A New One-Stage Method for Nose Reconstruction: The Supratrochlear Artery Perforator Propeller Flap

LETTER TO EDITO

A GEOSITE TO BE SAVED: THE TYRRHENIAN FOSSIL DEPOSIT ON THE ISLAND OF USTICA

During the 1960s, fossil beds characterized by a tropical-sea malacofauna were discovered by G. Ruggieri and G. Buccheri in the Island of Ustica, on the southern slope of Falconiera hill, 32 m asl. Thanks to the presence of Strombus bubonius and other Senegalese guests, the authors estimated that the molluscan fauna had lived around 125,000 years ago, during the Tyrrhenian stage. Recently on the initiative of the “Centro Studi e Documentazione Isola di Ustica”, a research has been initiated to verify the persistence of sand-layers mixed up with Tyrrhenian fossils, even though, in the last 50 years, that area has undergone great changes, because of earthworks which have sealed the deposit. The new research led to the discovery of a fossil assemblage formed by 22 taxa (16 species of gastropods and 6 of bivalves), characterized by the presence of some Senegalese guests and other accompanying species that can be associated with the Eutyrrhenian subunit (MIS 5.5). This is the main subject of this note, along with the suggestion to preserve what remains of the Ustica Tyrrhenian deposit

Il servizio civile: un'esperienza lavorativa e un'opportunità per acquisire competenze reali

Il ruolo diversificato che i Musei scientifici hanno assunto, ha comportato un ampliamento delle attività che si svolgono sia al suo interno che nel territorio. Se da un lato le attività museali richiedono sempre più professionalità, specializzazione, interdisciplinarietà, trasversalità e lavoro di gruppo, dall’altro lato il numero di operatori presenti nei Musei, almeno quelli universitari, è sempre più ridotto. In questo complesso quadro, negli ultimi anni il Museo Geologico Gemmellaro è diventato sede di servizio civile nazionale. Questa opportunità oltre a costituire un insostituibile aiuto alle attività del museo rappresenta per i giovani un’esperienza lavorativa ed un’opportunità per acquisire competenze reali nell’ambito delle professioni museali

The occurrence of the extinct shark genus Sphenodus in the Jurassic of Sicily

During the systematic revision of some historical collections containing Mesozoic ammonites, housed at the "G.G. Gemmellaro" Geological Museum of the Palermo University, a fossil shark’s tooth has been discovered. This specimen, indicated as Lamna in the original catalogue, can be attributed to the genus Sphenodus, an extinct cosmopolitan shark ranging from Lower Jurassic rocks to the Paleocene. The specimen is part of the Mariano Gemmellaro Collection which mainly consists of Middle-Upper Jurassic ammonites coming from Tardàra Mountain, between Menfi and Sambuca di Sicilia (Agrigento Province, Southwestern Sicily). Some of the ammonite specimens were listed, but not illustrated, by M. Gemmellaro in a note of 1919. The succession described in this area consists (from bottom to the top) of Lower Jurassic shallow-water carbonates followed by condensed ammonitic limestones of “Rosso ammonitico-type” (Middle-Late Jurassic in age), Calpionellid limestones (Upper Jurassic-Lower Cretaceous) and cherty calcilutites of Scaglia-type (Upper Cretaceous-Eocene). Since the exact stratigraphic level from which the shark tooth comes is not recorded, a thin section was made of the rock matrix surrounding the tooth. The sedimentological and paleontological analysis of the thin section has highlighted the presence of a microfacies characteristic of the Upper Jurassic condensed deposits of Rosso ammonitico-type, data that fits very well with the geology of the Tardàra area. The study of the Tardàra shark’s tooth has provided both the stimulus and opportunity to undertake a taxonomic review of the Jurassic specimens of Sphenodus collected from a range of Sicilian localities (Gemmellaro G.G., 1871; Seguenza G., 1887; Di Stefano & Cortese, 1891; Seguenza L., 1900; De Gregorio A., 1922) that, to date, have not been re-examined in the light of more recent scholarship. In particular, the specimens described and illustrated by G.G. Gemmellaro (1871), and stored in his eponymous museum, have been revised with the aim of providing a contribution to our knowledge of the genus Sphenodus in the Sicilian Mesozoic successions

Exposed subcutaneous implantable devices: an operative protocol for management and salvage

Implantable venous and electrical devices are prone to exposure and infection. Indications for management are controversial, but-especially if infected-exposed devices are often removed and an additional operation is needed to replace the device, causing a delay in chemotherapy and prolonging healing time. We present our protocol for device salvage, on which limited literature is available

