Accidental latissimus dorsi flap pedicle avulsion during immediate breast reconstruction: salvage by conversion to free flap.

Pedicle damage is a rare complication of latissimus dorsi (LD) flap breast reconstruction. We report a case of accidental avulsion of the vascular pedicle of a totally autologous (extended) LD flap during immediate breast reconstruction in a patient who had previously undergone contralateral breast reconstruction with a pedicled TRAM flap based on the opposite superior epigastric vessels. The intra-operative strategy to salvage the avulsed LD flap by conversion to a free flap while not compromising the contralateral breast reconstruction is discussed.

[Infiltrating ductal breast carcinoma after radiotherapy and chemotherapy for non-Hodgkin's lymphoma in a young woman. Case report]. / Carcinoma duttale infiltrante della mammella dopo radioterapia e chemioterapia per linfoma non Hodgkin in una giovane donna. Case report.

Lymphoma was one of the first cancers curable by radiotherapy and/or chemotherapy. However the increased risk of second malignancies in lymphoma survivors appeared to be the price of success of modern treatment modalities. In particular, breast cancer has been a major concern among women irradiated for lymphoma at a young age. There are several reports of breast cancer after Hodgkin's lymphoma, but few after non-Hodgkin's lymphoma. Owing to the particularity of this condition and the difficulties in its diagnosis and treatment, we wish to report the case of ductal infiltrant carcinoma of the breast in a young woman survived to a non-Hodgkin's lymphoma. Women who are survivors of pediatric lymphoma have a significantly increased risk of subsequent breast cancer compared with the general population and are at a high risk of developing bilateral disease within a short interval. Several studies have shown that the relative risk for secondary breast cancer becomes significantly increased between 5 and 9 years and rises dramatically between 15 and 19 years after lymphoma treatment. Screening programs to detect breast cancer should be initiated early after Hodgkin's and non-Hodgkin's lymphomas. Screening have to include breast self examinations every month, clinical breast examinations every 6 months, and mammography every 2-3 years. The patients should start breast self-examination at puberty. In these high-risk patients, "aggressive" biopsy is appropriate for suspicious lesions.

A study of 17 patients affected with plexiform neurofibromas in upper and lower extremities: comparison between different surgical techniques.

Plexiform neurofibromas (PN) are one of the most common and severe types of neurofibroma that occur in neurofibromatosis type I. These tumours affect long portions of nerves, infiltrating the nerve and surrounding tissue thus causing significant pain, deformity and functional problems in the affected part of the body. Treatment of this variant of neurofibromas is currently surgical. The aim of this study was to analyze the surgical treatment of plexiform neurofibromas in the lower and upper extremities. The clinical pathological features of 29 neurofibromas, 12 in the upper extremities and 17 in the lower extremities, as diagnosed at the Department of Plastic and Reconstructive Surgery of University "La Sapienza" in Rome from 2000 to 2007, were reviewed. We established that subtotal and total resection without functional destruction is often possible for superficial PN.

The propeller flap for chronic osteomyelitis of the lower extremities: a case report.

The goals of the treatment of chronic osteomyelitis are infection eradication with systemic antibiotic therapy and local management with radical excision of the infected tissue and obliteration of the remaining dead space. Adequate debridement and coverage with a well-vascularised tissue are mandatory for successful outcomes. Use of muscle covering for chronic osteomyelitis in the lower extremities is considered the best procedure. However, there have been instances where debridement of the bone tissue did not leave a deep cavity along the leg bones and fasciocutaneous flaps can be used in these instances to cover the defect and to restore function without recurrence of the disease. Recently, free non-muscle flaps have been used and assessed for chronic osteomyelitis or covering of exposed bone. Perforator flaps have been shown to be well vascularised due to a structural haemodynamic enhancement. In the light of these findings we report a successful case of chronic osteomyelitis of the right fibula treated with excision of the affected tissue and covering with a propeller flap. Instead of free flap covering, in order to optimise surgical reconstruction, reducing the operative time, donor and recipient site morbidity and risk of total flap failure, local perforator flaps and particularly the propeller flap may be indicated in the treatment of chronic osteomyelitis in selected patients when the defect is limited and there is no need to fill a deep bone cavity or a dead space. To our knowledge, this the first report of the use of a propeller flap in the treatment of chronic osteomyelitis in the lower extremities.

Breast asymmetry: a new vision of this malformation.

Breast asymmetry is defined as a difference of form, position or volume of the breast and is a pathology affecting over half of the female population (1, 4). Fortunately although it is very frequent, surgical correction is seldom necessary. The authors present the results of the surgical treatment of 73 patients affected with breast asymmetry and they describe the employment of a new instrumental method (SCAN-3D) that may be used both within the correction program and during the follow-up of the surgical treatment. The system involves the use of a laser to scan the surface to be acquired and by the subsequent analysis of the image produced by the overlap of itself with the area under examination, by utilising specific software, we retrieve information regarding both the morphologic and volumetric connections in all three dimensions. The employment of new research methods (Three-dimensional scanning) is an important aid to the aesthetic surgeon, as it allows the study of the mammary glands morpho-volumetric component in relation to the rest of the thorax. Moreover, in the future, the custom production of breast implants, made to measure, and perfectly adaptable to the deformity of each patient may be possible.