Tecnica “a scaletta” nel trattamento delle perdite di sostanza del labbro inferiore

La patologia che con maggior frequenza colpisce il labbro inferiore è la patologia neoplastica, in particolar modo il carcinoma spinocellulare. L’approccio terapeutico di elezione è l’exeresi chirurgica ampia dalla quale possono derivare importanti alterazioni morfo-funzionali ed estetiche. Presso il Dipartimento di Chirurgia Plastica e Ricostruttiva del Policlinico Umberto I, “Sapienza” Università di Roma, dal 2005 al 2008 sono stati trattati 36 pazienti: 19 mediante escissione semplice (gruppo I) e 17 mediante la tecnica di Johanson (gruppo II), tutti sottoposti a follow-up a 6 e 12 mesi per valutate le alterazioni della funzionalità, la presenza/assenza di asimmetrie e la cicatrizzazione. Inoltre, ai pazienti è stata proposta una scheda di valutazione a punteggio costituita da 9 domande che indagano sia aspetti funzionali che estetici. Dai dati ottenuti è risultato che l’utilizzo del lembo di Johanson consente una radicalità oncologica non inferiore all’escissione semplice ma con migliori risultati funzionali ed estetici, una maggior soddisfazione da parte del paziente e tempi di degenza sovrapponibili

Clinical and morphological characteristics of head-facial haemangiomas

BACKGROUND: Haemangiomas of the head or face are a frequent vascular pathology, consisting in an embryonic dysplasia that involves the cranial-facial vascular network. Haemangiomas show clinical, morphological, developmental and structural changes during their course. METHODS: The clinical characteristics of head-facial haemagiomas were studied in 28 individuals (9 males and 19 females) admitted in our Hospital. Sixteen of these patients(n = 16) underwent surgery for the removal of the haemangiomas. All the removed tissues were transferred in experimental laboratories for the staining of microanatomical details, somatic and visceral nerve fibres, adrenergic and catecholaminergic nerve fibres. Beta-adrenergic receptors were died with a fluorescent method. All results were submitted to the quantitative analysis of images and statistical evaluation of the data. RESULTS: The morphological results revealed numerous micro-anatomical characteristics of the haemangiomatous vessels. The somatic and visceral nerve fibres were poor and located exclusively in the adventitial layer. There was a marked decrease of adrenergic nerve fibres in the haemangiomatous vessels. The fluorescence of catecholaminergic nerve fibres and the overall area of fluorescent structures were also decreased in haemangiomatous vessels. Beta adrenergic receptors are strongly decreased in haemangiomatous vessels. The morphometrical analysis of images and statistical evaluation of the data confirmed all our experimental results. CONCLUSION: The catecholaminergic innervation of the human haemangiomatous vessels comprises nerve fibres containing the main catecholaminergic neurotransmitters that are sympathetic in nature. These neurotransmitters are closely related to beta-adrenergic receptors. The sympathetic nervous system plays a key role in the control of the vascular bed flow and vascular motility in both normal and haemangiomatous vessels

Ulcere cutanee in paziente con policitemia vera in trattamento con idrossicarbamide. Case report

Le ulcere dell’arto inferiore sono una complicanza grave e frequente della policitemia vera. Esse derivano da una azione sinergica di meccanismi fisiopatologici di natura vascolare, neurologica e infettiva. Inoltre, le terapie citostatiche impiegate per controllare la patologia mieloproliferativa interferiscono negativamente sullo sviluppo del tessuto di granulazione delle ulcere, ritardandone la guarigione. Viene descritto il caso di una donna di 70 anni, affetta da policitemia vera, con ulcere calcaneari e perimalleolari molto dolorose, tali da impedire il sonno e la normale deambulazione e particolarmente resistenti alle terapie. Esami approfonditi hanno evidenziato che le ulcere erano complicanza della terapia in atto con idrossicarbamide e non della patologia ematologica. La comparsa di ulcere alle gambe in corso di terapia con idrossicarbamide è una condizione relativamente frequente ma sottostimata. La patogenesi è legata a numerosi fattori tra cui il danno cellulare e l'ipossia tissutale conseguenziali alla macroeritrocitosi indotta dal farmaco. La sostituzione del farmaco e la prosecuzione delle terapie topiche hanno permesso nella nostra paziente la risoluzione nelle ulcere cutanee gravi per estensione e sintomatologia

Total and subtotal upper eyelid reconstruction with the nasal chondromucosal flap: A 10-year experience

