patients with combined postcapillary and precapillary PH (Cpc-PH) associated with left heart failure with reduced ejection fraction (HF-rEF). BACKGROUND: Pulmonary hypertension (PH) in patients with left ventricular systolic dysfunction has a negative impact on outcome. METHODS: The combination of pulmonary artery systolic pressure (PAPs) ≥60 mmHg, transpulmonary pressure gradient (TPG) ≥12 mmHg, nonreversible mean PAP, and pulmonary vascular resistance (PVR) ≥3.5 Wood Units was considered as too high risk for heart transplantation (HTx). The clinical efficacy endpoint was an improvement in 6-min walking test and the hemodynamic endpoints were changes in PAPs, PVR, and TPG between baseline and 6 months. Circumferential radiofrequency applications were delivered around distal main, left and right pulmonary arteries. At each ablation point temperature was 45°C and energy 10 W. RESULTS: TPADN was performed in 10 patients. At 6-month in 5 patients we observed reduction in PAP, PVR, TPG, and DPG and then 1 had successful HTx, 2 are on HTx waiting list, 2 received LVADs, 2 patients did not improve, and 3 patients died. CONCLUSIONS: TPADN may be beneficial in selected patients with HF-rEF and Cpc-PH.

Titin-Related Dilated Cardiomyopathy: The Clinical Trajectory and the Role of Circulating Biomarkers in the Clinical Assessment.

Titin truncating variants (TTNtv) are known as the leading cause of inherited dilated cardiomyopathy (DCM). Nevertheless, it is unclear whether circulating cardiac biomarkers are helpful in detection and risk assessment. We sought to assess 1) early indicators of cardiotitinopathy including the serum biomarkers high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in clinically stable patients, and 2) predictors of outcome among TTNtv carriers. Our single-center cohort consisted of 108 TTNtv carriers (including 70 DCM patients) from 43 families. Clinical, laboratory and follow-up data were analyzed. The earliest abnormality was left ventricular dysfunction, present in 8, 26 and 47% of patients in the second, third and fourth decade of life, respectively. It was followed by symptoms of heart failure, linked to NT-proBNP elevation and severe left ventricular systolic dysfunction, and later by arrhythmias. Hs-cTnT serum levels were increased in the late stage of the disease only. During the median follow-up of 5.2 years, both malignant ventricular arrhythmia (MVA) and end-stage heart failure (esHF) occurred in 12% of TTNtv carriers. In multivariable analysis, NT-proBNP level ≥650 pg/mL was the best predictor of both composite endpoints (MVA and esHF) and of MVA alone. In conclusion, echocardiographic abnormalities are the first detectable anomalies in the course of cardiotitinopathies. The assessment of circulating cardiac biomarkers is not useful in the detection of the disease onset but may be helpful in risk assessment.

Dimethyl fumarate treatment shifts the immune environment toward an anti-inflammatory cell profile while maintaining protective humoral immunity.

BACKGROUND: Delayed-release dimethyl fumarate (DMF) demonstrates sustained efficacy and safety for relapsing forms of MS. Absolute lymphocyte count (ALC) is reduced initially, then stabilizes on treatment. OBJECTIVE: PROCLAIM, a 96-week, prospective, open-label, phase 3b study, assessed lymphocyte subsets and immunoglobulin (Ig) levels during 48 and 96 weeks (W) of DMF treatment. METHODS: Patients received 240 mg DMF BID. Endpoints: lymphocyte subset count changes (primary); Ig isotypes and ALC changes (secondary); adverse events and relationship between ALC changes and ARR/EDSS (exploratory); and neurofilament assessment (ad hoc). RESULTS: Of 218 patients enrolled, 158 (72%) completed the study. Median ALC decreased 39% from baseline to W96 (BL-W96), stabilizing above the lower limit of normal (baseline: 1.82 × 109/L; W48: 1.06 × 109/L; W96: 1.05 × 109/L). CD4 + and CD8 + T cells correlated highly with ALC from BL-W96 (p < 0.001). Relative to total T cells, naive CD4 + and CD8 + T cells increased, whereas CD4 + and CD8 + central and effector memory T cells decreased. Total IgA, IgG, IgM, and IgG1-4 subclass levels remained stable. Adverse event rates were similar across ALC subgroups. ARR, EDSS, and neurofilament were not correlated with ALCs. CONCLUSION: Lymphocyte decreases with DMF were maintained over treatment, yet immunoglobulins remained stable. No increase in infection incidence was observed in patients with or without lymphopenia. SUPPORT: Biogen.

