Neuro-ocular cutaneous syndrome: a case report.

Neuro-ocular cutaneous syndrome is a rare and little-known illness. It affects the ocular apparatus, the nervous system and the skin. The disease causes pathologies such as phacomatosis, which is a generic term used to describe small cutaneous neoformations, as well as other ectodermal organ malformations (ocular apparatus and central nervous system). The symptoms of this disease are ocular, neurological and dermatological and can include: corneal opacity, papillary coloboma, optical atrophy, epibulbar dermoids, corectopia, palpebral coloboma, frontoparietal alopecia, epilepsy, psychomotor delay, pedunculated skin growths, a yellowing of the frontal area, milled papules, milled patches of skin, cutaneous spotting, familial angioma and hemiplegia. Due to the complexity of this disease, it is imperative that specialists (including ophthalmologists, neurologists, dermatologists, plastic surgeons, pediatricians and genetics) examine a great number of families affected by this rare pathology in a precise, accurate and ongoing manner. The clinical case of a 15 year-old patient (who was diagnosed at 10 months old) affected by the neuro-ocular cutaneous syndrome will be discussed below.

Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals.

Many techniques have been described to create an aesthetic and functional neo-phallus after penile amputation or in female-to-male transsexuals. Microsurgical free-flap phalloplasty seems to be the preferred method of penile reconstruction. For many years the radial forearm free flap has been considered the best procedure, but other flaps have been attempted to minimize donor site morbidity and optimize outcome. Pedicled flaps are considered to be reliable and to decrease the risk of total failure. Recently, a one-stage non-microsurgical technique was described for phallic reconstruction in a young male patient. We report successful total phallic reconstruction in a female-to-male transsexual patient using an island pedicled anterolateral thigh (ALT) flap. Urethral reconstruction was left as a possible further procedure due to patient's preference. A malleable soft silicone penile prosthesis was inserted within the flap and the lateral cutaneous femoral nerve stump was sutured to the dorsal clitoris branch from the pudendal nerve for flap sensation. After 6 months, the patient demonstrated successful aesthetic and functional reconstruction referring to satisfactory sexual activity. To our knowledge, this is the first report of an innervated island pedicled ALT flap used for female-to-male penile reconstruction in a transsexual patient. The pedicled ALT flap may be a reliable option to avoid visible scarring at the donor site on exposed parts of the body, and reduce the risk of total flap failure from microsurgical procedures for reconstruction of a neo-phallus in this increasing population of patients.

Randomized prospective study on the efficacy of a new revitalizing filler composed of hyaluronic acid (Wipeline).

AIM: The aim of the study was to test the efficacy of a new revitalizing filler (Wipeline) formed by a buffer physiological solution of hyaluronic acid (HA). METHODS: A prospective study was performed on 100 patients (aging between 40 and 70 years), with clear signs of premature facial aging. Patients were randomly assigned to two groups, one treated with a HA concentration of 1.6%, the other with a concentration of 2% in the tested product. The treatment protocol consisted of three sessions with a four weeks intervals between them. Visual Analogue Scale (VAS) and digital photos were used to evaluate results after 1, 3, 6 and 12 months from treatment end. RESULTS: An improvement of turgidity, elasticity and luminosity of the skin and a reduction of folds and wrinkles of the treated areas were observed in both groups. The higher concentrated solution of HA had a more prolonged effect and a greater filling effect. Products were well tolerated and no adverse reactions observed. CONCLUSION: The efficacy of Wipeline has been clinically supported. This revitalizing filler succeeded in increasing skin elasticity and tone by dermal hydration. The procedure is simple and little invasive. It represents a good treatment option to restore vitality and turgidity of skin presenting the signs of aging.

Use of the reverse flow island sural flap in the replacement of tissue loss involving the distal third of the leg, ankle and heel.

The events leading to a tissue loss in the lower limbs are varied. The aetiology can be traumatic, infective, neoplastic, iatrogenic, vascular or systemic. Five patients with lesions involving the distal third of the lower limb, the ankle and the heel, traumatic in origin, presented at our service within the Faculty of Plastic and Reconstructive Surgery, University Hospital "La Sapienza" in Rome. In such patients, the surgical approach involved the repair of tissue loss through the use of the neurocutaneous distally based sural artery flap. The use of the reverse flow island sural flap, compared to other therapeutic options, is advantageous from varying points of view: ease in taking the sample, limited morbidity of the donator site, less time required for the surgical procedure. Regarding the flap, safety and simplicity of execution were implemented in accordance with our experience, dissecting a wide adipo-fascial peduncle. Post-operative precautions were implemented in order to avoid compression of the transposed flap and of the peduncle. The healing in these patients was satisfactory.