The post-adipocytic phase of the adipose cell cycle.

Subcutaneous white adipose tissue harvested by liposuction has been studied with the aim to understand how the adipocytes modify their morphology when subjected to the passage in a needle for liposuction and to cryopreservation. The work try to clarify the ultrastructural aspects of adipose tissue, in the conditions described before, examining samples of body fat employed in fat graft procedures, and samples after cryopreservation. Scanning and transmission electron microscopy show that the first event that occur in the adipocytes is a lesion of mild degree detectable early in the samples fixed immediately after liposuction. The sequence of events following the adipocyte stress appeared composed by different phases: plasmatic membrane interruption, loss of lipid charge, formation of cup-like adipocytes and formation of post-adipocytes (i.e. cells that survive to traumatic events and restart to internalize lipid droplets). In conclusion, the study suggests that the loss of lipid charge in adipose cell is an active process that can be due to a small hole in the cytoplasmic membrane with the preservation of a large part of the cytoplasmatic content and that at the end of the process of lipid extrusion the cell can maintain viability.

Subcutaneous adipose tissue classification.

The developments in the technologies based on the use of autologous adipose tissue attracted attention to minor depots as possible sampling areas. Some of those depots have never been studied in detail. The present study was performed on subcutaneous adipose depots sampled in different areas with the aim of explaining their morphology, particularly as far as regards stem niches. The results demonstrated that three different types of white adipose tissue (WAT) can be differentiated on the basis of structural and ultrastructural features: deposit WAT (dWAT), structural WAT (sWAT) and fibrous WAT (fWAT). dWAT can be found essentially in large fatty depots in the abdominal area (periumbilical). In the dWAT, cells are tightly packed and linked by a weak net of isolated collagen fibers. Collagenic components are very poor, cells are large and few blood vessels are present. The deep portion appears more fibrous then the superficial one. The microcirculation is formed by thin walled capillaries with rare stem niches. Reinforcement pericyte elements are rarely evident. The sWAT is more stromal; it is located in some areas in the limbs and in the hips. The stroma is fairly well represented, with a good vascularity and adequate staminality. Cells are wrapped by a basket of collagen fibers. The fatty depots of the knees and of the trochanteric areas have quite loose meshes. The fWAT has a noteworthy fibrous component and can be found in areas where a severe mechanic stress occurs. Adipocytes have an individual thick fibrous shell. In conclusion, the present study demonstrates evident differences among subcutaneous WAT deposits, thus suggesting that in regenerative procedures based on autologous adipose tissues the sampling area should not be randomly chosen, but it should be oriented by evidence based evaluations. The structural peculiarities of the sWAT, and particularly of its microcirculation, suggest that it could represent a privileged source for regenerative procedures based on autologous adipose tissues.

Treatment of Romberg's disease with parascapular free flap and polyethylene porous implants.

Romberg's disease is a rare condition characterized by progressive hemifacial atrophy. The atrophic process typically has its onset in the first or second decade of life, it continues for a few years (usually 2, but up to 10), and then it stops spontaneously. The subcutaneous tissue is the first to be involved by the disease, followed by muscles, bones, and, rarely, the skin. The etiology of the disease is unknown. The only available treatment is surgical. Several techniques have been reported in the literature, from fat transplant, to silicon prostheses, to the use of flaps. We present our experience in successfully treating six patients (3 males and 3 females) affected by Romberg's hemifacial atrophy of intermediate or severe degree. A technique including a free parascapular microvascular flap with the adjunct of porous polyethylene implants was used. Further correction was performed with remodeling or resuspension.

Refinements in microvascular repair of extended oromaxillofacial defects with radial forearm free flap.

The radial forearm free flap (RFFF) is one of the most widely used and versatile fasciocutaneous free flaps in head and neck reconstruction because of its qualities--the consistent vascular anatomy; the thin and pliable nature; the minimal hair presence; and the possibility of harvesting and transferring it as a composite tissue flap, with bone, tendon, and nerve. The RFFF provides a method of single-stage reconstruction of wide residual defects after excision of advanced cancer (T3-T4) in the head and neck region. We present our ten-year experience with RFFF and the good results obtained with some refinements, which allowed us to verify the efficacy of the oral competence using the palmaris gracilis tendon as a sling. We also present the possibility of harvesting long segments of radius (up to 18 cm), and the discovery that use of antithrombotic or anticoagulant therapy is not necessary for the flap survival. This treatment does not guarantee a complete recovery, but it can improve the quality of the patient's life.

Late results of breast reconstruction with free TRAM flaps: a prospective multicentric study.

When the free TRAM flap was introduced for breast reconstruction, it was supposed to have many advantages over the pedicled TRAM flap: good perfusion of all four zones, better mobility and easier shaping of the breast, lower incidence of abdominal-wall complications, and less restrictive selection of patients. However, we have experienced several complications after free TRAM flaps in our practice, including fat necrosis, partial and complete flap necrosis, abdominal-wall weakness, and hernias. In order to evaluate the incidence and types of complications, as well as the influence of preoperative risk factors (chemotherapy, radiotherapy, overweight, smoking habits, and abdominal scars), on complications, a multicentric prospective study including Bern (Switzerland), Leuven (Belgium), Stuttgart (Germany), and Verona (Italy) was designed. In 111 consecutive patients, operated on over a period of 18 months, 123 flaps were done; 99 flaps were unilateral and 24 bilateral, and 36 were used for primary and 87 for late reconstruction. There was no preoperative selection of patients. The follow-up period was from 8 to 24 months (average 19 months). A two-team operating approach was used. All four zones were always included in the flap, and the end-to-end anastomoses were done to the thoracodorsal, the circumflex scapular, or the internal mammary arteries. The total number of fat and flap necroses was 24 (19.5 percent), 6 (5 percent) minor and 4 (3 percent) major fat necroses, 2 (1.6 percent) minor and 6 (5 percent) major flap necroses, and 6 (5 percent) total flap necroses. Twenty-two (20 percent) patients had abdominal-wall complications. The results of this study show that the complication rate of free TRAM flaps is considerable. Preoperative risk factors did not play a major role in the development of complications and should not be considered as contraindications for free TRAM flap surgery. All total flap failures resulted from impaired arterial inflow to the flap, and the choice of recipient vessel did not influence the outcome. The incidence of total flap failures might be reduced by good postoperative flap monitoring and early revision of the anastomosis. Partial fat and flap necroses might be prevented by removing the fat under the scarpa fascia in zones 4 and 3 or by reducing zone 4. Sparingly harvesting the rectus muscle and its sheath as well as the use of mesh in the rectus sheath repair may reduce the abdominal-wall complications.

Beta 2-microglobulins and renal dysfunction in burned patients.

Studies have been made of the serum and urinary beta-microglobulin levels in 18 burns patients in order to estimate glomerular and proximal tubular dysfunction. The greatest urinary excretion of beta 2-microglobulin was found in severely burned patients during the second and third weeks after injury. Urinary measurements of this protein in patients with renal tubular dysfunction have proved to be of value in the assessment of renal tubular damage.

[Burns in an aeronautic environment]. / Le ustioni in ambiente aeronautico.

Following an examination of the aetiology of burns in aeronautic environments, the physiopathology, classification and general and local treatment of the burn case is discussed. Special mention is then made of aircraft as an extremely useful means of transport.