Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries

Background Orthoplastics is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches. Material and methods Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospectively reviewed. All patients presented a post traumatic soft tissue defect associated with a Gustilo III tibial fracture or a tibial septic pseudarthrosis. Data on type and timing of bone and soft tissue reconstruction, outcomes, complications and need for re-operation were extrapolated and compared to an historic group of patients treated with an orthopedic-based approach. Results In the orthoplastic group, soft tissues were reconstructed with an ALT flap in most cases; a muscle-sparing VL or ALT-VL chimeric flap was necessary in cases with a very extensive defect. In the orthopedic group, soft tissues were left to heal by second intention or patients were lately referred to plastic surgeons. Statistical comparison between the two groups has showed significant differences on the following data: Time for soft tissue healing, time to bone union, number of reinterventions, post-operative deep infection rate, time to return to work. Conclusion The orthoplastic approach to complex leg defects yields shorter treatment time and better functional results compared to the orthopedic-based approach. External fixation and microsurgical reconstruction are not necessarily alternative procedures but can integrate in an orthoplastic path to address at best both soft tissue and bone reconstruction

Patrie storiografiche sui confini orientali tra Otto e Novecento

La storia, specialmente se intesa come scienza, è stata spesso usata per sostenere le rivendicazioni  ideologiche e patriottiche. Un simile impiego si è manifestato anche in occasione della fondazione della Società storica friulana (1911), le cui origini e i cui protagonisti si studiano qui in comparazione con quanto accadde nelle vicine regioni: Veneto, Trentino, Venezia Giulia, Carinzia e Tirolo

Reconstruction of the face with skin-grafted muscle flaps: optimizing the aesthetic outcome.

BACKGROUND: Reconstruction of large defects in the temporal region can be performed with skin grafts or pedicled or free flaps. Results are often not optimal because of the patch of a skin graft, lack of availability of local flaps, and distant skin from free flaps. A technique for reconstruction of these defects with local tissue is presented in this article that uses superficial musculoaponeurotic system (SMAS) plication to allow wide advancement of a cervicofacial flap. METHODS: Once the defect is outlined, a face-lift-like skin incision is used to raise the flap. The SMAS is plicated with two purse-string sutures that relieve tension on the flap and allow maximal advancement. Thirteen face-lift SMAS plication flaps were used in 12 patients (mean age, 70.2 years) after cancer resection, which was bilateral in one case. Defects up to 8 cm in largest diameter can be closed. In one case of an 8 7 6-cm defect, a 1 7 1.5-cm skin graft was necessary. RESULTS: All flaps healed uneventfully, and no reoperation was necessary. Scars are almost completely hidden and the cosmetic result is satisfactory. The asymmetrical face-lift effect fades out within 6 months. CONCLUSIONS: The face-lift SMAS plication (FLISP) flap allows reconstruction of large defects in the temporal region with a local flap providing an excellent cosmetic result and avoiding the need for distant tissue and multiple scarring. This flap provides an example of how reconstructive surgery and cosmetic surgery are complementary and can be mutually beneficial

The use of triamcinolone combined with surgery in major ear keloid treatment: a personal two stages approach

Background: Keloid is a fibroproliferative disorder characterized by an abnormal deposition of collagen within a wound. Despite an increased understanding of wound healing and collagen metabolism, the exact cause, the clinical behavior, and gold standard of treatment for keloids remain an enigma. There is no one right way of treatment, the results are variable, and the management of ear keloids can be difficult and frustrating both for patients and physicians. Traditional techniques include intralesional steroids, topical applications of silicone, vitamins, and segmental excision by lasers or surgery. The purposes of this article are to review the literature concerning the current therapies as well as to present the authors’ experience in the treatment of major ear keloids. Methods: Twenty-seven consecutive black race patients (18 cases and 9 controls) underwent surgery for major keloids of the external ear at the Plastic and Reconstructive Surgery Unit of University of Palermo. The authors performed the radical excision and intralesional triamcinolone acetonide injection intraoperative and 1 month after surgical treatment. Results: No complications were noticed in the early postoperative period, and no recurrence was noticed in all the patients. Conclusions: The radical excision and the intralesional triamcinolone acetonide injection appear to be a successful option of treatment for major ear keloids. Compared to other methods, it does not necessitate several stages of treatment, moreover, it has the advantages to lower the risk of recurrence, the healing process is rapid, and improvement of quality of life is significant. Level of evidence: Level IV, therapeutic stud

INFLUENCE OF CAROTID AND PERIPHERAL ATHEROSCLEROSIS ON THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

INFLUENCE OF CAROTID AND PERIPHERAL ATHERLSCLEROSIS IN THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROM

Effect of nitrides precipitation on the corrosion behavior of Duplex Stainless Steels - Effetto della precipitazione di nitruri sul comportamento corrosionistico di acciai duplex

