New head-mounted miniaturized microscope in hypospadia surgical correction.

AIM: The aim of this paper was to report our experience using VarioscopeÒM5 in hypospadia surgical correction. To suggest the use of microsurgical principles that can result in the successful repair of hypospadias with a few complications. METHODS: Forty-three patients (age 12-16 months), affected by hypospadia, underwent longitudinal dorsal preputial island flap (Scuderi's technique) surgical procedure. All the procedures were performed with Varioscope®M5. This new device is a head-mounted miniaturized microscope which combines a microsurgical microscope illumination and magnification with the freedom of loupes. RESULTS: In 39 (91.1%) of the patients the postoperative course was uneventful. One patient (2.3%) developed urethral fistula and a second intervention was necessary to correct it. He was affected by fourth degree hypospadia. In 3 patients (6.6%) we observed a mild stenosis. Urethral strictures were dilated during multiple sessions, by weekly introduction of catheters of progressively increasing caliber. At 3 months after surgery all urethral strictures had been solved by non surgical treatment, thus decreasing complication rate of the surgical procedure from 8.9% to 2.3%. Evaluation of flow rate was repeated at 3 weeks, 6 and 12 months. The aesthetic outcome was evaluated by the parents on a VAS scale. Results were judged optimal (8-9 out of 10). CONCLUSION: In order to achieve a better aesthetic and functional outcome and to reduce complications we deem a perfect flap dissection and anastomosis necessary. A well lighted and magnified surgical field is essential to achieve the best result due to the small anatomical structures involved in the surgical technique we have adopted. The Varioscope®M5 offers essential advantages in this regard.

["Skin reducing mastectomy" and immediate breast reconstruction with Becker 35 contour profile breast implant: our experience]. / "Skin reducing mastectomy" e ricostruzione immediata con protesi/espansore Becker 35 contour profile. Nostra esperienza.

AIM: We describe in this paper our experience with the technique of skin-reducing mastectomy in the treatment of breast cancer. METHODS: Between October 2005 and April 2010 in our Center 33 patients underwent breast surgery utilizing the skin-reducing mastectomy technique and immediate breast reconstruction with expansor/definitive implant Becker 35 contour profile. Contralateral symmetrization was performed in the same operation. All selected patients satisfied inclusion critera either for nipple-sparing mastectomy or prophylactic mastectomy. We selected patients who had large ptosic breasts: areola-submammary fold >8 cm and jugular-nipple distance >25 cm. After histologic exam to confirm the lack of retroareolar tissue infiltration the nipple was preserved in a superior flap. RESULTS: Twenty-four out of 33 patients (72.7%) did not suffer from complications. In 9 patients (27.3%) we observed early complications. During follow-up we observed in 24 patients (72.7%) Baker I capsular contracture, in 9 patients (27.3%) Baker II capsular contracture. Esthetic results of symmetry, shape and volume were good to optimal. Patients' satisfaction was similar. During the follow up (6-33 months, average 17.7 months) no patient suffered from breast cancer recurrence. CONCLUSION: The "skin-reducing mastectomy" reduces mutilation and unsightly scar visibility. It gives a pleasant aesthetic outcome without hindering oncological safety.

L-specular plasty versus double-round plasty: two new techniques for earlobe split repair.

BACKGROUND: Split earlobes can be classified into two groups: congenital and traumatic. The congenital group can be divided into three categories: anterior, posterior with doubled earlobe, and sagittal. The traumatic group can be divided into two categories: complete and incomplete. This report describes and compares two new techniques the authors have developed for split earlobe repair: L-specular plasty and double-curve-specular plasty. Both techniques are simple to perform and deliver a good aesthetic result. METHODS: A series of 30 patients with split earlobes underwent surgery from September 2007 to September 2009. All the patients enjoyed good health with no organic pathologies. All the patients had surgery under local anesthesia. The L-specular plasty technique was used to treat 15 patients (13 complete splits, 2 incomplete splits). The remaining 15 patients (13 complete splits, 2 incomplete splits) were treated with the double-curve-specular plasty. RESULTS: Skin necrosis was not reported for any of the treated patients. Sutures are completely removed after 2 weeks. The sutures for three patients were removed after 20 days due to slow cicatrization. Repiercing of the ear may occur after 6 months. One patient (8%) experienced a wound infection, treated successfully with systemic antibiotic therapy. Two patients (16%) experienced hypertrophic scars. Only two patients (16%) had recurrence during a mean follow-up period of 13.4 months (range, 6-24 months: September 2007-2009). CONCLUSION: Both double-curve-specular plasty and L-specular plasty are simple, reliable procedures. They both deliver very good aesthetic results thanks to the curve incisions that follow the natural shape of the earlobe. However, the patients treated with double-curve-specular plasty reported greater satisfaction in the outcome of their surgery.

