Inverted Nipple Treatment and Poliglecaprone Spacer.

INTRODUCTION: Nipple inversion is defined as a non-projectile nipple. It is a frequent pathologic condition, in which the whole nipple, or a portion of its, is buried inward towards the lactiferous duct and lies below the plane of the areola. Numerous strategies have been described to correct nipple inversion. All the procedures have the purpose to give a good shape to the nipple, preserving its function and sensitivity, when it is possible. To avoid recurrences and to obtain good aesthetic results, we present a modified percutaneous technique. METHOD: We performed a retrospective study between 2011 and 2016 and included all the cases of inverted nipples treated in our department. Our modified percutaneous technique consists of a minimal incision supported by a percutaneous suture as a temporary spacer to fill the defect caused by releasing the fibro-ductal bands. RESULTS: A total of 41 cases of inverted nipples were corrected in 32 patients. After 1 year of follow-up, no recurrence was observed and all nipples maintained complete eversion. There was only one case of partial unilateral necrosis in a patient who underwent tumorectomy and radiotherapy. All patients were satisfied with the aesthetic outcomes. CONCLUSION: This is a simple, safe and cheap technique that should be considered as a reliable method for long-term correction of nipple inversion. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Venous Supercharging Reduces Complications and Improves Outcomes of Distally Based Sural Flaps.

Background The use of distally based neurocutaneous sural flaps (DBNCSF) is one of the most common methods of reconstructing the distal lower leg. However, they have developed a bad reputation because of their propensity for venous engorgement. Venous congestion that can lead to distal necrosis can be prevented by venous supercharging. Using a prospective comparative study, we thus explored the effect of venous supercharging on the reliability of these useful workhorse flaps. Methods We prospectively included 38 patients who received a conventional DBNCSF and 38 patients who received a supercharged version of this flap (sDBNCSF) between January 2012 and July 2016. Results No significant difference was identified between the groups in terms of age, sex, comorbidity, or defect origin. The main reconstruction etiology was traumatic (open fracture, scar disunion, and chronic osteitis). The flap size was noticeably larger in the sDBNCSF group, albeit without significance. The length-width ratio was significantly greater in the sDBNCSF group (6.08 vs. 5.53, p = 0.022). Venous congestion was significantly more common in the non-supercharged group (28.6 vs. 2.6%, p = 0.01), as was coverage failure (23.7 vs. 2.6%, p = 0.035). Conclusion There are significant benefits to using venous supercharging of DBNCSF, when technically feasible. In our experience, venous supercharging increases reliability, allows the raise of larger skin paddles with much narrower pedicles limiting the morbidity of the procedure, and improves the functional and esthetic results.

Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume.

INTRODUCTION: The concept of extended thoracodorsal artery perforator (TDAP) flap was described in 2015 for breast reconstruction. Our anatomical study aims to identify the territories vascularised by the thoracodorsal artery perforator via the deep muscular fascial network. The second goal was to define the volume of the extended TDAP flap. MATERIALS AND METHOD: Ten extended TDAP flaps were dissected on 5 fresh human cadavers. Around the classical skin paddle of a TDAP flap, the dissections were performed in a subfascial level, including the muscular fascia and the adipose tissue compartments to increase the volume of the flap. After injection of methylene blue in the thoracodorsal artery, we measured the length and width, the surface and the volume of the coloured flap. RESULTS: The mean sizes of the extended TDAP flap were 24.9 cm × 20.1 cm. The mean surface of the total vascularization zone was 441 cm2. The mean volume of the vascularized flap was 193 ml. CONCLUSION: The thoracodorsal artery perforator via the deep muscular fascial network allows us to harvest a flap of 25 cm × 20 cm with a mean surface of 441 cm² and a mean volume of 193 ml. The extended TDAP flap is a credible option in breast reconstruction.

Histopathological aspects of some rare forms of facial basal cell carcinoma.

AIM: The main objective of the study was to highlight the histopathological aspects of some rare forms of facial basal cell carcinomas. PATIENTS, MATERIALS AND METHODS: The 65 selected patients were diagnosed with head basal cell carcinoma (BCC), during 2011-2013, and they underwent surgery. The excised tumor tissue fragments were processed for paraffin embedding and stained with Hematoxylin-Eosin (HE), Masson's trichrome with Aniline Blue, and Alcian Blue-Periodic Acid Schiff (AB-PAS). RESULTS: The youngest patient was 23 years old, while the oldest was 91 years. The facial BCC there was slightly higher prevalence in males of 34 out of 65 cases. Histopathologically, great varieties of morphological types have been identified in the 65 cases investigated. According to our data, by far the most common are nodular BCCs type, which represented 44.6% from the investigated cases, followed at some distance by morpheiform and superficial subtypes with 13.8% and 10.7%, respectively. The most rare cases of facial BCCs were: cystic, adenoid, fibroepithelial and basal with adnexal differentiation with in one single case each. Relatively rare were the following varieties: pigmented (four cases), combinations of several forms (four cases), metatypical (three cases), keratotic (three cases), and micronodular (two cases). CONCLUSIONS: Within the limits of this study, the data reported here shown that such a lesional pleomorphism very often requires to make a careful differential diagnosis with a number of other tumor or non-tumor entities.

A new option for autologous anterior chest wall reconstruction: the composite thoracodorsal artery perforator flap.

Sternal chondrosarcoma is rare and often requires total or subtotal sternectomy. The authors describe the case of a 70-year-old man with sternoclavicular joint chondrosarcoma who underwent subtotal sternectomy with partial resection of the two clavicles and anterior arches of first to third right ribs. Anterior chest wall reconstruction was performed with a composite thoracodorsal artery perforator free flap with sixth and seventh ribs vascularized on serratus muscle. The postoperative course was uneventful. Seven months after surgery, the patient was doing well. This surgical procedure is a new option for autologous reconstruction without prosthetic material after extensive sternectomy.