Reconstruction of post-traumatic losses of substance of the scalp: our experience.

AIM: The reconstruction of post-traumatic losses of substance of the scalp is very difficult due to the unique characteristics of the scalp. The purpose of this paper is to evaluate the results obtained with several techniques in order to identify the most appropriate. METHODS: We treated 19 patients, 11 men and 8 women aged between 19 and 81 years, with post-traumatic loss of substance of the scalp from January 2006 to June 2011. The chosen treatments were the direct closure and the use of local flaps, the latter combined or not with the graft of the donor area and the post-operative correction of alopecic area with tissue expansion. RESULTS: None of the patients developed severe complications and all flaps were viable. The aesthetic results were variable, between good and satisfactory according to the technique used. CONCLUSION: The local flaps represent a good choice for the treatment of post-traumatic losses of substance of the scalp, restricting the use of direct suture and the use of skin grafting only in selected cases. Tissue expansion is a good choice for the revision of alopecic and cicatricial areas.

Reconstruction of the traumatic eyelid injuries: a 6-years experience.

AIM: Our aim is focused on the management of eyelid injuries and on the chose different techniques for the reconstruction. The reconstructions of the upper eyelid and lower eyelid should be based on both functional and cosmetic aspects. MATERIAL OF STUDY: We looked at 47 patients from 2005 to 2011 with eyelid injuries. All patients were subjected to a surgical treatment. RESULTS: After a median follow-up from one to five years, in all cases the skin coverage was reinstated and mobility was restored, thereby adhering to the principles of both morphological and functional reconstruction. DISCUSSION: Eyelids are complex structures and pose a challenge for reconstruction. They play an important role in protecting the globe from trauma, excessive light and in maintaining the integrity of tear films and moving the tears toward the lacrimal drainage system. Concerning reconstruction by means of flap, the main principles dictate that with this procedure the new coverage will appear as much as possible, "like" the original tissue. CONCLUSIONS: There are different techniques available for reconstructions of defects of eyelids. The availability of tissues, technical expertise and the specific needs of the patient have to kept in mind before choosing a particular method. Compared with other frequently used techniques, the nasal chondromucosal flap is a one-stage operation, does not damage the lower lid, and provides a thin, mobile eyelid with an anatomically complete reconstruction.

[Reconstruction of full-thickness loss of substance of lower lip. Our experience]. / Ricostruzione delle perdite di sostanza a tutto spessore del labbro inferiore Nostra esperienza.

AIM: Many methods have been described for the reconstruction of the lower lip, but each has its own advantages and its disadvantages. The purpose of this study is to evaluate the results obtained with the use of different methods in order to choose the most appropriate method, according to the characteristics of the loss of substance. METHODS: From January 2006 to March 2011 were treated 110 patients with full-thickness loss of substance of the lower lip using various techniques: direct closure in small losses of substance (20 patients), Abbe flap (14 patients), Johanson technique (12 patients), Gillies fan flap (9 patients), Estlander flap (8 patients), Mc Gregor flap (11 patients), Karapandzic flap (18 patients), the nasolabial flap by Von Bruns (10 patients) and Bernard-Burow flap modified by Webster (8 patients). RESULTS: All flaps were vital and there were no cases of necrosis, infection, seromas or hematoma. Among the main complications, there was a delay in wound healing in 11 patients and the development of microstomia, of variable degrees, in 9 patients. The results from the aesthetic point of view were between good and satisfactory. CONCLUSIONS: The extension of the loss of substance is the main criterion that should direct the choice of an appropriate surgical technique: for larger defects reconstruction is less than optimal and obtain an adequate sphincter function is the main goal to achieve also with the use of near tissue.

[Polythelia and supernumerary breast. Personal experience and review of the literature]. / Politelia e mammella sopranumeraria. Nostra esperienza e revisione della letteratura.

AIM: Our study focuses on the approach, management and treatment of patients with polythelia and supernumerary breast and the target is the search for a treatment algorithm for these diseases. MATERIAL OF STUDY: We considered at 18 patients treated from 2006 to 2011 for breast congenital anomalies in excess. 14 surgical procedures were performed, 8 for supernumerary nipple excision (1 case associated with Poland Syndrome) and 6 for accessory breast ablation. All patients were aged between 15 and 34 years and belonged to both sexes. RESULTS: The breast tissue it was detected fibrocystic mastopathy in 5 cases of polimastia. In the remaining cases the nipples and mammary tissues were normal. After a median follow-up from one to five years, we obtained in all cases not only an excellent aesthetic result but also a psychological. DISCUSSION: The supernumerary breast tissue is not just a cosmetic problem, it is also subject to the same pathological lesions that are observed in a normal breast. In view of the potential malignant transformation of anomalous breast incidentally, early and accurate diagnosis is required as well as its monitoring over time. CONCLUSIONS. We therefore believe that surgical approach is always necessary in cases of polimastia, while considering options in the treatment of polythelia, where it becomes crucial if aesthetic and/or psychologically problems in the patient coexist.

[Treatment of ulcer and difficult wounds of the lower limbs: our experience]. / Trattamento delle ulcere e delle ferite difficili dell'arto inferiore. Nostra esperienza.

AIM: The purpose of this study is to evaluate the results obtained using traditional and advanced dressings, platelet gel, vacuum therapy and surgical techniques (grafts, flaps and dermal substitutes) in the treatment of ulcers and difficult wounds of the lower limbs to determine a treatment algorithm. MATERIAL OF STUDY: From January 2006 to September 2010 were performed 428 treatments on 377 patients (203 men and 174 women, age between 32 and 90 years). Both medical and surgical treatments were performed: 61 traditional medications, 149 advanced dressings, 25 with platelet gel, 42 with the vacuum therapy, 16 with surgical debridement, 86 with skin grafts of varying thickness, 8 with dermal substitutes and 42 with surgical flaps. RESULTS: The best results were obtained with the most innovative methods, which showed, on average, a higher healing rate compared to traditional medications. Positive results were also obtained with surgical treatment if properly preceded by a correct wound bed preparation. CONCLUSION: The main characteristic that should guide the choice of therapy is the clinical appearance of the lesion: correct management of all its aspects allows to increase the rate of healing and, when necessary to have recourse to less invasive surgical procedures.

Reconstruction of the loss of substance of the dorsum of the hand: from the conventional techniques to regenerative surgery procedures.

AIM: Our aim is focused on the advantages of new technologies compared with those of traditional methods in the reconstruction of the loss of substance of the dorsum of the hand. MATERIAL OF STUDY: We observed 37 patients from 2007 to 2010 with loss of substance of the dorsum of the hand, also associated with significant comorbidities. In 27 patients we chose surgical reconstruction, in 10 patients we opted for conservative reconstruction with the use of new technologies. RESULTS: After a median follow-up from one to three years, in all cases the skin coverage was reinstated and mobility was restored, thereby adhering to the principles of both morphological and functional reconstruction. DISCUSSION: Concerning reconstruction by means of flaps, the main principles dictate is the new coverage must appear as much as possible, similar to the original tissue. The reconstruction must be in a single surgical time. On the other hand, the advent of advanced dressings and bioengineering has optimized conservative skin repair. CONCLUSIONS: We have seen a considerable broadening of the indications for conservative reconstruction. This method is suitable for reconstruction of the dorsum of the hand with good effectiveness, it makes it possible to obtain a tissue of good quality, which is flexible and smooth on the tendons and is not excessively thick. These methods are achieved with relative ease even in patients with poor general health. Although costly, this procedure will ultimately save the patient from further surgeries and hospitalization expenses, making it advantageous when considering the benefit-cost ratio.