Tracheal allotransplantation: anatomical study on the use of ALT flap in composite transplant harvesting

La chirurgia della trachea è sempre stata una sfida per il chirurgo in considerazione delle notevoli difficoltà nel ripristinare la anatomia e la funzione dell’organo. Attualmente il trapianto di trachea umano rivascolarizzato non è stato ancora realizzato, principalmente a causa della mancanza di un peduncolo vascolare tracheale noto. Nel 2008 l’otorinolaringoiatra belga Paul Delaere ha descritto una tecnica di trapianto di trachea da cadavere mediante il confezionamento di un lembo composito. Il lembo antibrachiale utilizzato è una ottima alternativa, ma oggi sono più utilizzati i lembi perforanti rispetto ai lembi assiali, in base a una serie di vantaggi ben noti. La possibilità di utilizzare il lembo perforante anterolaterale di coscia al posto del lembo “cinese” come base per il trapianto composito sfrutta i vantaggi di questo tipo di lembo. Nello studio è stata valutata la fattibilità tecnica del lembo composito mediante una valutazione anatomica su cadavere.Trachea surgery has always been a challenge for the surgeon in view of remarkable difficulty in restoring the anatomy and the function. Currently revascularized human trachea transplantation is not possible due to the lack of a single vascular pedicle. In 2008 Paul Delaere described a tracheal transplantation technique using a cadaveric donor. The chinese flap used by Delaere to harvest the compiste flap is a good alternative, but today perforator flaps represent a better choice. The possibility to use the anterolateral thigh perforator flap in place of the chinese flap was studied on cadavers in the present stduy

Allotrapianto di trachea: studio anatomico sull'utilizzo del lembo ALT

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Severe local skin reaction after the application of ingenol mebutate gel treated by photodynamic therapy: A case report

Ingenol mebutate (IM) was recently introduced for the treatment of actinic keratosis (AK). It is considered a safe and effective treatment in spite of local reactions frequently reported. These reactions may consist of erythema, flaking, crusting, swelling, vesicles and erosions, and would usually spontaneously recede within 20–30 days. We reported a case of a patient affected by multiple actinic keratosis of the scalp treated with IM. The patient reported a severe reaction that was not solved in two months. We decided to treat the reaction with photodynamic therapy and aminolevulinic acid. This treatment was demonstrated to be effective in solving this severe side effec

Severe local skin reaction after the application of ingenol mebutate gel treated by photodynamic therapy: A case report

none6Ingenol mebutate (IM) was recently introduced for the treatment of actinic keratosis (AK). It is considered a safe and effective treatment in spite of local reactions frequently reported. These reactions may consist of erythema, flaking, crusting, swelling, vesicles and erosions, and would usually spontaneously recede within 20–30 days. We reported a case of a patient affected by multiple actinic keratosis of the scalp treated with IM. The patient reported a severe reaction that was not solved in two months. We decided to treat the reaction with photodynamic therapy and aminolevulinic acid. This treatment was demonstrated to be effective in solving this severe side effectmixedNegosanti, Luca; Sgarzani, Rossella; Santoli, Matteo; Negosanti, Massimino; Banzola, Nicoletta; Negosanti, Francesca .Negosanti, Luca; Sgarzani, Rossella; Santoli, Matteo; Negosanti, Massimino; Banzola, Nicoletta; Negosanti, Francesca

Association of Surgery and Pulsed Dye Laser for the Treatment of an Ear Keloid: A Case Report

Background and Objective: A keloidal scar is a benign hyperproliferation of dermal collagen resulting from abnormal healing. The ear is probably the most frequent interested area and these kind of keloids are responsible for cosmetic disfigurement. Numerous treatments have been applied for keloids. Surgery is generally not indicated because of the high risk of recurrence while laser technologies have been tested to prevent and treat hypertrophic scars. The association between laser and surgery was poorly reported in literature. We decided to associate surgery and pulsed Dye laser in just one case of ear keloid. Materials and Methods: We treated a female patient affected by an earlobe keloid with a surgical excision and subsequent pulsed Dye laser treatment. Results: The aesthetic result was good and no signs of recurrence was observed. Conclusion: We believe that the association between surgery and Pulsed-Dye laser can be useful to treat keloids reducing the risk of recurrence

Multiple Flaps for Trochanteric Pressure Sore Reconstruction: A Case Series

Trochanteric pressure sores can be quite difficult to treat, especially in cases of large bone involvement requiring a wide debridement. The residual wound is large and deep, and the reconstruction must ensure a complete fill of all dead spaces, then must be covered with adequate tissue to allow for healing, and reduce the risk of recurrence. We report a case series of spinal cord-injured patients affected by a trochanteric pressure sore. The reconstruction was achieved using a combination of muscle and a cutaneous muscle flap from the thigh. The result was complete healing of the wound with no recurrence at 18 months. In these cases, muscle or musculocutaneous flaps are the better choices because they permit the use of a good volume of viable tissue. In some cases, the flap can be combined to obtain a better result

