Comparison of round smooth and shaped micro-textured implants in terms of quality of life and aesthetic outcomes in women undergoing breast reconstruction: a single-centre prospective study.

Breast cancer (BC) is the most frequent cancer among women, impacting 2.1 million women each year and having caused 627,000 deaths in 2018. In Italy, BC represents the first cancer diagnosis with 53,000 new cases in 2019 and the first cause of mortality for cancer among the female population. Breast implants represent the first reconstructive choice after mastectomy: in Italy, 411,000 prostheses have been implanted since 2010 and more than 95% of them are macro-texturized. The attempt to reduce complications such as capsular contracture, rotation and rupture of the prosthesis and the most recent BIA-ALCL association with macro-texturized implants have led to the development of new materials and the refinement of implants' coating techniques. We carried out a 1-year prospective single-centre study to evaluate patient-reported quality of life (QoL) and aesthetic outcomes after breast reconstructive surgery using two different prostheses: shaped micro-textured implants and round smooth implants. We treated 62 patients with radical or conservative mastectomy followed by reconstructive surgery performed with 44 shaped implants and 48 round implants. Quality of life evaluated through the Breast-Q®-questionnaire showed high scores of psycho-social well being in both groups, as well as pre- and post-operative aesthetic satisfaction and physical well being. Round smooth implants appear to be better in terms of softness, volume and less association with rippling, whereas shaped micro-textured implants prove to be better in the profile delineation. This study confirms the potentialities of both shaped micro-textured and round smooth implants in reconstructive surgery.

Adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical evaluation for cell-based therapies in patients with scars on the face.

BACKGROUND: Actually, autologous fat grafts have many clinical applications in breast surgery, facial rejuvenation, buttock augmentation, and Romberg syndrome as well as a treatment of liposuction sequelae. OBJECTIVE: The aim of this article was to describe the preparation and isolation procedures for stromal vascular fraction (SVF), the preparation of platelet-rich plasma (PRP), and the clinical application in the treatment of the scar on the face. METHODS: Ten patients with burns sequelae (n = 6) and post-traumatic scars (n = 4) were treated with SVF-enhanced autologous fat grafts obtained by the Celution System. Another 10 patients with burns sequelae (n = 5) and post-traumatic scars (n = 5) were treated with fat grafting based on the Coleman technique mixed with 0.5 mL of PRP.To assess the effects of their treatment, the authors compared their results with those of a control group consisting of 10 patients treated with centrifuged fat. RESULTS: In the patients treated with SVF-enhanced autologous fat grafts, we observed a 63% maintenance of contour restoring after 1 year compared with only 39% of the control group (n = 10) treated with centrifuged fat graft (P < 0.0001). In the patients treated with fat grafting and PRP, we observed a 69% maintenance of contour restoring after 1 year compared with that of the control group (n = 10). CONCLUSIONS: Autologous fat grafting is a good method for the correction of scars on the face instead of the traditional scar surgical excision.

Skin necrosis of scrotum due to endovascular embolisation: a case report.

The aim of our case report was to analyse the results obtained with the Matriderm® system and autologous skin grafting for the surgical treatment of skin necrosis of scrotum as a result of endovascular embolisation. We recruited one patient with scrotum skin necrosis as a result of endovascular embolisation admitted at the department of Plastic and Reconstructive Surgery, University of Rome 'Tor Vergata'. The patient underwent Matriderm® system and autologous skin grafting for skin necrosis treatment. After a single treatment, reduction of the skin necrosis was obtained, after 30 days from the surgical treatment. Patient experienced a reduction in pain and a complete restoration of the loss in volume and quality of skin was noticed. Matriderm® system and autologous skin grafting is a simple, safe and feasible technique. When comparing this treatment with others, Matriderm® is a simpler, more economic and less time-consuming method, and does not require sophisticated laboratory facilities.

The use of MatriDerm® and skin grafting in post-traumatic wounds.

The aim of this study was to prove the effectiveness of MatriDerm(®) combined with skin grafting versus skin grafting alone in post-traumatic wounds treatment. At the Department of Plastic and Reconstructive Surgery of the University of Rome Tor Vergata, we treated 60 patients: 30 patients with dermal substitutes (MatriDerm(®)) combined with autologous skin graft and 30 with skin graft alone. Two weeks after the first treatment, 95% of wounds treated with MatriDerm(®) and skin graft showed a re-epithelisation, whereas it was 75-80% in the control group. We used the Manchester Scar Scale (MSS) and patient's self-estimation scale to assess the outcomes. Mann-Whitney U test was performed for the five items of the MSS and the results were combined to those of patient's self-estimation scale and the re-epithelialisation percentage to test the significance between the two groups. These data confirm the evidence of the clinical use of MatriDerm(®) technology in the healing of soft tissue wounds and prove the effectiveness of combining MatriDerm(®) and skin grafting for the first time. Furthermore, we observed a percentage reduction of wound contraction and in the same time an improvement of elasticity, quality of scars tissue and dermal architecture.

