Processing techniques of the adipose tissue: centrifugation vs decantation.

The processing techniques of the adipose tissue represents one of the most debated topics. There are different processing techniques. As of today, the standard considered procedure is the centri1Romafugaton according to Coleman. In addition, other procedures include decantation/sedimentation, filtration and water jet force, which offer the specialist valid alternatives. In the present review, the clinical evidence of the techniques of centrifugation and decantation will be evaluated by studying histological data; maintenance of tropism and the maintenance of mesenchymal cells. These two aspects are different in the centrifugation and decantation techniques.

New body contouring technique in male: the muscular sculpture.

UNLABELLED: Optimal male body contouring considers the entire body and drapes tight skin over the muscles. Males have pride in the appearance of their muscular development. There should be a deliberate effort to achieve an athletic body contour that reveals superficial musculature and selectively highlights adherences. We describe a new technique of male body contouring to achieve tight skin that very well reveals muscular bulk and accentuates adherences; minimal observable scars; a male muscular and athletic body, even for patients who are not, nor have been in the past, bodybuilders. Normal-weight and overweight patients need one operative step, in which the fat is removed and the muscles are sculpted at the same time by using selective liposuction, and if necessary, the fat is repositioned through lipofilling. The ex-obese patients need two operative steps: in the first, we perform abdominoplasty with inguinal scar (to remove the excess abdominal tissue and to lift the pubis) and periareolar scar (to breast lift and reduction); in the second, we sculpt the muscles and the adherences by selective liposuction. In all male patients, the authors strive to achieve a trapezoid chest and sculpted pectoralis major muscle, pronounced alba and semilunar lines, evident muscular bulk, and adherences in both the abdomen and extremities. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

New head-mounted miniaturized microscope in hypospadia surgical correction.

AIM: The aim of this paper was to report our experience using VarioscopeÒM5 in hypospadia surgical correction. To suggest the use of microsurgical principles that can result in the successful repair of hypospadias with a few complications. METHODS: Forty-three patients (age 12-16 months), affected by hypospadia, underwent longitudinal dorsal preputial island flap (Scuderi's technique) surgical procedure. All the procedures were performed with Varioscope®M5. This new device is a head-mounted miniaturized microscope which combines a microsurgical microscope illumination and magnification with the freedom of loupes. RESULTS: In 39 (91.1%) of the patients the postoperative course was uneventful. One patient (2.3%) developed urethral fistula and a second intervention was necessary to correct it. He was affected by fourth degree hypospadia. In 3 patients (6.6%) we observed a mild stenosis. Urethral strictures were dilated during multiple sessions, by weekly introduction of catheters of progressively increasing caliber. At 3 months after surgery all urethral strictures had been solved by non surgical treatment, thus decreasing complication rate of the surgical procedure from 8.9% to 2.3%. Evaluation of flow rate was repeated at 3 weeks, 6 and 12 months. The aesthetic outcome was evaluated by the parents on a VAS scale. Results were judged optimal (8-9 out of 10). CONCLUSION: In order to achieve a better aesthetic and functional outcome and to reduce complications we deem a perfect flap dissection and anastomosis necessary. A well lighted and magnified surgical field is essential to achieve the best result due to the small anatomical structures involved in the surgical technique we have adopted. The Varioscope®M5 offers essential advantages in this regard.

Prepuce-sparing plasty and simple running suture for phimosis.

AIM: Circumcision is the most common procedure for phimosis. In recent years, the value of foreskin properties as well as aesthetic reasons determined to other operations preserving the foreskin. We report 5-years experience with a technique that preserve the physical foreskin appearance intact. PATIENTS AND METHODS: Fifty-two patients, eligible to undergo phimosis surgery, underwent prepuce-sparing plasty and simple running suture. Evaluation of results was made with photos comparative and verified by using presence/absence of recurrence, scarring evaluation, and VAS for patient satisfaction. RESULTS: Forty-eight patients reported no complications. There were no cases of bleeding, infection, pathological scarring, phimosis recurrence. The scar showed a good pliability and a thin thickness. Patient satisfaction was high. CONCLUSIONS: The association of prepuce-sparing plasty and simple running suture highlighted an effective and easy method for the correction of acquired phimosis in adult patients, with excellent functional and cosmetic results.

Multicentric osteolytic lesion of the middle finger of the hand. Case report.

