Breast reconstruction with anatomical implants: A review of indications and techniques based on current literature

One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of \u201cthe ideal breast size\u201d, although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article

Valutazione dell’efficacia di Plasma Ricco di Piastrine autologo associato a cellule multipotenti adulte mesenchimali autologhe isolate da lipoaspirato quali adiuvanti la guarigione di ulcere cutanee croniche

Il problema delle ulcere cutanee ha assunto un’importanza sempre maggiore negli ultimi decenni a causa del progressivo incremento della popolazione anziana e delle patologie croniche correlate. Le ulcere cutanee sono un serio e crescente problema di salute, sono spesso disabilitanti e difficili da trattare. Secondo l'Associazione Italiana per le Ulcere Cutanee (AIUC) queste patologie costano al Servizio Sanitario nazionale più di un milione di euro ogni anno e la perdita di circa 500.000 ore di lavoro. Fra i diabetici lungo sopravviventi il rischio di ulcere da piede diabetico raggiunge il 25% e circa il 20% delle spese sanitarie può essere attribuito a questo tipo di ulcere. Le più comuni cause di ulcere sono i disordini vascolari (arteriosi o venosi), i traumi, i decubiti e il piede diabetico. Le ulcere cutanee sono tutte caratterizzate da perdita di tessuto che coinvolge l’epidermide, il derma e alcune volte il tessuto adiposo e muscolare e da una mancanza di riparazione spontanea forse dovuta all'età della popolazione residente di cellule staminali mesenchimali o all'incapacità di reperire precursori cellulari circolanti. Si avverte un grande bisogno di approcci terapeutici innovativi nel trattamento delle ulcere e queste devono essere economicamente praticabili e applicabili su larga scala. Uno dei più interessanti approcci terapeutici si basa sull'utilizzo del “gel piastrinico”, un emocomponente per uso topico ottenuto dalle piastrine concentrate attivate con una preparazione di trombina umana in presenza di calcio. Il gel piastrinico è stato utilizzato per numerosi anni nel trattamento di ulcere cutanee poiché è noto avere un effetto sulla promozione della rigenerazione del tessuto mesenchimale come il tessuto connettivo, tendineo, osseo e vascolare. A livello clinico sulle ulcere cutanee, in primo luogo si manifesta la comparsa di tessuto di granulazione e successivamente la riepitelizzazione della superficie cutanea. Negli ultimi anni si è affermato l'utilizzo del tessuto adiposo come sorgente di cellule stromali mesenchimali nella medicina rigenerativa in particolare per la rigenerazione del tessuto osseo, cartilagineo e dei tessuti molli. Queste cellule hanno la capacità di differenziarsi in linee cellulari mesodermiche come adipociti, osteociti e condrociti. Il midollo osseo è stato utilizzato come principale risorsa di cellule staminali mesenchimali per molti anni, attualmente si assiste ad un progressivo incremento delle MCS isolate da tessuto adiposo. Questa sorgente presenta numerosi vantaggi rispetto al midollo osseo, infatti il tessuto adiposo è più facilmente reperibile, è ampiamente disponibile e contiene un'altra concentrazione di MCS. Attualmente per la rigenerazione di ferite difficili che non rispondono ai trattamenti standard, viene utilizzato il PRP. Attraverso questa ricerca volevamo sperimentare qualcosa di più efficiente sfruttando la capacità del PRP di stimolare la proliferazione 3 delle cellule stromali mesenchimali. E quindi ottenere una maggior percentuale di guarigione delle ulcere cutanee degli arti inferiori in pazienti con piede diabetico o con vasculopatie arteriose o venose

Geophagia: An extraordinary cause of\ua0perforation of the sigmoid colon

A case of large bowel perforation due to geophagi

Prepectoral breast reconstruction using the Braxon® porcine acellular dermal matrix: a retrospective study

