Could Abdominoplasty with Diastasis Recti Abdominis Correction Improve Stress Urinary Symptoms? A 1-Year Follow-up Prospective Study.

BACKGROUND: Diastasis recti abdominis (DRA) indicates an abnormal separation of the rectus abdominal muscles from the midline, resulting in abdominal bulging. Recent literature shows a correlation between DRA and back pain, stress urinary incontinence. Primary goal of this study is to check the correlation between DRA correction in abdominoplasty and improvement of urinary symptoms. MATERIALS AND METHODS: This is a prospective study on patients with post-pregnancy rectus diastasis who underwent surgical correction of diastasis through conventional abdominoplasty. All patients were asked to complete the ICIQ-FLUTS questionnaire, which assesses urinary disorders, and the SF-36 questionnaire, aimed at quantifying health-related quality of life. The questionnaires were administered to patients the day before surgery and one year after surgery. RESULTS: The recruited patients (n = 51) were then stratified on the presence or absence of stress urinary incontinence. Of the 39 patients with preoperative incontinence, the average scores of the ICIQ-FLUTS were analyzed. In particular, for the questions relating to stress urinary incontinence a statistically significant difference was reported between the preoperative mean and the 1-year mean for all questions (p value<0.05). As regards quality of life, comparing the average scores of each question of SF-36 there is an improvement in the values of all the variables of the questionnaire. CONCLUSION: The strength of this study, which distinguishes it from other literature, is that the changes in abdominal pressure post-abdominoplasty which should lead to a worsening of stress incontinence, do not cause it. On the contrary, we have demonstrated the improvement of this symptom after conventional abdominoplasty surgery in most patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Combined Surgery (Mommy-Makeover) Compared to Single Procedure (Abdominoplasty) in After-Pregnancy Women: A Prospective Study on Risks and Benefits.

BACKGROUND: Mommy-makeover is becoming very popular to help them reshaping their own bodies and restoring self-perception, hardly stressed by childbearing-related changes. However, debate exists in the literature concerning safety and aesthetic outcome in patients undergoing combined procedures. The study aims to shed a light on advantages and disadvantages in mommy-makeover technique compared to conventional abdominoplasty with a particular attention to psychological aspects. MATERIALS AND METHODS: In total, 37 women were enrolled at Campus Bio-Medico Hospital in Rome between October 2019 and January 2022. All of the patients were eligible for both abdominoplasty only and mommy-makeover. We proposed to the patients both procedures explaining risks and benefits; then, based on the preference of the single patient, we performed either mommy-makeover (Group A) or abdominoplasty alone (Group B). In order to evaluate patients' satisfaction and safety, multiple questionnaires were administered 9-month postoperatively (BUT, POSAS, visual perception, etc.). RESULTS: The sample analyzed was composed of 37 patients (treatment group = 18, control group = 19). In the pre-post comparisons of BUT-A performed, there were statistically significant differences recorded in both groups and for all observed variables. The significance values were all less than 1% (p < 0.01). CONCLUSIONS: Combined surgery proved not to be inferior in terms of patient safety. At the same time, the effectiveness in improving diastasis-related symptoms is fully comparable with single surgery. Treatment group showcases a considerable superiority in terms of body-image perception improvement and overall patient satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modified Extracorporeal Septoplasty: Functional Results at 6-Year Follow-up.

BACKGROUND: Septal deviations represent a major cause of aesthetic disorders and respiratory obstruction. The traditional septoplasty techniques may often be inadequate to treat severe deviations. Recently, we described a modified extracorporeal septoplasty approach based on partial resection of the cartilaginous septum, with preservation of a superocaudal L-strut measuring approximately 0.5 cm in height. At 6-month follow-up, we demonstrated this technique to be functionally and aesthetically effective in addressing mild to severe septal deviation. The aim of the present study was to evaluate the long-term outcomes of this technique in the patients included in the initial prospective study, followed up during a period of 4 to 6 years. METHODS: One hundred fifty-three patients underwent modified extracorporeal septoplasty from January 2006 to June 2009. One hundred twenty of these patients were included in the present study. Patients were grouped according to the preoperative septal deviation as follows: mild (one-third reduction of the nasal cavity), moderate (half reduction), and severe (two-thirds reduction). Follow-up ranged from 4 to 6 years. Respiratory flow improvement was assessed with active anterior rhinomanometry; subjective evaluation of the respiratory function was obtained by mean of Nasal Obstruction Symptom Evaluation (NOSE) scale. Active anterior rhinomanometry values and NOSE scores were compared with the results obtained preoperatively and at 6-month postintervention. RESULTS: In the whole cohort, rhinomanometric analyses and NOSE scores at long-term follow-up demonstrated a statistically significant improvement in inspiratory flow and obstructive symptoms (P = 0.0122 and P < 0.0001, respectively) compared to preoperative values. In group analysis, a significant improvement in NOSE scores was found in patients with severe (P < 0.0001) and moderate (P < 0.0001) deviations. A significant improvement in inspiratory flow was reported in the severe (P < 0.0001) and moderate (P = 0.0212) deviation groups. CONCLUSIONS: The modified extracorporeal septoplasty technique proved to be functionally effective at long-term follow-up in cases of moderate or severe septal deviation: the improvements in respiratory function and obstructive symptoms found 6 months postoperatively were maintained at 4 to 6 years postintervention. With this technique, structural support is achieved without destabilizing the keystone area; moreover, conservative remodeling of the quadrangular cartilage allows the use of septal cartilage grafts in secondary or revision rhinoplasty.

