Mechanically fragmented cartilage grafts in rhinoplasty: An up-to-date systematic review.

INTRODUCTION: Grafts play key roles in functional and aesthetic rhinoplasty. Autologous grafts are generally preferred for their biocompatibility and less visibility when used in a fragmented fashion. The aim of this study was to review mechanically fragmented cartilage grafts techniques described in the literature, outlining indications, outcomes, and complications. MATERIAL AND METHODS: A systematic review of articles published from 1999 until December 2022 was conducted, using the following key words: "rhinoplasty," "cartilage," and "graft." Studies were selected according to the inclusion and exclusion criteria, and data were extracted and grouped for subgroup analysis. Rates of partial resorption, total resorption, surgical revision, and major and minor complications were statistically analyzed. RESULTS: Thirty eligible studies were included. Three cartilage fragmentation methods were identified: diced, shaved, and crushed. Cartilage grafts were further divided into injectable and noninjectable grafts. Diced cartilage was the most commonly used. Dorsal irregularities were the main indication. Overall, 1.68% of patients experienced partial resorption, 0.27% experienced total resorption, and 1.46% needed revision. The partial resorption rate in the diced group was significantly lower than that in the shaved group. Injectable grafts showed a higher rate of partial resorption. The revision rate was higher with noninjectable grafts. CONCLUSION: The partial resorption rate was lower in patients treated with diced cartilage. Injectable grafts are malleable and suitable for the correction of minimal irregularities, although they are affected by a higher rate of partial resorption. Wrapping materials may be used when significant augmentation is required.

Correlation Between General Satisfaction with the Breasts and Appearance of the Scars in Patients Undergoing Inverted T-Scar Reduction Mammaplasty: A Prospective PROMs-Based Study.

BACKGROUND: Inverted-T scar reduction mammaplasty is still the most chosen technique for breast reduction even if scars are relevant. Sometimes, surgical scars may be esthetically unpleasant and may cause severe pain, tenderness, sleep disturbances, anxiety, and depression in these patients. This study aimed to assess any possible correlation between general satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty. Secondary aim was to evaluate average variations of BREAST-Q and SCAR-Q at different postoperative times. MATERIALS AND METHODS: 121 patients who underwent breast reduction using Pitanguy technique with inferiorly based dermo-adipose flap according to Ribeiro were enrolled in this prospective cross-sectional study. All patients filled the BREAST-Q REDUCTION and SCAR-Q questionnaires in paper form at 1, 6 and 12 months after surgery. BREAST-Q REDUCTION "Satisfaction with breast" scale was also administered preoperatively. Values were exported in Prism 9 for the statistical analysis. RESULTS: Correlation index of Pearson between "Satisfaction with breast" and "Appearance of scar" was 0.09 at 1 month post-operative and - 0.07 and 0.21 at 6 and 12 months PO respectively. "Satisfaction with breast" mean value tends to rise over time. "Appearance of scar" mean value tends to decrease over time. CONCLUSION: No correlation at different postoperative times between the general satisfaction with the breast and appearance of the scars was found. Data showed that satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty tend to improve over time. LEVEL OF EVIDENCE IV: 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 .

Switching from Galenic to Advanced Dressings or Vacuum Assisted Closure Therapy Can Improve Quality of Life of Patients with Chronic Non-Responsive Pressure Skin Ulcers: Preliminary Data with Italian Translation of WOUND-Q.

Objective: A few studies have focused on the quality of life (QoL) of patients with chronic non-responsive pressure skin ulcers. The aim of this study was to assess how correct treatment (advanced wound care [AWC] dressings alone or vacuum assisted closure [VAC] therapy alone) changes the QoL of these patients. Approach: One hundred six patients with chronic non-responsive pressure skin ulcers, who had previously used galenic dressings, applied without proper therapeutic indication, were included in this study. We administered the WOUND-Q, at time 0 and after 1 month of appropriate therapy, to assess patient-reported outcome measures. Group 1 consisted of 30 patients treated with advanced dressings, Group 2: 22 patients treated with VAC therapy, and Group 3: 30 patients continuing conventional galenic dressings (Control group). Statistical analysis allowed us to analyze QoL changes over time and to compare WOUND-Q Group 1 and 2 deltas with those of Group 3. The study followed the STROBE statement. Results and Innovation: In all the scales evaluated (Assessment, Drainage, Smell, Life impact, Psychological, Social, Sleep and Dressing), there were significant improvements in mean values for Groups 1 and 2. Kruskal-Wallis tests with Dunn's multiple-comparisons tests and Brown-Forsythe and Welch Analysis of Variance tests demonstrated significant differences between deltas of Group 1 and Group 2 compared with those of Group 3 for most scales analyzed. Conclusions: Administration of the WOUND-Q demonstrated that the application of advanced dressings alone or VAC therapy alone positively affects the QoL of patients with chronic nonresponsive pressure wounds, in comparison with galenic dressings alone. The WOUND-Q has been shown to be a valid tool in studying changes in QoL of these patients.