Use of platelet-rich plasma and hyaluronic acid in the loss of substance with bone exposure.

OBJECTIVE: : In lower-extremity surgery, the complex wound with bone exposure remains a challenging problem for the plastic surgeon. The purpose of this study was to describe a new therapeutic approach to stimulate the regeneration of the lower-extremity complex wounds based on a combined treatment composed of platelet-rich plasma (PRP) and hyaluronic acid (HA) dressing. DESIGN: : Wounds with posttraumatic bone exposure have been treated with HA dressing alone or in combination with PRP. PATIENT: : Fifteen patients affected by lower-extremity wound with posttraumatic bone exposure have been treated at the Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome, Italy. RESULTS: : After a single treatment, the authors observed that the mean re-epithelialization time was 8.1 weeks in 73.3% patients treated with PRP and HA dressing versus the 30% patients treated with HA dressing only. CONCLUSION: : These data confirm the evidence of using PRP technology in the healing of both soft- and hard-tissue wounds. Moreover, the satisfaction of the patient confirms the quality of this study's results.

The use of Matriderm and autologous skin grafting in the treatment of diabetic ulcers: a case report.

The aim of our case report was to analyse the results obtained with the Matriderm system and autologous skin grafting for the surgical treatment of diabetic ulcers. We recruited one patient with diabetic ulcers admitted at the Department of Plastic and Reconstructive Surgery, University of Rome 'Tor Vergata'. The patient underwent Matriderm system and autologous skin grafting for diabetic ulcer treatment. After just a single treatment, we obtained reduction in ulcer after 15 days from the surgical treatment. We achieved a reduction in pain and exudate secretion of the ulcer. We noticed an almost complete restoration of the missing volume and good quality of skin. Matriderm system and autologous skin grafting is a simple, safe and feasible technique. This method, when compared with other methods of treatment, is simple, cheap, less time consuming and does not require sophisticated laboratory facilities.

Tissue regeneration in loss of substance on the lower limbs through use of platelet-rich plasma, stem cells from adipose tissue, and hyaluronic acid.

BACKGROUND: Platelet-rich plasma (PRP) induces wound regeneration and tissue repair through cell proliferation and differentiation, promoting tissue healing and also acting as an autologous scaffold. With a small quantity of blood, it is possible to obtain the necessary optimal volume of PRP to treat the loss of substance in the lower limb. It has been demonstrated that mesenchymal stem cells are present in the adipose tissue (thus accelerating the effect of the PRP). METHODS: The analysis involved 30 patients with lesions ranging from ulcerative, dystrophic, with substance loss, with differentiating etiopathogenesis all localized on the inferior limb, and to those treated with PRP and autologous fat grafts. The wounds were covered with a 3-dimensional, polymerized hyaluronic acid medicated biologic dressing. The authors' protocol consists of a general checkup; wound examination; instrumental, microbiological, and immunohistochemical diagnostic examinations; and acquisition of photographic images with follow-up at 0, 1, 2, and 3 weeks; 1, 3, and 6 months; and 1 year. RESULTS: The results show an improvement from minor to moderate in 100% of patients after 3 weeks, healing in less than 6 weeks in 47% of patients, and complete wound healing in 57% of patients within 3 months. CONCLUSIONS: The authors' data demonstrate the ability of the combination of PRP and autologous adipose graft to regenerate tissue and epithelialization with wound closure, with a significant healing-time reduction. Furthermore, the minimally invasive technique is well accepted by patients, with a noteworthy improvement of the quality of life along with cost reduction due to the fewer number of medications.

Autologous platelet-rich plasma mixed with purified fat graft in aesthetic plastic surgery.

Platelet-rich plasma (PRP) is a platelet concentrate that has widely been used to accelerate the healing of soft and hard tissues. The preparation of PRP has been described by several authors. Preparation protocols vary from system to system, depending on the concentration of different integrating proteins. The objective of this article is to describe the principal use of PRP mixed with fat grafts in aesthetic plastic surgery.