Surgical approach to a rare case of Beckwith Wiedemann syndrome with left thigh hyperplasia.

Thigh lift surgery is generally performed in patients with severe weight loss outcomes, particularly those undergoing bariatric surgery. However, there are other congenital malformation conditions that may require the same treatment, such as Beckwith Wideman syndrome.

A rare case of Brooke-Spiegler syndrome: integrated surgical treatment of multiple giant eccrine spiradenomas of the head and neck in a young girl.

INTRODUCTION: The authors present a "four-step" integrated surgical protocol to treat a rare case of multiple giant eccrine spiradenoma (ES) of the head and neck in a young patient. PRESENTATION OF CASE: An 18-year-old female patient presented with multiple swellings in the head and neck regions. The patient had a severe psychological trauma with a negative impact on her social life. Physical examination revealed multiple papulo-nodular swellings measuring between 5 cm × 8 cm and up to 10 cm × 20 cm in size with cerebriform aspect and soft consistency. Major lesions were located in the scalp, frontal area, neck, occipitotemporal, and retroauricular regions. Tissue biopsy found a benign composite adnexal neoplasm consisted in ES, trichoepithelioma, and cylindroma, a typical feature of Brooke-Spiegler Syndrome. A staged excision was planned, and available reconstructive options were considered. Scalp reconstruction included tissue expansions, advancement flaps, skin grafts, and dermal regeneration template (Integra®). All treatments were successful, and no recurrence was observed. The patient returned to a normal social life, and a radical excision with satisfying aesthetic results was achieved. DISCUSSION: Although adnexal tumors are benign in most of the cases, these lesions are prone to arise in the craniofacial region, thereby causing aesthetic discomfort associated with pain, hemorrhage, and infection to the patient every day. Furthermore, there is a potential risk of malignant transformation. These concerns demonstrate the need to establish a surgical protocol for the treatment of adnexal tumors. CONCLUSIONS: Our integrated surgical approach showed excellent aesthetic and functional results with benefits to the patient's life and complete oncological excision.

The role of lipofilling in reconstructions with dermal regeneration template: clinical and histological assessment.

Skin and soft tissue reconstruction represents one of the most debated issues of plastic surgery. The advent of regenerative medicine has shown new pathways with the use of lipofilling and dermal regeneration templates. The aim of this study was to investigate the histological and clinical modifications occurring after lipofilling in the areas previously reconstructed with Integra® and an autologous thin dermal-epidermal graft. Histological and immunohistochemical analysis were performed on nine patients to compare skin before and after lipofilling. Pre- and post-operative examinations (POSAS, VAS scale) were carried out as well as taking clinical photographs. The authors detected an overall clinical and histological improvement in all cases. Data obtained from POSAS and VAS scale showed a statistically significant (p less than 0.05) improvement concerning all variables investigated before surgery. The biopsies revealed qualitative modifications with hematoxylin-eosin and Masson trichrome stain. Immunohistochemistry with CD31 antibody also demonstrated quantitative changes with an increased number of vessels. The photographs enabled to compare the clinical situation before and after lipofilling with better aesthetic outcomes. Lipofilling gave good functional and aesthetic results in the areas treated with Integra® and autologous thin dermal-epidermal grafts.

Adipose-derived mesenchymal stromal (stem) cells differentiate to osteoblast and chondroblast lineages upon incubation with conditioned media from dental pulp stem cell-derived osteoblasts and auricle cartilage chondrocytes.

The potential of adipose-derived mesenchymal stromal (stem) cells (ADSCs) to differentiate into either osteoblasts or chondrocytes is controversial. In this study we investigated the multicapacity potential of ADSCs to differentiate towards adipocyte, osteoblast, and chondrocyte lineages when cells are seeded onto plastic in comparison with incubation with conditioned media (CM) obtained from differentiated cell types.ADSCs, obtained from liposuctions, were characterized for mesenchymal and hematopoietic markers by cytofluorimetry. Their differentiation capacity towards adipocytes, osteoblasts, and chondrocytes was investigated by histochemistry methods (Oil-Red-O staining, Safranin O and Alizarin Red staining, respectively). Dental pulp stem cells (DPSCs) and dedifferentiated auricle derived-chondrocytes were differentiated towards osteoblastic and chondrocytic lineages respectively, and the CM obtained from these cultures was used to induce differentiation of ADSCs. ADSCs were positive for mesenchymal markers (CD29, CD105, CD73, CD44), but not for hematopoietic lineage markers (CD14, CD34, CD45) and this behavior was conserved from the isolation up to the fifth passage. While ADSCs were readily differentiated in adipocytes, they were not towards chondrocytes and osteoblastic lineages, a behavior different from that of bone marrow-derived MSCs that differentiated into the three lineages at two weeks post-induction. Only ADSCs treated with CM from cultured chondrocytes and DPSCs, produced glycosaminoglycans and mineralized matrix. These results indicate that ADSCs need growth/morphogenic factor supplementation from the tissue environment to be appropriately differentiated to mesodermic lineages.

Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: Results from a long-term longitudinal cohort study.

Few studies of long-term outcome of hypospadias treatment in terms of voiding, surgical complications, sexual functioning, intimate relationships and cosmetic results have been investigated and contrasting results have been obtained so far. The aim of our study is to investigate the long-term outcome of urinary and sexual function, cosmesis and the quality of intimate relationships in a series of hypospadias. In this study, 42 patients who underwent surgery for hypospadias were prospectively followed for 15 years. Medical records provided the hypospadias data, the number of reconstructive operations and the reconstruction technique that was used. Patients underwent physical examination, including penile length measurement and completed International Prostatic Symptoms Score (I-PSS), International Index Of Erectile Function (IIEF 15) and the Penile Perception Score questionnaire (PPPS). Twenty patients agreed to participate in the study. At the enrolment, the median value of HOSE was 13, as regards PPPS, 18/20 (90%) were satisfied, while in 1998 only 80% were satisfied. No significant statistical difference has been reported from the results obtained at enrolment and those obtained at follow-up, in terms of PPPS (P = 0.81), IPSS and IIEF-15. Penile length was 6.5 cm flaccid and 10.5 cm stretched. Our data show how cosmesis, function and psychosexual development for these patients are highly connected to surgical outcome, which is understood to be a decrease in penile size.

Morphostructural changes in transferred fasciocutaneous free flaps: a preliminary clinical and immunohistochemical report.

Many local factors, yet to be investigated, can promote changes in tissue transferred by microsurgical technique into the recipient site. Several studies have attempted to assess the nature of modifications that occur in the vascular network of such a flap after transfer. Although these investigations have interesting conclusions, the majority of them were based only on indirect evaluations. The aim of this study was to detect, by histological and statistical analysis, the morphostructural changes that occurred in fasciocutaneous free flaps transferred to the cephalic region or to the lower limb. Patients were enrolled in this study only when neither local inflammatory reactions nor systemic diseases were observed at the time of biopsy. Six patients consented to undergo biopsy at both the donor and the recipient area of a previously transferred fasciocutaneous free flap. Three flaps were used for facial reconstruction, and three others for lower limb reconstruction. Standard staining and immunohistochemical investigations were performed. The sections were also analysed by specific software. Statistical analysis of the data was performed using the student's t-test and Fisher's test. In five out of six transferred flaps (83%), there was increased microvascularity compared to the donor area. It was correlated to the neoangiogenesis in the dermal layer of the flaps. In five recipient sites there were more new vessels. In particular, a higher score of angiogenesis was observed both in the cheek (one flap) and in the non weight-bearing area of the foot (two flaps) (P<0.001). Some differences in microvascularity between the donor and the recipient site in the same flap were related to the specific recipient site. This represents the first demonstration of adaptation of fasciocutaneous free flaps to the recipient area, as well as to their new function, at both the macroscopic and microscopic level.

Microsurgical treatment of injury to peripheral nerves in upper and lower limbs: a critical review of the last 8 years.

Nerve injuries to the upper and inferior limbs represent a common event due both to home and working accidents. Minor traumas can lead to severe disabilities if a wrong treatment is carried out. From 1997 to 2005, 920 patients were observed with a total of 1,200 major or minor nerves injuries operated. In 852 cases acute lesions treated. In 68 patients we reviewed old injuries. In 707 patients direct nerve suture and in 145 patients nerve grafts were carried out. One to 8 years follow up observed. Different protocols were adopted according to the injury: simple cut, complex lesion or surgical revision. Results were evaluated during the follow up period with different models: motor evaluation in six levels (BMRC), sensitive evaluation in five levels (HIGHET), and global evaluation with four grades (from the worst to the best result). Nerve healing is a complex biological phenomenon influenced by many parameters related both to the patient characteristics and nerve lesion. Functional and esthetical outcomes vary also according to: age, cultural and economic condition, health status, and smoking. Post operative rehabilitation is mandatory to obtain an acceptable functional result. Nerve injuries to the upper and inferior limbs represent a challenge for the microsurgeon. Ultimate success in nerve surgery is judged by functional as well as cosmetic parameters. Only patients with the appropriate indication should be operated and always by a skilled surgeon.