Pulsed radiofrequency energy device (PEAK plasmablade™) and CustomBone® Cranioplasty: an appealing surgical rendez-vous.

BACKGROUND: CustomBone® prosthesis is a widely recognized effective and successful technique for the reconstruction of cranial bone defects. Prior the cranioplasty implant, meticulous dissection within thick scar tissue is required. During this delicate surgical manoeuvre is vital to avoid damage to the skin flap itself and to the underlying cerebrovascular structures. We report our experience and potential applications of a novel, pulsed monopolar radiofrequency energy device (PEAK PlasmaBlade™, Medtronic plc). It reduced the incidence of post operativesubgaleal hematoma, the operative times and the intra operative blood loss following cranioplasty compared to the traditional scalpel and scissor dissection. METHODS: The authors present a one centre case series study to review the indications, safety and efficacy of the PEAK PlasmaBlade™ in adult patientsunderwent cranioplasty. Two surgical techniques for tissue dissection were compared: PEAK PlasmaBlade™ versus scalpel and scissor dissection (SSD). Treatment outcomes following each of these surgical approaches, relative to rate of post-operative subgalealhematoma formation, hospital admission, and operative times were compared. RESULTS: A total of 10 patients that had cranioplasty treatment were evaluated. In patients underwent scalp dissection with the PEAKPlasmaBlade™, we observed a reduction in the operative times, in the subgaleal hematoma formation and then in the hospital stay. CONCLUSION: PEAK PlasmaBlade™ revealed to be a safe and effective device in tissues dissection for cranioplasty implant. It provided reduction of the rate of subgaleal hematoma formation, operating times and less potential risk to damage cerebrovascular structures.

Skin-nipple-sparing mastectomy: The first approach in primary myxoid chondrosarcoma of the breast.

The primary mammary chondrosarcoma corresponds to less than 0,5% of the mammary malignancies. For the period ranging from 1967 to 2014, only 18 cases were reported in the literature. A 41year old woman found a hard nodule on her external right superior quadrant/axillary prolongation through breast self-examination. The vacuum-assisted core biopsy (VACB) revealed "high grade extra-skeletal myxoid chondrosarcoma". A skin-nipple-sparing mastectomy with the insertion of a mammary expander was performed. A protocol of adjuvant radiotherapy was also indicated. Until 2013, the gold standard was the radical mastectomy. By 2014, there were two cases of conservative approach to quadrantectomy. To our knowledge, this represents the first case in the literature in which a skin-nipple-sparing mastectomy has been performed on a primitive mesenchymal neoplasm of the breast. Such an oncoplastic approach was performed considering the young age of the woman, to assure the surgical radicality and a better quality of life to the patient.

Reconstruction of the face with skin-grafted muscle flaps: optimizing the aesthetic outcome.

BACKGROUND: Cutaneous facial defects repaired with perforator or fasciocutaneous flaps do not always give optimal aesthetic results due to excess bulk and colour mismatch. The authors present their experience in reconstruction of cutaneous facial defects with skin-grafted free muscle flaps. MATERIALS AND METHODS: From May 2004 to May 2006, 9 serratus anterior, 2 gracilis and 1 vastus lateralis skin-grafted free muscle flaps were used on 12 patients, after cancer excision in 11 cases and after hardware exposure in 1 case. Full thickness skin grafts were taken from the supraclavicular skin in 3 cases, from the groin in 1 case and from the muscle donor site in 8. RESULTS: No major complications were observed. Results were excellent in terms of contour and colour match. In the elderly, FTSGs taken from the muscle harvesting incision seem to eventually make a good colour match with the facial skin. No relevant donor site morbidity was observed with the muscles used in this series. CONCLUSIONS: In the search for good aesthetic results in facial skin reconstruction, skin-grafted muscle flaps permit optimal contour and colour match to be achieved with little donor site morbidity and a shorter operating time.