Chemical Composition and Anti-Candida Activity of Mentha suaveolens Ehrh. Essential Oils Obtained by Different Distillation Processes.

A comparative study on essential oils extracted from Mentha suaveolens Ehrh. from Italy is reported. Two extraction procedures were investigated: hydrodistillation and steam distillation, carried out as a continuous and fractionated procedure. Fresh and dried plant material from two harvests was used. The hydrodistillation method yielded a higher amount of essential oil. The dried plant was significantly richer in essential oil per kg of starting plant material. Gas chromatography-mass spectrometry analysis of 112 samples showed that the essential oils belong to the piperitenone oxide-rich chemotype. In addition, piperitenone, p-cymen-8-ol, and limonene were among the most abundant compounds in the different samples. A higher amount of piperitenone oxide was obtained by hydrodistillation, while steam distillation gave a higher percentage of piperitenone and limonene. The essential oils were characterized for their anti-Candida albicans activity; higher potency was observed for the samples rich in piperitenone oxide, with MIC values ranging from 0.39 to 0.78 mg·mL-1 (0.039% and 0.078% p/v). The results of this work provide a deep insight into the methodology of essential oil extraction and the associated chemical variability of M. suaveolens Ehrh. Some of the essential oils are potent against C. albicans and could be considered for potential use in therapy.

The use of inter-alar ligaments flap for tip and supra-tip contouring in primary open structural rhinoplasty.

BACKGROUND: Precise tip contouring is paramount to achieve pleasant cosmetic results in rhinoplasty. Loss of tip projection or rotation, supra-tip deformities, as well as long-lasting edema, may jeopardize the outcome, thus leading to patient's dissatisfaction or re-intervention. Several approaches were previously reported, sometimes with considerable drawbacks or conclusions mainly supported by experience. The aim of this study is to describe the inter-alar ligaments flap for tip and supra-tip contouring and to comparatively assess its efficacy and safety. METHODS: The study included 147 patients who underwent primary structured open rhinoplasty and divided into 2 groups: group 1 underwent harvesting and repositioning of the inter-alar ligaments flap, group 2 underwent conventional tip dissection. Tip edema, supra-tip definition and fullness were blindly scored at 2-, 6- and 12-month post-operative follow-up. Naso-labial angle was measured at 2 and 12 months post-operatively. Univariate analysis and and multivariable regression model were performed. RESULTS: Supra-tip definition was significantly higher in group 1 at 2-, 6- and 12-months post-operative follow up (p<0.05, p<0.01 and p<0.01, respectively). Tip edema and supratip fullness were significantly lower in group 1 at each time point (p<0.01). Naso-labial angle, as well as its modification between 2- and 12-months post-intervention, did not differ in the 2 groups. All findings were confirmed when controlled for eventual confounders. CONCLUSIONS: The inter-alar ligaments flap proved to be versatile, effective and consistently reliable in reducing tip edema and improving supra-tip definition. It may be tailored to the patient, partially folded to improve tip projection or used to camouflage tip grafts.

Cathelicidin LL-37 expression in human breast implant capsules.

BACKGROUND: Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling and clinical outcomes. METHODS: The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin/eosin, Masson trichrome, immunohistochemistry and immunofluorescence for LL-37, CD68, α-SMA, Collagen type I and III, CD31 and TLR-4. RESULTS: LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and 9 (31%) of the specimens, respectively. In 8 cases (27.5%) it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages (p<0.001). Moreover, LL-37 expression by macrophages of peri-expander capsules negatively correlated with the severity of capsular contracture on definitive implants (p=0.04). CONCLUSIONS: This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophages modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture.