Case report: Enlarging symmetrical masses of the palate of idiopathic etiology [version 1; peer review: 1 approved, 1 approved with reservations]

We report the case of a 33 year-old woman who came to our attention with slowly enlarging exophytic masses of the palate, histologically characterized by sub-epithelial fibrous proliferation with packed collagen bundles and increased fibroblasts number. We describe the condition of idiopathic fibrous hyperplasia, its diagnosis and its surgical treatment, which in our case was carried out with the aid of a custom made thermal printed plaque used as a scaffold

Postoperative care in finger replantation. Our case-load and review of the literature

OBJECTIVE: Technical success of a finger replantation depends on several factors such as surgical procedure, type of injury, number of segments amputated, amputation level and individual patient factors. Among early complications that can occur in this type of surgery the onset of venous or arterial thrombosis is the most dreaded. Local irrigating solutions, oral and intravenous anticoagulants, thrombolytic agents, plasma expanders, vasodilating, and antiaggregant drugs are routinely used in patients undergoing microvascular procedures, but currently there is only a non-standardized practice based on anecdotal personal experience. MATERIALS AND METHODS: The aim of our study is to review selected literature relating to perioperative therapy in microsurgical digital replantation. We also report our case-load of 16 patients with finger avulsion describing our particular protocol for postoperative anticoagulation and restoration of fluid and electrolyte balance. RESULTS: Following our daily pharmacological protocol, the postoperative course of the replanted fingers was uneventful. The survival rate for finger replantations performed was 100% (n = 16) with no need for surgical revisions. CONCLUSIONS: The association Dextran-40/Heparin/fluids in the proposed standardized pro-weight pharmacological protocol is an optimal postoperative prophylactic/therapeutic plan to reduce the incidence of endovascular thrombosis after replantation, so ensuring high rate of success in microvascular surgery

Methylene Blue: A Color Test for a Quality De-epithelialization

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The Expander-Implant Breast Reconstruction in the COVID Era: Which is the “Unhappy” Tissue Expander Priority?

Breast surgeons seem to agree on the fact that a same-day surgery (mastectomy and breast reconstruction) protocol provides appropriate cancer treatment during times of unprecedented resource limitations, such as in the COVID era. In this scenario, pre-pectoral implant-based breast reconstruction can be definitively considered a sustainable technique. Nevertheless, the authors focus on the management of patients who had already undergone a same day procedure with two-stage breast reconstruction, implanting a breast tissue expander during the last two-year period and have been progressively delayed according to a surgical care based on priority. We coined the expression “unhappy tissue expander” to define all those symptomatic patients for which surgery should not be delayed even during an epidemic context. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

the use of poly lactic acid to improve projection of reconstructed nipple

Abstract Purpose Nipple-areola reconstruction represents an important step for final mammary reconstruction. Many techniques have been described. The drawback is the progressive nipple projection loss with time from 50% to over 70% of the initial projection. In this report, we evaluated the effect of injectable poly-lactic acid (PLLA) to improve projection of reconstructed nipples. Results We selected 12 patients with a residual nipple projection between 0.1 and 2 mm. The patients were injected locally inside the nipple with 0.5 ml of PLLA (dilution 1:4) every 4 weeks for 4 times. At the study end, patients were satisfied with results. No adverse effects were observed. After one year, an increase of nipple projection ranging from 0.5 to 3.5 mm was obtained with an average increase of 2.3 mm (282%) and this variation was statistically significant ( p Conclusion The use of injectable PLLA is a simple and effective procedure to improve projection of reconstructed nipple

Spitzer-IRAC survey of molecular jets in Vela-D

We present a survey of H2 jets from young protostars in the Vela-D molecular cloud (VMR-D), based on Spitzer -IRAC data between 3.6 and 8.0 micron. Our search has led to the identification of 15 jets and about 70 well aligned knots within 1.2 squared degree. We compare the IRAC maps with observations of the H2 1-0 S(1) line at 2.12 micron, with a Spitzer-MIPS map at 24 and 70 micron, and with a map of the dust continuum emission at 1.2 mm. We find a association between molecular jets and dust peaks. The jet candidate exciting sources have been searched for in the published catalog of the Young Stellar Objects of VMR-D. We selected all the sources of Class II or earlier which are located close to the jet center and aligned with it.The association between jet and exciting source was validated by estimating the differential extinction between the jet opposite lobes. We are able to find a best-candidate exciting source in all but two jets. Four exciting sources are not (or very barely) observed at wavelengths shorter than 24 micron, suggesting they are very young protostars. Three of them are also associated with the most compact jets. The exciting source Spectral Energy Distributions have been modeled by means of the photometric data between 1.2 micron and 1.2 mm. From SEDs fits we derive the main source parameters, which indicate that most of them are low-mass protostars. A significant correlation is found between the projected jet length and the [24] - [70] color, which is consistent with an evolutionary scenario according to which shorter jets are associated with younger sources. A rough correlation is found between IRAC line cooling and exciting source bolometric luminosity, in agreement with the previous literature. The emerging trend suggests that mass loss and mass accretion are tightly related phenomena and that both decrease with time.Comment: Accepted by The Astrophysical Journa

