Considerations on 100 cases of free microsurgical flaps in the reconstruction of the soft tissues of the lower limb.

The authors evaluate the results for 100 cases of severe loss of substance of the lower limb treated by microvascular free flaps at the Division of Plastic Surgery, Bellaria Hospital in Bologna, between 1994 and 2001. The cases involved recent traumatic loss of substance in 48 cases, post-traumatic defects such as osteomyelitis, ulcers, unstable scarring, sequelae of burns in 40, and neoplasms in 12. Muscular flaps were used in 89 cases, skin flaps in 9, a flap of the omentum in 1; the latissumus dorsi flap was that most frequently used (50 cases). A total of 87 cases had favorable results, while in 13 cases there was failure of the flap. Based on the results obtained, and experience, current indications and causes of failure are discussed.

Use of the trans-abdominal rectus abdominis flap in sacrum surgery.

The authors describe the method used to reconstruct the posterior wall of the pelvis using a flap taken from the rectus abdominis muscle after resection of the sacrum to treat neoplasm.

[Free-flap fibula for the reconstruction of composite mandibular defects]. / Il lembo libero microvascolare di perone nella ricostruzione di difetti mandibolari complessi.

The advent of microsurgery has revolutionized the reconstruction of composite tissue defects of the mandibular region. Well-vascularized bone and soft-tissues can be used to repair any kind of oromandibular defects and many of the morphological and functional goals of mandibular reconstruction can now be achieved. The ideal flap should provide a vascularized bone of sufficient length and height, easily shaped to match the original mandible with a thin, abundant soft-tissue component. The donor site morbidity should be minimal and a two-team approach possible. Different flaps have been used for mandibular reconstruction including fibula, iliac crest, radius and scapula. According to us, fibula free-flap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. 8 fibula free flaps were used in 6 cases of primary and 2 cases of secondary reconstructions. The defects were secondary to resections of oral cancers in 4 cases and of osteosarcomas in 4 cases. The mandibular defects were between 8 and 16 cm in length. Multiple osteotomies were used to shape the bone and miniplates were utilized for rigid fixation of the osteotomized bone and of the remaining mandible. An important soft-tissue defect was present in 6 cases requiring a skin paddle for oral lining. In 6 cases there was a complete survive of the flaps with very satisfactory results and good mandibular contour. There was one flap failure for a venous thrombosis and in one case the flap was removed after 8 days for complications independent of the microvascular technique. Donor site morbidity was minimal with no significant gait disturbance. In conclusion, the advantages of microvascular surgery and the reliability of fibula free-flap make it an attractive and versatile option in one-stage reconstruction of composite tissue defects in the mandibular region.

[Role of microvascular free flaps in the treatment of amputation stumps]. / Ruolo dei lembi liberi microvascolari nel trattamento dei monconi di amputazione degli arti.

The authors report the importance of plastic surgery in rehabilitation of the amputated stump. After having referred the tight dependence between amputated stump and prosthesis, they underline the importance of a trophic and painless stump characterized by a satisfactory "useful length". They report two cases in which these priorities have been satisfied by using latissimus dorsi free flap. The authors believe that better rehabilitative results can be achieved by applying the most recent techniques utilized in plastic surgery and particularly microvascular free flaps.

[Toxic occupational liver diseases. Therapeutic effects of silymarin]. / Epatopatie tossiche professionali. Effetti terapeutici della silimarina.

We considered two groups, one of 35 and the other of 20 patients, with occupational toxic hepatopathy caused by various toxic substances (mostly solvents, paints and glues). The patients were mostly suffering from chronic or subacute forms. We considered the work conditions in the anamnesis, the period of exposure and most important laboratory parameters of hepatic function checked before and after treatment with Silymarin (420 mg/die/os) for the first group and with "placebo" for the second group. Five patients of the first group were diagnosed by biopsy. The treatment with Silymarin has shown slight variations in some parameters. The therapeutic effect is probably not dependent upon the kind of pathogen noxa; it seems instead to be more evident when the exposure period is shorter. The group "placebo" does not show significant variations.