Reconstruction of medial canthal region with orbicularis oculi myocutaneous flap: Our experience.

Reconstructive surgery of the medial canthus is among one of the most challenging due to its complex anatomy and aesthetic features. In this area even the slightest deformity or asymmetry is noticeable. Reconstructive surgery of this anatomical region aims to restore the tissue defect ensuring an appropriate aesthetic and functional feature, restoring colour, thickness and consistency of the replaced tissue. Orbicularis oculi myocutaneous flap is an option to reconstruct the medial canthal region; in this paper the authors present their experience with orbicularis oculi myocutaneous flap in 10 patients with medial canthal malignant lesions. The patients' postoperative period was uneventful, the flaps usually showed some degree of temporary venous congestion during the first days after surgery, and any donor site morbidity was observed: no lid lag, ectropion, ptosis, or other eyelid deformity. This flap offers a similarity in texture, colour, and thickness to the recipient site and a negligible incidence of donor site morbidity, and it can be easily tailored to fit the shape of the soft tissue defect.

Distally Prophylactic Lymphaticovenular Anastomoses after Axillary or Inguinal Complete Lymph Node Dissection Followed by Radiotherapy: A Case Series.

Background and Objectives: Lymphedema is an important and underestimated condition, and this progressive chronic disease has serious implications on patients' quality of life. The main goal of research would be to prevent lymphedema, instead of curing it. Patients receiving radiotherapy after lymph node dissection have a significantly higher risk of developing lymphedema. Through the prophylactic use of microsurgical lymphaticovenular anastomoses in selected patients, we could prevent the development of lymphedema. Materials and Methods: Six patients who underwent prophylactic lymphaticovenular anastomoses in a distal site to the axillary or groin region after axillary or inguinal complete lymph node dissection followed by radiotherapy were analyzed. Patients characteristics, comorbidities, operative details, postoperative complications and follow-up assessments were recorded. Results: Neither early nor late generic surgical complications were reported. We observed no lymphedema development throughout the post-surgical follow-up. In particular, we observed no increase in limb diameter measured at 1, 3, 6 and 12 months postoperatively. Conclusion: In our experience, performing LVA after axillary or groin lymphadenectomy and after adjuvant radiotherapy, and distally to the irradiated area, allows us to ensure the long-term patency of anastomoses in order to obtain the best results in terms of reducing the risk of iatrogenic lymphedema. This preliminary report is encouraging, and the adoption of our approach should be considered in selected patients.

Poland syndrome: an algorithm to select the appropriate chest wall surgical reconstructive treatment.

AIM: Poland syndrome is a constellation of rare congenital anomalies of the chest wall, with or without alterations to the ipsilateral superior extremity. Actually Foucras' classification is commonly used to choose the most appropriate surgical treatment, but often only a radiological classification proves unsatisfactory in order to achieve the best aesthetic result. MATERIAL AND METHODS: Since November 2006 in our institute have been treated 6 patients (3 M, 3 F) with Poland Syndrome affected by only chest wall and/or breast deformities. RESULTS: We treated 6 patients opting for different surgical procedures, depending on the deformity detected. We experienced only one procedural complication, a fat necrosis with superior migration of the prosthesis, successfully managed. DISCUSSION: Surgical alternative treatments of the Poland's abnormalities of the chest wall are independent from the corrective surgery of the ipsilateral affected forearm ad hand. Surgeons should be able to develop an operative plan to address aesthetic goals while preserving muscular functionality. Indeed surgical techniques should be minimally invasive and possible available in every hospital structure. CONCLUSIONS: This study has been designed to review a series of surgical options of breast reconstruction in patients with Poland Syndrome in order to develop a new flow chart to plan the best surgical choice analyzing only breast/chest wall deformities according to Blondeel's point of view about reconstruction of the new breast and thoracic wall. KEY WORDS: Breast reconstruction, Poland syndrome.

Commissural localization of squamocellular carcinoma of the lip Our experience.

AIM: Lip cancer is the most common malignant tumour of the oral cavity and the oral commissure is the origin of the tumour in 6% to 8.5% of cases. Reconstruction of oral commissure defects aims at securing oral competence and providing an acceptable appearance. Satisfactory reconstruction of defects affecting the lip commissure is always challenging. MATERIAL OF STUDY: The authors present a selected group of 22 patients, who, between November 2005 and 31st October 2012, underwent reconstruction for primary or secondary defects involving the oral commissure. RESULTS: The results were generally satisfactory, both functionally and cosmetically. The patients had been followed up for 5 years. CONCLUSIONS: All patients had excellent oral competence during rest, speaking and eating. Good sphinteric function was obtained in early postoperative days. No drooling or air leakage. The aesthetic results were good in all patients.

Evaluation of the sensitivity after reduction mammoplasty. Our experience and review of the literature.

