The art of rhinoplasty: researching technical and cultural foundations of western world rhinosurgery, from the middle ages to the renaissance

The analysis of the written sources allowed to follow the gradual development of every new technique in the field of rhinoplasty but also to understand the value of this surgery in those ancient times, highlighting a deep connection between traumatologic surgery of the nose and the development of modern ‘‘aesthetic and reconstructive’’ Rhinosurgery. Specifically, we analyzed the techniques described by less known surgeons to emphasize their cultural and surgical value. As a matter of fact, the descriptions offered by these authors clearly show the importance of rhinoplasty as a cardinal and autonomous practice since Antiquity, also clarifying the persistence and development of specific techniques for this surgical practice in the History of medicine. In the manuscript, the contributions of the Italian surgeons, such as Brancas and Vianeos families, are highlighted, demonstrating their influence on the progress of this surgical specialty in the Early Modern Age. Finally, we deepen the description of Gaspare Tagliacozzi’s work, pointing out the topics and controversial debates arising from his techniques and innovations in ‘‘rhinosurgery’’ and also in the field of tissue transplantation, laying the foundations of modern Plastic Surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266

Galactocele after aesthetic breast augmentation with silicone implants. An uncommon presentation

Background: Breast augmentation is one of the most frequently performed esthetic operations. Galactorrhea and galactocele formation are both very rare complications. The real cause still remains unknown, but various risk factors have been well reported in the literature. This report concerns a case of postoperativegalactocele following bilateral breast augmentation via the inframammary approach with dual-plane insertion of implants, which is usually considered a protective approach in terms of risk factors for induction of postoperative galactorrhea. Methods: The patient had no significant surgical, gynecological or medical history, including galactorrhea or hyperprolactinemia, and did not present any chest wall abnormalities. There has been no use of oral contraceptives or any other drugs. After the surgical procedure, the patient presented with infection-like symptoms, for which galactorrhea or galactocele was initially not considered, mainly for the absence ofspecific risk factors. Results: After antibiotic and bromocriptine therapy, her breast returned to normal, with no pain, inflammation, enlargement or esthetic alterations. After 6 months of follow-up, the patient did not present any abnormality and she was satisfied with the result. Conclusion: With our report, we want to underline that galactorrhea and galactocele cannot be ruled out, even in patients with no risk factors and with procedures considered as “protective.” With a fast diagnosis and a specific therapy, implants and final result can be rescued. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

The Medical Historical Cultural Foundations of Western Nasal Surgery from Ancient Greece to the Middle Ages

Abstract: The manuscript aims to clarify the origins of Western rhinosurgery through the ancient texts of the greatest physicians of the past, up to the Byzantine Era, focusing on the “exchange of knowledge” between peoples. This excursus is carried out by quoting the texts of the greatest doctors of the past, such as Hippocrates, Galen and Celsus and by analysing the works of Byzantine authors such as Oribasius, Aetius, Antillus, which, more than others, represent the moment of fusion and interpenetration of Ancient Medical knowledge, paving the way for the Medieval Scholae Medicae in the West. The aim, therefore, is to fill that sort of "great gap" (from the foundation of Constantinople in the 4th century AD to the early Arab culture in the 11th century AD) due to the fact that figures such as Branca, Vianeo and, finally, Tagliacozzi, are considered direct actors of a recovery of the “ancient knowledge” of classic authors. This literature tends to less evaluate, instead, that important and huge cultural exchange -literally osmotic- in medical and surgical knowledge between peoples and civilizations, that find a trait d'union in the application of medical knowledge and surgical practical techniques matured in the Byzantine, Arab and Early Medieval period. In final analysis, through the History of Rhinosurgery, this paper aims to highlight how Western medical knowledge is made up of the ensemble of cultures which are apparently distant and different from each other, which merge themselves in a truly universal and transcultural knowledge: the Medical knowledge. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Characterisation of process-induced variability in wrinkle defects during double diaphragm forming of non-crimp fabric

Experiments and numerical simulations are employed to determine the critical process variables that affect the quality of a two-layer biaxial non-crimp fabric (NCF) preformed using the double diaphragm forming (DDF) process. To prevent wrinkling defects, the process variables must be controlled, including the vacuum pressure, diaphragm tension, and ply-tool alignment. Inter-ply friction plays a critical role in the deformation mechanism, while the frictional interaction between the diaphragm and tool has a limited impact. The study also reveals that geometrical features have an impact on the variability induced by the forming process. Preforms deformed to tools with geometrical features of higher asymmetry or Gaussian curvatures reduce the uncertainty of the forming process by maintaining the same preform quality despite changes in forming variables

Depression risk among patients with chronic wounds

OBJECTIVE: A wound is defined as chronic when it requires more than 6 weeks to heal. The link between chronic wounds and depression was first pointed out by House and Hughes in 1996 and later evaluated by other numerous studies. Several studies demonstrate that among chronic skin wounds causing chronical physical disease, the leg ulcers are the most frequently associated with depression. The aim of our study is to evaluate the prevalence of depression in patients with different types of chronic wounds. PATIENTS AND METHODS: We enrolled a total of 33 patients with chronic wounds and 33 healthy controls matched by sex and age. Both patients and controls underwent a BDI II survey. We evaluated 33 patients, with a mean age of 71 years (range 25-87), and 33 controls, with a mean age of 73 years (range 31-88). RESULTS: T he a verage s core a t t he B DI I I questionnaire was 14.5 and 8, respectively. CONCLUSIONS: The depression among patients with chronic wounds has a multifactorial origin that should be treated with a multidisciplinary approach. Since the improvement of the psycho-emotional state means better compliance of the patient, we can also expect a better result in terms of efficacy in chronic wound treatment

Venous thromboembolism prophylaxis in plastic surgery: state of the art and our approach

OBJECTIVE: The issue of prevention of thromboembolism in plastic surgery is a rather controversial subject. The actual frequency of VTE among plastic surgery patients is probably higher than we know. Although several studies have shown that chemoprophylaxis likely increases rates of re-operative hematoma by less than one percent, surgeons are strongly resistant to adopting chemoprophylaxis due to the fear of increased bleeding and its complications. MATERIALS AND METHODS: A literature review was conducted. The 2012 ACCP guidelines suggest the use of the 2005 Caprini score as the most widely used and well-validated individualized risk-stratification tool. We propose a modified 2005 Caprini score, with specific changes pertaining to plastic surgery, in which we combine a patient risk stratification model and a procedure-driven approach explicitly indicating what procedures have to be considered at high or low risk. RESULTS: The risk of venous thromboembolism in plastic surgery cannot be disregarded. However, the plastic surgery literature still lacks high-level evidence for appropriate means of VTE prophylaxis, although an increasing amount of attention has been paid to the topic. We suggest the development of an international guideline, based on plastic surgical data, using a validated risk assessment model, which combines the surgical risk with the patient related risk. CONCLUSIONS: Determining the proper venous thromboembolism prophylaxis is a clinical decision that should be made on a patient-to-patient basis. The algorithm presented in this article is meant to simplify this complex problem and to help expedite and clarify the decision-making process