Infrahyoid myocutaneous flap in head and neck reconstruction: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to analyse the literature on the infrahyoid myocutaneous flap (IHMCF) and evaluate its clinical outcomes. The MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus databases were searched (inception to December 31, 2021). Meta-analyses were then conducted to estimate the overall rates of partial flap loss, total flap loss, salivary fistula, and surgical revision. The 21 studies that met the inclusion criteria included 768 patients undergoing head and neck reconstruction with 773 IHMCF. The oral cavity (77.7%) and oropharynx (13.0%) were the most reconstructed sites. The meta-analyses estimated a pooled partial flap loss rate of 10.4% (99% confidence interval (CI) 5.4-16.7%), total loss rate of 1.8% (99% CI 0.8-3.2%), salivary fistula rate of 3.0% (99% CI 1.3-5.3%), and surgical revision rate of 1.9% (99% CI 0.7-3.7%). Fast flap harvesting and low donor site morbidity were other flap features. Previous thyroid surgery or neck dissection and advanced lymph nodal stage were considered contraindications to IHMCF reconstruction by most authors, while prior neck radiotherapy was reported as a relative contraindication. This pedicled cervical flap is a versatile and reliable reconstructive option for medium-sized head and neck defects. Careful preoperative assessment of the neck condition allows for its safe use.

A novel technique for decellularization of allogenic nerves and in vivo study of their use for peripheral nerve reconstruction.

Autografts represent the gold standard for peripheral nerve reconstruction but their limited availability, the discrepancy of nerve caliber, and long surgical times are drawbacks. Allografts have therefore become a valid alternative option. In particular, acellular nerve allografts (ANAs) rather than fresh allografts do not need immunosuppression and appear to be safe and effective based on recent studies. An innovative method was conceived to obtain ANAs, so as to speed up nerve decellularization, without compromising nerve architecture, and without breaking the asepsis chain. Several detergent-based techniques, integrated with sonication and mechanical stirring, were tested in vitro on rabbit nerves, to identify, by microscopy and immunohistochemistry, the most effective protocol in terms of cell lysis and cellular debris clearance, while maintaining nerve architecture. Furthermore, a pilot in vivo study was performed: ANAs were implanted into tibial nerve defects of three rabbits, and autografts, representing the gold standard, in other three animals. Twelve weeks postoperatively, rabbits were clinically evaluated and euthanasized; grafts were harvested and microscopically and histomorphometrically analyzed. The method proved to be effective in vitro: the treatment removed axons, myelin and cells, without altering nerve architecture. The in vivo study did not reveal any adverse effect: animals maintained normal weight and function of posterior limb during the entire experimental time. A mild fibrotic reaction was observed, macrophages and leukocytes were rare or absent; ANAs regenerated fascicles and bundles were comparable versus autografts. Based on these results, this decellularization protocol is encouraging and deserves deeper investigations with further preclinical and clinical studies. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2228-2240, 2017.

Modified round block mastopexy versus traditional round block mastopexy.

OBJECTIVE: Breast ptosis may be caused by several factors, including significant weight loss, pregnancy, long breastfeeding periods, and involution of the postmenopausal breast tissue. The authors performed a prospective study to evaluate patient satisfaction and the rate of complications after modified round block mastopexy versus traditional round block mastopexy. PATIENTS AND METHODS: Forty-four patients fulfilled the inclusion criteria for undergoing round block mastopexy in a prospective randomized controlled study performed from 2007 to 2008. All the patients received polyurethane silicone implants. Group A included patients who underwent the traditional round block technique described by Benelli. Group B included patients who underwent the traditional round block and 4 cardinal glando-glandular permanent sutures. The overall satisfaction with body appearance after breast mastopexy was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). RESULTS: Group A patient ages ranged from 28 to 52 years and in Group B ranged from 29 to 49 years. The mean implant volume was 215 cc in both Groups. The complication and satisfaction rates for both Groups are reported. CONCLUSIONS: The combination of the cardinal glandulo-glandular sutures along with the traditional round block appears to be key to preventing the areolar enlargement and persistent breast ptosis. The satisfaction rates in patients who underwent the modified round mastopexy appear superior when compared to the traditional round block mastopexy. Furhter long-term follow-up need to be performed in order to confirm the favorable results seen in this series of cases.

