[Significance of antibiotic prophylaxis in infection prevention in biliary surgery. Personal experience]. / Significato della profilassi antibiotica nella prevenzione delle infezioni in chirugia biliare. Esperienza personale.

Postoperative infections are one of the most frequent causes of morbidity in surgical patients. In biliary tract surgery the risk of septic complications is essentially increased by opening the bile ducts. Aim of this paper is to evaluate indications and effectiveness of short-term prophylaxis in preventing infective complications of biliary surgery. Authors report a personal six years review regarding 530 patients operated for biliary tract diseases. The patients were divided into two groups: the first one (n. 245) operated under short-term prophylaxis; the second one (n. 285) treated only postoperativelly with antibiotics. The results obtained show a significatively higher rate of infective complications in the second group of patients. There is a little difference between the groups in the case of elective cholecystectomy, whereas there is a great difference in case of non-elective surgery, bile ducts opening, external biliary drainages placement or sphincteropapillotomy. Authors furthermore emphasize how surgical results are conditioned by individual risk factors, especially obesity and diabetes.

[The radical treatment of hepatic hydatidosis with deep and multiple locations. The role of new technologies particularly in the case of multiple locations]. / Sul trattamento radicale dell'idatidosi epatica a localizzazione profonda e multipla. Ruolo delle nuove tecnologie, specie in caso di localizzazioni multiple.

Advanced technologies (intraoperative ultrasonography, CT scan, argon coagulator ...) have changed the surgical approach of liver hydatid disease, allowing even multiple or deeply located cysts to be detected and treated successfully. Authors report a series of 4 patients with single (3) or multiple (1) unilocular hepatic cysts; and 1 patient with thoraco-pulmonary hydatid recurrent disease. Treatments of choice and surgical techniques are described. No infective compliances occurred. The mean period of hospitalization was 19 days (ranging between 10 days and 4 weeks). The longest hospitalization was observed in a patient with a post-operative biliary fistula at low out put. Total cysto-pericystectomy is emphasized as the gold standard procedure in the treatment of non complicated unilocular hydatid cysts of the liver. Modern means of investigation and technical equipment make it feasible and safe even in unfavorable localizations, allowing radical removal of the cysts preserving in the meantime all the surrounding liver parenchyma.

[The distal pedicle fasciocutaneous flaps of the leg. Analysis of 21 cases of lower limb reconstruction]. / I lembi fascio-cutanei di gamba a peduncolo distale. Analisi di 21 casi di ricostruzione dell'arto inferiore.

The fascio-cutaneous flaps with distal pedicle, with the new discoveries on fascial and septal circulation of the lower limbs, are a valid reconstructing method for the loss of substance localized on the third inferior of the leg and in the heel's region. In 21 patients, 18 men and 3 women, fascio-cutaneous flaps were employed for the traumatic loss of substance, just in two cases consequentially to removal of maligns lesions, all of them were omolaterals except in three cases in which cross-leg were used. The results are satisfying if we remember that just in two cases we had partial necrosis and in other two cases we had to reinstate the flap which had survived just in his deep position. The advantages of using this technique are supported by his good results and simple execution, realising anyhow that complicated or contaminated trumas need more complex plastic reconstruction.

[Injury of the popliteal artery & the popliteal branches: analysis of 31 consecutive cases]. / I traumi dell'arteria poplitea e dei rami infrapoplitei: analisi di 31 casi consecutivi.

In complex traumas of lower limbs it is fundamental the reducing of the time of ischemia to reduce the number of failures in repairing surgery and the percentage of the demolishing of necessity surgery. The experience of the authors is based on 31 complex traumas of lower limbs with distal vascular injuries to Hunter's canal, which were associated to bone, nervous and muscular lesions. In total we are treated 37 vascular injuries by interposition of venous autografts in 37 cases, lateral pacth in one case ant suture T-T in two cases. The protection of the reconstructed vases, in case of a concomitant loss of substance, was entrused to microvascular flaps for 7 times latissimus dorsi, iliac crest and fascio-cutaneous for 5 times posterior reversed with distal baset and for three times antero-lateral, which in three cases of them needed successively a dermoepidermic grafts. The bone injuries, which were treated by external fixation, intramedullary nailing, plate and screws, just in two cases became worse in pseudoarthroses and just in one in osteomyelitis. The reparation of nervous injuries had bad results just in two cases. The percentage of saving of the limb it was about 83.9%.

[Venous grafts in reimplantation of the thumb]. / Innesti venosi nel reimpianto del pollice.

The Authors analyze their experience of 25 thumb reimplantations and revascularizations within 5 years. The importance of the first finger in the functional hand economy as well as the ratio between reimplantation take rate and degree of functional recovery with regard to the type of trauma, technique used, and possible and incidental complications are underlined. The venous autologous grafts are of great importance in this microsurgical area and they are more and more applied. In most cases, indeed, intimal lesions are more extended than their macroscopic appearance and the tract of damaged vessels is always wider than assessed. The graft interposition solves the problem with the further advantage to preserve the maximal bone length and to avoid especially contaminated areas. The results achieved confirm these statements and the Authors conclude for the absolute need of venous grafts in thumb reimplantations, especially after amputation from avulsion or crush traumas, even though a greater skill is necessary in using this technique.

[Latissimus dorsi flap in reconstructive surgery of the lower limbs]. / Il lembo libero di gran dorsale nella chirurgia ricostruttiva degli arti inferiori.

The free latissimus dorsi flap has been used to repair 10 complex losses of substance of the lower extremity. The results have shown the great reconstructive potentialities of the microvascular transfer of this muscle, considered by the authors the most versatile of the myocutaneous flaps. Among the advantages there are the extended surface, its thickness, its pedicle with adequate length and diameter as well as the absence of functional involvement, especially by preserving the upper branch of the thoracodorsal nerve. The indications, however, are limited due to a significant rate of complications which prevent its extended use.

[Role of microsurgery in chronic distal obstructive arteriopathies]. / Ruolo della microchirurgia nelle arteriopatie croniche ostruttive distali.

The Authors analyze the role of microsurgery in the treatment of chronic obstructive arteriopathies. In accordance with their results, they stress the usefulness of the microtechniques in the rescue of ischaemic limbs due to distal occlusion, and how these procedures are less dangerous than amputation, even though results are not long lasting.