Management of gynecomastia: an outcome analysis in a multicentric study.

AIM: Male gynecomastia (MG), the most frequent mammary anomaly in human males, is a clinical disease occurring mainly in adolescence and old age. The aim of this study was therefore to analyze 126 consecutive cases of mixed gynecomastia, in order to assess the incidence of early and late postoperative complications and to evaluate the aesthetic results and the quality of life after surgery. METHODS: From January 1st, 2000, to December 31st, 2006 a total of 126 cases of MG were performed by the Plastic Surgery Units of Siena and Pisa. Patients' average age was 28 years, 111 patients (88%) presented bilateral MG, and 15 (11.9%) had monolateral MG. The prevalent surgical approach was adenomammectomy with periareolar inferior or inverted "Omega" incision, other technique included circumareolar or vertical scar incision and liposuction. Before and one year after surgery, all patients were given a questionnaires to evaluate the motivations leading to the request of a treatment ,the degree of satisfaction related to the result and the improvement of the quality of life. RESULTS: Overall complication rate was 17.72% All patients reported an improvement in their quality of life with an average score of satisfaction of 8.2/10. CONCLUSION: Patients' degree of satisfaction was high, surgery, in fact, has contributed in all cases to improve their quality of life. On the basis of the short operating time and of the few sequele, we suggest to the patients affected by gynecomastia to undergo surgery always and as soon as possible. A separated analysis of the data obtained by the two University Centres show that they overlap in respect to the sample, the employed technique and results.

Treatment with vacuum-assisted closure and cryo-preserved homologous de-epidermalised dermis of complex traumas to the lower limbs with loss of substance, and bones and tendons exposure.

SUMMARY: Lower-limb injuries with loss of tissue and exposure of bones and tendons are an increasing problem. The condition of the wound locally and the patient in general does not always allow immediate and adequate coverage of the structures exposed by the trauma. Therefore, new therapeutic solutions are needed. A reduction in the time that bones and tendons are exposed is essential to achieve complete healing of bone fractures, with reduced risks of infection and less disabling outcomes. The effectiveness of vacuum-assisted closure (VAC) therapy in supporting wound healing and of cryopreserved homologous de-epidermalised dermis (DED) in providing an effective template for re-epithelialisation has been previously reported. We carried out a study to evaluate the effectiveness of the synergistic and combined use of the two methodologies. Eighteen patients with traumatic loss of tissue in the lower limbs, involving exposure of bone and tendon structures, were enrolled in the study. All participants had local, general contraindications to first-instance reconstructions, or both. All patients received a combination of VAC therapy and DED implants. Granulation tissue was obtained in all wounds, with complete coverage of exposed structures. No infections were detected in the cohort, and all patients were prepared for further necessary reconstructive treatments. In our experience, the combination of VAC therapy and DED could, in selected cases, constitute an effective treatment for complex lower limb traumatic injuries with bone and tendon exposure.