Acral Lentiginous Melanoma - misdiagnosis, referral delay and 5 years specific survival according to site.

OBJECTIVES: Acral lentiginous melanoma (ALM) is a defined histopathological entity with peculiar clinical-pathological features and is the most common subtype of malignant melanoma in acral locations. The 5-year survival rate is lower than that for all cutaneous malignant melanoma overall (80.3% versus 91.3%). Controversy exists in the literature as to whether this worse prognosis is attributable to a more aggressive biological nature or to difficult-to-see sites and consequent advanced stage at the time of diagnosis. The main purpose of the study was to explore any prognostic difference according to upper limb or lower limb localizations, based on the hypothesis that upper limb localizations might receive attention sooner than lower limb localizations. PATIENTS AND METHODS: A cohort longitudinal study was performed through a retrospective review of all patients consecutively referred to our Unit with histological confirmation of ALM. Data were collected from a 10 year period between 1996 and 2006 to allow determination of 5 year survival statistics. RESULTS: Out of 87 patients included in the study, 32 were men (37%) and 55 were women 63%. The average number of months it took for patients to present was 62 months with a mode of 12 months. Overall 5 year survival was 80% and a multivariate analysis showed that the most reliable prognostic indicators are the Breslow's thickness and the margins of complete excision. When controlling the survival rates for Breslow thickness, the values were similar to the reported rates indicated in the recent literature for cutaneous malignant melanoma. CONCLUSIONS: The higher aggressiveness of ALM was noticed to be attributable to a later stage and more advanced thickness at diagnosis. No significant difference was found between upper and lower limb localization in terms of prognosis.

A retrospective study on mesh repair alone vs. mesh repair plus pedicle flap for large incisional hernias.

OBJECTIVE: Our experience with the treatment of large incisional hernias (IH) was reviewed comparing mesh repair alone vs. mesh repair plus pedicle flaps. MATERIALS AND METHODS: A retrospective study was performed on patients treated between 2001 and 2005 that underwent component separation technique (CST) repair with polypropylene mesh alone or with polypropylene mesh and local "pedicle" dermal flaps. The primary outcome evaluated was the recurrence rate, secondary outcomes the complication rate, hospital stay and reoperation rate. RESULTS: Forty-eight patients were reviewed. Six patients (13%) developed an IH recurrence, two of them (4%) required secondary repair. CST combined with prosthetic mesh repair and pedicle flap was performed in 19 patients (39.6%) while CST combined with mesh repair alone in 29 patients (60.4%). The duration of surgery, hospitalization, postoperative complications as well as long-term results were similar. CONCLUSIONS: Dermal pedicled flaps obtained through deepithelization of redundant skin following corrections of large incisional hernias are a safe, relatively easy and effective technique that allows reliable soft tissue coverage of the abdominal submuscular mesh.

Thirtyfour years of liposuction: past, present and future.

Initial, variably successful attempts of fat sculpting date back to the beginning of the 20th Century, but Gerard Illouz was the first to introduce the modern, safe, widespread method of liposuction. Preoperative injection of local anaesthesia, saline, distilled water, adrenaline and hyaluronidase, defined wet technique, established as a safe and effective adjunct to lipoaspiration. This procedure was initially based on an automatic pump system, but then the accuracy of syringe aspiration was popularized by Toledo in the eighties. Liposuction in the subcutaneous tissue, just 3-4 mm deep to dermis, also called superficial liposuction, is a modern effective evolution of the technique, but requires a good mastery in order to avoid disfiguring outcomes. Ultrasound and laser lipoplasty methods have provided further advancement in the range of technical choices offered to the plastic surgeon. Liposuction is a purely surgical procedure, and as such, carries risks of minor and major complications. In the nineties, an interplay between abdominoplasty and abdominal liposuction as simultaneous procedures, also called lipoabdominoplasty, has become more and more popular. Reinjection of the harvested fat with the purpose of liposculpture for both reconstructive and cosmetic indications is a relatively recent development which has established as a successful, world-wide accepted procedure. Adipose stem cells, extracted from the unlimited source represented by human adipose tissue, are a great promise for future tissue-engineering. Liposuction has nowadays become a safe, effective, popular procedure for contouring adipose tissue and human body in general, in many reconstructive and cosmetic indications.