The microbiota of the bilio-pancreatic system: A cohort, STROBE-compliant study

Background: The gut microbiota play an essential role in protecting the host against pathogenic microorganisms by modulating immunity and regulating metabolic processes. In response to environmental factors, microbes can hugely alter their metabolism. These factors can substantially impact the host and have potential pathologic implications. Particularly pathogenic microorganisms colonizing pancreas and biliary tract tissues may be involved in chronic inflammation and cancer evolution. Purpose: To evaluate the effect of bile microbiota on survival in patients with pancreas and biliary tract disease (PBD). Patients and Methods: We investigated 152 Italian patients with cholelithiasis (CHL), cholangitis (CHA), cholangiocarcinoma (CCA), gallbladder carcinoma (GBC), pancreas head carcinoma (PHC), ampullary carcinoma (ACA), and chronic pancreatitis (CHP). Demographics, bile cultures, therapy, and survival rates were analyzed in cohorts (T1 death <6 months; T2 death <12 months; T3 death <18 months, T3S alive at 18 months). Results: The most common bacteria in T1 were E. coli, K. pneumoniae, andP. aeruginosa. In T2, the most common bacteria were E. coli and P. aeruginosa. InT3, there were no significant bacteria isolated, while in T3S the most common bacteria were like those found in T1. E. coli and K. pneumoniae were positive predictors of survival for PHC and ACA, respectively. E. coli, K. pneumoniae, andP. aeruginosa showed a high percentage of resistant bacteria to 3CGS, aminoglycosides class, and quinolone group especially at T1 and T2 in cancer patients. Conclusions: An unprecedented increase of E. coli in bile leads to a decrease in survival. We suggest that some strains isolated in bile samples may be considered within the group of risk factors in carcinogenesis and/or progression of hepato-biliary malignancy. A better understanding of bile microbiota in patients with PBD should lead to a multifaceted approach to rapidly detect and treat pathogens before patients enter the surgical setting in tandem with the implementation of the infection control policy

ALGORITHM OF PARTIAL BREAST RECONSTRUCTION WITH PEDICLED PERFORATOR FLAPS

INTRODUCTION: The authors present an algorithm of partial breast reconstruction following quadrantectomy that allows to restore the breast volume defect with the use of pedicled perforator flaps. MATERIAL AND METHODS: Between March 2009 and May 2010, at the Plastic and Reconstructive Institute of University of Palermo, pedicled perforator flaps were used to integrate volume and/or breast skin in 12 patients after benign and malignant breast tumors. The flaps used were based on perforators of the thoraco-dorsal artery (TDAP) and of the intercostal arteries (ICAP). TDAP flaps were used to reconstruct defects in any breast quadrant, while ICAP perforator were used to reconstruct lateral and central inferior pole defects. RESULTS: All flaps survived completely. Breast size, shape and volume were satisfactorily restored. Contralateral breast procedure to adjust symmetry were not necessary. Donor sites scars were well hidden in the inframammary fold or under the brassiere. CONCLUSIONS : Partial breast reconstruction can be performed, in selected patients, with pedicled perforator flaps to restore both volume, shape and skin envelope. Donor site scars are negligible and better with the anterior ICAP because the scar is hidden in the submammary sulcus

A propeller flap for single-stage nose reconstruction in selected patients: supratrochlear artery axial propeller flap

The paramedian forehead flap is the gold standard technique for nose reconstruction. It requires two different surgical operations which prolonged the postoperative dressing and care. We present our 5-year experience with a propeller flap based on the supratrochlear artery, which allows one-stage transfer of the forehead skin to the nose without the need for pedicle division. This technique is indicated in a selected group of patients who are not suitable for multiple-stage reconstructions because they have concurrent medical conditions, reduced mobility, or live far away from specialized medical centers. We have renamed this procedure as supratrochlear artery axial propeller flap, from the acronym STAAP flap, to stress the axial, well known and constant, vascularization of the flap. In the past 5 years, we have been performing 25 STAAP flaps; full-thickness nasal reconstruction was performed in 11 cases. The patients were 16 males and 9 females, with a mean age of 79.5 years. All patients had multiple comorbidities. Complete flap survival was observed in 23 cases and healing was complete in 7 days. In two cases, there was a partial distal necrosis of the flap treated conservatively. Cosmetic results were good and the patient's satisfaction was significant. These results indicate that the STAAP flap is a reliable and useful technique in selected cases, as old or noncompliant patients who benefit from a one-stage technique of nose reconstructio

Reply: Comparison of preoperative and postoperative lymphatic function is essential to understand the changes in lymphatic function

Reply to a Letter to Edito