Introduction to "Propeller Flaps"

open2siThe editors of this issue of Seminars in Plastic Surgery dedicated to propeller flaps met in 2009 at the "1st Tokyo Meeting on Perforator and Propeller Flaps." On that occasion, as part of the advisory panel of the meeting, they contributed to the definition and classification of these flaps. Since then, several evolutions and new applications of propeller flaps appeared in the literature. In 2019, the editors met again in Bologna, Italy, where they decided to collect the experiences from prominent authors in propeller flap surgery and provide them to the readers in this monographic dedicated publication.embargoed_20210921Pignatti, M; Hallock, GGPignatti, M; Hallock, G

Breast amyloidosis: a case report

Amyloidosis is an uncommon disorder characterized by extracellular deposition of abnormal proteins. Breast involvement has rarely been reported and can clinically be misdiagnosed as breast cancer. A 60-year-old woman presented with a 3-mm diameter mass in the right breast close to a silicon implant positioned 20 years before. A core biopsy, performed to rule out breast cancer, showed amyloid deposit. Further exams confirmed a systemic amyloid light chain amyloidosis. After few months the mass increased causing breast volume and shape distortion. Since breast cancer may be the cause of amyloid deposits or be hidden by it, the patient underwent a bilateral skin sparing mastectomy and expander and fat grafting breast reconstruction. The resection specimens showed amyloid deposits only, no evidence of cancer. At 2 years follow-up, no breast amyloidosis recurrence was shown. Breast amyloidosis is rare but can occur in a plastic surgeon\u2019s practice. It is mandatory to rule out a comitant breast cancer or systemic amyloidosis

“Flora Italiana Digitale”: an interactive identification tool for the Flora of Italy

The digital facilities of the second edition of Pignatti’s “Flora d’Italia” are presented. A software, called FID (i.e. “Flora Italiana Digitale”) will link together a random-access interactive identification tool, a thesaurus, synoptic tables and one template for each single species, including a distribution map (referred to the Italian regions), “ecograms”, a text-box and up to 24 highresolution colour images. The FID follows a “shareware phylosophy”. All contents and images can be integrated and/or replaced over time, in order to continuously improve the diagnostic and qualitative performance of the provided utilities. Ideally, the community of users should interact on the web, so that every user could easily become content provider

Axial propeller flaps : a proposal for update of the 'Tokyo consensus on propeller flaps'

LETTER TO EDITO

Evaluation and selection of lower limb lymphedema patients for lymphaticovenular anastomosis: A prospective study

Background: Lymphaticovenular anastomosis (LVA) with supramicrosurgical technique has recently gained popularity as a treatment method for patients with lymphedema. The aim of this study was to prospectively evaluate objective changes in leg volume in patients operated with LVA for lymphedema in the lower extremity, and to find positive predictors for the treatment method to facilitate the location of the venules and lymphatic vessels. Patients & Methods: 31 consecutive patients with lymphedema in the lower extremity and positive pitting test were examined with lymphoscintigraphy and indocyanine green (ICG) lymphography. The causes of the lymphedema were either cancer or unknown cause/primary lymphedema. Fourteen of the patients with pathological lymphangiographic patterns were chosen for surgery and 12 of them were operated with one to four LVAs each. The lymphedema volume in the lower extremity was measured preoperatively, 6- and 12 months after surgery according to the truncated cone formula with the patient \u301s contralateral leg used as control. Ten patients had unilateral lymphedema and two patients had bilateral lymphedema. Results: Five of 12 patients showed between 1-8 % edema reductions in the lower extremity after 12 months. With examination considering edema duration, number of anastomoses, radiotherapy and lymph node dissection we found a 6,2 % difference in edema reduction between patients who had undergone lymph node dissection and those who had not (p=0.03). Conclusions: The current study indicates that supramicrosurgery with LVA may reduce edema volumes, where the most distinctive positive predictor for edema reduction with LVAs was previous lymph node dissection

Complications and Solutions in Propeller Flap Surgery

open7siPropeller perforator flaps (PPFs) have long been proven as valid reconstructive tools for a wide range of soft tissue defects in different body regions. During the last decade, despite their numerous advantages, many authors have thoroughly analyzed outcomes of these flaps, sometimes discouraging their use mainly because of a high failure rate. Accurate patient selection, adequate preoperative planning, and an appropriate dissection technique seem to potentially improve outcomes. Our study provides a review of the relevant literature related to PPF complications and of our experience, describing reasons for failure, measures for preventing them, and approaches for a prompt evaluation and management of complications.embargoed_20210801Cajozzo, M; Jiga, LP; Jandali, Z; Muradov, M; Pignatti, M; Cordova, A; D'Arpa, SCajozzo, M; Jiga, LP; Jandali, Z; Muradov, M; Pignatti, M; Cordova, A; D'Arpa,