Limb contouring after massive weight loss: functional rather than aesthetic improvement.

BACKGROUND: After massive weight loss, both upper and lower limbs show a similar deformity which consists of redundancy and ptosis of the cutaneous mantle. Many disturbances are associated with this abnormality, which can be treated surgically. A retrospective review of limb-contouring procedures after massive weight loss is presented. METHODS: Thigh lift and arm lift procedures are described. All surgeries of upper and lower limbs contouring performed between 2003 and 2006 are reviewed with regard to quantity of tissue removed, comorbidities, complications and patients' satisfaction, which was surveyed through a questionnaire exploring functional and esthetic results (maximum score 3). RESULTS: Among 48 bilateral limb-contouring procedures, medial thigh lifts were 35 (73%) and brachioplasties were 13 (27%). Mean age was 46 and average body mass index variation was 20 kg/m(2). The most frequent comorbidity was gallstones (28%). In 46% of the whole group of patients, there was no complication to mention. The most frequent complication was acute anaemia in both procedures (43% in thigh lift and 54% in arm lift). Mean quantity of adipose-dermoid tissue removed was 766 g in thigh lift and 463 g in arm lift. In case of surgery combined with liposuction, the average aspirated volume was 1,933 ml (thighs) and 1,117 ml (arms). Patients' satisfaction was 2.7 for thighs and 2.6 for arms, as average. CONCLUSION: The rate of complications in limb contouring after weight loss is higher than the analogue esthetic procedures. Nevertheless, due to the rehabilitative significance of limb surgery after weight loss, this step is to be included as fundamental in obese patients' surgical therapy.

[The correlation between morphology, electrolytic content and risk factors in breast cysts]. / Correlazione tra morfologia, contenuto elettrolitico e fattori di rischio nelle cisti mammarie.

Many studies on the biochemical composition of the liquid aspirated from breast cysts have identified three types of cysts: type I (apocrine) cysts, with a high concentration of K+ and low levels of Na+ and C1-; type II (transudate) cysts, with an electrolytic content similar to that of plasma and high Na+ levels and, finally, type III cysts, with intermediate characteristics. The literature data appear to indicate that the women with type I cysts are at higher risk for breast cancer. The authors report the results of a study carried out on 143 women from October, 1991, through October, 1994, in the Radiology Department of the University of Bologna, to investigate the correlations between some risk factors for breast cancer, the characteristics of cyst fluid and the morphology of the cysts after pneumocystography. Of 186 cysts, 104 (55.9%) were type I, 49 (26.4%) were type II, and 33 (17.7%) were type III. Among the risk factors we considered, only the premenopausal state (41 to 45 years of age) exhibited a statistically significant correlation with the presence of type I cysts. The morphological study of the cysts after pneumocystography showed a surprisingly high correlation between the honeycomb pattern and type I cysts. The constant correlation between cyst morphology and electrolytic content may allow the easy identification of the subgroups of patients eligible for a closer follow-up.

[Transrectal ultrasonography in the study of recurrences in patients surgically treated for rectal neoplasms]. / Studio mediante ecografia transrettale delle recidive nei pazienti operati per neoplasia rettale.

The value of transrectal US is known in the preoperative staging of rectal cancer but remains debated in the follow-up of the patients submitted to anterior resection or local therapy. The authors report their experience with the postoperative follow-up of 80 patients submitted to 125 transrectal US exams to study method reliability. The results were 9 true positive, 2 false positive, 113 true negative and 1 false negative cases, with 90% sensitivity, 98.3% specificity and 97.6% accuracy rates. Positive predictive value was 81.8% and negative predictive values was 99.1%. Twelve patients were submitted also to MRI which correctly diagnosed one false negative result of transrectal US. Twenty-one patients were examined also with transrectal Doppler and color-Doppler US: in rectal cancer recurrences the peak velocity of hemorrhoid vascular flow was higher than in non-recurrent patients. On the basis of our results, transrectal US deserves to be included in the postoperative follow-up of the patients submitted to anterior resection or to local therapy for rectal cancer. Moreover, according to our preliminary findings, Doppler and color-Doppler US can improve transrectal US reliability in detecting local recurrences.

