3D Lipogluing: Preliminary Results of a Novel Technique for Direct Three-dimensional Fat Grafting in Breast Reconstruction Surgery.

Lipofilling has emerged as an effective technique in breast reconstruction for enhancing aesthetic outcomes and addressing residual deformities. Traditionally, fat grafting has been performed as a secondary step in implant-based breast reconstruction during the replacement of the expander with a breast implant or as a revisional procedure. Our study investigates the technical feasibility and presents preliminary results of a new promising technique for delivering fat grafting in a three-dimensional (3D) shape, directly during mastectomy with immediate breast reconstruction or in delayed breast reconstructive procedures. Our new 3D lipogluing technique involves securing the fat tissue in a 3D manner using fibrin glue. This method enhances the coverage of soft tissues and provides improved volume and shape supplementation. In selected cases between December 2015 and September 2023, we treated 24 patients using the 3D lipogluing technique and five patients using 3D lipocubing (without use of fibrin glue).The patient cohort consisted of different indications for breast reconstructions: direct-to-implant, expander-based breast reconstruction, and "conservative" surgery. Preliminary findings suggest the technique is a safe and effective approach that can enhance the soft-tissue envelope of reconstructed breasts by acting as an autologous scaffold, owing to its regenerative properties. This technique not only improves the overall aesthetic outcome but also has the potential to reduce implant-related complications. Furthermore, ongoing studies are investigating methods to optimize the results and explore the potential application of 3D lipogluing and 3D lipocubing in breast-conserving oncoplastic surgery, cosmetic breast surgery, and other areas of plastic reconstructive and aesthetic surgery.

A Rare Case of Pulmonary Restrictive Syndrome after Liquid Silicone Injection: The Role of the Plastic Surgeon.

Despite being especially used in its solid form, silicone is still injected as a liquid filler for breast contouring in many countries. Here, we present a rare case of a woman with silicone pneumonitis and extended breast scarring after breast silicone injection. Because of evidence of a restrictive syndrome due to the thoracic extensive scarring tissue and the high demand of oxygen therapy, as jointly agreed with the pulmonologists, we decided to perform a surgical asportation of the scarring tissue and covering with microsurgical flap. We chose the deep inferior epigastric perforator flap mainly because of the large amount of skin that is possible to use, the good skin texture matching, and the possibility of double team working without changing patient's position.

Combining Rotation and V-Y Design for Lower Forehead and Temporal Region Reconstruction With Myocutaneous Frontal Flap: Our Experience on 27 Consecutive Cases.

BACKGROUND: Because of direct sun exposure, lower forehead and temporal area are anatomical regions with frequently observed skin tumors. The resulting defects after oncological ablations are usually treated, especially in older patients, by split thickness skin grafting or A-to-T and O-to-T flaps if facing small defects. On specific sites that expose bone or periosteum as well as when a skin graft is best avoided for cosmetic reasons, alternative reconstructive procedures should be considered. An excellent option is the use of myocutaneous frontal flap with rotation and V-Y design, which provide a reliable coverage of defects especially of the temporal area, dispensing appropriate like-tissue by its wide arc of rotation. METHODS: Between 2010 and 2019, 27 patients underwent myocutaneous frontal flap with rotation and V-Y design reconstruction of medium-to-large-sized soft-tissue defects of the lower forehead and temporal area after tumor excision. The malignant skin lesions involved were basal cell carcinoma (n = 17), squamous cell carcinoma (n = 9), and melanoma (n = 1). Twenty one patients were male, and 6 were female with an average age of 64 (54-86) years. RESULTS: All defects were successfully resurfaced with no local recurrences. CONCLUSIONS: The authors present a modification to myocutaneous frontal flap harvesting, with emphasis on its extensive arc of rotation with a V-Y design to minimize donor-site morbidity. The advantages of myocutaneous frontal flap with rotation and V-Y design include a good contour with excellent color, texture, and thickness match and good to excellent aesthetic results.

Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection.