Clinical evidences, personal experiences, recent applications

Management of difficult wounds can be a complex, challenging and expensive task, especially for wounds showing a slow healing process. Topical negative pressure (TNP) therapy has greatly improved difficult wounds treatment. It allows to treat patient on an outpatient management, to reduce the complication rate with shorter hospital stay, to avoid frequent dressings with expensive advanced materials and allow a lower commitment of health professionals. Vacuum Assisted Closure\uae (VAC\uae) system is a therapeutic device based on the administration of a controlled TNP introduced by Morykwas and Argenta in 1997. It is indicated in different kinds of wound, but clinical evidences are present only for few of them. In this work we summarize indications and recommendations for VAC\uae therapy and we analyze the actual better choice of treatment based on evidences and personal experience in order to stimulate further studies. Finally we introduce recent applications of VAC\uae system such as Prevena\uae, VAC Instill\uae and VAC Via\uae. Prevena\uae is a system based on TNP indicated in the management of closed wounds that present risk factors for dehiscence. VAC Instill\uae is a system that allows to associate TNP and topical administration of solutions, such as antibiotics or disinfectants, to treat specific type of wounds. VAC Via\uae is a device based on TNP, characterized by little dimension and a preset system that allow the treatment of little wounds for 7 d, with no impairment for the patient. The aim of our paper is to describe a report of VAC\uae therapy use in order to stimulate further studies and to define the level of evidence of VAC\uae therapy

Photodynamic therapy with topical aminolevulinic acid

Photodynamic therapy (PDT) is a relatively new therapy in dermatology that uses the topical application of a porphyrin derivative to selectively destroy a cutaneous target. The action is implemented by the application of a specific light frequency. The ability of porphyrin to selectively target tumor tissue has been known since the 1960s. In the late 1970s, the underlying mechanism was defined, and Dougherty\u2019s discovery of the first chromophore led to the production and commercialization of Photofrin\uae. Many other chromophores that can act as photosensitizers have been studied since then, with aminolevulinic acid currently the most commonly used chromophore in clinical practice. PDT is simple, minimally invasive and can be administered on an outpatient basis. The efficacy of PDT has been proven for actinic keratosis, Bowen\u2019s disease and basal cell carcinoma; another of its well-known applications is the treatment of photoaging. Indications for its use are continuously increasing, and promising results are reported for various skin diseases. In this paper we report the mechanism of action of PDT with aminolevulinic acid, the literature concerning the most common diseases treated with PDT and the subsequent level of evidence

Deepithelialized reverse pedicled forearm flap: a technical modification useful in hand and wrist reconstruction

Reverse pedicled forearm flap is a reliable and easy option for hand and wrist reconstruction. Between 2000 and 2009, eight patients underwent elective reconstruction of an upper extremity using a pedicled reverse radial forearm flap with a modified technique; a retrospective chart review of the results is presented. The surgically modified procedure is described. The flap donor area is deepithelialized with a dermatome and the split-thickness skin graft obtained is left on the donor site pedicled proximally; the deepithelialized flap is then elevated and rotated with the standard technique and the forearm donor site is covered by repositioning and suturing the skin previously harvested with the dermatome. This useful and easy technical modification allows prevention of post-operative pain and long-term dyschromia in the split-thickness skin graft donor site, making the reverse pedicled forearm flap an even better option in hand and wrist reconstruction

Reconstructive Surgery of Pressure Injuries in Spinal Cord Injury/Disorder Patients: Retrospective Observational Study and Proposal of an Algorithm for the Flap Choice.

Pressure injuries (PIs) are a common complication in patients with spinal cord injury/disorder (SCI/D), and deep PIs require surgical treatment consisting of wide debridement and adequate reconstruction. We conducted a retrospective observational study at a tertiary rehabilitation hospital for SCI/D in Italy with the aim of describing the incidence and associated risk factors of postoperative complications in individuals with SCI/D presenting with chronic deep PIs, treated with a specific flap selection algorithm based on the site of the defect, the presence of scars from previous surgeries, and the need to spare reconstructive options for possible future recurrences. Medical records of surgical procedures performed on SCI/D patients with fourth-degree PIs, according to NPUAP classification (National Pressure Ulcer Advisory Panel), between July 2011 and January 2018 were reviewed. A total of 434 surgical procedures for fourth-degree PIs in 375 SCI/D patients were analyzed. After a mean follow-up of 21 months (range 12–36), 59 PIs (13.6%) had minor complications, and 17 (3.9%) had major complications requiring reoperation. The sacral site and muscular and musculocutaneous flaps were significant risk factors for postoperative complications. Six patients (1.4%) had a recurrence. The choice of flap correlates with the outcome of decubitus reconstruction. Therefore, reconstructive planning should be based on established principles