Exhaustive diagnosis of breast implants with capsular contracture: The microbiology laboratory as a major support.

The most frequent complications of post-mastectomy reconstructions are breast implant (BI) infection and capsular contracture (CC). The diagnosis of BI colonization is based on cultures from the sonicated BI and from the capsule tissue. Therefore, we first aimed to assess the yield of conventional culture and molecular techniques in periprosthetic fluid, in addition to BI and capsular tissue. Moreover, we compare colonization and biofilm production between patients with and without CC. During 19 months, we prospectively included patients whose BIs had been removed and divided them into two groups: A (CC, Baker III-IV) and B (no CC). Samples were obtained for conventional culture, 16 s rRNA PCR, and MALDI-TOF. Biofilm production was also evaluated. We included 81 BIs from 69 patients with CC (22) and without CC (53). Forty-three (53.1%) of the 81 BIs had ≥1 positive culture. The culture was positive in 57.1% and 50.9% in groups A and B, respectively (p = 0.645). The highest 16 s rRNA PCR positivity rate was detected in capsular tissue (40.5%). MALDI-TOF was unable to detect colonization in any of the samples. High biofilm production was the following: high biomass: A, 29.8%; B, 39.7% (p = 0.293); high metabolic activity: A, 36.2%; B, 34.5% (p = 0.857). We confirm that cultures from different sites are mandatory to ensure a proper diagnosis of BI colonization. Our study is the first to demonstrate that CC was not associated with BI colonization or high biofilm production. The application of molecular techniques in BI samples was not substantially useful for predicting colonization.

The role of biofilm production in Cutibacterium acnes strains isolated from breast implants.

The role of C. acnes biofilm production in the pathogenesis of breast implants infections has not been deeply assessed. We analyze biofilm production (in terms of biomass and metabolic activity) between 40 Cutibacterium acnes strains isolated from breast implants and 32 from other sites. C. acnes strains isolated from breast implants showed higher metabolic activity than those isolated from other-locations and, especially, those from patients with capsular contracture .

Circumferential Pharyngoesophageal Reconstruction and Total Larynx Preservation with Extra-anatomical Free Flaps.

Reconstruction of total circumferential pharyngeal defects following caustic or stenosant lesions of the pharynx present major challenges with respect to minimizing surgical morbidity and restoring functional deficits. With recent advances in microvascular free tissue transfer, the options for pharyngeal reconstruction have multiplied in order to maximize swallowing and voice. There is long experience in the reconstruction of the pharynx and the cervical esophagus in oncological patients after total pharyngolaryngectomy, but there are not many publications concerning circumferential pharyngeal reconstruction preserving the larynx. Here, we discuss 2 new techniques for total circumferential pharyngeal reconstruction respecting swallowing and voice by means of extra-anatomical bypasses (visceral or fasciocutaneous), upholding the larynx in its original placement.

Comparing Efficacy and Costs of Four Facial Fillers in Human Immunodeficiency Virus-Associated Lipodystrophy: A Clinical Trial.

BACKGROUND: The objective of this study was to evaluate and compare the safety and effectiveness of four different dermal fillers in the treatment of facial lipoatrophy secondary to human immunodeficiency virus. METHODS: The authors conducted a clinical trial including 147 patients suffering from human immunodeficiency virus-induced lipoatrophy treated with Sculptra (poly-L-lactic acid), Radiesse (calcium hydroxylapatite), Aquamid (polyacrylamide), or autologous fat. Objective and subjective changes were evaluated during a 24-month follow-up. Number of sessions, total volume injected, and overall costs of treatment were also analyzed. A comparative cost-effectiveness analysis of the treatment options was performed. RESULTS: Objective improvement in facial lipoatrophy, assessed by the surgeon in terms of changes from baseline using the published classification of Fontdevila, was reported in 53 percent of the cases. Patient self-evaluation showed a general improvement after the use of facial fillers. Patients reported being satisfied with the treatment and with the reduced impact of lipodystrophy on their quality of life. Despite the nonsignificant differences observed in the number of sessions and volume, autologous fat showed significantly lower costs than all synthetic fillers (p < 0.05). CONCLUSIONS: Surgical treatment of human immunodeficiency virus-associated facial lipoatrophy using dermal fillers is a safe and effective procedure that improves the aesthetic appearance and the quality of life of patients. Permanent fillers and autologous fat achieve the most consistent results over time, with lipofilling being the most cost-effective procedure.

