Snip conjunctivoplasty associated with methylene blue staining for treatment of postoperative conjunctival chemosis.

Conjunctival chemosis usually undergoes spontaneous resolution; sometimes, it requires treatment. We present the case of a 43 years-old female patient who developed bilateral conjunctival chemosis following upper and lower blepharoplasty. Two months after the operation, patient underwent bilateral snip conjunctivoplasty with methylene blue demarcation of the chemotic conjunctiva.

Skin-reducing oncoplasty: A new concept and classification in breast cancer surgery.

BACKGROUND AND OBJECTIVES: Breast-conserving surgery and skin-sparing mastectomy are nowadays widely accepted as the standard of care in selected patients with early breast cancer. After an accurate review of the literature, it appeared that no ordered list of the numerous techniques described for conservative breast surgery has been established so far. The aim of this study was to develop a simple classification of the different skin incision patterns that may be used in breast surgery. METHODS: A systematic review of the English literature was conducted using the PubMed database to identify all the articles reporting breast-conserving surgery and skin-sparring mastectomy techniques up to the 31st of December 2016. RESULTS: Among the 1426 titles identified, 230 were selected for review. Based on the reviewed papers, the skin-reducing oncoplasty incision pattern (SROIP) classification was elaborated. CONCLUSIONS: Breast cancer surgery should nowadays optimise aesthetic outcomes by improving the final breast shape, volume and scar location. This may be achieved using different procedures that we grouped together under the term skin-reducing oncoplasty (SRO). Depending on the breast cancer location, the SROIP classification helps in the choice of the best technique to be used.

Comparative study between biodegradable nasopore (BNP) and Merocel hemox 10 cm after septo-turbinoplasty procedure.

OBJECTIVE: The purpose of our study was to compare Merocel (Merocel Hemox 10 cm) and BNP (biodegradable nasopore) during a septoturbinoplasty procedure in terms of efficiency and patient comfort. PATIENTS AND METHODS: We carried out a retrospective review of 72 patients who had undergone septoturbinoplasty between January 2015 and January 2016. Each group, packed with BNP or Merocel Hemox 10 cm was composed of 36 patients. A standard visual analogue scale ranging from zero (no symptoms) to 10 (the most severe symptoms) was used to assess subjective symptoms. To compare the usefulness of materials we evaluated the postoperative bleeding, infection and adhesion after the removal of packing with and endoscopic examination using a 5-point scale (zero, absent; 1, mild; 2, moderate; 3, severe; and 4, very severe). Secretions and crusts were evaluated 1 week and 4 weeks after surgery in both groups using a 5-point scale (zero, absent; 1, mild; 2, moderate; 3, severe; and 4, very severe). RESULTS: A total of 72 patients were enrolled in the study, 45 women and 27 men; age range 15-78 with a mean age of 47 years. In the group A (Merocel group), 21 cases showed grade 1 bleeding (58%), 11 cases grade 2 (30%) and 4 patients grade 0 (11.1%). In the group B (BNP group), 29 cases showed grade 0 bleeding (80.56%) and 7 cases showed grade 1 bleeding (19.44%). There was a statistical significant difference between the Merocel group and the BNP group in terms of bleeding after removal of packing material (p < 0.05). In the group A, 16 patients developed mild adhesion (44%), 8 patients moderate adhesion (22.2%), 3 patients severe adhesion (8.33%) and 1 patient very severe adhesion (2.77%). BNP nasal packing didn't cause any adhesion in 25 patients (69.4%), 11 patients developed mild adhesion (30.5%). So there was a statistical significant difference between group A and group B regarding the adhesion (p < 0.05). There was a statistically significance reduction of nasal secretions and crusts at a week after surgery in the BNP group vs. Merocel group. The difference is not statistically significant 4 weeks after surgery. About the severity of symptoms related to nasal packing, we found a statistically significant difference (p < 0.05) between Merocel and BNP group regarding the pain during packing removal, the general satisfaction and the pressure. CONCLUSIONS: Biodegradable nasopore reduced pain and patient discomfort during packing removal and causes less bleeding compared to Merocel hemox 10 cm. This type of material can be used after septoturbinolplasty.

Use of suborbicularis oculi fat flap to cover peri-orbital bone exposure.

