A Case of Large Aplasia Cutis Congenita with Underlying Skull Defect: Effective Surgical Treatment with Integra® Dermal Regeneration Template.

INTRODUCTION: Aplasia cutis congenita (ACC) is a rare congenital abnormality characterized by the absence of a portion of skin at birth which most commonly involves the scalp and can affect the galea, the pericranium, the bone, and the dura mater. It can be an isolated condition or associated with other disorders. CASE REPORT: We present a case of ACC with a large defect of the scalp and the underlying bone treated with the use of Integra® Dermal regeneration template. At 5 months of follow-up, the wound is completely healed and the bony defect greatly reduced. Contraction of the area of alopecia was observed. DISCUSSION: Several surgical and conservative options have been described to treat this congenital condition: advanced dressing, skin graft, local flaps, free flaps, and other methods. In our case, we used Integra® Dermal templates which provide a barrier for infections, promote cellular activity for a rapid vascularization, and improve healing.

Breast Cerclage: An Innovative Expedient for Perimammary Dehiscence Healing.

The perimammary zone is a critical area for healing, due to high incidence of dehiscences, expecially sternal ones. Although deep sternal wound complications are nowadays less common after cardiac surgery, in some at risk patients, dehiscences still represent important complications of major cardiac or vascular surgeries and they are directly correlated to an increased risk of patient's morbidity and mortality. A heavy breast represents a source of tension on the perimammary wound, inhibiting or delaying a complete recovery. We report the case of a 66-year-old female patient with a critical post-surgical sternal dehiscence and multiple chronic comorbidities. The dehiscence was managed with a routinely performed primary intention closure combined with an innovative breast cerclage. To our opinion, this is the first reported description of a breast cerclage used as an expedient to reduce tension on the wound and minimize the risk of relapse, allowing a rapid and complete healing. This novel technique has proved to be effective and satisfactory in the achievement of both a functional and aesthetic results and we are confident that it could become a fully-fledged wound healing issue in chest wall reconstruction.

Chronic Ulcer by Cutaneous GvHD After Bone Marrow Transplantation Treated With Skin Allograft From HLA-Identical Donor: Case Report and Literature Review.

We present a successful split-thickness skin allograft for a chronic cutaneous graft-versus-host disease of the thigh in an immunosuppressed patient, treated for acute myeloid leukemia with allogenic bone marrow stem cells transplant.

Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery.

BACKGROUND: The aim of this prospective, controlled study was to evaluate the effects on coagulation function of active patient warming during elective plastic surgery. METHODS: Seventy-six patients undergoing elective plastic surgery (additive and reductive mastoplasty, rhinoplasty, and liposuction) were either covered with standard sterile drapes (control group, n = 38) or actively warmed during surgery with countercurrent fluid warming and forced-air skin warming (treatment group, n = 38). Complete evaluation of the coagulation activity was performed 1 hour before general anesthesia was induced and then at the end of surgery. RESULTS: Although no differences in preoperative core temperature were observed (36.0 +/- 0.5 degrees C in the control group and 36.1 +/- 0.4 degrees C in the treatment group; p = 0.12), core temperature was lower at the end of surgery in the control group (34 +/- 1.0 degrees C) than in the treatment group (36 +/- 0.6 degrees C) (p = 0.0005). No differences in prothrombin time and fibrinogen plasma concentrations were observed between the two groups. At the end of surgery, control group patients showed significantly larger activated partial thromboplastin times (36.8 +/- 3.5 seconds) and bleeding times (8.1 +/- 1.6 minutes) as compared with patients maintained normothermic during surgery (34.0 +/- 2.9 seconds and 4.3 +/- 1.1 minutes; p = 0.0005 and p = 0.0005, respectively). CONCLUSION: Actively maintaining intraoperative normothermia allows patients to maintain normal coagulation function during elective plastic surgery lasting longer than 2 hours, potentially reducing the occurrence of bleeding-related complications after plastic surgery.