Acral lentiginous melanoma. A retrospective study

Background: Acral lentiginous melanoma (ALM) carries one of the worst prognoses among other subtypes. This malignant tumor is found on the distal limbs and is usually detected at late stages. Hereby, the authors present their experience on this melanoma subtype. Methods: A retrospective study was conducted. Data were extracted from patients’ medical records and from phone interviews. Results: A total of 43 patients were included in the study. The main signs and symptoms disclosed by the patients were bleeding (41.9%), size greater than 6 mm (41.9%), change in size (37.2%), change in shape (30.2%), rise above the surface of the skin (27.9%), change in color (20.9%), irregular borders (16.3%), and inflammation (16.3%). The first healthcare professional consulted was a general practitioner or a dermatologist in the majority of cases (88.3%). Only 44.2% of the patients were sent by their first physician for a biopsy, whereas 30.3% were sent by the 2nd physician. 14 patients underwent biopsy within 1 month from the first appointment with a physician, while 20 patients within 3 months and 9 patients within 6 months. Only 7 patients sought medical attention in the first 3 months; 21 patients sought medical care between 3 months and one year from the appearance of the lesion, while the remaining 15 patients waited more than a year. Conclusions: One of the major issues found in ALM is represented by the diagnostic delay; this may be due to either the patients or the physicians’ failure to recognize warning signs

Oncoplastic conservative surgery for breast cancer: long-term outcomes of our first ten years experience

The main goal of oncoplastic breast surgery (OBS) is to optimize cosmetic outcomes and reduce patient morbidity, while still providing an oncologically-safe surgical outcome and extending the target population of conservative surgery. Although the growing number of reported experiences with oncoplastic surgery, few studies account for the long-term outcomes

Oncological safety of stromal vascular fraction enriched fat grafting in two-stage breast reconstruction after nipple sparing mastectomy: long-term results of a prospective study

OBJECTIVE: Autologous fat transfer (AFT) is commonly used to treat implant palpability and prevent fibrosis and thinning in mastectomy skin flaps. A major limit to this procedure is volume retention over time, leading to the introduction of fat enrichment with stromal vascular fraction (SVF+AFT). Oncological concerns have been raised over the injection of an increased concentration of progenitors cells (ASCs) in the SVF. The aim of the study is to evaluate the long-term cancer recurrence risk of SVF+AFT cases compared to AFT, in patients undergoing Nipple Sparing Mastectomy (NSM). PATIENTS AND METHODS: A prospective study was designed to compare three groups of patients undergoing NSM followed by SVF+AFT, AFT or none (control group), after a two-stage breast reconstruction. Patients were strictly followed-up for at least 5-years from the second stage reconstructive procedure. Loco-regional and systemic recurrence rate were evaluated over time as the primary outcome. Logistic regression was used to investigate which factors were associated with recurrence events and independent variables of interest were: surgical technique, age above 50 years old, lympho-vascular invasion, oncological stage, adjuvant or neoadjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy. RESULTS: 41 women were included in G1 (SVF+AFT), 64 in G2 (AFT), and 64 in G3 (control group). Loco-regional recurrence rate was 2.4% for G1, 4.7% for G2, and 1.6% for G3. Systemic recurrence was 7.3%, 3.1%, and 3.1%, respectively. Among the variables included, there were no significant risk factors influencing a recurrence event, either loco-regional or systemic. In particular, SVF+AFT (G1) did not increase the oncological recurrence. CONCLUSIONS: Our data suggest that both centrifuged and SVF-enhanced fat transfer have a similar safety level in comparison to patients who did not undergo fat grafting in breast reconstruction after NSM

Non-invasive computer navigation can quantify the pivot shift maneuver with good to excellent reliability in healthy volunteers

