Otoplasty for prominent ears deformity.

OBJECTIVE: Prominent ears are a common congenital deformity of the external ear, derived from a combination of defects in the antihelix and concha. The majority of cases are treated surgically, but one of major difficulties associated with otoplasty regards the achievement of lasting aesthetic results. With the present study we propose an effective combination of four surgical techniques of cartilage reshaping with the ultimate goal of creating a new stable antihelical fold. PATIENTS AND METHODS: Forty-one patients with prominent ears were involved prospectively. The subjects (16 male and 25 female) ranged in age from 6 to 43 years, with a mean age of 12 years. All patients underwent to the same surgical procedure and we performed softening and reshaping of the antihelix adopting the consecutive use of four surgical techniques: hemitransfixing microincisions, scoring, squeezing and posterior mattress suture fixation. RESULTS: Total number of ears that underwent surgery was 71. The mean postoperative follow-up period was 2 years. The mean postoperative change of protrusion was 7.96 mm referring to the superior cephaloauricular distance, while it was 12.18 mm considering the middle cephaloauricular distance. No patient developed complications or recurrence. CONCLUSIONS: The proposed surgical procedure for otoplasty resulted in endurance of auricular appearance and symmetry with high success rate and low morbidity.

Nasal reconstruction with the two stages vs three stages forehead flap. A three centres experience over ten years.

INTRODUCTION: In nasal reconstruction all anatomic layers as cover, lining, and support, have to be replaced to restore proper aesthetics. Forehead skin has been acknowledged as the best donor site to resurface the nose. Traditionally forehead flap reconstruction is performed in two stages, but Millard described an intermediate third stage between flap transfer and pedicle division. This study compared the two methods. MATERIALS AND METHODS: The study enrolled 31 patients undergoing total or subtotal nose reconstruction between January 2001 and January 2012. 20 patients underwent to the two-step technique (2S Group), and 11 the three-step technique (3S Group). Thickness of the flap was measured in three different areas. A plastic surgeon not involved in the study completed an evaluation questionnaire to assess aesthetic satisfaction (VAS = 1-10). RESULTS: The total number of procedures performed (including revisions) ranged from 3 to 6. The average number of procedures performed in group 2S patients was 4 (range: 3-6) in the group 3S was 3.46 (range: 3-5). VAS mean values were studied with t Student test and were found to be significant. DISCUSSION: The timing of thinning of the flap and detachment of the pedicle varies among Authors. There are generally two trends: defatting of the flap before the pedicle transection, performed usually 3 weeks from flap harvesting and defatting a few months after disconnection of the pedicle. We think this technique is suited for defects including underlying structures and particularly for all those defects located in the distal part of the nose (tip and nostrils).

Upper eyelid necrosis and reconstruction after spider byte: case report and review of the literature.

Spider bites are not very common, especially in the Mediterranean area, and those affecting the ocular-palpebral region involving reconstructive surgery are particularly rare. In May 2010, the case of a Caucasian 24-year-old female patient was brought to the attention of the Dermatology Department, University of Cagliari, Italy. The patient reported she woke up feeling an intense pain with itching and that also she had noticed a spider of an unknown species on her bed. The dermatosis had affected the right orbital region, where there was a considerable red and violet erythema and a hard edema, not foldable. When the necrosis appeared the patient was treated at the Plastic Surgery Unit where she underwent a reconstruction of the eyelid with a full thickness skin graft from the retroauricular area. The post-operative course was regular with a perfect in-take of the skin graft. When the patient was discharged she was sent to an Entomological University Centre to identify the spider species and the possible venom which caused the skin lesion. The spider which caused the injury has been a Loxosceles rufescens (Dufour, 1820). Loxoscelism is a necrotic arachnoidism caused by the poisonous bite of spiders belonging to the Loxosceles species. It is very important to identify what sort of lesion it is and to treat it in a combined way in order to choose the proper timing for surgery to avoid damages to the eyelid functioning.

Cagliari University Hospital (CUH) protocol for immediate alloplastic breast reconstruction and unplanned radiotherapy. A preliminary report.

INTRODUCTION: Alloplastic breast reconstruction necessitating postmastectomy radiotherapy (PMRT) is at increased risk for complications such as capsular contracture, infection, extrusion, and poor cosmetic results. However, often the indication for PMRT is not decided until a permanent histological examination with review of the permanent sections is carried out, and the expander has already been inserted. Techniques described to face this issue (delayed-immediate reconstruction and Memorial Sloan Kettering Cancer Center protocol) both have disadvantages. MATERIALS AND METHODS: The protocol we suggest is based on (1) reconstruction with tissue expander placement at the time of mastectomy; (2) complete tissue expansion during postoperative chemotherapy; (3) radiotherapy, as suggested by oncologists; (4) two or three fat grafting session, according to Coleman's technique, 4-6 months after RT; (5) exchange of the tissue expander for a permanent implant approximately 3 months after the completion of fat grafting. Ten patients were treated according to these guidelines. RESULTS: Results at 15 months have been encouraging, with no grade 3-4 Baker's capsular contracture. DISCUSSION: Although the group of patients treated according to our CUH Protocol for immediate implant-based breast reconstruction and radiotherapy is small, and follow-up is short; nevertheless, results are encouraging.