Giant cell-rich osteolytic lesions may have overlapping clinical, radiologic, and histopathologic features, with an important degree of difficulty of diagnosis and treatment. We report a case of double osteolytic lesion at the middle-finger in a young man without previous history of hand trauma. He underwent en-bloc resection of the bone lesions and reconstruction by graft of hydroxyapatite, resulting in a good morpho-functional result. Histological diagnosis was giant cell reparative granuloma (GCRG), although several features were considered atypical, including the appearance of the giant cells and the areas of the stroma that more closely resembled a giant cell tumor. GCRG is a benign rare intraosseous lesion and the true nature is controversial and unknown. The theories are that it could be a reactive lesion, a developmental anomaly or a benign neoplasm. It appears as an osteolytic lesion that must be considered in the differential diagnosis of other "critical" bone lesions similar in clinical, as well as radiologic and pathological appearance. Further characterization studies are helpful and necessary for the proper management.

Comparative analysis between nasolabial and island pedicle flaps in the ala nose reconstruction. Prospective study.

The goals of reconstructing deformities of the face secondary to skin cancer include reconstructing the area with similar tissue. The comparison between different types of local flaps for reconstruction of nasal ala is presented in a prospective, randomized study. The objective of this study was to compare the functional and esthetic outcomes between the nasolabial and island flaps. A total of 60 patients with skin cancer of the nose underwent ala reconstruction: 30 cases by nasolabial flap (group A) and 30 by island flap (group B). The two groups were homogeneous for sex, age, and anatomical area. Complications, scarring according to the scale of Vancouver, cosmetic appearance, and disorders of sensations were analyzed and statistical analysis was performed. In group A, early complications were more common than in group B. The scars of group B patients were more like those of undamaged skin. A total of 10% patients of group A evaluated the cosmetic appearance of their nose as very good, while in group B, 30% patients gave such an evaluation. Local flaps provide better reconstruction and the island flap appears to have more efficacy when compared with nasolabial flap for nasal ala reconstruction.

Comparison of surgical methods in catastrophic antiphospholipid syndrome (CAPS).

Antiphospholipid syndrome (APS) is an autoimmune condition characterized by vascular thromboses and/or pregnancy morbidity in the presence of antiphospholipid antibodies. The variant "catastrophic" (CAPS) is defined as a potential life-threatening disease, characterized by multiple small vessel thromboses that can lead to multiple organ failure. Surgery is between precipitating factors in CAPS International Registry, but it's still unclear the relationship between surgery and syndrome. The present study reports two surgical procedures, performed on two patients with APS admitted with diagnosis of loss of substance of the lower limb needing of reconstructive treatment. We compared and analyzed aggressive and minimally invasive surgery.

Ulnar artery thrombosis and nerve entrapment at Guyon's canal: our diagnostic and therapeutic algorithm.

Hypothenar hammer syndrome is a rare condition of ulnar artery aneurysm or thrombosis, which can be associated with a neuropathy of the ulnar nerve. There is no agreement regarding an optimal diagnosis and treatment for this syndrome. Most authors suggest angiography as the gold standard for diagnosis and recommend observation for the thrombotic type, and reconstructive surgery for the aneurysmal type. We report here our diagnostic and therapeutic algorithm, reviewing 9 patients with ulnar artery thrombosis and nerve entrapment at Guyon's canal; and an evaluation of the type of management including: anamnesis, diagnostic tests, and reconstructive surgery. We consider resection of the arterial thrombotic segment as the treatment of choice, due to the fact that ulnar arterial thrombosis can induce severe chronic inflammation into Guyon's canal and ulnar nerve sufferance. Therefore, we propose a planned approach, including 3 steps: clinical evaluation with Tinel and Allen's tests; magnetic resonance and ultrasound images; ulnar nerve decompression and arterial reconstruction. We believe that this practice is important for the early therapy of ulnar arterio-neuropathy in affected patients.

["Step technique" in the treatment of the loss of substance of the lower lip]. / Tecnica "a scaletta" nel trattamento delle perdite di sostanza del labbro inferiore.