Postoperative care in finger replantation: our case-load and review of the literature

OBJECTIVE: Technical success of a finger replantation depends on several factors such as surgical procedure, type of injury, number of segments amputated, amputation level and individual patient factors. Among early complications that can occur in this type of surgery the onset of venous or arterial thrombosis is the most dreaded. Local irrigating solutions, oral and intravenous anticoagulants, thrombolytic agents, plasma expanders, vasodilating, and antiaggregant drugs are routinely used in patients undergoing microvascular procedures, but currently there is only a non-standardized practice based on anecdotal personal experience. MATERIALS AND METHODS: The aim of our study is to review selected literature relating to perioperative therapy in microsurgical digital replantation. We also report our case-load of 16 patients with finger avulsion describing our particular protocol for postoperative anticoagulation and restoration of fluid and electrolyte balance. RESULTS: Following our daily pharmacological protocol, the postoperative course of the replanted fingers was uneventful. The survival rate for finger replantations performed was 100% (n = 16) with no need for surgical revisions. CONCLUSIONS: The association Dextran-40/Heparin/fluids in the proposed standardized pro-weight pharmacological protocol is an optimal postoperative prophylactic/therapeutic plan to reduce the incidence of endovascular thrombosis after replantation, so ensuring high rate of success in microvascular surgery

Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal

Introduction: Autologous fat is ideal soft tissue filler. It is easily accessible, biocompatible, cheap, and it provides both volume augmentation and skin quality improvement. Fat grafting has been used since 1893, but it has only gained widespread popularity since the development of modern liposuction by Colemann and Illouz in the 1980s. Every year more than half a million facial fat grafting procedures are carried out worldwide and the trend is rapidly increasing. Overall, general complications associated with facial fat grafting are assumed to be around 2%. Is that true? Material and Methods: Until July 2021, a systematic search of the literature was performed interrogating PubMed search engines. The following algorithm was used for the research: (fat graft OR lipofilling) AND face AND complications. Exclusion criteria applied hierarchically were review articles, not reporting recipient site complications; not in English and paediatric population. Abstracts were manually screened by LS, GS, JM and PDS separately and subsequently matched for accuracy. Pertinent full-text articles were retrieved and analysed and data were extracted from the database. The flow chart of article selection is described following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In total, 462 papers were identified by PubMed search. A total of 359 were excluded: 38 papers were not in English, 41 were review articles, 279 articles did not report recipient site complications and 1 was not on human subjects. Average complication rate ranged from 1.5% to 81.4%. A total of 298 adverse events were identified: 40 (13.4%) intravascular injections, 13 (4.3%) asymmetry, 57 (19.1%) irregularities, 22 (7.4%) graft hypertrophy, 21 (7%) fat necrosis, 73 (24.5%) prolonged oedema, 1 (0.3%) infection, 6 (2%) prolonged erythema, 15 (5%) telangiectasia and 50 (16.8%) cases of acne activation. Conclusions: FFG related side effects could be resumed in three categories: severe, moderate, and minor. Severe (13.4%) side effects such as intravascular injection or migration require neurological or neurosurgical management and often lead to permanent disability or death. Moderate (38.3%) side effects such as fat hypertrophy, necrosis, cyst formation, irregularities and asymmetries require a retouch operation. Minor (48.3%) side effects such as prolonged oedema or erythema require no surgical management. Despite the fact that the overall general complication rate of facial fat grafting is assumed to be around 2%, the real complication rate of facial fat grafting is unknown due to a lack of reporting and the absence of consensus on side effect definition and identification. More RCTs are necessary to further determine the real complication rate of this procedure

Pollen as a component of the diet of Doru luteipes (Scudder, 1876) (Dermaptera: Forficulidade).

The properties of maize pollen in the diet of Doru luteipes were determined by biological responses of the predator feeding on natural preys and artificial diet. The biological parameters of D. luteipes fed on Spodoptera frugiperda (Smith, 1797) eggs, maize pollen, Rhopalosiphum maidis (Fitch, 1856) + maize pollen and R. maidis were assessed. The effect of pollen on artificial diet on the biological variables of the predator nymphs and adults were also evaluated. Time span of nymphal development was greater for D. luteipes exclusively fed on earwigs, with the lowest rate of nymph survival. However, maize pollen plus earwigs in the diet provided the predator´s highest survival rate, whilst percentage of fertile females was double when fed on diets composed of S. frugiperda and R. maidis eggs. Development period decreased when D. luteipes nymphs consumed artificial diet plus pollen but there were high fecundity rates (number of laying/female and total egg/female) and a greater percentage of fertile females when they were fed on maize pollen