[Total reconstruction of the lower lid by the Mustardé's technic]. / La ricostruzione totale della palpebra inferiore secondo Mustardé.

The total lower lid loss reconstructive technique of Mustardé is reported. The technique is presented step by step. The morphological and aesthetic results and the low incidence of complications are discussed.

[Tissue expansion in head and neck regions]. / L'espansione tissutale nell'estremo cefalico.

The Authors describe their experience with the use of 56 tissue expanders implanted in the head and neck regions of 45 patients observed in a follow-up of an average of 25 months. They emphasize the various possibilities of reconstructive surgery with the use of tissue expanders and the different mental approach required in order to organize surgical when this technique is employed. The criteria used in the selection of the type of tissue expanders is outlined and useful advice concerning the formulation of a surgical plan which employs the most favourable approach in making to avoid poor functional or aesthetic results or secondary complications is presented. Furthermore the surgical technique used to obtain adequate pockets for the insertion of tissue expanders in the different anatomical areas of the head and neck is described. The Authors affiem that in order to avoid damage to the surrounding neurovascular structures and to obtain good tissue expansion, the correct level of dissection is imperative. The options of using different anatomical areas during reconstructive surgery are discussed. For example, the insertion of a tissue expander in the forehead permits the availability of a large amount of usable tissue during nasal reconstruction, thus leaving the donor area without tension and with minimal scarring. Many different causes of baldness can be treated with the use of tissue expanders, such as posttraumatic injury, burns or infections. Tissue expansion can be utilized in the cheek area for the reconstruction of the lower eyelids, the paranasal and the mandibular area. Tissue expanders used in the cervical area can be utilized for reconstructive surgery of the lower lip or the mandibular area. In addition, the Authors discuss possible complications of this technique such as infection, suture distension and tissue expander extrusion. Recommendations are discussed in order to prevent these major complications. Having reviewed their personal experience the Authors feel they can confirm the reliability of this revolutionary technique in the field of plastic and reconstructive surgery. The use of tissue expanders permits the surgeon to obtain improved functional and aesthetic results which only a few years ago were not conceivable.

[Idiopathic unilateral hypoplasia of the breast]. / L'ipoplasia mammaria monolaterale idiopatica.

Unilateral hypoplastic breast is a rare anomaly. The correction of the asymmetry is usually achieved by the use of breast implants or breast expanders. Sometimes the controlateral breast must be modified to gain a good symmetry.

Recurrent basal cell carcinoma of the back infiltrating the spine. Recurrent basal cell carcinoma.

BACKGROUND: Risk of basal cell carcinoma (BCC) recurrence appears to be related to tumor location, tumor size, treatment modality, radicalness of excision, and histologic type. Recurrences of BCC on the trunk and extremities are rare, with 97% of all recurrent lesions being located in the head and neck region. OBJECTIVE: This report concerns a man who had a BCC of the back removed with electrodesiccation and curettage in 1980 at the age of 36. In the following 10 years the patient experienced five recurrences and finally developed infiltration of the thoracic spine that precluded further attempts at radical excision of the neoplasm. METHODS AND RESULTS: The pathology of the BCC in our patient revealed a number of histologic features that have been associated with aggressive behaviour. These include an infiltrative growth pattern characterized by an irregular and acute tapered profile of the tumor cell groups and fibroblast-rich stroma, infiltrating invading tumour edges, poorly peripheral palisading, nuclear pleomorphism, and perineural invasion. CONCLUSION: Basal cell carcinomas that occur in sunlight-protected areas of the trunk of middle-aged individuals can occasionally exhibit aggressive and highly invasive features as well as a marked tendency for local uncontrollable recurrences. The prognosis for patients with this variety of BCC is poor, especially when progressive infiltration of deep tissues does not permit, as in our case, any possible further radical surgical procedure.