Strong nonlinear terahertz response induced by Dirac surface states in Bi2Se3 topological insulator.

Electrons with a linear energy/momentum dispersion are called massless Dirac electrons and represent the low-energy excitations in exotic materials such as graphene and topological insulators. Dirac electrons are characterized by notable properties such as a high mobility, a tunable density and, in topological insulators, a protection against backscattering through the spin-momentum locking mechanism. All those properties make graphene and topological insulators appealing for plasmonics applications. However, Dirac electrons are expected to present also a strong nonlinear optical behaviour. This should mirror in phenomena such as electromagnetic-induced transparency and harmonic generation. Here we demonstrate that in Bi2Se3 topological insulator, an electromagnetic-induced transparency is achieved under the application of a strong terahertz electric field. This effect, concomitantly determined by harmonic generation and charge-mobility reduction, is exclusively related to the presence of Dirac electron at the surface of Bi2Se3, and opens the road towards tunable terahertz nonlinear optical devices based on topological insulator materials.

New Refinements in Greater Omentum Free Flap Transfer for Severe Secondary Lymphedema Surgical Treatment.

Lymphedema is a chronic debilitating disease, affecting a considerable part of the population; it results from impairment of the lymphatic system. It is highly prevalent among patients subjected to axillary and groin nodal dissection after surgery for breast cancer, abdominopelvic surgery, and lymphadenectomy after melanoma surgery. Interestingly, among the surgical treatment options for lymphedema, groin lymph node transfer is gaining popularity; however, in some cases, dissection at this site can cause significant morbidity, including possible development of iatrogenic lymphedema. To avoid these complications, new donor nodal groups are being proposed (eg, submental or supraclavicular). We have used the greater omentum as a lymph node and lymph vessel donor site. Dissection of the omentum is easy to perform and can even be done in patients who have undergone previous abdominal surgeries. We present refinements in the surgical technique for free omentum transfer in the management of secondary lymphedema: the first free omental flap dissection performed laparoscopically and the use of a primary flap as the recipient pedicle of a free greater omentum flap for anatomical repair after chest osteoradionecrosis and simultaneous functional repair of chronic lymphedema.

Technical standardization of laparoscopic direct hernia repair in pediatric patients.

BACKGROUND: The aim of this article is to standardize the laparoscopic technique to treat direct inguinal hernia in pediatric patients. PATIENTS AND METHODS: In the last 3 years we treated laparoscopically 163 patients with a diagnosis of inguinal hernia. In 7 patients we discovered laparoscopically a direct inguinal hernia. This study is focused on the management of these 7 cases (4 girls and 3 boys; median age 4.6 years). They presented a right defect in 4 cases and a left defect in 3 cases. Six of 7 patients had been already operated for an inguinal hernia and presented a recurrence of the hernia. We used three trocars, 5-mm 0 degree optic, and two 3-mm instruments. In each case, after the resection of the lipoma using the hook cautery, the defect was closed by means of separated stitches. In every case we used the vesical ligament as an autologous patch to reinforce the closure of the defect. RESULTS: The average operative time was 35 minutes. All the procedures were performed in a day-hospital setting. We had neither conversions nor complications in our series. With a minimum follow-up of 1 year, we had no recurrence. CONCLUSIONS: Laparoscopic identification and repair of direct inguinal hernia in children is a safe and effective procedure to adopt. The key points of the technique are the resection of the lipoma, the closure of the defect using separated, nonabsorbable sutures, and the use of the vesical ligament to reinforce the suture. We believe that in case of recurrence of inguinal hernias after inguinal approach, laparoscopy is the gold standard technique to identify and treat the cause of the recurrence itself.