Purpose: The aim of this study was to determine the inter- and intra-observer reliability of knee laxity assessment using a non-invasive navigation system in a population of healthy young athletes. It was hypothesized that knee laxity parameters recorded using non-invasive computer navigation would demonstrate good inter- and intra- observer reliability. Methods: Healthy volunteers aged between 18 to 30 years were recruited to the study. Static and dynamic knee laxity parameters including anterior tibial translation and tibial rotation during the pivot shift test were recorded on awake patients using non-invasive computer navigation by two independent observers: at the first visit each athlete was evaluated by the consultant and resident surgeons independently; 6 weeks after the first visit all the participants were re-tested only by the resident surgeon. Inter- and intra-observer reliability was calculated and then interpreted according to Cicchetti’s criteria. Results: One hundred healthy volunteers were recruited to the study, of these 38 were women (38%), and the average age was 25.5 ± 2.4 years. According to Cicchetti’s criteria the intra- and inter-observer reliability for static measurements were fair for anterior tibial translation (0.572 and 0.529, respectively) and excellent for total passive tibial rotation (0.859 and 0.883, respectively). For the dynamic measurements of translation and rotation during the pivot shift maneuver both measurements demonstrated good to excellent reliability with intra and inter observer reliability ranging from 0.684 to 0.936. Conclusion: Non-invasive navigation for the assessment of knee laxity is associated with fair to excellent inter- and intra-observer reliability in a population of healthy volunteers

The effects of COVID-19 pandemic on elective post-bariatric surgery waiting list. A single plastic surgery center investigation

Objective: After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. Patients and methods: A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. Results: 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. Conclusions: The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased

Erratum to: Co2/Erbium:YAG/Dye Laser Combination: An Effective and Successful Treatment for Angiofibromas in Tuberous Sclerosis.

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The patient’s pathway for breast cancer in the COVID-19 era: An Italian single-center experience

COVID-19 has been declared a pandemic by the World Health Organization. As of April 1, 2020, Italy was the country with the second highest number of cases in the world. The spread of COVID-19 has required a rapid reorganization of health service delivery in face of the pandemic. Breast cancer units have reprioritized their workload to guarantee the health of oncologic patients at the highest risk and regular screening activities. However, at the end of the pandemic emergency, many benign and reconstructive cases will return to our attention and their surgical treatment will be necessary as soon as possible

Subcutaneous expanders and synthetic mesh for breast reconstruction: long-term and patient-reported BREAST-Q outcomes of a single-center prospective study

Summary Recently, prepectoral breast reconstruction is experiencing a revival. Despite the growing body of early reports about subcutaneous breast reconstruction, literature lacks in long-term results and studies focusing on patient-reported outcomes and health-related quality of life. Between January 2012 and December 2016, patients undergoing mastectomy were enrolled at our institution. We selected patients diagnosed with breast cancer or genetic predisposition to breast cancer, undergoing conservative mastectomy, either nipple-sparing or skin-sparing mastectomy, and willing for prepectoral tissue expander reconstruction assisted by a synthetic mesh. Exclusion criteria were body mass index greater than 35 kg/m2 and pregnancy. BREAST-Q questionnaire was administered prior to surgery and after 1 year. Capsular contracture was evaluated using Baker scale. Oncological, surgical, and esthetic outcomes along with the changes in BREAST-Q score were analyzed over time. One hundred eighty-seven patients were enrolled, with an average age of 55.5 years. One hundred thirty-seven unilateral mastectomy and 50 bilateral mastectomy procedures were performed, accounting for a total of 237 operated breasts. The average follow-up period after the second stage was 36.5 months. Postoperative complications that require a second operation occurred in 16 cases (6.7%) (4 wound dehiscence, 2 skin–nipple necrosis, 7 infections, and 3 seroma cases). A locoregional recurrence occurred in 3 cases (1.9%) and a systemic recurrence occurred in 2 cases (1.3%). Patients scored high level of satisfaction with outcome. Overall satisfaction with breasts, psychosocial well-being, and sexual well-being was all significantly increased after the surgery (p < 0.05). Two-stage expander reconstruction technique provides the preservation of the pectoralis major muscle with an acceptable rate of complications. We confirm satisfactory patient-reported and esthetic results, with high patient comfort