BACKGROUND: The risk of infection continues to be a subject of discussion within the field of implant-based breast reconstruction. Studies have shown the feasibility of immediate single-stage procedures with acellular dermal matrix (ADM), yet 2-stage tissue expander techniques continue to be the procedure most often performed. The purpose of this study was to evaluate postoperative infections and to identify associated predictors. METHODS: A retrospective study at Papa Giovanni XXIII Hospital was conducted between 2013 and 2017. Patients' demographic data were compared between single-stage and 2-stage procedures. Rate of infection and predictors were examined. Minor infections could be treated by oral antibiotics only, major infections required inpatient treatment. Healing was considered a successful treatment with antibiotics only, whereas any supplementary surgical intervention resulting in the preservation of an implant device was considered salvage. Breast reconstruction was defined a failure in case of implant loss or need for autologous reconstruction. RESULTS: Three hundred ninety-three patients underwent 336 monolateral and 57 bilateral implant-based breast reconstruction. Ninety-two patients had a submuscular direct-to-implant reconstruction with ADM with an infection rate of 11.4% compared with an infection rate of 7.8% among the 268 patients with a 2-stage tissue expander procedure. Beta-binomial regression showed obesity and preoperative radiotherapy as significant predictors for infection (OR, 4.65, P = 0.038, and OR, 7.13, P = 0.015, respectively). Average time of onset of infection among the submuscular direct-to-implant with ADM group was 67.1 days compared with 80.1 days among tissue-expander group with postoperative chemotherapy and preoperative radiotherapy having a significant effect on time of infection onset (P = 0.014, P = 0.034, respectively). CONCLUSIONS: Direct-to-implant breast reconstruction with ADM is a procedure with acceptable risks of infection in comparison to tissue expander procedures. A profound patient selection pre- and intraoperatively is the basis of successful breast reconstruction.

Open rhinoplasty concepts in facilitating tip reconstruction.

The nose is a frequent site for skin cancer, accounting for approximately 26% of basal cell carcinomas and approximately 13% of spinal cell carcinomas of the facial district. Also melanomas, mostly as lentigo maligna melanomas, are frequently located at the nasal pyramid. Although defects can be of varying size and depth, some even involving the whole trilaminar structure of the nose, most remain superficial and seldom reach and infiltrate the underlying framework. In contrast, they can be wide, thus requesting large flaps to resurface the defect. Although a technically well-planned and well-performed surgery can lead to excellent aesthetic results, scars from both donor and recipient sites can be noticeable. Since skin cancers generally affect older people, we often deal with aged noses. Such noses typically present some common features such as plunging tip, increased length, and a prominent hump due to several reasons, already well described in the literature. In this scenario, by reducing and addressing the framework, we can obtain a variable quota of downsizing of the original defect, thus requiring less skin for coverage, and thus reducing the size of needed flaps and consequent scars. This is greatly facilitated by the open rhinoplasty approach. Most of the maneuvers aimed at reducing the framework are indeed the same.

"On demand" posterior tibial artery perforator flaps: a versatile surgical procedure for reconstruction of soft tissue defects of the leg after tumor excision.

Relatively small soft-tissue defects of the lower leg following tumor excision are usually treated, especially in older patients, by split-thickness skin grafting. On specific sites where periosteum or paratenon is exposed, as well as when a skin graft is best avoided for cosmetic reasons, an excellent alternative option is the use of posterior tibial artery perforator flaps.Such flaps are designed and elevated "on demand," ie, according to the defect location and on whichever perforator is best found suited to supply the flap and allow adequate transposition.However, operative time is longer, and the surgeon needs to be judicious in dissection, as well as versatile in choosing the best flap design after identifying a suitable perforator.Between 2003 and 2008, 24 patients underwent this procedure, with uniformly successful result except for 2 partial flap necrosis.The advantages of posterior tibial artery perforator flaps are a quick and usually safe procedure, which provides good contour with excellent color, texture, and thickness match, with long-term stability of the reconstruction at the expense of minimal donor-site morbidity.