Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

EVOLUTION OF MICROSURGICAL CORRECTION IN FACIAL CONTOUR DEFORMITIES: REMARKS ON 22 CONSECUTIVE FLAPS

Aim: Facial contour deformities with hemifacial or bilateral tissue atrophy can have many different etiologies, both congenital and acquired. Microsurgical reconstruction is currently the treatment of choice for facial soft tissue integration, to obtain satisfactory and long-lasting countour restoration. Methods. Our experience includes 20 patients with facial contour deformity, treated with the transfer of 22 microsurgical flaps, from 1990 to 2007. We have experienced an evolution in flap selection: we used the scapular flap in our first four patients and then adopted the perforator flaps (ALT,DIEP,SGAP, with a total of 14 perforator flaps in 13 patients). Our current standard approach in these cases is the adiposal DIEP flap. Results. There were no flap losses in this series of 22 flaps, two patients developed postoperative hematoma and flap revision was performed in eight patients (liposuction,fat graft,scar revision). Unlike our previous experience with the scapular plaps, using the perforato flaps we have been able to reduce donor site morbidity , and obtain better contour restoration, as perforator flaps are more easily modelled. The introduction of adiposal DIEP flaps has led to further reduction of donor site morbidity, with minor residual scarring in the suprapubic region, and a softer and more natural reconstruction, thanks to the lack of a dermal component. Conclusion. Based on our experience, the adiposal DIEP flaps can currently be considered the gold standard in the treatment of facial contour deformieties

Abdominal Wall Transplantation and Technique

Many patients undergoing intestinal or multivisceral transplantation have a past history of complete midgut removal with the loss of the domain of the abdominal compartment or have severely damaged abdominal walls from repeated laparotomies or enterocutaneous fistulae. These patients may encounter severe abdominal wall closure problems at the end of transplantation, resulting in increased morbidity and mortality. It is, therefore, of paramount importance to properly cover transplanted organs in order to reduce postoperative complications. Abdominal wall transplantation was proposed for closure of patients undergoing both small bowel and multivisceral transplantation. We present our experience in abdominal wall transplantation in which, by taking advantage of microsurgical experience, we were able to re-vascularize the composite tissue allograft anastomosing the deep inferior epigastric vessels of the graft to those of the recipient. This technique allows to preserve donor\u2019s vascular pedicle that can be used as grafts for vascular procedures

Microsurgical Reconstruction of the Nose: The Aesthetic Approach to Total Defects

Background Reconstruction of complex defects involving nose and close facial units represents an aesthetic and functional challenge. Restoring satisfactory nasal shape, combining aesthetic, nasal function and patent airways is mandatory. In this paper, we describe our approach to total nose defects and we report our 20-year experience in microvascular nose reconstruction.Clinical cases are shown to illustrate different surgical techniques and the evolution of our approach. Methods Nasal reconstruction procedures were performed on 21 patients between 2000 and 2020 using the radial forearm flap (RFF) or anterolateral thigh (ALT) flap. Reported reconstructions included total/subtotal nasal defects, caused by cancer resections. The key point of our approach is the expanded forehead flap for skin coverage. Reconstruction is completed by cartilage grafts to restore nasal framework and to shape nasal tip. Ancillary procedures were needed in some cases to optimize aesthetic outcomes. Results Twenty-one patients completed the multistage nasal reconstruction. The RFF flap was used in 56% of the cases (n = 11), while the ALT flap was used in 44% (n = 10) of our case series. No difference has been detected in the number of reconstructive stages required to achieve the final result comparing RFF and ALT reconstruction (3.3 vs. 3.1 reconstructive steps). Ancillary procedures were performed in 7 patients. Conclusion Microvascular tissue transfer plays a key role in full-thickness nasal defects restoration. Comparing the two groups, both the RFF and ALT are effective and reliable options in lining reconstruction, although with different indications. Expanded forehead flap, combined to free cartilage graft, is our gold standard to provide external skin coverage to rebuild the nasal framework. According to our current approach, accurate preoperative planning, supported by modern technologic tools, multistage reconstruction, and ancillary procedures are useful to accomplish satisfactory functional and aesthetic outcomes

Vascular pedicle ossification of free fibular flap: is it a rare phenomenon? Is it possible to avoid this risk?

