Estudio preoperatorio de vasos receptores en reconstrucción mamaria con colgajo DIEP / Preoperative planning of receiver vessels in breast reconstruction with DIEP flap

El estudio preoperatorio vascular de cualquier colgajo microquirúrgico es esencial para el buen desarrollo del mismo. En el colgajo DIEP (colgajo de perforante de arteriaepigástrica inferior profunda) aplicado a la reconstrucción mamaria, se han establecido durante los últimos años diferentes técnicas para la planificación preoperatoria de la anatomía de los vasos perforantes de la arteriaepigástrica inferior. Sin embargo, pensamos, que también es muy importante la planificación anatómica preoperatoria de los vasos receptores, que en la mayoría de los casos son la arteria y vena mamarias internas. Estos vasos sufren en ocasiones variaciones anatómicas, llegando incluso a no existir en algunos pacientes. El conocimiento exacto de la localización, permeabilidad y calibre de estos vasos receptores hará que la intervención sea más rápida y sencilla (AU)

An accurate preoperative vascular evaluation of microsurgical flaps is essential for a good procedure. In DIEP (deep inferior epigastric perforator flap), in breast reconstruction, have been described different preoperative techniques to study the anatomy of the deep inferiorepigastric perforators. We think that preoperative planning of the receiver vessels, (internal mammary artery and vein, in most of cases) is very important too. These vessels have anatomic changes in some patients. To know the exact location, permeability, and calibre of these vessels will help us to have a more easy and quick operation (AU)

Use of a novel autologous cell-harvesting device to promote epithelialization and enhance appropriate pigmentation in scar reconstruction.

BACKGROUND: Epidermal replacement is an important step in the management of patients with post-traumatic and iatrogenic scars. Skin-colour variation from disease or trauma causes significant changes in self-image and appearance. AIM: The aim of our study was to analyse the results obtained with a novel autologous cell-harvesting system (ReCell) for epidermal replacement in patients with post-traumatic scars that had not improved with any other surgical procedure. METHODS: We recruited 30 patients with post-traumatic or iatrogenic scars admitted to our department over 2 years. The primary endpoints of the study were: (i) time for complete epithelialization (both treated area and biopsy site) and (ii) aesthetic and functional quality of the epitheliaization (colour, joint contractures). Infections, inflammations or any adverse effects of the procedure were also reported. RESULTS: In total, 30 patients were analysed. The aesthetic and functional outcomes were rated by both patient and surgeon. Pigmentation was rated by the Vancouver Scar Scale. Most (80%) of the patients had an excellent or good outcome, with pigmentation rated as normal in 60% of the group. CONCLUSIONS: The procedure is a feasible, simple and safe technique. It gives similar results to skin grafting but because it harvests from much smaller areas, can open possible future applications in the management of patients with large scars.

Bone-anchored implant in cosmetic finger reconstruction.

The majority of the patients, who underwent amputation of one or more fingers or present congenital absence of some phalanges, can be treated by microsurgical reconstruction. Several reconstructive techniques are available, but in some cases the use of osseous-integrated implants to anchor silicon digital prosthesis is a valid alternative. We present one case, a 27 years old male, affected by congenital hypoplasia of the second finger of the right hand who underwent reconstruction by prosthesis and extraoral bone-anchored implant.

A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns.

BACKGROUND: Our purpose was to directly compare results obtained with the ReCell system and the classic skin grafting for epidermal replacement in deep partial thickness burns. MATERIALS AND METHODS: We recruited all patients with deep partial thickness burns admitted at the Burn Centre of S. Eugenio Hospital in Rome over 2 years. Enrollment was conducted with a controlled strategy--sampling chart--that allowed homogeneous groups (ReCell and skin grafting) for age, gender, type of burns and total burn surface area (TBSA). We evaluated as primary endpoints of the study the (i) time for complete epithelization (both treated area and biopsy site) and (ii) aesthetic and functional quality of the epithelization (color, joint contractures). Secondary endpoints were the assessment of infections, inflammations or any adverse effects of the ReCell procedure, particular medications assumed, postoperative pain. RESULTS: Eighty-two patients were analyzed in two homogeneous groups. All of them received adequate epidermal replacement, but skin grafting was faster than ReCell (p<0.05). On the contrary, ReCell biopsy areas and postoperative pain were smaller than classic grafting (p<0.05). The aesthetic and functional outcomes were similar between procedures. CONCLUSIONS: ReCell is a feasible, simple and safe technique. It gives similar results to skin grafting but, harvesting minor areas, can open possible future applications in the management of large-burns patients.

The Maltese cross technique: umbilical reconstruction after dermolipectomy.

A simple and easy technique for reconstruction of the umbilicus was devised, with emphasis on forming walls of the umbilicus and a depression in a caudal direction. A quite satisfactory result was obtained. A permanent and sufficient depression for the umbilicus can be expected as a result of three-dimensional formation of walls. We also obtained a natural-looking neo-umbilicus.

Reconstruction of the nasal dorsum with autologous rib cartilage.

The authors present their experience with the correction of deformities of the nasal saddleback using rib cartilage grafts. They present a review of international literature on this topic, analyzing 33 patients selected from 452 cases of rhinoplasties performed between January 1990 and December 2004 at the Department of Plastic and Reconstructive Surgery of the University of Rome "Tor Vergata." Nasal saddleback is one of the most complicated defects to correct surgically. It can be a consequence of nasoethmoid-orbital fractures and is in this case associated with other evident signs like telecanthus, teleorbitism, or orbital dystopia. It can be also a consequence of surgical procedures in the nasal area where a loss of bone or septal cartilaginous support has occurred. They compare the techniques employed in the reconstruction and describe the advantage of the use of cartilage from the 11th rib and evaluate the results of an engineering analysis of tension forces on the rib cartilage. Of the total number of patients treated, good cosmetic results were obtained in 84% of the cases and excellent functional results in almost all of the cases (94%).

[Dilated cardiomyopathy secondary to idiopathic hypoparathyroidism in adults. Description of a case]. / Miocardiopatia dilatativa secondaria ad ipoparatiroidismo idiopatico dell'adulto. Descrizione di un caso.

The authors report the clinical history of a 56-year-old man with cardiomyopathy due to undiagnosed hypocalcemia. Heart dilation and hypokinesia were assessed by echocardiography. Cardiac failure was refractory to digitalis preparations and to diuretics. The restoration of serum calcium to normal levels obtained with adequate therapy dramatically improved the motion of ventricular walls and decreased the size of the left ventricle. The pathogenetic mechanisms of hypocalcemic cardiomyopathy are discussed and the importance of considering the possibility of hypocalcemia when dealing with the differential diagnosis of cardiomyopathies is underlined. In the presence of hypocalcemic cardiomyopathy, the correction of calcium deficiency with calcitriol is the treatment of choice.

Comparison of methods for the biodegradability evaluation of soluble and insoluble organochemicals.

Pyridine and nitrilotriacetic acid sodium salt as models of soluble compounds and linear dodecylbenzene, branched dodecylbenzene, and stearic acid as models of insoluble compounds were compared for their biodegradability in three tests: the ODCE modified test and the Sturm and enrichment culture tests. The degradation of soluble compounds was measured as dissolved organic carbon removal and CO2 evolution, while for the insoluble compounds, which were tested only in the Sturm test, CO2 evolution was determined. The individual tests were characterized by comparing their results with those obtained in the others. Comparable biodegradation values higher than 90% were obtained for the soluble compounds. The Sturm test proved to be very suitable for the evaluation of biodegradability of either soluble or insoluble compounds.