Two-Staged Frontal Bone Defect Reconstruction: Perioperative Assessment of Scalp Vascularization Using Near-Infrared Indocyanine Green Video Angiography (Visionsense Iridium).

BACKGROUND: Head trauma and neurosurgical-related osteomyelitis are common causes of cranial bone defect. Even though cranioplasty is considered a safe and well-consolidated procedure, there are still some issues about the flap's vascularization assessment. In this paper we describe a 2-staged cranioplasty procedure, focusing on the perioperative evaluation of the skin flap vascularization. Our goal is to assess if the skin flap's perfusion measurement with indocyanine green fluorescence can be considered a reliable method to predict good outcome in cranioplasties. CASE DESCRIPTION: A 50-year-old patient presented with a wide frontal bone defect due to a prior surgery-related osteomyelitis. During the first operation, a tissue expander was placed under the scalp in order to grant an appropriate skin stretching. During the second operation the defect was repaired with a custom-made prosthesis after tissue expander removal. During all procedures, vascular integrity of the skin flap was intraoperatively assessed by means of indocyanine green fluorescence. CONCLUSIONS: Surgical procedures were well tolerated; at 1 year of follow-up the cosmetic defect was unremarkable. Indocyanine green fluorescence can be a good aid to predict the probability of the skin flap survival by measuring its perfusion.

Extra-projected implants as an alternative surgical model for breast reconstruction. Implantation strategy and early results.

The present study reports on patients who underwent breast reconstructions with extra-projection implants. Two-hundred and thirty-four women were treated for 238 breast reconstructions irrespectively of breast shape and size. In this series we aimed to reconstruct for all women a bilateral cosmetic medium-size breast (between 400 and 500 cc), highly projected, with a little to moderate ptosis rather then a ptotic one exactly matching the contra-lateral. This is demonstrated by volume of implants that ranged from 397 cc for ladies with small breast who received an augmentation, to 533 cc for those who side required a reduction surgery. Eighty-six percent of patients received contra-lateral procedures. Complication rate was 8.4% and 66% of reconstructions were rated as good in the patients' opinion. Extra-projection implants, coupled with contra-lateral breast surgery, provide a good aesthetic outcome and avoid myocutaneous flaps only on the basis of breast size and shape.

Combined therapy with dabrafenib and trametinib in BRAF-mutated metastatic melanoma in a real-life setting: the INT Milan experience.

PURPOSE: Combination therapy with dabrafenib and trametinib is safer and more effective than BRAF inhibitor-based monotherapy for metastatic melanoma. METHODS: We retrospectively analyzed BRAF-mutated metastatic melanoma patients treated at our institution with daily oral dabrafenib 300 mg and trametinib 2 mg from November 2013 to April 2016. This clinical record included both untreated and previously treated stage IV melanomas. Physical examination and laboratory examinations were performed monthly and disease re-evaluations were performed every 3 months. RESULTS: A total of 48 patients (24 male, 24 female) with BRAF-mutated metastatic melanoma received dabrafenib and trametinib; median age was 48 years (range 23-75). Median follow-up was 362.5 days (range 72-879). Best overall response rate consisted of 6.2% (3 patients) complete response, 64.6% (31) partial response, and 25% (12) stable disease; median time to best response was 11 weeks (range 5.7-125.5). Progression of disease was seen in 19 patients (39.6%), with median time to progression (TTP) of 26 weeks (range 8-54). A total of 15 patients (31.2%) died due to progression of disease. Median progression-free survival and median overall survival were not reached. To date, 30 patients (62.5%) are still under treatment. A total of 27 (56.2%) patients had at least one adverse event (AE); grade 3-4 AEs were seen in 4 cases (8.3%). The main toxicities were fever (25%), skin rash (14.6%), arthralgias (10.4%), and aspartate aminotransferase/alanine aminotransferase increase (8.3%). Treatment dose was reduced in 7 subjects (14.6%), with only one case of discontinuation due to AE. CONCLUSIONS: Our data, using combined targeted therapy, are in line with the scientific literature in terms of both safety and effectiveness in a real-life setting.