Free fibula flap is the most common free tissue transfer for maxillary and mandibular reconstructions. The distal part of the harvested bone is transferred, while the proximal part is removed by sub-periosteum dissection. The vascularized periosteum attached to the vascular pedicle has osteogenic potential. 61 patients reconstructed with free fibula flaps were divided in 2 groups: 41 flaps performed with a standard technique and 20 flaps performed by dissecting the periosteum from the pedicle. Patients were followed up with orthopantomography and CT scan at 6, 12, 18 and 24 months after surgery. The minimum follow-up time was 18 months. With retrospective analysis of the first group we diagnosed 7 pedicle ossifications on 41 reconstructions (17%). In the second group, no pedicle ossification was observed (p < 0.05). The dissection of periosteum from the vascular pedicle of free fibula flaps avoids the risk of ossification

Cross-leg as salvage procedure after free flaps transfer failure: a case report

Abstract: Posttraumatic wounds of the lower leg with soft tissue defects and exposed fractures are a reconstructive challenge due to the scarce availability of local tissues and recipient vessels. Even when a free tissue transfer can be performed the risk of failure remains considerable. When a free flap is contraindicated or after a free flap failure, the cross-leg flap is still nowadays a possible option. We report a case of a male with a severe posttraumatic wound of the lower leg with exposed tibia fracture firstly treated with two consecutive latissimus dorsi muscular free flaps, failed for vascular thrombosis; the coverage was then achieved with a cross-leg flap with acceptable results

Refractory Complex Crohn's Perianal Fistulas: A Role for Autologous Microfragmented Adipose Tissue Injection

BACKGROUND: Complex perianal fistulas represent one of the most challenging manifestations of Crohn's disease. Combined surgical and medical therapy with biologic drugs today represent the first-line treatment option, but its efficacy does not exceed 60%. Recently, new therapeutic approaches, such as the use of mesenchymal stromal cells, have shown promising results. The adipose tissue is an abundant and easy to access source. The effectiveness, safety, and feasibility of local injections of microfragmented adipose tissue in patients with refractory complex fistulizing perianal Crohn's disease (PCD) were evaluated. METHODS: Fifteen patients with persistent complex fistulizing PCD after biosurgical approach and subsequent surgical "rescue" repair were treated in S. Orsola-Malpighi Hospital with a single-local administration of microfragmented adipose tissue prepared using a minimal manipulation technique (Lipogems) in a closed system. Clinical outcomes were determined at 24-week follow-ups assessing success rate, defined as combined clinical and radiological remission. RESULTS: Upon clinical examination at 24 weeks, 10 patients had combined remission (clinical and radiographic), 4 patients showed improvements, and 1 patient failed. The results were confirmed in all patients by pelvic MRI. No relevant postoperative complications nor adverse events were reported. CONCLUSION: These results suggest that the local injection of autologous microfragmented adipose tissue is a safe and promising "rescue therapy" for patients with multiresistant complex fistulizing PCD. This approach might be proposed as routine because it is affordable, is minimally invasive, has no risk of sphincteric damage, and can be carried out in a day-surgery setting

Reverse Pedicled and Disepithelized Forearm Flap for Hand Reconstruction

none8DOI volume: 10.1159/000224773. Abstract n° 170noneC. Gelati; R. Sgarzani; E. Fabbri; F. Contedini; V. Pinto; P. Nejad; L. Negosanti; R. CiprianiC. Gelati; R. Sgarzani; E. Fabbri; F. Contedini; V. Pinto; P. Nejad; L. Negosanti; R. Ciprian