Cretaceous tetrapod tracks from Italy: a treasure trove of exceptional biodiversity

After about thirty years of investigation, the Cretaceous tetrapod track record from Italy has proved to be a ‘Rosetta Stone’ for improving understanding of the palaeogeographical and palaeoenvironmental evolution of the peri-Adriatic area. In the present contribution, we summarize current knowledge and diferent interpretations proposed on the basis of twelve ichnosites from northern, central and southern Italy. The tetrapod track record is represented by few ichnosites in the earliest Cretaceous, with the bulk of the record reported from carbonate platform deposits of the Aptian-Cenomanian interval and, in the Late Cretaceous, from a extensive-tracksite in Apulia preserving thousands of dinosaur footprints. On the whole, the ichnological diversity documented by the material indicates a high diversity of trackmakers, among which are sauropods, diferent kinds of theropods, ankylosaurs and hadrosaurs. The persistent occurrence of dinosaur footprints at diferent stratigraphic levels produced significant questions and constituted a dramatic constraint for the understanding of palaeogeographical and geodynamical evolution of the Mediterranean area during the Mesozoic, suggesting new and diferent interpretations that challenged previous reconstructions.Fil: Petti, Fabio Massimo. Museo Delle Scienze Di Trento; ItaliaFil: Antonelli, Mateo. Università di Roma; ItaliaFil: Citton, Paolo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Mariotti, Nino. Università di Roma; ItaliaFil: Petruzzelli, Marco. Università di Bari, Dipartimento di Scienze della Terra e Geoambientali; ItaliaFil: Pignatti, Johannes. Università di Roma; ItaliaFil: D’Orazi Porchetti, Simone. Università di Roma; ItaliaFil: Romano, Marco. Università di Roma; ItaliaFil: Sacchi, Eva. Università di Roma; ItaliaFil: Sacco, Enrico. Università di Roma; ItaliaFil: Wagensommer, Alexander. GRID (Gruppo di Ricerca sulle Impronte di Dinosauro), San Giovanni Rotondo; Itali

Complete aromatase deficiency in four adult men: detection of a novel mutation and two known mutations in the CYP19A1 gene

The abstracts descibes four new cases of patients with aromatase deficiency. Both the clinical features and the results of the molecular studies are reported

Meta-analysis of the effects of venous super-drainage in deep inferior epigastric artery perforator flaps for breast reconstruction

INTRODUCTION: Venous congestion is the most common vascular complication of the deep inferior epigastric artery perforator (DIEP) flaps. Adding a second venous drainage by anastomosing a flap vein and a recipient vein (super-drainage) is considered the solution of choice. Evidence to support this procedure, had not yet been confirmed by an analysis of the literature. We aimed to provide this evidence.MATERIALS AND METHODS: We searched the literature (MedLine, Scopus, EMBASE, Cochrane Library, and Google Scholar), for studies discussing venous congestion and venous super-drainage in DIEP flap for breast reconstruction. Thirteen of the 35 articles compared results between one or two venous anastomoses. Meta-analysis was performed following PRISMA guidelines. Pooled risk ratio (RRs) for congestion, fat necrosis, partial necrosis, and total necrosis with corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model with the Mantel-Haenszel method. The need to return to surgery (95% CI) was estimated with a random effect model using the DerSimonian and Liard method.RESULTS: We showed a statistically significant advantage of super-drainage to reduce the venous congestion of the flap (RR: 0.12, 95% CI: 0.04-0.34, p-value <.001), partial flap necrosis (RR: 0.50, 95% CI: 0.30-0.84, p-value .008), total flap necrosis (RR: 0.31, 95% CI: 0.11-0.85, p-value .023), and the need to take the patient back to surgery for perfusion-related complications (RR: 0.45, 95% CI: 0.21-0.99, p value .048).CONCLUSIONS: Performing a second venous anastomosis between the SIEV and a recipient vein (venous superdrainage) reduces venous congestion and related complications in DIEP flaps for breast reconstruction

Meta-analysis of the effects of venous super-drainage in deep inferior epigastric artery perforator flaps for breast reconstruction

Venous congestion is the most common vascular complication of the deep inferior epigastric artery perforator (DIEP) flaps. Adding a second venous drainage by anastomosing a flap vein and a recipient vein (super-drainage) is considered the solution of choice. Evidence to support this procedure, had not yet been confirmed by an analysis of the literature. We aimed to provide this evidence