[Aminoacids and hyaluronic acid in topical treatment of bedsores. Clinical report]. / Il trattamento topico di ulcere da pressione con aminoacidi e acido ialuronico. Caso clinico.

Pressure ulcers are evolutive tissue of the skin, derma and subcutaneous layer. If not treated properly, but sometimes despite that, they may even reach muscles and bones. Nutritional status of the patient is the most important and potentially reversible factor which can contribute to wound recovery. Several studies underline in particular the importance of the proteic and caloric intake in order to stimulate the formation of granulation tissue and collagen. We thought giving the nutrients for wound repair directly on the wound bed, topically, therefore using the wound bed as exchange surface and presuming the wounded tissues are able to absorb, metabolize and ultimately use the aminoacids to repair the damage. The goal of our work is to describe the clinical case patient treated with a new active wound dressing releasing aminoacids and hyaluronic acid.

[Leg ulcers in patient affected by polycythemia vera in treatment with hydroxycarbamide. Case report]. / Ulcere cutanee in paziente con policitemia vera in trattamento con idrossicarbamide. Case report.

Leg ulcers are a frequent and serious complication of polycythemia vera (PV). They are caused by a synergic action of vascular, neurological and infectious physiopathologic mechanisms. Furthermore, cytostatic therapies commonly employed to control the myeloproliferative disease negatively interfere on the development of granulation tissue, slowing down the recovery of the ulcer. We describe the case of a 70 years old woman with PV, who had calcaneous and perimalleolar ulcers. They were so painful that they made it almost impossible for her to sleep and walk normally. These ulcers were particularly resistant to common topical therapy. Further and accurate investigations showed that these ulcers were a complication of hydroxycarbamide therapy employed and they were not a complication of the ematologic disease. Leg ulcers during hydroxycarbamide therapy are a relatively frequent but underestimated condition. Pathogenesis is bound to numerous factors, i.o. cellular damage and tissutal hypoxia, consequent of drug induced macroerythrosis. In our patient drug substitution and prosecution of topic therapies allowed the recovery of the leg ulcers, particularly serious for both, extensiveness and symptoms.

Thigh compression after great saphenous surgery is more effective with high pressure.

AIM: Methods to compress thigh veins effectively after venous surgery or endovenous procedures are still disputed. The aim of this paper was to compare the clinical outcomes with three different compression devices as a function of the pressures exerted. METHODS: Fifty-four patients undergoing invagination stripping of the great saphenous vein and side branch evulsion under local anaesthesia were treated postoperatively in sequential order by 1) thigh length compression stockings; 2) adhesive bandages; and 3) newly developed eccentric compression pads fixed with tapes and a thigh length stocking on top. Sub-bandage pressures were measured at mid-thigh level under these devices after application and one week later before compression was removed. Pain, hematoma, bleeding through the bandage, discomfort and skin irritations were recorded and rated as major or minor adverse events. RESULTS: The lowest sub-bandage pressure of around 15 mmHg at thigh level in the lying position were found in group A under the compression stockings, which nominally provide 23-32 mmHg at ankle level. Group B and group C showed significantly higher values (median values of 47 and 68 mmHg respectively in lying position, P<0.001). The median pressure values in the three groups upon standing were 16 mmHg, 63 mmHg and 98 mmHg. One week later there was a pressure-drop in the lying position in the three groups of 13%, 64%, and 46% respectively. Major adverse events were seen in a total of 10 of 18 patients in group A, in 1/18 in group B, and in 0/18 in group C. Minor adverse events in the three groups consisting mainly of light discomfort for compression devices and local skin irritations were observed in 6, 6 and 15 cases respectively. CONCLUSIONS: The best results with respect to the reduction of pain and hematoma were obtained when eccentric compression pads were taped to the skin of the thigh and a compression stocking was worn on top. A possible explanation for these observations is the very high local pressures under the eccentric device.