Extracranial association of arteriovenous and venous malformations. Case report.

Association of multiple vascular malformations of the face is a rare condition. An arteriovenous malformation (AVM) with a venous malformation as the draining vein is also a rarity. We report a case of extracranial mixed vascular malformations that deformed the normal architecture of the lower face. Removal of the AVM was followed by stability of the jaw and tongue malformation, indicating the AVM used the venous malformation as its draining vein. This approach spared the patient severe cosmetic and functional sequelae.

Evaluation of fat grafting safety in patients with intraepithelial neoplasia: a matched-cohort study.

BACKGROUND: Fat grafting is widely carried out in breast cancer patients to improve quality in breast reconstruction. Recently, in vitro and animal studies have questioned the role of adipose tissues in cancer development. DESIGNS: Matched-cohort study. We analysed: (i) 59 intraepithelial neoplasia patients who had undergone lipofilling, with no recurrence between primary surgery and lipofilling. (ii) A control group of 118 matched patients (two controls per lipofilling patient) with the corresponding recurrence-free intervals. Both groups were also matched for main cancer criteria. A local event (LE) was the primary end point, with follow-up starting from the baseline. RESULTS: Median follow-up was 63 and 66 months from surgery, and 38 and 42 from baseline, for the lipofilling and control groups, respectively; the 5-year cumulative incidence of LE was 18% and 3% (P = 0.02). Ki-67 was the significant factor in univariate survival analysis. A subgroup analysis showed that lipofilling increased the risk of LE in women <50 years, with high grade neoplasia, Ki-67 ≥ 14 or who had undergone quadrantectomy. CONCLUSION: Higher risk of LE was observed in intraepithelial neoplasia patients following lipofilling. Although further studies are required to validate our conclusions, patients belonging to this subgroup should be informed of these results and the potential risks.

["Skin reducing mastectomy" and immediate breast reconstruction with Becker 35 contour profile breast implant: our experience]. / "Skin reducing mastectomy" e ricostruzione immediata con protesi/espansore Becker 35 contour profile. Nostra esperienza.

AIM: We describe in this paper our experience with the technique of skin-reducing mastectomy in the treatment of breast cancer. METHODS: Between October 2005 and April 2010 in our Center 33 patients underwent breast surgery utilizing the skin-reducing mastectomy technique and immediate breast reconstruction with expansor/definitive implant Becker 35 contour profile. Contralateral symmetrization was performed in the same operation. All selected patients satisfied inclusion critera either for nipple-sparing mastectomy or prophylactic mastectomy. We selected patients who had large ptosic breasts: areola-submammary fold >8 cm and jugular-nipple distance >25 cm. After histologic exam to confirm the lack of retroareolar tissue infiltration the nipple was preserved in a superior flap. RESULTS: Twenty-four out of 33 patients (72.7%) did not suffer from complications. In 9 patients (27.3%) we observed early complications. During follow-up we observed in 24 patients (72.7%) Baker I capsular contracture, in 9 patients (27.3%) Baker II capsular contracture. Esthetic results of symmetry, shape and volume were good to optimal. Patients' satisfaction was similar. During the follow up (6-33 months, average 17.7 months) no patient suffered from breast cancer recurrence. CONCLUSION: The "skin-reducing mastectomy" reduces mutilation and unsightly scar visibility. It gives a pleasant aesthetic outcome without hindering oncological safety.

[The distally based sural neurocutaneous flap in reconstruction of lower limb: our experience]. / Il lembo neurocutaneo surale a base distale nella ricostruzione dell'arto inferiore: nostra esperienza.