Wide resection of recurrent basal cell carcinoma (BCC) in the peri-orbital-infraorbital-nasal area may include periosteum resection with maxillary or nasal bone exposure. The absence of vascularized periosteum makes the defect ungraftable and local flaps are often required. As an alternative to a large single flap or a combination of flaps, it is possible to turn the ungraftable portion of the defect into a graftable one. The suborbicularis oculi fat (SOOF) flap is an advancement flap that is used in aesthetic surgery for midface rejuvenation. The use of the SOOF flap along with a full-thickness skin graft, as an alternative to the use of other standardized flaps to cover defects in the peri-orbital-infraorbital-nasal area with avascularized tissue or noble structure exposure, is reported herein. As an immediate single-stage reconstruction, this procedure leaves other flap options intact in the event of re-operation for a recurrent tumour.

A rare case of 'histiocytoid haemangioma' of the hand.

Histiocytoid haemangioma has been identified by Rosai in 1979 as a group of vascular tumour-like lesions. This lesion can occur in a wide variety of sites. Surgical excision is the treatment of choice. We present the case of a 35-year-old man with a swelling in the thenar region of his right hand. Preoperative X-rays, magnetic resonance imaging (MRI) and angio-computed tomography (angio-CT) demonstrated a lesion invading the radial digital artery to the index finger without any bone erosion. It was excised 'en bloc' with the artery itself. The radial digital nerve to the index finger and the main digital artery to the thumb were preserved. No local recurrence was observed at the 3-year follow-up. Histiocytoid haemangioma of the hand is a rare disease, and patients should undergo early surgical treatment to achieve complete excision of the lesion without any functional deficit.

Reconstruction of lower eyelid and periorbital district: an orbicularis oculi myocutaneous flap.

The upper eyelid has long been considered a good source of skin graft, but it is infrequently used as a unipedicled flap, based either medially or laterally, to reconstruct the skin of the lower eyelid. Here we describe a procedure in which we use the upper eyelid skin and underlying orbicularis muscle as a myocutaneous flap to reconstruct the lower eyelid and periorbital region.

The ultrasound halo sign in angiolymphoid hyperplasia of the temporal artery.

An ultrasound halo sign surrounding the temporal artery is a well recognized feature associated with giant cell arteritis. We report a previously unreported case of this halo sign being present around the temporal artery due to angiolymphoid hyperplasia with eosinophilia (ALHE) in a young female patient.

[Laboratory model of a microvascular free flap in the rat: the epigastric flap]. / Modello sperimentale di lembo libero microchirurgico nel ratto: il lembo epigastrico.

BACKGROUND: Soft tissue defects are mostly managed surgically by free microvascular flaps. The progressive development of techniques and the availability and reliability of new different and free flaps encouraged this surgical approach. Thus, there is a constant need of free flap models to reproduce in laboratory. The experience with the use of the epigastric free flap in the rat as a laboratory model for microsurgical trainees is presented. In our microsurgical flap model the anastomoses were constantly performed on the femoral vessels. METHODS: The flap was used in 25 rats during the practical sessions of periodical experimental microsurgery courses. The main steps were: flap harvesting on the superficial epigastric vessels; flap anastomosis on the femoral vessels; pedicle section; microvascular anastomosis. RESULTS: The epigastric free flap showed to be an easy surgical model. The mean duration of the exercise was 2 hours and 11 minutes. These surgical times were considered acceptable to the requirement of a laboratory model. CONCLUSIONS: The epigastric free flap in the rat is a reproducible experimental model which is still up to date in microsurgical training.

Redefinition of the helical rim in cauliflower-ear surgery.

Cauliflower ear is a serious deformity of the auricle induced by single or repeated injury to the external ear. Few papers deal with surgical techniques for correcting this deformity. We describe the use of ipsilateral excess cartilage to restore the helical rim.

Introduction of a hand trauma day surgery operating list.

Due to a huge increase in hand trauma referrals to our busy plastic surgical unit, we introduced a dedicated half-day hand trauma day surgery (HTDS) list to try and reduce the pressure on inpatient beds and length of wait for surgery. We reviewed the first 101 cases treated on the HTDS list to determine whether this allowed adequate specialist treatment of these injuries and to assess outcome and complications rates. Only one patient needed admission following surgery and our complication rate compared favourably with that of patients admitted and treated in the standard manner. We conclude that a HTDS list is both an effective and efficient method of treating a wide range of hand injuries.