Extracorporeal septoplasty: functional results of a modified technique.

BACKGROUND: Severe nasoseptal deviations still represent challenging situations for plastic surgeons. Septal surgery plays a central role in the management of complex cosmetic and functional problems, and should be considered as a basic procedure in nasal surgery. The classic septoplasty approach seems to be unsuitable for severe septal deviations. Other authors have found the standard extracorporeal septoplasty approach more reliable for a correct functional and cosmetic surgery. However, a drawback of this technique is the destabilization of the keystone area. In an effort to minimize the risk of destabilization, we have modified the classic technique with a more conservative approach that spares the dorsal cartilage and a portion of the caudal septum. METHODS: This study included 153 patients who underwent primary rhinoplasty from January 2006 to June 2009. The purpose was to evaluate the effectiveness of this technique in terms of objective (Active Anterior Rhinomanometry) and subjective (Nasal Obstruction Symptom Evaluation [NOSE] scale) improvements of the respiratory function and in terms of postoperative complications. There was a significant improvement in mean NOSE score at 3 and 6 months postoperatively. Rhinomanometrical assessment showed a significant increase of the nasal inspiratory flow at 3 and 6 months after surgery. No complications were reported. CONCLUSIONS: The results obtained with NOSE score and with rhinomanometrical assessment revealed that this technique increases patient's quality of life and nasal respiratory function, respectively. Furthermore, our approach avoids the most important complication of classic extracorporeal septoplasty, thus preserving a structured support of the nasal archway.

Regret and Quality of Life After Mastectomy With or Without Reconstruction.

BACKGROUND: Mastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and the quality of life (QoL) of women so treated, with or without breast reconstruction (BR). PATIENTS AND METHODS: A total of 709 patients underwent mastectomy with or without BR between 2002 and 2012 at one institution. Among 468 surviving patients, a 60-query QoL questionnaire on personal issues including some European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire items was presented either by email, letter, or telephone interview. RESULTS: Of those questioned, 328 patients participated, whereas 140 (30%) declined the invitation or were unavailable. The median age was 63 years (range, 30-93 years). Stage I or II of disease was recorded in 73% of patients. Immediate BR was performed in 168 (51%) of 328 patients. Of the remaining patients, only 7 (4%) of 160 proceeded to delayed BR. Younger women had significantly worse Emotional Functioning and Social Functioning (SF) scores (P < .001), independently of tumor stage, and immediate BR improved that (P = .02). SF score was also worsened by chemotherapy (P = .03). Cognitive Functioning score was independent of age, BR, stage, or adjuvant therapies. Body Image and Sexual Functioning scores improved with BR (P < .03), and age was a strong co-variable (P < .001). On multivariate analysis, immediate BR was correlated with age and preoperative plastic surgery consultation. Some 68 (21%) of 328 patients regretted their decision or were disappointed with their choice regarding BR. CONCLUSIONS: Younger patients with breast cancer report a worse impact on their Emotional Functioning and SF scores after mastectomy, both of which are improved by BR. Reconstructing the breast at the time of mastectomy has a significant impact on Body Image and Sexual Functioning scores. A preoperative plastic surgeon consultation improves the rate of immediate BR, whereas delayed reconstruction is rarely adopted. Some 20% of patients are disappointed in or regret their decision regarding BR. We need to improve our management in consideration of these findings.

Upper eyelid Merkel cell carcinoma treated with neoadjuvant chemotherapy and surgical excision.

Merkel cell carcinoma is a rare cutaneous carcinoma, featured by an aggressive clinical course and a mortality rate of 28% at 2 years. A 71-year-old female was affected by a 4.1-cm-wide locally advanced Merkel cell carcinoma of the upper eyelid, previously misdiagnosed as chalazion, with involvement of the extraocular muscles. Although the tumor showed a macroscopic spontaneous regression in size after the incisional biopsy, the mass was treated with neoadjuvant chemotherapy and surgical excision. Good functional and aesthetic result with preservation of the eyeball and absence of tumor recurrence were achieved at 3-year follow-up. In our experience, the combination of the inflammatory cascade due to the incisional biopsy and neoadjuvant chemotherapy led to the regression of a locally advanced large Merkel cell carcinoma of the eyelid.

Recurrent atypical eccrine spiradenoma of the forehead.