BACKGROUND: Our study concerns eight patients who have undergone surgery at the Department of Plastic, Reconstructive and Aesthetic Surgery of the University of Perugia, for the reconstruction of lower limb using the distally based sural neurocutaneous flap for covering loss of substance of various origin, from October 2007 to November 2009. PATIENTS AND METHODS: The aim of our study is to demonstrate the reliability of distally based neurocutaneous sural flap in reconstruction of lower limb following a loss of substance of different nature involving the lower third of the leg. Eight patients were on systemic and local clinical conditions that can not be undergoing surgery with use of free flap. In five patients (62%) the loss of substance had been caused by traffic accident while another patient (12%) had been the victim of an accident at work. Two patients (26%) had suffered from pressure ulcers and were unstable with regard to the vascularisation. RESULTS: We observed no cases of total necrosis of the flap and in all eight patients we showed good healing. Follow up was 2, 4, 6, and 9 months after surgical intervention. CONCLUSION: Our study has shown that the use of the distally based sural neurocutaneous flap in reconstruction of lower limbs, as a salvage procedure, is still a valid alternative procedure to free tissue transfer. Because of reduced operative times, reduced anaesthetic risk, reduced risk of total flap necrosis and reduced costs, it could be considered as a preferable choice in selected cases.

L-specular plasty versus double-round plasty: two new techniques for earlobe split repair.

BACKGROUND: Split earlobes can be classified into two groups: congenital and traumatic. The congenital group can be divided into three categories: anterior, posterior with doubled earlobe, and sagittal. The traumatic group can be divided into two categories: complete and incomplete. This report describes and compares two new techniques the authors have developed for split earlobe repair: L-specular plasty and double-curve-specular plasty. Both techniques are simple to perform and deliver a good aesthetic result. METHODS: A series of 30 patients with split earlobes underwent surgery from September 2007 to September 2009. All the patients enjoyed good health with no organic pathologies. All the patients had surgery under local anesthesia. The L-specular plasty technique was used to treat 15 patients (13 complete splits, 2 incomplete splits). The remaining 15 patients (13 complete splits, 2 incomplete splits) were treated with the double-curve-specular plasty. RESULTS: Skin necrosis was not reported for any of the treated patients. Sutures are completely removed after 2 weeks. The sutures for three patients were removed after 20 days due to slow cicatrization. Repiercing of the ear may occur after 6 months. One patient (8%) experienced a wound infection, treated successfully with systemic antibiotic therapy. Two patients (16%) experienced hypertrophic scars. Only two patients (16%) had recurrence during a mean follow-up period of 13.4 months (range, 6-24 months: September 2007-2009). CONCLUSION: Both double-curve-specular plasty and L-specular plasty are simple, reliable procedures. They both deliver very good aesthetic results thanks to the curve incisions that follow the natural shape of the earlobe. However, the patients treated with double-curve-specular plasty reported greater satisfaction in the outcome of their surgery.

The use of pectoralis major myocutaneous flap as "salvage procedure" following intraoral and oropharyngeal cancer excision.

BACKGROUND: The benefits and superiority of free flaps for head and neck reconstruction are well recognized. However, in some instances, especially in elderly and critical patients with advanced intraoral and oropharyngeal cancers or in patients with underlying systemic syndromes (i.e. uncontrolled diabetes, cardio-pulmonary failure, renal insufficiency), the use of pectoralis mayor myocutaneous flap may be a preferable option with fewer risks for the patient. PATIENTS AND METHODS: We present a series of 12 pectoralis major myocutaneous flaps, performed from January 2007 to June 2008, in 12 critical patients who presented with advanced carcinomas of the oral cavity and oropharynx. In all cases, histology showed (T3-T4)-(N0-N3)-M0 squamous cell carcinomas. Tumors were: 4 intraoral (33%), 2 in the oropharynx (16%), 5 in the hypopharynx (41%) and 1 of the skin left auricle (8%). RESULTS: There were no flap loss. Partial skin necrosis (<10%) occurred in 1 case (8%); one patient (8%) developed wound infection treated successfully with systemic antibiotic therapy. Minor oro cutaneous fistulas developed in 2 patients (16%). At the follow-up 4 patients (34%) died after 4 months, 2 patients (16%) had recurrence of disease, 6 patients (50%) showed no evidence of disease. CONCLUSION: The use of pectoralis major myocutaneous flap as a salvage procedure in immediate reconstruction following ablative surgery of head and neck cancers is still a valid alternative procedure to free tissue transfer. Because of reduced operative times, reduced anaesthetic risk, reduced risk of total flap necrosis and reduced costs, it could be considered as a preferable choice in selected cases.