Two-thirds lip defects. A new combined reconstructive technique for patients with epithelial cancer

BACKGROUND: The lips are a common site prone to squamous cell carcinomas, which arise in the facial region. There are different techniques to reconstruct the excised lip region, according to dimensions, area, and position of the tumor. The authors describe a new technique of lip reconstruction born from a combination between a nasolabial flap and adipose tissue transplant. METHODS: The study was lead in the Plastic and Reconstructive Surgery Department of the University of Catanzaro. It includes 10 patients with squamous and basal cell carcinomas that interested lower or upper lip. The authors used a nasolabial flap to reconstruct two-thirds of the excised lip. All patients were staged and resulted free of disease. As a result of surgery, deformities and depressions persisted in 5 patients. This induced the authors to subject them to transplantation of adipose tissue to maximize results. Aesthetic and functional evaluation was performed with the Patient and Observer Scar Assessment Scale v 2.0 and drooling rating scale questionnaires. Moreover, an anthropometric analysis was performed in patients treated with fat transplant. Data were analyzed using Wilcoxon signed-rank test. RESULTS: All patients had an acceptable aesthetic and functional outcome. Oral competence, sensation, and movements of the area were adequate and aesthetic was good. Adipose tissue transplant compared with surgery alone, determine a real modification of various parameters, that was statistically significant (P = 0.043) to our analysis. CONCLUSIONS: The inverted nasolabial flap is versatile and simple. This technique allows to repair large lip defects by maintaining the eurythmia of the face. Autologous fat transplant is a favorable filler. Our data show that surgery alone is unable to restore face eurythmia after a tumor excision. Adipose tissue transplant allows to reach this goal. These 2 techniques, together, may significantly modify the functional and aesthetic result of the lip reconstruction, ensuring an optimal long-term result

Pyoderma Gangrenosum and inflammatory bowel disease: a combined medical and surgical approach - case report and literature review

OBJECTIVE: Pyoderma Gangrenosum (PG) is an immune-mediated neutrophilic dermatosis. characterized by large painful ulcers occurring in various body segments. It can be associated to Inflammatory Bowel Disease (IBD) including both Ulcerative Colitis and Crohn Disease. Prompt and effective management is fundamental, due to its high morbidity and mortality rates. By presenting our clinical experience. we aimed at showing the efficacy of a combined therapeutic approach, in which the best of every specialty cooperates managing this hazardous disease.PATIENTS AND METHODS: We report on two patients attending our outpatient clinic with ulcerative skin lesions at the level of the back. Patient 1 suffered from Crohn disease and Patient 2 presented a positive history of abdominal pain, diarrhea with mucus and blood in the stool. Histological exam was performed with final diagnosis of PG associated with IBD. A Literature review was carried out in order to highlight the role of combined clinical-surgical management of PG in adult patients with IBD.RESULTS: Complete resolution of the lesions was achieved in 4 months and 3 months for each patient respectively without relapse. PubMed was searched from 2000 to 2020 with the following keywords: (Pyoderma) AND/OR (Pyoderma Gangrenosum) AND (Inflammatory Bowel Disease) AND/OR (Ulcerative Colitis) AND/OR (Crohn Disease) AND (Management). Seven pa- pers were included (4 case reports, 2 case series, 1 comprehensive review) and reviewed using a descriptive checklist.CONCLUSIONS: PG should be treated by dedicated multidisciplinary teams, in which every specialist plays a crucial role from the diagnosis to the treatment and up to the long-term follow-up

Skin Grafting and Topical Application of Platelet Gel in the Treatment of Vascular Lower Extremity Ulcers.

Aim. Chronic wounds of lower limbs are a significant issue for physicians and specialists across a wide variety of dis- ciplines. These chronic wounds are result primarily from chronic venous insufficiency, arterial disease, diabetes. When a chronic wounds fail to heal within six weeks after appro- priate treatment skin grafting procedure may be considered. Aim of this study was to provide evidence of the use of local platelet gel (PG) in order to enhance healing time after skin grafting procedure. Methods. A total of 162 patients (69 males, 93 females) with lower limbs ulcers (venous, arterial, diabetic) with a duration of more than six weeks were recruited in order to undergo autologous skin grafting procedure. Results. Patients were randomized in two groups: Group A (87 patients) which received also local PG as adjuvant treat- ment and Group B (75 patients) which did not receive PG ad- juvant treatment. In our study the use of local PG, in Group A patients, enhanced the engraftment of autologous skin grafts respect to patients of Group B. Conclusion. The use of PG in skin grafting seems to be an effective and safe tool in order to speed up the healing rate of difficult-to-treat ulcers