Salvage of Upper Limb following a Severe Crushing Trauma: Immediate Reconstruction with a Free Flap and Subsequent Hyperbaric Oxygen Therapy.

A microsurgical latissimus dorsi flap was performed for resurfacing a large soft tissue defect of the forearm with exposure of the vital structures and contaminated wound. Early coverage of a defect is a generally accepted concept to achieve a better functional result. The authors present a case report where a free latissimus dorsi flap with subsequent hyperbaric oxygen therapy allowed a successful single stage reconstruction of this complex severely contaminated defect.

Circumareolar mastopexy with multiple glandular plications for symmetry of the contra-lateral breast, in patients undergoing breast reconstruction with prosthesis. Experience on 50 cases.

4 years experience on 50 cases using the Elliott's technique for symmetrization of the contra-lateral breast in patients undergoing breast reconstruction with an anatomical prosthesis is presented in this paper.The Elliott's technique with its double superior and horizontal plication is a suitable and long-lasting procedure for patients with small-moderate ptotic breast and elastic skin, who wish to have a simple procedure and an immediate result with minimal scars.

Incompletely excised basal cell carcinomas: Our guidelines.

A retrospective review of 982 patients treated for basal cell carcinoma (BCC) was conducted over a period of 8 years from 1996 to 2004. Of these patients, 16 presented a margin involvement. Two cohorts of patients with involved margin were identified: the group whose basal cell carcinoma was re-excised, and the "wait and see" group. Both sets of results obtained were compared, and then matched with recent international literature reviews. Reexcision is our current practice for incompletely excised tumor. However during the period examined only 36 patients of 116 with margin involvement, proceeded to re-excision, and of the remaining 80 patients just 39 were followed-up. The others were missed mainly because of the difficulty of attending follow-up consultations because of advanced age, poor general conditions, and unavailability of transport facilities. On the basis of several points, including a high number of residual tumors detected in the re-excised patients, and difficulty in maintaining diligent follow-up in the "wait and see" group, we stress the importance of considering an early re-excision in case of margin involvement (focal, lateral, or deep), to avoid a significant risk of recurrence. In this study 16 patients out of 39 in the "wait and see" group had recurrences over 8 years of follow-up; a significant number of recurrences was observed after 5 years. We therefore reserve a clinical follow-up only for patients in whom poor general health dissuades us from re-operation.

Microsurgical scalp and skull reconstruction using a combined flap composed of serratus anterior myo-osseous flap and latissimus dorsi myocutaneous flap.

A combined microvascular flap composed of serratus anterior myo-osseous and a latissimus dorsi myocutaneous flap has been performed for resurfacing massive scalp and skull defects, accompanied by chronic infection and heavy radiation damage. The authors present a case report where the combined procedure allowed a single-stage reconstruction of this complex defect.

Pregnancy and tram-flap breast reconstruction after mastectomy: a case report.

A 38-year-old patient had a right radical (Patey) mastectomy for an infiltrating ductal carcinoma followed by chemotherapy and, one year later, a TRAM flap breast reconstruction. She was given clear and exhaustive information about the possible consequences of pregnancy, but despite this she became pregnant four months after the reconstruction. The pregnancy was taken to term despite the appearance at four months of a slow-growing abdominal hernia. In the light of our experience and that of others, we recommend an interval of at least 12 months between breast reconstruction with a TRAM flap and pregnancy.

Electrochemical treatment of olive oil mill wastewater.

The possibility of oxidizing at a PbO2 anode the phenols and polyphenols, present in the olive oil mill wastewater, has been studied as a pretreatment for the submission of such wastewater to the traditional biological treatments. The results obtained operating at current densities ranging 500 to 2000 A/m2 show that it is possible to reduce the concentration of the phenolic components, which interfere with the biological treatments, down to low values without decreasing too much the total organic content of the wastewater.

Budd-Chiari syndrome in a patient with ulcerative colitis: association with anticardiolipin antibodies.

This is the first reported case of a young patient with ulcerative colitis who developed acute Budd-Chiari syndrome and was found positive for anticardiolipin antibodies. Although an association between ulcerative colitis and Budd-Chiari syndrome, and between the latter and antiphospholipid antibodies, has been shown in the literature, the coexistence of these three conditions has never been reported. The patient we describe did poorly and was considered as a candidate for liver transplantation in spite of prompt heparin therapy, probably because of the presence of multiple risk factors.

[Breast reconstruction]. / La ricostruzione mammaria.