Microalbuminuria in diabetic children and adolescents. Relationship with puberty and growth hormone.

Urinary albumin excretion (UAE) was determined by radioimmunoassay in two 24 h urine collections from 125 diabetic children and adolescents and from 71 normal children matched for age and sex. Thirteen patients (10.4%) aged greater than 12 years had microalbuminuria, i.e. log transformed UAE levels above the upper normal range (24.5 mg/24 h). UAE values were positively correlated with age, GH secretion, but not with duration of disease, glycosylated hemoglobin, renal size or N-acetyl-beta-glucosaminidase excretion. Diabetic normoalbuminuric children aged 10 years and older had significantly higher UAE than controls and than younger diabetic patients matched for duration of disease. HLA DR3/DR4 heterozygosity frequency was significantly higher (p less than 0.01) in the microalbuminuric group than in the normoalbuminuric. All microalbuminuric subjects (n = 8) with short duration of disease (3.92 +/- 3.43 yr) developed diabetes at puberty. In conclusion, our cross-sectional study suggests: if a number of factors are combined, i.e. HLA DR3/DR4 heterozygosity, onset of disease at puberty and higher GH values, the probability of developing abnormal levels of UAE will increase.

[Role fo ultrasound in the study of latero-cervical metastases]. / Ruolo dell'ecografia nello studio delle metastasi laterocervicali.

In patients undergoing radiotherapy (RT) for malignant neoplasies of the head and neck the availability of a diagnostic method permitting frequent, easy checkups of the latero-cervical lymph nodes would be extremely useful. This is especially so because clinical examination is often hindered by the post-actinic fibrosis of the tissues. Among the methods presently available for this purpose (CAT, NMR, lymphoscintigraphy, xerography, ultrasound) echotomography appears to be the most indicated as it is least invasive, can easily be repeated and is not difficult to perform. The refining of ultrasound techniques would, as reported in the literature, make it possible today to evaluate the effects of RT on latero-cervical metastases both during and some time after treatment. The authors, therefore evaluated the advantages and limitations of the method examining 33 patients undergoing RT for latero-cervical metastases due to head and neck carcinoma. Each patient underwent ultrasound examination prior to, during and at the end of the RT treatment cycle. Once treatment had been terminated 18 underwent latero-cervical neck dissection. Upon termination of the radiation treatment three distinct types of ultrasound behaviour were identified: complete response; partial response; minimal or negligible response. For those patients undergoing surgery this response was compared to lymph node chain histology while, for the others, it was compared to the ultrasound findings of subsequent examinations. The results obtained appear to indicate that a systematic scheduling of ultrasound checkups offers a reliable evaluation of how metastatic adenopathies respond to RT. At times such response can only be completed several months after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Echotomography of pathological masses of the mediastinum. Indications and limits]. / L'ecotomografia nella patologia espansiva del mediastino. Indicazioni e limiti.

The authors refer to the application of sonography in the evaluation of mediastinal masses. In this pathology, sonography is useful if neither air nor bone tissue are present between the transducer and the mass. Sector scans are obtained through the transgiugular line, the intercostal spaces, the hepatic and splenic windows, the sternal notch. The diagnostic value is due to the possibility to define the solid or liquid content of the investigated masses.

[Skeletal changes in Wolf's syndrome (4p--) and in Klinefelter quadrisomy (author's transl)]. / Alterazioni scheletriche nella sindrome wolfiana (4p--) e nella quadrisomia di Klinefelter.

Clinical-genetic research is at present foundamental to the diagnosis of diseases caused by cromosome abnormalities. Radiologic investigation is necessary to complete the diagnosis evincing morphologic and skeletric changes peculiar to each disease.