Lipofilling after total parotidectomy: a useful option to prevent functional and aesthetic sequelae.

Objective: Parotidectomy is the main treatment for parotid tumours, but its functional and aesthetic sequelae can be very disturbing for patients. Methods: 15 patients underwent total conservative parotidectomy, harvesting of a superficial musculoaponeurotic system (SMAS) flap and lipofilling between May 2014 and June 2020 for a benign parotid tumour. Aesthetic, functional sequelae and cosmetic results were assessed with the House-Brackmann scale, Luna-Ortiz's classification and a semiquantitative questionnaire. Lipofilling resorption was analysed by maxillofacial and neck MRI imaging at 2 years after surgery. The results were compared to a group of 21 patients who underwent total parotidectomy without harvesting a SMAS flap and lipofilling. Results: No complications were observed. No facial defects were seen during follow-up. Post-operative MRI showed fat resorption was less than 20% in 12 patients and from 20 to 30% in 3 patients. Cosmetic satisfaction was 100% in all cases. Only 1 patient (6%) complained of Frey's syndrome. Conclusions: Lipofilling is an excellent solution considering its efficacy, safety, simplicity, duration over time and economic costs. Donor site invasiveness is minimal, and reintervention is always possible. Face-lift incision and SMAS flap can improve aesthetic results and minimise the disfiguring impact of the surgical scar.

Videocapillaroscopy in postburn scars: in vivo analysis of the microcirculation.

OBJECTIVE: The aim of the study was the evaluation in vivo of the differences between the microcirculatory characteristics of the postburn scar and the healthy skin. METHODS: Twelve patients with postburn scars were included in the study, evaluating fifteen scar areas and twelve healthy skin areas by means of contact optical probe videocapillaroscopy. The examined areas for each patient were the right and the left upper limb. Capillary density, length and diameter, together with capillary distribution pattern (punctiform, reticular, directional) and the presence of microhaemorrhages and neoangiogenesis were studied. RESULTS: The results were obtained by two different researchers using the capillaroscope's software. Capillary loop diameter and length, capillary distribution pattern and presence of neoangiogenesis were found to be significantly increased in postburn scars compared with controls. There were also significant differences between hypertrophic tissue in the active phase and the one in the remission phase for capillary diameter and presence of neoangiogenesis. CONCLUSION: Videocapillaroscopy showed "in vivo" a change in local microcirculation architecture using a microscope. Patients with hypertrophic burn scars showed a variety of microcirculatory changes, often clustered in a characteristic pattern of abnormally oriented, dilated capillaries and neoangiogenetic phenomena. This methodology is highly likely to be of value in the assessment and prognostication of burn outcome.

Accuracy of 18F-FDG-PET/CT for staging of oral squamous cell carcinoma.

BACKGROUND: This study prospectively assessed 2-[F18]-fluoro-2-deoxy-D-glucose-positron emission tomography (18F-FDG-PET)/CT (PET/CT) in oral squamous cell carcinoma. METHODS: Twenty-three patients completed preoperative TNM staging (CT, MR, whole-body fusion imaging PET/CT). In patients who underwent surgical therapy (19 of 23), TNM staging based on PET/CT scan was compared with pTNM. RESULTS: PET/CT correctly staged 16 of 19 primary tumors (accuracy 84.2%, sensitivity 84.2%, positive predictive value 100%) and correctly ruled out bone invasion in 3 patients with false-positive results according to CT and/or MR. PET/CT incorrectly identified neck involvement in 5 of 15 patients (3 false positives, 2 false negatives) who underwent neck dissection (accuracy 66.7%, specificity 76.9%, negative predictive value 83.3%). False-negative cases showed a nodal size not exceeding 10 mm. One patient with a bronchial synchronous primary tumor was identified. CONCLUSION: PET/CT scan showed good accuracy in determining the extension and/or depth of invasion of the primary tumor. Nevertheless, PET/CT was not accurate to rule out nodal metastases.

Acute complex traumas of the lower limbs: a modern reconstructive approach with negative pressure therapy.

Acute traumas of the lower limbs cause complex functional damage for the association of skin loss with exposed tendons, bones, and/or vessels, requiring a multidisciplinary approach. Once bone fixation and vascular repair have been carried out, the surgical treatment for skin damage is usually based on early coverage with conventional or microsurgical flaps. Negative pressure therapy can play a primary role in the management of the elderly or intensive care patients, where wounds are secondary to life-threatening problems. A total of 35 patients with 37 acute traumatic wounds of the lower limbs were treated with vacuum-assisted closure (VAC) therapy for an average of 22 days (range 3-46 days). The sponge was applied the day after bone fixation, vascular repair, and surgical debridement of nonviable tissues, so as to obtain a better control of bleeding. After VAC treatment, all patients quickly developed healthy granulation tissue and a significant reduction in both extent and depth of wounds. Split-thickness skin grafts were used to cover granulation tissue in most of the cases (66% -- 24 cases), and then local flaps (13% -- five cases) or direct sutures (8% -- three cases). The wounds healed spontaneously without surgical management in four patients. One patient died during the treatment period for concomitant diseases. No relevant complications directly related to VAC therapy were observed other than one case of severe pain in an amputated stump. The average follow-up duration was 265 days (range 33-874 days). No further tegumentary reconstruction was required. VAC therapy may represent a valid alternative to immediate reconstruction in selected cases of acute complex traumas of the lower limb and allows for a stable functional result, using a minimally invasive approach.

Neurotube for facial nerve repair.

Facial nerve reconstruction for lesions with nerve gaps frequently require autologous or tubulized grafts of biological or synthetic origin. Neurotube, a bioabsorbable polyglycolic acid tube, represents a valid solution for this kind of defect in emergency and planned surgery. Seven posttraumatic lesions of terminal branches of the facial nerve were repaired by means of Neurotube from September 1999-September 2001. The nerve gap size ranged between 1-3 cm. Nerve regeneration was evaluated at 7-12 months of follow-up when muscle recovery function was examined. Muscle function was very good in 1 case, good in 4, and fair in 2 (71% positive results). No intolerance or discomfort was reported or observed. Neurotube is useful for the reconstruction of facial nerve lesions with a small nerve gap (less then 3 cm) when a direct anastomosis of the two stumps is not possible, or when the suture appears to be in tension. It is a valid alternative to autologous and biological tubulized grafts. The limits of this method are: 1) it can only be used with gaps of less than 3 cm; 2) it is quite costly; 3) there are reports of possible intolerance; and 4) it is not suitable for lesions of the proximal part of the facial nerve.