AIM: The preservation of the sensitivity of the nipple-areola complex after reduction mammoplasty is an important goal of the modern surgery. The aim of this paper is to evaluate the differences in the recovery of sensitivity after reduction mammoplasty using different techniques. MATERIAL OF STUDY: Using the Semmes-Weinstein monofilament the sensitivity was evaluated in 64 patients undergone to a bilateral reduction mammoplasty: 36 were treated with inferior pedicle technique and 28 with a superior pedicle techniques. The evaluation of the sensitivity was performed in nine points: the nipple, the four quadrants of the areola and the 4 quadrants of the skin around the areola both in the preoperative and at 3 weeks, 3, 6 and 12 months postoperatively. RESULTS: The major alterations were found in the sensitivity of the nipple: the major deficiencies were seen in women treated with a superior pedicle techniques. Minor differences were found about the sensitivity of the areola and periareolar skin. CONCLUSION: The techniques which provide the preparation of a glandular flap with superior pedicle have an increased risk of altering the innervation of the nipple-areola complex. The preparation of a glandular flap with inferior pedicle allows the restoration of the pre-operative sensitivity in 6-12 months. KEY WORDS: Breast sensitivity, Reduction mammoplasty, Sensitivity alteration.

Negative pressure dressing in split-thickness skin grafts: experience with an alternative method.

BACKGROUND: The use of negative pressure in the dressing of splitthickness skin grafts has been shown to promote healing by a variety of mechanisms, including a decrease in interstitial edema, an increase in perfusion, and a decrease in bacterial colonization. METHODS: An observational study was performed on 52 patients at the Department of Plastic Surgery, University of Perugia in Perugia, Italy, undergoing split-thickness skin grafting for acute wounds after trauma and for chronic wounds, such as pressure ulcers and diabetic wounds. The dressing used consisted of a single foam sheet, a conventional disposable closed-system suction drain, and an adhesive dressing. RESULTS: In all patients, there was a 95% take of the graft, with 5% of partial loss. There were no significant complications encountered. CONCLUSIONS: Negative pressure wound therapy is an innovative and commercially successful concept for the management of difficultto- treat wounds of nearly every etiology, and the authors' technique is an alternative to commercially available negative pressure dressings..

Surgical treatment of upper eyelid coloboma: our experience.

AIM: The purpose of this paper is to evaluate the results obtained in the surgical treatment of upper eyelid coloboma with methods that do not involve a prolonged occlusion of the eye. MATERIAL OF STUDY: We treated five patients aged between 7 months and 21 years; the surgical techniques adopted were the direct closure (2 patients), the full-thickness graft from the contralateral upper eyelid (2 patients) and the nasal chondromucosal flap (1 patient). RESULTS: The results were good in all patients with vitality of all grafts and flaps; also absent were hematomas, seromas and infections. None of the patients developed amblyopia and lagophthalmos. DISCUSSION: The use of these methods prevents the development of some complications, such as amblyopia, occurring with the use of other techniques, as shown in the literature. In addition, allowing the reconstruction with similar tissues or very flexible and thin tissues provides greater functionality to the new eyelid. CONCLUSIONS: When possible, early intervention with the use of the described techniques will provide good results in the short and long term, allowing to avoid minimal complications which may arise from a prolonged occlusion of one eye.

[Reconstruction of full-thickness loss of substance of lower lip. Our experience]. / Ricostruzione delle perdite di sostanza a tutto spessore del labbro inferiore Nostra esperienza.

AIM: Many methods have been described for the reconstruction of the lower lip, but each has its own advantages and its disadvantages. The purpose of this study is to evaluate the results obtained with the use of different methods in order to choose the most appropriate method, according to the characteristics of the loss of substance. METHODS: From January 2006 to March 2011 were treated 110 patients with full-thickness loss of substance of the lower lip using various techniques: direct closure in small losses of substance (20 patients), Abbe flap (14 patients), Johanson technique (12 patients), Gillies fan flap (9 patients), Estlander flap (8 patients), Mc Gregor flap (11 patients), Karapandzic flap (18 patients), the nasolabial flap by Von Bruns (10 patients) and Bernard-Burow flap modified by Webster (8 patients). RESULTS: All flaps were vital and there were no cases of necrosis, infection, seromas or hematoma. Among the main complications, there was a delay in wound healing in 11 patients and the development of microstomia, of variable degrees, in 9 patients. The results from the aesthetic point of view were between good and satisfactory. CONCLUSIONS: The extension of the loss of substance is the main criterion that should direct the choice of an appropriate surgical technique: for larger defects reconstruction is less than optimal and obtain an adequate sphincter function is the main goal to achieve also with the use of near tissue.

[Polythelia and supernumerary breast. Personal experience and review of the literature]. / Politelia e mammella sopranumeraria. Nostra esperienza e revisione della letteratura.

AIM: Our study focuses on the approach, management and treatment of patients with polythelia and supernumerary breast and the target is the search for a treatment algorithm for these diseases. MATERIAL OF STUDY: We considered at 18 patients treated from 2006 to 2011 for breast congenital anomalies in excess. 14 surgical procedures were performed, 8 for supernumerary nipple excision (1 case associated with Poland Syndrome) and 6 for accessory breast ablation. All patients were aged between 15 and 34 years and belonged to both sexes. RESULTS: The breast tissue it was detected fibrocystic mastopathy in 5 cases of polimastia. In the remaining cases the nipples and mammary tissues were normal. After a median follow-up from one to five years, we obtained in all cases not only an excellent aesthetic result but also a psychological. DISCUSSION: The supernumerary breast tissue is not just a cosmetic problem, it is also subject to the same pathological lesions that are observed in a normal breast. In view of the potential malignant transformation of anomalous breast incidentally, early and accurate diagnosis is required as well as its monitoring over time. CONCLUSIONS. We therefore believe that surgical approach is always necessary in cases of polimastia, while considering options in the treatment of polythelia, where it becomes crucial if aesthetic and/or psychologically problems in the patient coexist.