Impact of Bacillus Calmette-Guérin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection

There is little evidence around the potentially protective role of previous Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 vaccination. Prior BCG vaccination did not protect SARS-CoV-2 infected patients against postoperative pulmonary complications and 30-day mortality

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

Microsurgical treatment of frontal mucocele sequelae

Skull base surgery has undergone a revolution in recent decades with the introduction and development of new surgical approaches correlated with many modifications in this anatomically and functionally complex area. The most important progress has been possible with the advent of microsurgical flaps, which allow for the movement of large masses and different tissue components, providing effective separation and coverage of the endocranial content, replacement of the composite craniofacial defects, and reconstruction of poorly vascularized areas. To reduce the incidence of complications in the treatment of frontal recurrent mucoceles, accurate planning of reconstruction is mandatory. We introduce 2 cases involving anterior cranial base repair after radical resection of chronically infected tissues in patients affected by frontal recurrent mucoceles. Reconstruction was accomplished through a forearm flap and a frontal bone reconstruction with custommade prosthesis

Use of porous polyethylene for correcting defects of temporal region following transposition of temporalis myofascial flap

Transposition of the temporalis myofascial flap results in permanent aesthetic stigma in the donor site. Reconstruction of this deformity is desirable. The Authors present personal experience in the use of a porous polyethylene prosthesis to camouflage the temporal defects following transposition of the temporalis myofascial flap. From 2002 to 2005, 12 patients (5 male, 7 female, age range 36-84 years, mean 60), following the transposition of the temporalis myofascial flap, underwent reconstruction of the temporal region defect using porous high-density polyethylene temporal implants. The majority of the neoplasms removed proved to be squamous cell carcinomas of the alveolar crest or of the sinusal antrum. The standard surgical technique was used, namely, hemicoronal access and placement of 12 porous high-density polyethylene prostheses (5 left, 7 right). The size of the implants to be used (small, medium, large) was decided during the surgical operation. Of the 12 patients, 2 underwent post-operative radiotherapy, 6 weeks after the implantation of the prosthesis, without adopting any particular precautions to protect the area directly involved in the prosthesis implant. All patients are alive and free from disease, and implant placement appears to be free from post-operative complications. During the period of radiotherapy no complications. directly or indirectly related to the prosthetic implant, arose. Placement of the high-density polyethylene prosthesis fulfilled its filling effect on the deficit with a cosmetic success rate of 90%, as it was well integrated with no evident discontinuity between the edges of the prosthesis and the surrounding tissue or any alteration in the physiological convexity of the treated region. There were no incidents of pain or dysaesthesia of the skin covering the prosthesis. In conclusion, reconstruction of the temporal defect after temporalis myofascial flap transposition with the use of high-density polyethylene implants is an easy and safe method, with excellent functional and aesthetic results

Microcystic adnexal carcinoma of the centrofacial region: a case report.

Microcystic adnexal carcinoma is a rare, locally aggressive neoplasm with both eccrine and follicular differentiation and a high probability of perineural invasion of the centrofacial region. Given the histopathological features of this tumour, early diagnosis is essential for adequate management. This report refers to a case of microcystic adnexal carcinoma of the nasogenial region, with infiltration of the deep planes extending to the anterior wall of the maxillary sinus. Surgical treatment involved wide demolition of the centrofacial region followed by reconstruction using four locoregional flaps: an Indian flap and a Mustardé flap were used for cutaneous reconstruction; a septal flap to support the maxillogenial region; a mucosal flap to separate the nasal cavities

Genetic effects of vicryl® on fibroblast primary culture

Vicryl® (polyglactin 910) is an absorbable, synthetic, usually braided suture, indicated for soft tissue approximation and ligation. Vicryl® has a special coating for minimizing friction, easing passage through tissue and easy knot tie down. It is synthetic for minimal tissue reaction. Fibroblasts are the main cells of connective tissue that synthesize extracellular matrix. In this work, we tried to judge the action of Vicryl® on fibroblasts behaviour. We evaluated the expression levels of some adhesion and traction-resistance related genes (ELN, DSP, FN1, FBN1, ITGB1, ITGA1, ITGA5, ITGA2, COL1A1, COL3A1) by using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All but 2 genes resulted up-regulated after 48 h of treatment. Our preliminary results point out the potential of Vicryl® as a biocompatible and regenerative tool in medicine.Vicryl (R) (polyglactin 910) is an absorbable, synthetic, usually braided suture, indicated for soft tissue approximation and ligation. Vicryl (R) has a special coating for minimizing friction, easing passage through tissue and easy knot tie down. It is synthetic for minimal tissue reaction. Fibroblasts are the main cells of connective tissue that synthesize extracellular matrix. In this work, we tried to judge the action of Vicryl (R) on fibroblasts behaviour. We evaluated the expression levels of some adhesion and traction- resistance related genes (ELN, DSP, FN1, FBN1, ITGB1, ITGA1, ITGA5, ITGA2, COL1A1, COL3A1) by using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All but 2 genes resulted up-regulated after 48 h of treatment. Our preliminary results point out the potential of Vicryl (R) as a biocompatible and regenerative tool in medicine

Genetic effects of BIOPAD® on fibroblast primary culture

BIOPAD® is an ivory-white soft sponge, made exclusively of lyophilized type I native heterologous collagen extracted from horse flexor tendon, gelatine free, that keeps its native structure specific to the body’s skin tissue. BIOPAD® is an active dressing, playing an active role in all stages of wound healing process, stimulating granulation tissue growth and enhancing regeneration tissues. It ensures balance between absorption and humidity at wound surface, gaseous exchange of soft tissues during healing process, barrier to prevent bacterial infections and it is completely non-adherent. The use of BIOPAD® is painless for the patient and does not require removal or change of dressing. In this work, we evaluated the effect of BIOPAD® on fibroblasts behavior in term of cell viability, survival and growth and collagen production. The expression levels of some adhesion and traction-resistance related genes (ELN, DSP, FN1, FBN1, ITGB1, ITGA1, ITGA5, ITGA2, COL1A1, COL3A1) were analyzed using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All genes, except for ELN, DSP, ITGB1 and ITGA1 are up-regulated after 48 h of treatment. Altogether, our results point out the good potential of BIOPAD® as a biocompatible and regenerative tool in medicine

Use of Buccinator Myomucosal Flap in Tongue Reconstruction

The myomucosal buccinator flap, first described by Bozola in 1989, has become an important tool for intraoral defects reconstruction. In the literature, there is a variety of proposed myomucosal cheek flaps, both pedicled and island, based on the buccal or the facial arteries. From January 2007 to December 2011, the authors used a pedicled buccinator flap based posteriorly on the buccal artery to reconstruct partial lingual defects following tumor resection in 27 patients. The buccal fat pad was translated to cover the donor site defect. After 3 to 4 weeks from the original surgery, a second procedure under local anesthesia was performed to detach the pedicle and remodel the flap. The morphological and functional outcomes of the procedures were evaluated by the surgeons and a speech and language therapist. All patients presented satisfactory results. The authors consider the use of the described technique as the gold standard in the reconstruction of partial tongue defects after tumor resection