Preparing Patients for Cosmetic Surgery and Aesthetic Procedures: Ensuring an Optimal Nutritional Status for Successful Results.

Aesthetic and cosmetic medical practices have attracted considerable consumer attention globally. However, possible complications vary and range from mild, self-resolving ecchymoses or edema to more persistent complications. The aim of this review is to identify the nutritional deficits or excesses associated with the major complications of reconstructive surgery, aesthetic surgery, and mini-invasive aesthetic procedures. An additional goal is to provide a bundle of actions for professionals working in the industry in order to reduce the risks of aesthetic procedures and improve the clinical outcomes. Granulomas, hypertrophic scars and keloids, seromas, infections and xerosis, hyperpigmentation, petechiae, livedo reticularis, slower wound healing, and other poor outcomes are frequently associated with nutritional deficiencies. Nutritional status can markedly affect wound healing and tissue repair following surgical interventions, as well as the outcomes of aesthetic and cosmetic medical practices. Professionals working in this industry, therefore, need to consider the nutritional aspects of their patients to obtain the best results.

HMGA1 and MMP-11 Are Overexpressed in Human Non-melanoma Skin Cancer.

BACKGROUND/AIM: The High-Mobility Group A1 (HMGA1) protein has been implicated in human malignancies, playing an important role in cancer proliferation, angiogenesis and metastasis. Increased HMGA1 expression has been found in skin mouse tumors, whereas Hmga1-null mice were protected against skin carcinogenesis. Here, we examined the expression of HMGA1 in human skin tumors, squamous cell carcinoma and basal cell carcinoma. MATERIALS AND METHODS: Tumor and normal skin tissues from 15 affected patients were surgically excised, and mRNA and protein extraction was performed. mRNA and protein content for both HMGA1 and MMP-11, a proteinase enzyme that plays a role in tumor development and progression, was measured by real-time PCR and western blotting, respectively. Data were analyzed by the SPSS software. RESULTS: HMGA1 mRNA and protein expression patterns were higher in neoplastic skin lesions, compared to normal skin (p<0.001). Similar results were observed for MMP-11. CONCLUSION: Our data confirm previous observations in mice studies, and suggest that HMGA1 and MMP-11 may play a key role in the proliferation and progression of skin tumors in humans.

Two-Thirds Lip Defects: A New Combined Reconstructive Technique for Patients With Epithelial Cancer.

BACKGROUND: The lips are a common site prone to squamous cell carcinomas, which arise in the facial region. There are different techniques to reconstruct the excised lip region, according to dimensions, area, and position of the tumor. The authors describe a new technique of lip reconstruction born from a combination between a nasolabial flap and adipose tissue transplant. METHODS: The study was lead in the Plastic and Reconstructive Surgery Department of the University of Catanzaro. It includes 10 patients with squamous and basal cell carcinomas that interested lower or upper lip. The authors used a nasolabial flap to reconstruct two-thirds of the excised lip. All patients were staged and resulted free of disease. As a result of surgery, deformities and depressions persisted in 5 patients. This induced the authors to subject them to transplantation of adipose tissue to maximize results. Aesthetic and functional evaluation was performed with the Patient and Observer Scar Assessment Scale v 2.0 and drooling rating scale questionnaires. Moreover, an anthropometric analysis was performed in patients treated with fat transplant. Data were analyzed using Wilcoxon signed-rank test. RESULTS: All patients had an acceptable aesthetic and functional outcome. Oral competence, sensation, and movements of the area were adequate and aesthetic was good. Adipose tissue transplant compared with surgery alone, determine a real modification of various parameters, that was statistically significant (P = 0.043) to our analysis. CONCLUSIONS: The inverted nasolabial flap is versatile and simple. This technique allows to repair large lip defects by maintaining the eurythmia of the face. Autologous fat transplant is a favorable filler. Our data show that surgery alone is unable to restore face eurythmia after a tumor excision. Adipose tissue transplant allows to reach this goal. These 2 techniques, together, may significantly modify the functional and aesthetic result of the lip reconstruction, ensuring an optimal long-term result.

Surgical strategies for cutaneous neoplasm of the scalp. State of art.

AIM: Scalp reconstruction has always been a challenging task, in particular after oncological demolition and this article gives an overview on the state of the art in scalp reconstruction strategies. MATERIAL OF STUDY: We elaborated a systematic algorithm for scalp reconstruction based on location and size defects, presence or absence of periosteum, bone involvement, the quality of surrounding scalp tissue, the presence or absence of hair, location of the hairline, patient comorbidities and different procedures commonly used in plastic surgery. RESULTS: Our algorithm allows plastic surgeons to perform scalp reconstruction after the most devastating of defects. DISCUSSION: Successful reconstruction of the scalp requires careful preoperative planning and detailed knowledge of scalp anatomy, hair physiology, variety of available local tissue and plastic surgery procedures as well as synthetic substitutes or products provided by tissue engineering. CONCLUSION: However, the challenge today is to do so with excellent cosmetic results.

Abdominal desmoid tumors. A new reconstructive approach.

