Versatility of the perforator radial artery flap in the reconstruction of the upper limbs and comparison of the outcomes with the “classic” radial flap, a retrospective study

Introduction: Radial forearm flap, first described in the early eighties in China, is a well-known and handy flap to cover soft tissue defects of the distal upper limb. It has, though, some inconveniences, such as the sacrifice of the radial artery and non-neglectable esthetic sequelae in the donor site. In the following years, a similar flap based on the perforators of the radial artery has been described as achieving similar results, allowing to spare a main vessel. The authors reviewed retrospectively the patients that underwent surgery with one of those two flaps in their center to compare outcomes. Materials and methods: Patients operated between January 2016 and January 2022 have been reviewed. Ten had a classic radial artery flap, and ten had a radial artery perforator flap. Twelve weeks after surgery, Vancouver Scar Scale was used to assess the results at the donor site and over the flap. Reintervention and failure rate within one year and patient satisfaction -using a visual analog scale ranging from 0 to ten-at 12 months were also assessed. Results: All classic radial artery flap group patients had “successful” surgery, and none needed secondary surgery. On the other side, three patients required a second surgery in the perforator flap group, and nine out of ten ended up with “successful” flaps. Mean Vancouver Scar Scale results regarding the flap are comparable, whereas those at the donor site are significantly better in the patients with the perforator flap. Patients’ satisfaction results are similar in both groups. Conclusion: The radial artery perforator flap is an important flap to be held in mind by all surgeons approaching reconstruction of the elbow, the forearm, and the hand, and should be preferred, when possible, to the classic radial forearm flap

Reconstruction of the loss of substance of the dorsum of the hand: from the conventional techniques to regenerative surgery procedures

Our aim is focused on the advantages of new technologies compared with those of traditional methods in the reconstruction of the loss of substance of the dorsum of the hand. Material of study: We observed 37 patients from 2007 to 2010 with loss of substance of the dorsum of the hand, also associated with significant comorbidities. In 27 patients we chose surgical reconstruction, in 10 patients we opted for conservative reconstruction with the use of new technologies. Results: After a median follow-up from one to three years, in all cases the skin coverage was reinstated and mobility was restored, thereby adhering to the principles of both morphological and functional reconstruction. Discussion: Concerning reconstruction by means of flaps, the main principles dictate is the new coverage must appear as much as possible, similar to the original tissue. The reconstruction must be in a single surgical time. On the other hand, the advent of advanced dressings and bioengineering has optimized conservative skin repair. Conclusions: We have seen a considerable broadening of the indications for conservative reconstruction. This method is suitable for reconstruction of the dorsum of the hand with good effectiveness, it makes it possible to obtain a tissue of good quality, which is flexible and smooth on the tendons and is not excessively thick. These methods are achieved with relative ease even in patients with poor general health. Although costly, this procedure will ultimately save the patient from further surgeries and hospitalization expenses, making it advantageous when considering the benefit-cost rati

"Skin reducing mastectomy" and immediate breast reconstruction with Becker 35 contour profile breast implant: our experience

Aim: We describe in this paper our experience with the technique of skin-reducing mastectomy in the treatment of breast cancer. Methods: Between October 2005 and April 2010 in our Center 33 patients underwent breast surgery utilizing the skin-reducing mastectomy technique and immediate breast reconstruction with expansor/definitive implant Becker 35 contour profile. Contralateral symmetrization was performed in the same operation. All selected patients satisfied inclusion critera either for nipple-sparing mastectomy or prophylactic mastectomy. We selected patients who had large ptosic breasts: areola-submammary fold >8 cm and jugular-nipple distance >25 cm. After histologic exam to confirm the lack of retroareolar tissue infiltration the nipple was preserved in a superior flap. Results: Twenty-four out of 33 patients (72.7%) did not suffer from complications. In 9 patients (27.3%) we observed early complications. During follow-up we observed in24 patients (72.7%) Baker I capsular contracture, in 9 patients (27.3%) Baker II capsular contracture. Esthetic results of symmetry, shape and volume were good to optimal. Patients' satisfaction was similar. During the follow up (6-33 months, average 17.7 months) no patient suffered from breast cancer recurrence. Conclusion: The "skin-reducing mastectomy" reduces mutilation and unsightly scar visibility. It gives a pleasant aesthetic outcome without hindering oncological safety

How transparent film applied on dermatologic imaging devices in order to prevent infections affects image quality?

Background: In the clinical practice, transparent films are used as sterile interfaces in in vivo dermatologic imaging in order to prevent the transmissions of infections. However, in our experience, the use of a transparent film can alter skin images. Our study aimed to compare the optical quality of a series of different plastic films used as interfaces in order to understand if some might be more suitable for imaging. Materials and methods: We tested the optical properties of 11 different protective transparent films that are marketed in France with a transparency meter and a spectrophotometer. Results: Transmission, minimal diffusion, amount of gray, and contrast were obtained for each transparent film. Transmission ranged from 93.24% to 96.88% (mean 95.36; standard deviation SD 1.02), minimal diffusion from 88.28% to 123.87% (mean 101.04; standard deviation SD 10.02) and contrast from 11.01 to 15.88 (mean 13.93 and SD 1.3). For some films, the transmission was lower at lower wavelengths. Conclusion: All tested films had excellent optical properties. However, some of them had better optical qualities and seemed more suitable for their use in dermatologic imaging. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Lt

Trattamento antalgico postoperatorio in chirurgia toracica

Trattamento antalgico postoperatorio in chirurgia toracic

Paternal cholestasis exacerbates obesity-associated hypertension in male offspring but is prevented by paternal ursodeoxycholic acid treatment

Obesity is a heterogeneous phenotype and risk associations to non-communicable diseases such as cardiovascular disease and type 2 diabetes are influenced by several factors. The paternal metabolic status at the time of conception influences offspring susceptibility to developing obesity and adiposity-associated cardiometabolic disease. Cholestatic liver diseases are characterized by raised circulating serum bile acid levels and dyslipidemia, and are commonly treated with ursodeoxycholic acid (UDCA). We hypothesized that paternal cholestasis alters offspring susceptibility to developing obesity and adiposity-associated cardiometabolic disease and that this may be modified by paternal UDCA treatment