Foot Reconstruction

Since the conquest of the upright position, the foot has gained more importance as an organ that supports both the lower limb and the whole body weight and that allows humans to stand up, walk, run, jump, and climb. Human evolution determined progressive changes in both the skeleton architecture and the soft tissue of the foot to cope with the new environmental requirements. From the orangutan to the chimpanzee, from the gorilla to the human, the most important modifications of the skeleton included the progressive reduction of the distal area of the phalanxes with the loss of the grasping function and the enlargement of the proximal bones (astragalus, calcaneum) to obtain a resistant yet flexible structure. See the image below

Fondamenti di materiali dentari

libro di test

Mammary implants : lab simulation of recreational diving conditions

Introduction: Diving is becoming an increasingly popular sport for women. This has created a group of patients with breast implants who practice diving. The purpose of this study was to ascertain i f mammary implants are prone to any change in conformation or structure i f submitted to recreational diving. Material and methods: Severi new implants (Mentor Siltex® Round gel and Siltex® Becker 50 Expander/ Mammary implant; McGhan style 120, 110, 150 and 410) and one undamaged implant removed after two years (McGhan style 410), were submitted to 40 simulated dives in a hyperbaric air compressed facility. Four matching implants were used as a control. Two immersions a day (maximum depth and bottom time of -39 mt and 30 min) were simulated, at controlied temperature (21°C) and humidity (between 60 and 70%). A photograph of ali implants was taken before and after the study. The volume of mammary implants was assessed at sea lcvel before and after each simulated dive by immersing the devices in a closed, water filled container where volume changes were determined by variations of water level in a capillary tube. After each simulated dive, the integrity of the implants was checked. Computerised tomography scan of each implant was done at the end of the protocol to assess variations in gel density, using the Hounsfield unit scale. Results: No implants showed ruptures or variation in volume. Ali implants showed shape alterations, doublé lumen implants showed also irregularity of the inner shell. No alterations of the density could be detected in new implants group. The two-year-old implant showed a hyperdense irregularly ovai shaped profile inside the implant. Conclusions: The tested mammary implants are relatively safe; there were some structural alterations under the test conditions, but not ruptures

Comparative evaluation of traditional, ultrasonic, and pneumatic assisted lipoplasty: Analysis of local and systemic effects, efficacy, and costs of these methods

Recently ultrasound assisted liposuction (UAL) and pneumatic assisted liposuction (PAL) have been introduced as an attempt to improve the results and reduce the pitfalls of standard liposuction (SAL). Until now no studies comparing, at the same time, UAL, PAL, and SAL have been published. The aim of this study was to analyze these methods from the surgeon's point of view, focusing not only on aesthetic results but also on local and systemic trauma, efficacy, handling, and cost. Forty-five cosmetic patients affected by local lipodystrophy, divided into three equal groups, have undergone liposuction with the three above-mentioned techniques. Quantitative and qualitative analysis of lipoaspirates, together with blood chemistry, local and systemic complications, time to aspirate 100 cm3, distress, fatigue, and costs of the procedures, has been recorded. Our results showed bloodier lipoaspirates in SAL and a higher percentage of triglycerides in UAL lipoaspirates. Blood tests revealed a slight decrease in the postoperative Hb in SAL only. Early complications observed were tour erythemas in PAL, three ecchymoses in SAL, and one long-lasting edema in UAL. Aesthetic results rated by independent viewers were similar for all methods. Efficacy was higher in the PAL group (4 min × 100 cm3 fat aspirated) than in SAL (7 min × 100 cm3 fat) and UAL (10 min × 100 cm3 fat). Surgeon's distress was higher in PAL than in SAL and UAL. Surgeon's fatigue was much lower in the PAL group than in the others. Costs expressed as multiples of 1 unit (1 unit = $500 U.S.) were highest for UAL, low for PAL, and lowest for SAL. In conclusion, PAL and UAL caused reduced vascular injury, UAL being more selective for adipocyte removal. Complications of UAL and PAL were mostly related to the longer learning curve of these methods. The UAL procedure was much more expensive than PAL and, especially, SAL. PAL proved to be a handy technique, with the most favorable cost/benefit ratio, and seems to be the best option for busy liposuction practices or fast office procedures, even though the choice of the ideal technique always depends on the surgeon's preference

Microsurgical reconstruction of wide simple and compound foot defects.

A mutilated foot as a result of traumas or resection for tumours or ulcers, is a serious physical and social handicap for the patient, because it impairs deambulation and affects his selfgovernment. The evolution of microsurgical techniques has allowed us to utilize such methods to reconstruct wide simple and composite losses of substance of the foot, usually treated conservatively or radically with amputation and prosthesization. Functional, cosmetic and social outcome has been evaluated. We evaluated 23 patients affected by cutaneous (19) and osteocutaneous (4) losses of substance of the foot (11 of rearfoot, 5 of forefoot, 4 of the sole, 1 of middlefoot, 1 of the dorsum, and 1 of the malleolus). We performed 23 microsurgical reconstructions harvesting 24 free flaps (14 radial flaps, 4 latissimus dorsi, 3 fibula, 1 scapular flap, 1 lateral arm, 1 iliac crest). Cutaneous and muscular flaps healed in 3 weeks, while osteocutaneous flaps healed in 10 to 12 weeks. Deambulation was restored in all patients but 1, within 6 months from surgery, and all patients went back to their work and social life. We observed in the early follow-up 2 cases of partial skin necrosis, which solved spontaneously and 1 case of total necrosis (overall complication = 4.3%). Donor area morbidity was rated as fair. Overall success rate was 95.7% at a mean follow-up of 3 years. Free microsurgical transfers allowed us to obtain a satisfactory and long-lasting morpho-functional restoration of wide superficial and deep losses of substance of the foot, guaranteeing the patient a fast psycho-physical and social rehabilitation