Use of the sternocleidomastoid flap in association with a dermal regeneration template and a skin graft in the temporal region reconstruction

Since its first description in 1908, the sternocleidomastoid flap (SCM) has gained popularity in head-and-neck reconstruction as a regional flap. We reported a 69-year-old Caucasian male who was evaluated in our clinic for a large, bloody, esophitic, and ulcerated lesion of the right temporoparotideal region associated with several actinic keratoses of the head skin. After resection of the tumor, taking into consideration the patient’s comorbidities and surgical defect characteristics, we decided to use the SCM flap for the reconstruction. The SCM flap was harvested as a muscular flap to avoid as possible skin paddle necrosis due to the poor conditions of the patient’s vessels. Moreover, considering the surgical site depth and to prevent a postsurgical excessive scar retraction, the muscle was covered with Integra® Dermal Regeneration Template single layer and a skin graft was harvested from the left thigh. The follow-up at 1 year confirmed that both oncological and reconstructive goals were successfully achieved. In our experience, the SCM flap in association with a dermal regeneration template and a skin graft can be considered as a reliable and possible option in temporal region reconstruction when local or systemic conditions of the patient do not permit other reconstructive options

Ligasure™ Impact and Ligasure™ Small Jaw in Body Contouring after Massive Weight Loss: A New Perspective

Background The most effective dissection technique for elevating flaps in body contouring is still controversial, particularly in high-risk massive weight loss (MWL) patients. LigaSure (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and improve outcomes. The aim of this study is to investigate the effectiveness of LigaSure Impact and LigaSure Small Jaw in body contouring after MWL compared with conventional technique. Material and methods Patients who underwent abdominoplasty, mastopexy, brachioplasty and thigh lift after MWL at a single center from 1 December 2018 to 1 March 2020 were retrospectively reviewed. In each procedure patients were divided into two groups according to the dissection technique: LigaSure group and monopolar electrosurgery group. Patients characteristics, perioperative details and postoperative complications were evaluated. Results Fourty-five patients underwent abdominoplasty, twenty-six mastopexy, twenty brachioplasty and sixteen medial thigh lift. Using LigaSure, operative time was longer in abdominoplasty and thigh lift, but shorter in mastopexy and brachioplasty. Although not statistically significant, the amount of blood and serum recorded from drains in the first 36 hours was reduced in LigaSure groups. Additional analgesic intake was reduced with LigaSure as well as postoperative subjective pain. In all body contouring procedures statistically significant difference was found in days of hospital stay favoring LigaSure groups. Complications occurred most frequently in control groups compared to LigaSure groups. Conclusion LigaSure Impact and LigaSure Small Jaw may be beneficial in improving outcomes because they might reduce fluids drainage, analgesics intake, hospital stay and postoperative complications

Adipocyte-derived extracellular vesicles regulate survival and function of pancreatic β cells

Extracellular vesicles (EVs) are implicated in the crosstalk between adipocytes and other metabolic organs, and an altered biological cargo has been observed in EVs from human obese adipose tissue (AT). Yet, the role of adipocyte-derived EVs in pancreatic β cells remains to be determined. Here, we explored the effects of EVs released from adipocytes isolated from both rodents and humans and human AT explants on survival and function of pancreatic β cells and human pancreatic islets. EVs from healthy 3T3-L1 adipocytes increased survival and proliferation and promoted insulin secretion in INS-1E β cells and human pancreatic islets, both those untreated or exposed to cytokines or glucolipotoxicity, whereas EVs from inflamed adipocytes caused β cell death and dysfunction. Human lean adipocyte-derived EVs produced similar beneficial effects, whereas EVs from obese AT explants were harmful for human EndoC-βH3 β cells. We observed differential expression of miRNAs in EVs from healthy and inflamed adipocytes, as well as alteration in signaling pathways and expression of β cell genes, adipokines, and cytokines in recipient β cells. These in vitro results suggest that, depending on the physiopathological state of AT, adipocyte-derived EVs may influence β cell fate and function