The most frequent pathology of the lower lip is the neoplastic pathology and squamous cell carcinoma is the most clinically diagnosed. Wide excision is the correct surgical approach but it may cause severe morpho-functional and aesthetic damages. At the Plastic and Reconstructive Department of Policlinico Umberto I, " Sapienza" University of Rome, from 2005 to 2008 36 patients were treated, 19 only by surgical excision (Group I) and 17 by Johanson's technique (Group II). Follow-up was at 6 and 12 months to evaluate the morpho-functional outcome, the asymmetry and the healing. Moreover a questionnaire of 9 items was proposed to patients to evaluate functional and aesthetic results. Data showed that Johansons' s flap achieves the same results of the complete surgical excision but with better morpho-functional and aesthetic outcomes, greater satisfaction and same staying in hospital for patients.

Innovative microsurgical device in perforator free flaps surgery.

Dissection of the small perforating vessels through the muscle/septum can be difficult, and microsurgical success is closely linked on a clear and well-magnified field vision. Since 2004, Varioscope M5 has been employed in our Plastic Surgery Departments. It is the first and only head-mounted microscope. In this study was examined 10 patients underwent to reconstructive procedures by harvest of perforator free flaps, working with Varioscope M5. At long-term follow-up, all patient present an exceptional outcome. Considering cost-effectiveness, portability, operator freedom, and effectiveness in the perforator flaps dissection and in the anastomosis making, we think that Varioscope M5 offers essential advantages Dissection of the small perforating vessels through the muscle/septum can be difficult, and microsurgical success is closely linked on a clear and well-magnified field vision. Since 2004, Varioscope M5 has been employed in our Plastic Surgery Departments. It is the first and only head-mounted microscope. In this study was examined 10 patients underwent to reconstructive procedures by harvest of perforator free flaps, working with Varioscope M5. At long-term follow-up, all patient present an exceptional outcome. Considering cost-effectiveness, portability, operator freedom, and effectiveness in the perforator flaps dissection and in the anastomosis making, we think that Varioscope M5 offers essential advantages.

[Treatment of a wide cutaneous post-traumatic loss of substance by cell cultures. Case report]. / Trattamento di un'ampia perdita di sostanza cutanea post-traumatica mediante colture cellulari. Case report.

Bioengineering skin represents a successful outcome in the interdisciplinary research applied to reconstructive surgery. In this study we report our experience in the reconstruction of a wide traumatic wound by autologous engineered skin, grown on a biomaterial scaffold. Advantages were rapid reparation of the trauma and good scars.

[Multicentric study on a topical compound with lymph-draining action in the treatment of the phlebostatic ulcer of the inferior limbs]. / Studio multicentrico su un preparato topico ad azione linfodrenante nel trattamento dell'ulcera flebostatica degli arti inferiori.

Phlebostatic sore of the lower limbs is a typical chronic venous insufficiency complication and is still a widely controversial issue in its treatment. The common therapies, in fact, are not yet standardized and they not show complete efficacy. Since 2005 to 2007 a multicentric clinical trial was conducted at the Plastic and Reconstructive Surgery of "Sapienza" University of Rome and at the Plastic and Reconstructive Surgery Department, University of Perugia, in order to evaluate the efficacy of the Idrastin lymph-draining cream in patients with phlebostatic sores of the lower limbs. This study enrolled on 80 patients, split into 2 homogeneous groups of 40 patients: group A was treated by only elastocompressive therapy, group B by elastocompressive therapy and Idrastin. Multicentric analysis has considered the following parameters: local pain, perilesional flogosis , granulation tissue, perilesional tissue tropism healing time. In the group B results highlighted: reduction of the local pain, stopped in 72 hours; flogosis decrease disappeared in one week; tissue granulation growth in one week; lesion healing in 4 weeks. These results pointed out statistically significance of the variables considered. In our opinion Idrastin compounds such as phytoessence of hops and Hedera helix, had contributed to analgesia; Aesculus hippocastanum, and Vitis vinifera and Ruscus aculeatus phytoessence showed anti-flogistic action; allantoin and Centella asiatica and jaluronic acid aided to sore healing. Idrastin gives an effective support to the treatment of the phlebostatic sores warrants a faster and more effective healing process, than to the wounds treated by only the elastocompressive therapy.

[Treatment of the capsular contracture around mammary implants: our experience]. / Trattamento della contrattura capsulare da impianto protesico mammario. Nostra esperienza.

The most common complication in patients who underwent mammary implant surgery is capsular contracture. Actually, there is no standard effective treatment for this complication. The aim of this article is to show our experience about LTRAs (leukotriene receptor antagonists) for the treatment of the capsular contracture. The findings indicate that these drugs may reduce pain and breast capsule distortion for patients with long-standing contracture.