BACKGROUND: The authors review their 10-year experience with the nasal chondromucosal flap for total and subtotal upper eyelid reconstruction. METHODS: After several modifications, the flap is now designed along the lateral nasal wall and is based on the terminal branch of the dorsal nasal artery, to include the subcutaneous tissues down to the periosteum and the cranial portion of the upper lateral cartilage. A skin graft is applied for cutaneous coverage. The flap can be harvested unilaterally or contralaterally. RESULTS: Fifteen patients, aged 50 to 75 years, have been operated on with this technique for total or subtotal defects of the upper eyelid since 1993. Follow-up included assessment of position, closure, presence of epiphora, length of palpebral rim, eyelid opening, levator function, aesthetic balance, and donor-site morbidity. The flap result was viable in every patient, without total or partial necrosis. Static parameters were within normal ranges, and 8 to 18 mm of levator function (mean, 13 mm) was achieved. CONCLUSIONS: Compared with other frequently used techniques, namely, the Cutler-Beard advancement flap and the Mustarde lid switch flap, this procedure is a one-stage operation, does not damage the lower lid, and provides a thin, mobile eyelid with an anatomically complete reconstruction. The nasal chondromucosal flap has thus become the authors' standard for large full-thickness defects of the upper lid

Il trattamento topico di ulcere da pressione con aminoacidi e acido ialuronico. Caso clinico

Riassunto: Il trattamento topico di ulcere da pressione con aminoacidi e acido ialuronico. Caso clinico. S. Chiummariello, S. Arleo, C. Alfano Le ulcere da pressione o piaghe da decubito sono lesioni tissutali con evoluzione necrotica, che interessano l’epidermide, il derma e gli strati sottocutanei, fino a raggiungere negli stadi più gravi i muscoli e le ossa. Lo stato nutrizionale rappresenta il più importante e potenzialmente reversibile fattore dell'ospite in grado di contribuire alla guarigione delle ferite. Numerosi studi sottolineano in particolare l'importanza dell'apporto calorico e proteico al fine di stimolare la formazione del tessuto di granulazione e in particolare del collagene. Si è pensato di somministrare per via topica, utilizzando il letto della ferita come superficie di scambio, i nutrienti necessari alla riparazione della lesione presupponendo che i tessuti lesionati siano in grado di assorbire e metabolizzare gli amminoacidi ai fini plastici. Scopo di questo lavoro è illustrare un caso clinico trattato con medicazione attiva a base di aminoacidi e acido ialuronico

Innovative microsurgical device in perforator free flaps surgery

Dissection of the small perforating vessels through the muscle/septum can be difficult, and microsurgical success is closely linked on a clear and well-magnified field vision. Since 2004, Varioscope®M5 has been employed in our Plastic Surgery Departments. It is the first and only head-mounted microscope. In this study was examined 10 patients underwent to reconstructive procedures by harvest of perforator free flaps, working with Varioscope®M5. At long-term follow-up, all patient present an exceptional outcome. Considering cost-effectiveness, portability, operator freedom, and effectiveness in the perforator flaps dissection and in the anastomosis making,we think that Varioscope®M5 offers essential advantage

Il lembo neurocutaneo surale a base distale nella ricostruzione dell’arto inferiore: nostra esperienza

Background. Our study concerns eight patients who have undergone surgery at the Department of Plastic, Reconstructive and Aesthetic Surgery of the University of Perugia, for the reconstruction of lower limb using the distally based sural neurocutaneous flap for covering loss of substance of various origin, from October 2007 to November 2009. Patients and methods. The aim of our study is to demonstrate the reliability of distally based neurocutaneous sural flap in reconstruction of lower limb following a loss of substance of different nature involving the lower third of the leg. Eight patients were on systemic and local clinical conditions that can not be undergoing surgery with use of free flap. In five patients (62%) the loss of substance had been caused by traffic accident while another patient (12%) had been the victim of an accident at work. Two patients (26%) had suffered from pressure ulcers and were unstable with regard to the vascularisation. Results. We observed no cases of total necrosis of the flap and in all eight patients we showed good healing. Follow up was 2, 4, 6, and 9 months after surgical intervention. Conclusion. Our study has shown that the use of the distally based sural neurocutaneous flap in reconstruction of lower limbs, as a salvage procedure, is still a valid alternative procedure to free tissue transfer. Because of reduced operative times, reduced anaesthetic risk, reduced risk of total flap necrosis and reduced costs, it could be considered as a preferable choice in selected cases

Extracranial association of arteriovenous and venous malformations. Case report

Association of multiple vascular malformations of the face is a rare condition. An arteriovenous malformation (AVM) with a venous malformation as the draining vein is also a rarity. We report a case of extracranial mixed vascular malformations that deformed the normal architecture of the lower face. Removal of the AVM was followed by stability of the jaw and tongue malformation, indicating the AVM used the venous malformation as its draining vein. This approach spared the patient severe cosmetic and functional sequelae