Eccrine spiradenoma is an uncommon but well recognized benign adnexal tumour of the eccrine sweat glands. It can appear at any age, but the highest rate of incidence is observed among young adults, without any sex predilection. The commonest clinical presentation is a solitary blue-red dermal or subcutaneous cystic nodule, ranging from 0.3 to 5 cm in diameter. Malignant transformation is a rare phenomenon, presenting as a rapidly enlarging nodule within a long-standing lesion. We report a case of eccrine spiradenoma in a thirty-six-year-old man who presented with a recurrent soft-tissue neoplasm of the forehead, with cytological atypia. The differential diagnosis of this tumour, as well as its possible malignant transformation, is discussed.

Burn after breast reconstruction.

AIMS: Burns occur rarely after breast reconstruction, and results from loss of sensory and thermoregulatory skin functions. We aimed to investigate the pathophysiological processes leading to these injuries. METHOD: Cases described in the literature are reviewed and discussed. Three cases of burn complicating the outcome of two implants and one autologous breast reconstruction are newly reported. DISCUSSION: The ineffectiveness of skin thermoregulatory reflexes, caused by different surgical procedures, plays an essential role in the pathogenesis of burns to reconstructed breasts; tissue expansion and radiotherapy are also essential aetiological factors.

Poroid hidradenoma: a case report.

Poroid hidradenoma is a variant of the eccrine poroma that belongs to the group of poroid neoplasms. It presents architectural features of hidradenoma, with solid and cystic areas and tumour cells restricted to the dermis, and cytological features of poroid neoplasm such as poroid and cuticular cells. Poroid hidradenoma becomes malignant in less than 1% of cases, but its histologic characteristics may resemble those of malignant neoplasms; thus it is easily misdiagnosed. Twenty percent of poroid hidradenomas occur in the extremities. To date, very few cases of this entity have been reported in the literature. We present a case of poroid hidradenoma in a 35-year-old man with a soft-tissue lesion on his right thigh.

Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy.

BACKGROUND: Nipple-sparing mastectomy (NSM) has been recently implemented to improve cosmetic outcome after mastectomy, but it is rarely considered today after neoadjuvant chemotherapy (NCH). PATIENTS AND METHODS: Among 275 NSMs performed from January 2007 to January 2015, 186 cases, with a minimum follow-up of 12 months, were carried out for invasive or intraductal carcinoma. Patients were considered for NSM if there were no clinical and radiological evidence of invasion or close proximity (<1 cm) to the nipple-areola complex (NAC). We compared patients operated with NSM after NCH (Group I N = 51) with those who underwent primary surgery (Group II, N = 135). RESULTS: At a median follow-up of 35 months, 166/186 patients were alive and disease-free (89.7%). Three local relapses (1.6%) were observed, all in the skin flap outside the NAC in Group I: (6%; p < 0.01). No NAC recurrences have been recorded, in either group. Nipple loss due to full thickness necrosis or resection for insufficient margins was recorded in 31 cases (17%); 12 in Group I (24%) and 19 in Group II (14%) (P = 0.1). This event decreased by half in the second part of the study (21/93 vs 10/93) (P = 0.03). CONCLUSIONS: NSM after NCH is not associated with a statistically significant difference in terms of post-operative complications, total nipple loss for necrosis or margins, and results improve with experience. The loco-regional relapse rate was higher after NCH, yet it was consistent with traditional mastectomy in the high-risk setting. There is no need to avoid NSM after NCH for locally advanced cancers, if the retro-areolar margins of resection are clear at the time of surgery.

Three cases of embolia cutis medicamentosa (Nicolau's syndrome).

Embolia cutis medicamentosa, also known as Nicolau's syndrome, is a rare complication due to i.m. injections. Its real incidence is actually underestimated. Many drugs have been associated with it, but at the time only a few studies showed a related pathogenetic mechanism. Symptoms consist of immediate local pain, edema and cutaneous, subcutaneous and even muscular necrosis occurring in the first 48 h. The type of treatment depends mostly on time of diagnosis. A medical resolution can be achieved through heparin and cortisone injections within the first 48 h. Surgical debridement has to be considered as the main treatment in case of late diagnosis. We present three cases of Nicolau's syndrome presenting to us in a short period of time that we treated with surgical debridement.

Multiple localization of granular cell tumour: a case report.

INTRODUCTION: Granular cell tumour, also known as Abrikossoff's tumour, is a rare entity occurring in the skin as well as in internal organs, more common among the third to fifth decade of life. It has often been described as a peripheral neuroectodermal tumour and its clinical behaviour is usually benign although malignant and multifocal forms are also known to occur. CASE PRESENTATION: We report a case of multiple granular cell tumour in a 17-year-old Caucasian woman who presented with a nodular lesion in the popliteal cave, diagnosed as an Abrikossoff's Tumour, followed 2 years later by another soft tissue mass in the neck. CONCLUSION: This case is quite rare: only a few cases were presented in literature with an extended period of time before the clinical presentation of subsequent disease.