Use of Indermil tissue adhesive for closure of superficial skin lacerations in children.

BACKGROUND: The aim of this study was to assess the use of tissue adhesive for paediatric wound closure in a minor injuries environment. METHODS: A n-butyl 2-cyanoacrylate adhesive formulation was used for the closure of traumatic skin lacerations in 56 children. RESULTS: Tissue adhesive succeeded in approximating skin margins in all cases. No episodes of wound dehiscence were experienced. There were no incidences of wound infection. CONCLUSIONS: This study indicates that this form of tissue adhesive can safely and effectively be utilised for traumatic superficial skin closure in children.

Lipoma extraction via small remote incisions.

We describe a technique for extraction of lipomata using gynaecological polyp forceps, via incisions placed in aesthetically better sites than directly over the lesion. Although this can also be achieved by liposuction, we have found that this alternative technique is valuable in those cases where liposuction has failed due to the fibrous nature of the lesion, or where equipment is not available.

Endoscopic carpal tunnel release in selected rheumatoid patients.

Twenty endoscopic carpal tunnel releases were performed in 15 patients with quiescent seropositive rheumatoid arthritis using the Agee technique. Patients were not considered for endoscopic carpal tunnel release if there was florid synovitis with crepitus or loss of active finger flexion, if there was evidence of flexor tendon rupture or if they had previously undergone surgery in the region. Access to the tunnel was significantly easier than normal and visualization of the flexor retinaculum was satisfactory in all cases. There were no complications. We conclude that endoscopic carpal tunnel release can be safely performed in selected patients with rheumatoid arthritis. The absence of a palmar scar can be a great advantage to these disabled patients.

Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials (Polydioxanone, Poliglecaprone 25, Glycomer 631).

Monofilament synthetic absorbable suture materials offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual bio-absorption. An investigation was conducted on 72 rats to compare three types of monofilament absorbable suture material (Polydioxanone, Poliglecaprone 25, Glycomer 631), with respect to their clinical characteristics, tissue inflammatory reaction and suture absorption times. The results identified different qualities for each suture: Poliglecaprone 25 and Glycomer 631 suture materials were found to be less reactive than Polydioxanone in rat skin. However, because of their extremely low tissue reaction values, all three materials were deemed particularly suitable for use as intracuticular sutures. Absorption times in rat skin were less than 3 months for Poliglecaprone 25, between 3 and 6 months for Glycomer 631 and 6 months for Polydioxanone. The differences in suture characteristics which were detected in our study can help in the surgical selection of the most appropriate suture material.

A simple technique for applying local splintage to the fingers.

We report a simple method of splinting the interphalangeal joints that we have employed as our standard technique without complication.

Progressive skin extension: clinical and histological evaluation of a modified procedure using Kirschner wires.

We describe a modification of a skin traction system for progressive skin extension before excision of skin lesions. The traction device consists of Kirschner wires and plastic straps. It results in more homogeneous traction and greater sparing of healthy skin as compared with the earlier silicone bar method. Moreover, the procedure results in lower rates of infection, skin necrosis and breakage of the cutaneous bridges. Histological changes to the treated skin area are similar to those obtained with skin expansion procedures.

Anthropometry and endoscopic carpal tunnel release.

A prospective study was performed in 100 consecutive endoscopic carpal tunnel releases (ECTR) to assess the effect of a number of anthropometric measures on the ease of introduction of the ECTR system into the carpal tunnel. Ease of access to the carpal tunnel correlated with the wrist circumference, height and age of patients. Surgeons should be aware that ECTR is likely to be more difficult in small patients with small wrists and should have a higher threshold for conversion to the open technique to avoid neurological complications.

[The intradermal cutaneous suture with separate stitches using a resorbable monofilament (Polyglecaprone 25)]. / Sutura cutanea intradermica a punti staccati con monofilamento riassorbibile (Poliglecaprone 25).

The introduction of sutures using Polyglecaprone 25 (Monocryl--Ethicon SpA) has facilitated the use of intradermal suture with separate stitches owing to its flexibility and softness, with extremely satisfactory aesthetic results. The authors report their experience regarding the use of this new material from May 1995 to April 1996 in 250 cases of intradermal suture with separate stitches. The paper also describes a few technical details and emphasis their advantages.