Association between abdominal separation and inguinal or crural hernias: our experience and surgical indications.

Abdominal wall weaknesses present several causative factors, both local and systemic and, as a consequence, abdominal hernias may develop in more than one site. Also, simultaneous hernia repair has been rarely reported in published reports. In the present study, the association of multiple weaknesses of the abdominal wall in patients undergoing conventional abdominoplasty or hernia repair were evaluated, and the advantages of simultaneous repair in a single operation are discussed. In a 3-year time period, all patients undergoing abdominoplasty or abdominal hernia repair were clinically and instrumentally evaluated for the association between median abdominal wall weakness and inguinal and/or crural hernias. The body mass index (BMI) was also considered and photographic documentation was taken before the operation and during the follow-up. When this association was confirmed, patients underwent contemporary correction of both conditions using an abdominoplasty approach. The presence of inguinal and/or crural hernias was observed in 10% of all patients undergoing conventional abdominoplasty and in 14.5% of patients with laparocele in the institution. The BMI was higher in patients with the association than in those without. Good aesthetic and functional results were achieved and the complication rate was low. The role of obesity as a triggering factor of abdominal wall weaknesses is confirmed by the higher BMI in patients with associated diseases. These observations remark the fact that the association between median abdominal wall weakness and inguinal or crural hernias should always be investigated. If this association is confirmed, it is preferable to treat both conditions simultaneously.

Does Veritas® play a role in breast reconstruction? a case report.

To reduce operative times and surgical complications in implant-based breast reconstruction, many authors advocate the use of exogenous material (modified xenograft) to support tissue regeneration. In this article, a case is presented in which a bovine collagen patch (Veritas® Collagen Matrix; Synovis Surgical Innovations, St Paul, MN) was used in the immediate breast reconstruction with an implant. The good results obtained in this case confirm Veritas® as a viable alternative to AlloDerm® Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) and further support its ability to sustain and stimulate recovery of the surrounding tissues.

Bilateral intra-areolar polythelia: report of a rare case.

A very rare case of bilateral intra-areolar polythelia with two nipples in each breast is presented. There were no other associated malformations and the patient's family history was normal. Surgical correction was performed for cosmetic reasons at the patient's request using transposition flaps in a Z-plasty design. The aesthetic and functional results were satisfactory.

Evaluation of polyurethane dressing with ibuprofen in the management of split-thickness skin graft donor sites.

BACKGROUND: The authors investigated the possible effect of ibuprofen when included in polyurethane dressing foam in the management of pain and healing related to split-thickness skin graft (STSG) donor sites. The study focused on the use of a foam dressing, Biatain-Ibu, the combination of an absorbent hydrophilic polyurethane foam, Biatain, and the active ingredient ibuprofen as an integral part of the matrix. PATIENTS AND METHODS: A prospective study was conducted from October 2006 to April 2007 and included 40 patients undergoing surgery for any reconstructive purposes with the use of STSG. The patients were divided into two groups in a randomized fashion. In the first group of 20 patients, the donor sites were covered using Biatain-Ibu foam dressing. In the second group of 20 patients, the donor sites were closed intra-operatively with a standard dressing which did not contain any known healing promoting agent. To evaluate the extent and quality of the pain experienced by the patients and to score pain over time, the patients in the study were asked to complete a form containing a visual analogue scale and answer questions on the quality of pain and the way normal daily activities were affected. RESULTS: The combined use of ibuprofen with bio-occlusive dressings accelerated wound healing compared to fine-mesh gauze dressings and almost eliminated pain and discomfort in all patients treated. In patients receiving topical ibuprofen, itch did not present a major problem. DISCUSSION: This study demonstrates that the Biatain-Ibu dressing is a useful tool in the management of STSG donor sites by providing an optimal environment for wound healing due to its bio-occlusive properties and by minimizing pain and discomfort.

Clinical application of autologous three-cellular cultured skin substitutes based on esterified hyaluronic acid scaffold: our experience.

BACKGROUND: The aim of this work was to present our experience in the use of autologous three-cellular cultured skin substitutes (CSS). This method represents a surgical alternative in the treatment of a variety of pathologies, including burns, ulcers, giant nevi and tumors. PATIENTS AND METHODS: CSS were obtained from full-thickness skin biopsies collected after enrolment of 11 patients in a clinical trial protocol approved by the local Institutional Review Boards of the 'La Sapienza' University of Rome and registered in clinicaltrials.gov (ID: NCT00718978). CSS consisted of a structure made by a pluristratified epithelial cell surface with melanocytes (ratio 1/20) and a basement of fibroblasts kept together by an esterified hyaluronic acid scaffold that can be surgically manipulated and is gradually reabsorbed after implantation and substituted by the host connectival stroma. RESULTS: At the time of withdrawal of medication, the graft take was comparable to that of autografts, whereas in the follow-up visits, loss of the epithelial layer varied markedly (from 5 to 70%) while fibroblast cellular component growth prevailed. In one patient, there was complete dermal-epidermal construct survival. CONCLUSION: Given the anatomical complexity of the skin, we still have a long way to go before we are able to recreate all the cellular and structural characteristics of this organ. Results are, however, gradually improving, as is demonstrated by a successful graft, which was histologically shown to have a three-dimensional structure that maintained its conformation in vivo (epithelium, basement membrane, dermis, subcutis) in one patient. The take of melanocytes improved the final esthetic outcome.