Clinical significance of the buccal fat pad: how to determine the correct surgical indications based on preoperative analysis

Background: Despite the multitude of clinical and aesthetic uses, the correct surgical indications for buccal fat pad (BFP) removal have yet to be fully elucidated. Although the procedure is widely performed and promoted for aesthetic purpose, literature lacks of studies accounting for a proper evaluation of patients undergoing BFP removal. Methods: Between 2012 and 2016 patients seeking an improvement of the malar contour by reduction of the submalar prominence have been visited at the Department of Plastic Surgery of the Institution. A preoperative MRI was requested in order to correctly identify the volume of the BFP and the presence of a masseter muscle (MM) hypertrophy. Results: According to clinical examination and the results of the preoperative imaging, patients were offered different treatment options: patients with BFP hypertrophy underwent BFP removal through an itraoral approach; patients with MM hypertrophy received injection of 50 UI of botulinum toxin (BTX). No complications were observed in the postoperative period and all patients were satisfied with the results. Conclusions: According to the experience, midface contouring procedures should take account of both surgeons’ experience, patients’ expectations and anatomical evaluation. As such, there is no given approach suitable for all cases. Suggested visual criteria, clinical examination and imaging analysis are useful in establishing patient’s condition and determining the appropriate methods of treatment to enhance the facial profile

Tecnica “a scaletta” nel trattamento delle perdite di sostanza del labbro inferiore

La patologia che con maggior frequenza colpisce il labbro inferiore è la patologia neoplastica, in particolar modo il carcinoma spinocellulare. L’approccio terapeutico di elezione è l’exeresi chirurgica ampia dalla quale possono derivare importanti alterazioni morfo-funzionali ed estetiche. Presso il Dipartimento di Chirurgia Plastica e Ricostruttiva del Policlinico Umberto I, “Sapienza” Università di Roma, dal 2005 al 2008 sono stati trattati 36 pazienti: 19 mediante escissione semplice (gruppo I) e 17 mediante la tecnica di Johanson (gruppo II), tutti sottoposti a follow-up a 6 e 12 mesi per valutate le alterazioni della funzionalità, la presenza/assenza di asimmetrie e la cicatrizzazione. Inoltre, ai pazienti è stata proposta una scheda di valutazione a punteggio costituita da 9 domande che indagano sia aspetti funzionali che estetici. Dai dati ottenuti è risultato che l’utilizzo del lembo di Johanson consente una radicalità oncologica non inferiore all’escissione semplice ma con migliori risultati funzionali ed estetici, una maggior soddisfazione da parte del paziente e tempi di degenza sovrapponibili

Trattamento della contrattura capsulare da impianto protesico mammario. Nostra esperienza

La più comune complicanza in pazienti sottoposte ad intervento chirurgico di impianto protesico mammario è la contrattura capsulare. Non esiste, attualmente, un trattamento standard efficace per questa complicanza. Lo scopo del presente articolo è illustrare la nostra esperienza sull’uso degli antagosisti dei recettori per i leucotrieni nel trattamento della contrattura capsulare. I risultati mostrano che l’utilizzo di questi farmaci è in grado di ridurre il dolore e la distorsione della mammella in pazienti con un lungo decorso di contrattura capsulare

Innovative microsurgical device in perforator free flaps surgery

Dissection of the small perforating vessels through the muscle/septum can be difficult, and microsurgical success is closely linked on a clear and well-magnified field vision. Since 2004, Varioscope®M5 has been employed in our Plastic Surgery Departments. It is the first and only head-mounted microscope. In this study was examined 10 patients underwent to reconstructive procedures by harvest of perforator free flaps, working with Varioscope®M5. At long-term follow-up, all patient present an exceptional outcome. Considering cost-effectiveness, portability, operator freedom, and effectiveness in the perforator flaps dissection and in the anastomosis making,we think that Varioscope®M5 offers essential advantage

Trattamento di un’ampia perdita di sostanza cutanea post-traumatica mediante colture cellulari. Case report

La cute “ingegnerizzata” rappresenta un successo nella ricerca interdisciplinare applicata alla chirurgia ricostruttiva. Riportiamo la nostra esperienza nella ricostruzione di un’ampia perdita di sostanza di origine traumatica mediante l’utilizzo di cellule autologhe coltivate su un biomateriale di supporto. I vantaggi evidenziati sono stati una rapida riparazione del trauma e buoni esiti cicatrizial

Repair of postauricular defects using a new technique: the swallowtail flap

We describe a case of an 81-year-old patient, where we used a new technique for the reconstruction of postauricular defects (of 3 x 4 cm diameter). The swallowtail flap is an advancement flap that allows getting beyond the repair of the defect, providing an excellent aesthetic result because the scar is masked in the neck and retroauricular folds and does not alter the shape and projection of the ear

Multicentric osteolytic lesion of the middle finger of the hand. Case report

Giant cell-rich osteolytic lesions may have overlapping clinical, radiologic, and histopathologic features, with an important degree of difficulty of diagnosis and treatment. We report a case of double osteolytic lesion at the middle-finger in a young man without previous history of hand trauma. He underwent en-bloc resection of the bone lesions and reconstruction by graft of hydroxyapatite, resulting in a good morpho-functional result. Histological diagnosis was giant cell reparative granuloma (GCRG), although several features were considered atypical, including the appearance of the giant cells and the areas of the stroma that more closely resembled a giant cell tumor. GCRG is a benign rare intraosseous lesion and the true nature is controversial and unknown. The theories are that it could be a reactive lesion, a developmental anomaly or a benign neoplasm. It appears as an osteolytic lesion that must be considered in the differential diagnosis of other “critical” bone lesions similar in clinical, as well as radiologic and pathological appearance. Further characterization studies are helpful and necessary for the proper management