Duplex Stainless Steels (DSS) are characterized by a dual-phase ferritic-austenitic microstructure and exhibit high corrosion resistance and excellent mechanical properties. However, formation of different types of intermetallic phases and precipitated compounds as chromium nitrides may occur during fabrication processes such as welding, hot working and heat treatments; this can influence their corrosion resistance and toughness. In the framework of controversial scientific studies on this topic, the aim of this paper is to evaluate the effective influence of the content/distribution of these particles on the corrosion behaviour of two largely adopted DSS, UNS S32205 and UNS S32750. From the obtained results it is evident that corrosion resistance of the DSSs is negatively affected by the presence of chromium nitrides. In addition, the corrosion development occurs with different morphologies depending on the type of analysed DSS. Gli acciai Duplex (Duplex Stainless Steels, DSSs) caratterizzati da una microstruttura ferritico-austenitica possiedono alta resistenza alla corrosione ed eccellenti proprieta\u300 meccaniche. Tuttavia, durante i processi di fabbricazione, quali saldatura, lavorazione a caldo e trattamenti termici, si puo\u300 realizzare la precipitazione di differenti tipi di fasi intermetalliche, tra le quali i nitruri di cromo; questi precipitati possono influenzare la resistenza alla corrosione e la tenacita\u300 tipiche di queste leghe. Nell\u2019ambito di informazioni controverse nella letteratura scientifica, scopo del lavoro e\u300 la valutazione dell\u2019effettiva influenza del contenuto e della distribuzione dei suddetti precipitati sulle proprieta\u300 corrosionistiche di due DSSs di piu\u300 largo impiego, UNS S32205 and UNS S3275. Dai risultati ottenuti emerge che la loro resistenza alla corrosione e\u300 influenzata negativamente dalla presenza dei nitruri di cromo. La corrosione, inoltre, si sviluppa con morfologie sensibilmente diverse in dipendenza del tipo di DSS

A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap.

BACKGROUND Basal cell carcinoma (BCC) greater than 5 cm in diameter is called giant basal cell carcinoma (GBCC), or super giant basal cell carcinoma if it has a diameter larger than 20 cm. Giant BCC only accounts for 0.5% of BCCs and super giant BCC is exceedingly rare. On account of their rarity, there are no established guidelines for GBCC treatment. CASE REPORT We describe a peculiar case of an 82-year-old woman with a GBCC carcinoma of the lower abdominal wall. The tumor was surgically removed with ipsilateral inguinal lymph nodes and the abdominal wall was reconstructed immediately with a pedicled deep inferior epigastric artery perforator (DIEP) flap. CONCLUSIONS Treatment of giant basal cell carcinoma is often difficult, especially in elderly patients with poor general health and multiple pathologies. The pedicled DIEP flap is rotated to cover the loss of substance without tension, and it is easy to harvest and transfer. This flap allowed a good result without local or systemic complication. We present this report as a reminder of the occasional occurrence of extremely aggressive BCCs. We believe that, especially for rare tumors like these, it is very useful for the entire scientific community to publish these cases and the therapeutic strategies used to treat them

THe role of autologous nerve fragments implantation in enhancing peripheral nerve regeneration

ntroduction: The aim of this study was to assess the effect of seeding a nerve suture with autologous nerve fragments. Our hypothesis is that the fragments could improve axonal regeneration. Back to Top | Article Outline Material and Methods: On 20 Sprague-Dawley rats a 15mm sciatic nerve defect was created and grafted. In the study group (n=10) a 1mm nerve segment was minced and seeded around the distal suture. In the control group (n=10) no fragments were seeded. Rats were sacrificed at 4 (n= 10) and 12 weeks (n= 10) and number of regenerated fibers, fiber area and density, Soleus and Gastrocnemius muscles mass indexes, and walking track analysis in the 12 weeks group were evaluated. The Student ttest was used for statistically analysis. Back to Top | Article Outline Results: A significantly (p= 0,042 and 0.032) higher number of regenerated axons (235 vs 160 and 378 vs 306) and fiber area (561 \ub5m2 vs 405 \ub5m2 and 883 \ub5m2 vs 661 \ub5m2, p= 0,043 and 0.033) were found in the study group both at 4 and 12 weeks. The Soleus muscle weight ratio at 12 weeks was significantly higher than in the control group (0,72 vs 0,40, p= 0.0207). Differences in Grastrocnemius muscle weight ratio and walking track analysis were not significant. Back to Top | Article Outline Conclusion: Our results show that nerve fragments seeded around the distal nerve suture increase the number of regenerated axons, the fiber area and the Soleus mass index

Skin-nipple-sparing mastectomy: The first approach in primary myxoid chondrosarcoma of the breast

The primary mammary chondrosarcoma corresponds to less than 0,5% of the mammary malignancies. For the period ranging from 1967 to 2014, only 18 cases were reported in the literature. A 41 year old woman found a hard nodule on her external right superior quadrant/axillary prolongation through breast self-examination. The vacuum-assisted core biopsy (VACB) revealed “high grade extra-skeletal myxoid chondrosarcoma”. A skin-nipple-sparing mastectomy with the insertion of a mammary expander was performed. A protocol of adjuvant radiotherapy was also indicated. Until 2013, the gold standard was the radical mastectomy. By 2014, there were two cases of conservative approach to quadrantectomy. To our knowledge, this represents the first case in the literature in which a skin-nipple-sparing mastectomy has been performed on a primitive mesenchymal neoplasm of the breast. Such an oncoplastic approach was performed considering the young age of the woman, to assure the surgical radicality and a better quality of life to the patient