Nanomechanics in Monitoring the Effectiveness of Drugs Targeting the Cancer Cell Cytoskeleton.

Increasing attention is devoted to the use of nanomechanics as a marker of various pathologies. Atomic force microscopy (AFM) is one of the techniques that could be applied to quantify the nanomechanical properties of living cells with a high spatial resolution. Thus, AFM offers the possibility to trace changes in the reorganization of the cytoskeleton in living cells. Impairments in the structure, organization, and functioning of two main cytoskeletal components, namely, actin filaments and microtubules, cause severe effects, leading to cell death. That is why these cytoskeletal components are targets for antitumor therapy. This review intends to describe the gathered knowledge on the capability of AFM to trace the alterations in the nanomechanical properties of living cells induced by the action of antitumor drugs that could translate into their effectiveness.

Indenting soft samples (hydrogels and cells) with cantilevers possessing various shapes of probing tip.

The identification of cancer-related changes in cells and tissues based on the measurements of elastic properties using atomic force microscopy (AFM) seems to be approaching clinical application. Several limiting aspects have already been discussed; however, still, no data have shown how specific AFM probe geometries are related to the biomechanical evaluation of cancer cells. Here, we analyze and compare the nanomechanical results of mechanically homogenous polyacrylamide gels and heterogeneous bladder cancer cells measured using AFM probes of various tip geometry, including symmetric and non-symmetric pyramids and a sphere. Our observations show large modulus variability aligned with both types of AFM probes used and with the internal structure of the cells. Altogether, these results demonstrate that it is possible to differentiate between compliant and rigid samples of kPa elasticity; however, simultaneously, they highlight the strong need for standardized protocols for AFM-based elasticity measurements if applied in clinical practice including the use of a single type of AFM cantilever.

Can Circulating Cardiac Biomarkers Be Helpful in the Assessment of LMNA Mutation Carriers?

Mutations in the lamin A/C gene are variably phenotypically expressed; however, it is unclear whether circulating cardiac biomarkers are helpful in the detection and risk assessment of cardiolaminopathies. We sought to assess (1) clinical characteristics including serum biomarkers: high sensitivity troponin T (hsTnT) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in clinically stable cardiolaminopathy patients, and (2) outcome among pathogenic/likely pathogenic lamin A/C gene (LMNA) mutation carriers. Our single-centre cohort included 53 patients from 21 families. Clinical, laboratory, follow-up data were analysed. Median follow-up was 1522 days. The earliest abnormality, emerging in the second and third decades of life, was elevated hsTnT (in 12% and in 27% of patients, respectively), followed by the presence of atrioventricular block, heart failure, and malignant ventricular arrhythmia (MVA). In patients with missense vs. other mutations, we found no difference in MVA occurrence and, surprisingly, worse transplant-free survival. Increased levels of both hsTnT and NT-proBNP were strongly associated with MVA occurrence (HR > 13, p ≤ 0.02 in both) in univariable analysis. In multivariable analysis, NT-proBNP level > 150 pg/mL was the only independent indicator of MVA. We conclude that assessment of circulating cardiac biomarkers may help in the detection and risk assessment of cardiolaminopathies.

Autologous fat transfer for facial recontouring in Parry-Romberg syndrome.