INTRODUCTION: Desmoid tumors are rare soft tissue tumors derived from musculoaponeurotic structures of the abdominal wall musculature. Although they are considered benign tumors because they don't metastasize to other parts of the body, they are clinically considered as malignant for their high tendency on infiltrative growth with local invasion and trend to recurrence after local excision. Several reconstructive techniques are proposed in the literature. METHODS: Nine female patients with abdominal desmoid tumors underwent the removal of a mass of tissue running from the skin to peritoneum near the tumor with a safety margin in macroscopically normal tissue at least of 5 centimeters from the edge of the tumor. After wide excision, a polypropylene mesh was placed in the rear muscular pocket without anchoring suture (sliding mesh sutureless hernioplasty) RESULTS: No patients had perioperative complications or abdominal wall weakness or an incisional hernia in the following 5 years. CONCLUSIONS: We consider this technique of abdominal wall reconstruction after desmoid tumor removal a simple procedure that reduces relapsing events and recurrences of abdominal hernia, reducing tension and pain caused by the traditional suture repair technique. LEVEL OF EVIDENCE: IV.

Skin grafting followed by low-molecular-weight heparin long-term therapy in chronic venous leg ulcers.

BACKGROUND: Venous leg ulcers are responsible for more than half of lower extremity ulcerations, with an overall prevalence ranging from 0.06 to 2% in the general population. METHODS: A total number of 120 patients with chronic venous leg ulcers (CEAP C6), secondary to primary chronic venous insufficiency, were recruited (81 F, 39 M, age range: 50-79, mean age: 64.6). All patients enrolled in this study had wounds that had failed to heal for more than 2 months and were refractory to conventional medical and physical therapy. Sixty patients (group A) underwent skin grafting followed by low-molecular-weight heparin long-term therapy. Sixty patients (group B) underwent skin grafting as sole procedure. The follow-up was of 5 years. RESULTS: At hospital discharge, all patients had healed ulcers. In group A, at 5 years, about 90% of the ulcers remained healed. In group B, at 5 years, about 56% of the ulcers remained healed. CONCLUSIONS: In our experience, long-term treatment with low-molecular-weight heparin seems to have improved early and late results of patients, who underwent reconstructive surgery for chronic venous ulcer; 90% of the ulcers remained healed at 5 years of follow-up. Probably, extracellular matrix-modulating treatments, such as heparin administration, may complete the management strategy for difficult-to-heal or chronic wounds.

A new technique of upper eyelid blepharoplasty using the orbicularis muscle flap.

BACKGROUND: Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. The orbicularis muscle flap technique provides good results for patients with atonic skin and an atonic orbicularis muscle when there is excessive fullness in the lateral aspect of the upper lid. This flap also can be used to contain a prominent lacrimal gland or retro-orbicularis oculi fat (ROOF) without dangerous removal of the last one. METHODS: A total of 30 patients underwent upper lid blepharoplasty through a supratarsal incision approach. Dissection of the orbicularis muscle flap was made 5-8 mm above the supratarsal fold. Before the muscle flap suspension, the excess skin and fat pad were removed. The flap suspension was achieved with its rotation and motion of a tunnel in the suborbicularis plane, which anchored it on the periosteum of the orbital lateral rim of the frontal bone with a permanent suture. RESULTS: This technique restores the sharp and crisp tarsal folds and pretarsal show with deepening of the orbitopalpebral sulcus. The orbicularis muscle flap also can be proposed for cases with a ptosis of the lateral upper lid. The authors believe this technique reduces the risk for "rounding" of the eyelid and produces better contact of the lid with the ocular globe. CONCLUSIONS: The orbicularis muscle flap procedure is a feasible technique that can be used reliably to reshape the lateral upper lid. It would be a useful addition to the armamentarium of the plastic surgeon who is called on to perform upper blepharoplasty.

The primacy of the Vianeo family in the invention of nasal reconstruction technique.

The birth of plastic surgery is identified with the history of rhinoplasty, which was practiced in ancient India when nose amputations were a common practice. Nose reconstruction was the most frequent surgical operation required in India at that time, and it was based on the use of a forehead flap and called an Indian method. The revolution of this technique took place in the south of Italy in the 15th century with the introduction of "the Italian method" invented by 2 families: the Brancas from Sicily and the Vianeos from Calabria. In our opinion, many questions remain as to why the Branca and Vianeo families began nose reconstruction; how and from whom they learned this technique; and which of the 2 families was first to practice it. Gustavo Branca has been always considered as the inventor of the Italian method. Historical references date Brancas in the first half of 15th century and Vianeos in the second half of the same century, but the dates can be inverted. Vianeos are no more the successor, but they are contemporary or immediately predecessors because by our documentation Vincenzo Vianeo, first surgeon of his family, performed rhinoplasty operation in the early years of the 15th century.

[Fournier's gangrene. A case report]. / Espressività clinica della sindrome di fournier. A proposito di un caso.

Fournier's gangrene is a rare pathology, whose aetiopathogenesis is very varied and much debated. In most cases, it occurs in debilitated patients with chronic diseases involving tissue ischaemia. Despite substantial progress in scientific research, it carries a high mortality rate because of the rapidity with which it sets in and evolves, presenting therefore as a medical and surgical emergency. Although this syndrome has long beenknown, it is still difficult to treat and the subject of considerable debate. The authors report a case of Fournier's gangrene of an idiopathic nature, not corresponding to any of the forms described in the literature, which gave rise to a number of medical and surgical considerations, demonstrating the importance of prompt treatment capable of arresting its course and preparing the affected areas for reconstructive surgery.