none6Background: Breast cancer is the leading cause of death attributable to cancer among women worldwide. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance to breast cancer survivors. Muscle-sparing techniques using an acellular dermal matrix (ADM) (Braxon; DECO med s.r.l., Venice, Italy) can be considered a possible alternative to immediate reconstruction or two-step reconstruction for patients with medium breasts who want to preserve their natural breast shape. Methods: We performed a retrospective analysis of reconstructions using a Braxon porcine-derived ADM at the Breast Unit of the University Hospital of Parma and the Breast Unit of Piacenza Hospital from January 2015 to September 2017. The objective was to evaluate the benefits and complications resulting from this technique. Results: We treated 42 patients and performed a total of 51 muscle-sparing reconstructions using the Braxon porcine-derived ADM. The incidence of cutaneous necrosis was 4% (n = 2); the incidence of seroma was 4% (n = 2). We had to remove the implants in two cases. Natural and symmetrical breasts with good form, ptosis, and softness were achieved for most patients. Conclusions: Good results were obtained with a high degree of esthetic and functional satisfaction for the majority of patients. A low rate of early complications compared to that reported in the international literature data was observed. Level of Evidence: Level IV, therapeutic study.noneGardani, Marco; Simonacci, Francesco; De Sario, Giuseppina; Cattadori, Francesca; Raposio, Edoardo; Palli, DanteGardani, Marco; Simonacci, Francesco; De Sario, Giuseppina; Cattadori, Francesca; Raposio, Edoardo; Palli, Dant

Pancreatic transection from blunt trauma associated with vascular and biliary lesions: A case report

Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries. In such cases, a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient. We herein describe a case of blunt abdominal trauma in a 29-year-old man whose pancreatic rupture was associated with hepatic artery, splenic vein and extrahepatic bile duct damage. Immediate surgery was performed after computer tomography (CT), the haemorrhagic lesions dictate the emergency transfer to the operating room. Spleno-pancreatic resection was done with reconstruction of the hepatic artery, ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion. The early post-operative course was complicated by stenosis of the arterial reconstruction, which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst, rest and antibiotics. Finally, the patient was discharged and was alive without clinical problems at the time when we wrote this case report. The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma

Pancreatic transection from blunt trauma associated with

doi:10.3748/wjg.14.482

Post-bariatric abdominoplasty: our experience

The fast increase in obesity has been followed by the growth in the demand for plastic surgery in formerly obese patients. The weight loss is accompanied by new dysfunctions and disorders of the outline of the body that affects the quality of life of the patient. Abdominoplasty is a cosmetic surgery procedure that aims to remove the excess of skin and the redundant fat. The aim of this paper was to analyze our experience in this field and to test how functional abdominoplasty improved quality of life in the operated patients. In our Unit from January 2012 to December 2014, 25 patients (18 women and 7 men, age: 24 - 79 years, mean: 51 years) underwent abdominoplastic surgery. Only at least six months after bariatric surgery the patients were eligible for functional abdominoplasty. Average weight of the patients before surgery was 83.5 kg (range 58 - 163 Kg); averege BMI was 31 (range 24.77 - 57). The average quantity of tissue removed was 1.765 Kg (range 250 g - 11,5 Kg). Minor complications rate was in agreement with the percentages reported in literature. No mortality and major complications have occurred in our series. The majority of patients undergoing post-bariatric abdominoplasty reported an improvement in the quality of life and psychological well-being. In our opinion, however, only a multidisciplinary (surgical, psychological, dietological) approach of the post-bariatric patient allows to maintain long-term aesthetic and functional results

In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

The aim of this study was to determine whether parameters related to TBI impacted upon OS and relapse in patients with acute leukemia in CR who underwent haematopoietic SCT (HSCT) in 11 Italian Radiation Oncology Centres. Data were analysed from 507 patients (313 males; 194 females; median age 15 years; 318 with ALL; 188 with AML; 1 case not recorded). Besides 128 autologous transplants, donors included 192 matched siblings, 74 mismatched family members and 113 unrelated individuals. Autologous and allogeneic transplants were analysed separately. Median follow-up was 40.1 months. TBI schedules and HSCT type were closely related. Uni- and multi-variate analyses showed no parameter was significant for OS or relapse in autologous transplantation. Multivariate analysis showed type of transplant and disease impacted significantly on OS in allogeneic transplantation. Disease, GVHD and TBI dose were risk factors for relapse. This analysis illustrates that Italian Transplant Centre use of TBI is in line with international practice. Most Centres adopted a hyperfractionated schedule that is used worldwide (12 Gy in six fractions over 3 days), which appears to have become standard. TBI doses impacted significantly upon relapse rates