BACKGROUND: Parry-Romberg syndrome (PRS) is a rare condition involving self-limited progressive facial hemiatrophy. AIMS: To analyze esthetic results of fat graft used for correcting soft-tissues atrophy in PRS patients, in the aspect of volume restoration and skin rejuvenation, to present our experience in redefining facial contours in PRS and modification of fat graft accusation technique (based on Coleman's technique). PATIENTS/METHODS: A prospective evaluation study was designed to analyze esthetic results (contour and skin condition), complications, and subjective satisfaction of eight patients with PRS treated with fat graft. RESULTS: All patients underwent two (n = 6) or three (n = 2) procedures in 3 months intervals (the mean 3.7 months). No major postoperative complications were observed. The authors evaluated their esthetic results concerning face contour and symmetry as good (in four patients) and very good (in four patients). Subjective assessment showed high patients' satisfaction with the final result of face contouring (the mean VAS [0-5]-4.75). CONCLUSIONS: Our experience shows that fat grafting in patients with PRS is safe and gives satisfactory results in the aspect of volume restoration and skin quality improvement. Modified technique of graft preparation (112 g for 3 minutes) enables to obtain less dense fat graft, which is more appropriate in case of PRS patients with thin atrophic skin.

Fluctuations in circulating endothelial progenitor cell levels and acute cardiac graft rejection.

INTRODUCTION: Endothelial progenitor cells (EPCs) in nontransplant settings have reparative properties. However, their role in heart transplantation (HT) is not well defined. OBJECTIVES: The aim of this study was to prospectively evaluate changes in EPC levels in relation to post­HT rejection. PATIENTS AND METHODS: EPC levels were measured in 27 HT recipients for 6 months after HT. Acute cellular rejection (ACR) or antibody­mediated rejection (AMR) were assessed by right ventricular endomyocardial biopsy. RESULTS: ACR and AMR were observed in 7 (25.9%) and 6 (22.2%) patients, respectively. The ACR status at 1 month post­HT did not differ with respect to EPC immediately post­HT. At 1 month post­HT in patients without ACR or AMR, EPC levels were significantly reduced compared with the measurements immediately post­HT (P <0.001). On further follow­up, EPC levels were similar regardless of the rejection events. Nonetheless, greater changes (coefficient of variation) in EPClog (logarithmic transformation) were associated with the risk of AMR or ACR compared with those without any rejection event (median [lower-upper quartile], 15 [13-18] vs 8 [5-13]; P = 0.02 and 22 [14-26] vs 8 [5-13]; P = 0.01, respectively). The receiver operating characteristic curve showed that the coefficient of variation of EPClog of 12 was the optimal cutoff value for the prediction of rejection (area under the curve = 0.85). Higher levels were associated with greater risk of ACR or AMR (P <0.005). CONCLUSIONS: Early reduction of EPC levels was related to a lower risk of ACR or AMR. Greater changes of EPC­levels during follow­up were associated with a significantly higher risk of rejection.

External auditory meatus and/or conchal bowl reconstruction with postauricular island flap in patients with Basal Cell Carcinoma or Squamous Cell Carcinoma.

AIMS: Presenting our clinical experience with the postauricular island flap (pif) and estimation of the results following partial external auditory canal (eac) and/or auricular conchal bowl reconstructions with the pif in patients after carcinoma resections. METHODS: We have analyzed postoperative results of 19 patients after auricular conchal bowl (11), or auricular conchal bowl and eac (8) reconstructions with pif, following malignant tumor resections, between 2000-2015. The patients were followed-up and evaluated in respect of early and long-term results after surgical treatment considering plastic surgeon's and patient's opinion. RESULTS: The cancers were completely excised in all patients, and there were no recurrences within at least 2 years of follow-up. The observed complications after reconstructions comprised venous congestion in five cases (26.3 %), pinning of the operated ear in four patients (21 %), prominent earlobe in three (15.8 %), and eac constriction in three cases (15.8 %). Postoperative result was very good in all cases (both in the opinion of plastic surgeon and patients), except patients with pinning of the operated ear, prominent earlobe (moderately satisfied). Conclusions 1. Combined operations involving postauricular island flap reconstructions after partial (external auditory meatus and/or auricular conchal bowl) resections allowed for complete removal of malignant tumors with no evidence of recurrence, and also preservation of proper conchal shape in the reconstructed ear. 2. Retroauricular approach in cases with cancer involvement of the external auditory meatus allowed for proper visualization and estimation of lesions extent, as well as adequate surgical access.