The ideal goal of every post-mastectomy breast reconstruction is to achieve a breast that is as "identical" as possible to the contralateral one in shape, size, consistency, mobility and degree of naturalness. At the same time, however, it is essential to rely on the simplest and safest reconstruction technique as far as the patient is concerned. Mastectomy and restoration of the lost morphology should be performed in a single operation whenever the opportunity arises and there are two reasons for this. First of all, by working this way reconstruction can be performed on an area that is completely free of any scar tissue. Secondly, there are psychological considerations involved, since this makes it possible to avoid the trauma of letting the patient seeing herself, even for just an instant, without her breast. The numerous different techniques used for the morphological reconstruction of breast volume can be classified into two basic groups: reconstruction with insertion of a prosthesis and reconstruction without a prosthesis. Both of these techniques make it possible to personalize surgical choices based on the patient's unique characteristics, in order to achieve a complete symmetry in relation to the contralateral breast.

[The postoperative expansion of a myocutaneous flap of the large dorsal muscle in postmastectomy breast reconstruction]. / L'espansione postoperatoria del lembo miocutaneo di muscolo gran dorsale nella ricostruzione mammaria postmastectomia.

BACKGROUND: Reconstructive breast surgery using the myocutaneous flap of the latissimus dorsi muscle with simultaneous insertion of a prosthesis represents a very useful procedure from a clinical standpoint. METHODS: Twenty-one breast reconstructions were performed using this type of surgery at the Plastic Surgery Clinic of the University of Udine between December 1993 and December 1995. RESULTS: Good aesthetic results can be obtained due to the relatively moderate functional and scarring complications, as well as to the vitality of the transposed tissue. The percentage of capsular contractures observed frequently in the past was lowered through the use of technologically-advanced prosthetic materials with a texturized surface. CONCLUSIONS: In addition, since the reconstructed breast can be expanded postoperatively through definitive Becker expanders, aesthetically satisfactory results can be achieved even with contralateral ptosic and/or large breasts.

Myofasciocutaneous expansion in the tegumentary rehabilitation of the amputation stump.

In post-traumatic amputations, in particular in leg amputations, the presence of an unstable scar or of ulcerous areas that are difficult to heal in the site of the amputation stump constitutes a repair problem that is not easily solved. In this specific field of reconstruction skin expansion has earned significant agreement, and is even considered to be a safe and reliable method for the surgical rehabilitation of the amputation stump, allowing us to obtain high-quality tegumentary covering, with no excessive thickness, that adapts well to the prosthesis and to the underlying skeleton, and that is characterized by good sensitivity of protection. Tegumentary amplification may, in some cases, also become myocutaneous, allowing us to obtain more tissue thickness for protection in patients submitted to chronic loading that lasts longer and in those with thin teguments, in which traditional expansion could determine excessive narrowing of the tegumentary covering, following atrophy caused by compression of the subcutaneous adipose tissue.

Illness behaviour, personality traits, anxiety, and depression in patients with Menière's disease.

OBJECTIVE: This study was conducted to evaluate illness behaviour, personality traits, anxiety and depression in patients with Menière's disease. DESIGN: A prospective study of patients and review of the literature is presented. METHODS: Fifty patients presenting to the ENT department of the Padua University were studied using the Illness Behaviour Questionnaire (IBQ), Eysenck Personality Inventory (EPI), State Trait Anxiety Inventory, and the Zung Self-Rating Depression Scale. RESULTS: Mean scores were found to be higher than normal for neuroticism with a stronger psychological perception of disease and a lower level of affective inhibition. Cluster analysis of the IBQ scores identified a subgroup of Meniere's patients with normal scores and another with severe psychological distress associated with high levels of neuroticism and psychoticism in the EPI and an abnormal illness behaviour: these were older patients with a longer history of Menière's disease and more hospital stays. CONCLUSION: Our results indicate the possibility of distinguishing those patients whose personality traits could facilitate the development of abnormal illness behaviour and psychological symptoms in relation to Menière's disease. Analysis of the data suggests that there is no specific link between such psychological aspects and the clinical disease.

Brachial plexus surgery. An historical perspective.

Clinical observations on brachial plexus palsy belong to the last decades of the 19th century. True brachial plexus surgery is even more recent, starting with the beginning of this century. Surgical endeavors on the plexus have been varied and have met with alternating fortunes, undertaken by surgeons in a fascinating blend of sheer enthusiasm and deep pessimism.