[A case of vulvar melanoma: surgical strategy and five years follow-up]. / Un caso di melanoma vulvare: strategia chirurgica e follow-up a 5 anni.

We report a case of a woman with vulvar melanoma, arisen from a plane melanocytic lesion, extended from clitoris to the left minor labium. After diagnostic biopsy, a preoperative lymphoscintigraphy with 99m-Tc nanocolloid was performed. Surgery consisted in a radical vulvectomy, radio-controlled lymphadenectomy and vulvar reconstruction by two bilateral subgluteus soft-tissue flaps, anastomosing the urethral and vaginal stumps. Five years follow-up was negative for neoplastic recurrence.

[Oncological and reconstructive management in a patient with multiple recurrences of basal cell carcinoma of the nose]. / Management oncologico e ricostruttivo nella recidiva multipla del carcinoma basocellulare del naso.

Basal cell carcinoma (BCC) grows by direct extension replacing local anatomical structure; it rarely metastasizes, however may cause severe injure expanding to contiguous tissues with a biological invasive behaviour. BCC of the nose is often a highly aggressive neoplasia with infiltrative growth pattern. Fast cancer extension to the adjacent facial structures requires wide resection for oncological management. In our study we present a 69-year-old male affected by BCC of the nose back and treated by surgical radical excision with free margin disease at histological examination. Patient, subsequently, developed a local relapse. Therefore, he underwent surgical excision of the recurrence and the histological evaluation pointed out a metatypical and infiltrative BCC pattern without margins involvement. Afterwards, the patient developed another local recurrence involving the left alar nose and the omolateral cheek. Histological examination still demonstrated a metatypical and infiltrative pattern, with disease free margins, but nasal vestibule involvement. Successively the patient had another local wide resection from the nasal wing to the maxillary bone without reconstructive procedure. Three years after, the patient developed another local relapse and underwent another surgical procedure, consisting in a very wide resection with concomitant selective left laterocervical node dissection. Histological evaluation demonstrated a metatypical solid infiltrative BCC pattern with disease free margins and lymph nodes. One year after, forehead flap was made to reconstruct the nose and left cheek deficit. At 16 months follow-up the patient remains disease free.

[Merkel cell carcinoma and sentinel lymph node dissection: nine cases report]. / Carcinoma a cellule di Merkel e linfonodo sentinella: osservazioni su nove casi clinici.

Merkel cell carcinoma (MCC) is an aggressive cutaneous-neuroendocrine neoplasia with poor prognosis and high propensity for locoregional and distant metastasis. Lack of knowledge about its biological behavior, pathogenesis, and prognostic factors, complicates the prospective evaluation. Sentinel node dissection, concomitant with radical excision of the lesion, has increased in the last few years. The suitability of this technique is linked to the MCC high tendency to spread "in primis" at locoregional nodes such as other malignancies such as cutaneous melanoma. Aim of the study is the prospective evaluation of the sentinel node dissection and of the adjuvant therapies in 9 patients MCC affected. All patients, underwent evaluation and staging of the neoplasia. Diagnosis was made by excisional biopsy and histological examination. Sentinel node dissection was performed in patients without clinical locoregional metastases (8 cases). Patients with sentinel node positive for metastasis underwent radical lymphadenectomy (3 cases). One patient affected by clinically locoregional metastases had, at once, radical lymphadenectomy. Radiotherapy and/or chemotherapy as adjuvant therapy were implemented (4 cases).

The use of mechanical acoustic vibrations to improve abdominal contour.

Adaptive effects caused by mechanical acoustic vibrations on the neuromuscular system are widely described. These vibrations applied to the muscle belly cause the "vibration tonic reflex" characterized by an improvement in power contraction of the stimulated muscle. Mechanical acoustic vibrations of moderate strength placed on limited body areas produce a positive muscle activity without damage. A prospective study from January to September 2006 investigated 60 sedentary patients presenting with muscular hypotrophy associated or not associated with lipodystrophy of the abdominal region who desired a substantial contour improvement of such area without invasive procedures. Of these patients, 40 were subjected to a treatment protocol with mechanical acoustic vibrations applied to the abdomen, associated or not associated with physical aerobic exercise of moderate intensity. The remaining 20 patients engaged only in the physical training. The study aimed to evaluate whether the application of mechanical acoustic vibrations could improve body contour.