An innovative reconstruction approach for scalp dermatofibrosarcoma protuberans using acellular dermal matrix (ADM): experience of a third referral center and long-term results

N/

Nipple Reconstruction Using the “Arrow Flap” Technique: Outcomes and Patients Satisfaction

Introduction: Skin-sparing mastectomy (SSM) entails complete removal of the breast tissue and the nipple and areola complex (NAC) with preservation of as much of the overlying skin as possible. The preservation of the natural skin envelope during SSM improves the aesthetic outcome of immediate breast reconstruction, but the lack of NAC determines that the reconstructed breast remains anatomically incomplete with not always satisfactory final results. For this purpose, the aim of the present study was to investigate and evaluate the impact of nipple reconstruction after skin sparing and skin reducing mastectomy on the patients' perception and intimate life. Materials and method: This was a comparative single-center prospective study that involved 42 patients underwent NAC reconstruction after SSM. A pre- and postoperative quality-of-life and psychological questionnaires Breast-Q questionnaire (Breast Conserving therapy module) were given to all the patients before the surgery and 6 months after. The statistical analysis with chi-square test was performed. Results: After 6 months a prevalence of patients reported to be very satisfied in regard to shape, appearance, naturalness, projection, position and symmetry. The study shows an overall improvement in all the psychological items analyzed with statistically significant difference regarding: "patient's satisfaction," "self-confidence," "appearance of the breast." Conclusion: The authors believe that the NAC reconstruction has useful functional and aesthetic results particularly appreciated by patients who feel demoralized after breast demolition surgery

Early Seroma Treatment Protocol Based on US-Guided Aspiration in DTI Prepectoral Reconstruction: A Prospective Study

Introduction: Seroma is a common complication after prepectoral prosthetic breast reconstruction with ADM, leading to wound dehiscencse, infection, and even loss of reconstruction at last. A new ultrasound (US) guided follow-up protocol has been applied to compare primary and secondary complications incidence and their treatment, and evaluate the effect of precocious seroma detection and its evacuation in reducing secondary complications. Methods: We enrolled 406 patients from January 1st, 2021 to July 1st, 2023 who underwent mastectomy and 1-stage prepectoral reconstruction with ADM. Experimental group counted 96 patients, whom have been treated as protocol fashion, therefore with multiple US-guided evaluations and eventual evacuations along with postoperative period; control group (310 patients) has exclusively been clinically evaluated. Results: Seroma incidence detected rate among experimental group, after 1-year follow-up, was 32.2%, compared to 16.8% in control cohort, additionally no other secondary complications were detected in the first group. Referring to the wound dehiscence incidence, a statistically significant higher frequency was observed in control group compared with treatment 1 (21.2% vs. 0%; P = .0027). Conclusions: Seroma and correlated secondary complications may lead to additional surgeries, higher sanitary costs and even reconstructive failure. With a seriated US follow-up protocol application, the surgeon could promptly manage and treat seroma, decreasing additional complications rate, particularly wound dehiscence. Level of evidence: III

How Porcine Acellular Dermal Matrix Influences the Development of the Breast Capsule 1 Year after Implantation: A Histopathological Analysis

Background: In prepectoral breast reconstruction (PPBR) the acellular dermal matrix (ADM)'s integration capacity into the tissue is known. The aim of this study was to analyze the effect of the ADM on development and composition of the peri-implant breast capsule in a dynamic setting of breast tissue expansion during two-stage prepectoral breast reconstruction.Methods: This is a prospective single-center study in which 50 patients who underwent mastectomy and breast reconstruction with prepectoral tissue expander and Braxon ADM (group A) and submuscular tissue expander (group B) were enrolled. One-year post implantation hematoxylin & eosin (H&E) staining and immunohistochemistry analyses were done on capsule tissue samples.Results: The analysis conducted on H&E-stained samples showed a significant reduction of cellular density and a decrease of the cellular infiltration in capsules of ADM-covered expanders compared with naked expander capsules (P < 0.05). The immunohistochemical analyses showed that group A capsules presented significantly less M1 CD68+ macrophages (P < 0.05), lower alfa-SMA expression levels, and a lower number of myofibroblasts (P < 0.05) compared with group B capsules. Presence of lymphatic vessels was minimally detected in both groups.Conclusions: The ADM presence around the prepectoral tissue expander influences the development of the peri-implant capsule, causing a significant reduction of the number of cells and inflammatory infiltrate, especially M1 macrophages and myofibroblasts. The ADM Braxon is therefore effective in creating a noninflamed capsule around the implant and in dynamic tissue conditions, and such an environment is maintained in time

Effects of harvest period, nitrogen fertilization and mycorrhizal fungus inoculation on triticale (×Triticosecale Wittmack) forage yield and quality

The practice of grazing winter cereals before heading and subsequently harvesting the forage is common in some countries. Triticale (× Triticosecale Wittmack) is particularly interesting due to its nutritional characteristics, and forage yield and quality are strongly influenced by agronomic techniques. The effect of two modes of utilization (cut at heading stage and cut during winter grazing simulation with regrowth cut at heading stage), three nitrogen (N) fertilization levels [0 and 100kgha−1 split in two phases; and 100kgha−1 before sowing, using a fertilizer with 3,4-dimethylpyrazole phosphate (DMPP) as a nitrification inhibitor (NI)] and mycorrhizal fungus inoculation (mixed inoculation of Glomus intraradices and Glomus moseae) on forage yield and quality, protein fractions and in vitro digestibility of triticale was determined in southern Italy. Mode of utilization and fertilization affected significantly forage yield and quality, while mycorrhizal fungus inoculation influenced positively some quality parameters. Cutting at heading stage of triticale led to high dry matter (DM) production compared to the winter cut simulating grazing, but no differences in protein yield (PY). N fertilization increased total DM and PYs, but no differences were reported among the application modalities of N fertilizers. Triticale protein fractions and protein and fiber digestibility were improved by N fertilization. Mycorrhizal fungus inoculation positively influenced forage quality at heading stage, which resulted in more digestible fiber and protein. As a result, when triticale was grown under Mediterranean conditions, mode of utilization and N fertilization resulted in greater forage yield and quality, while mycorrhizal fungus inoculation influenced positively forage nutritional quality parameters