Predictive and Protective Factors for Partial Necrosis in DIEP Flap Breast Reconstruction. Does Nulliparity Bias Flap Viability?

Although success rate of deep inferior epigastric perforator (DIEP) flap breast reconstruction has greatly improved, complications still occasionally occur. Perfusion-related complications (PRCs) (ie, fat necrosis and partial flap necrosis) are the most frequent concern, affecting aesthetic final result of the reconstructed breast.The aim of our study was to retrospectively investigate 287 consecutive DIEP flap breast reconstructions to investigate predictive and protective factors for PRCs.From May 2004 to February 2012, 287 DIEP flap breast reconstructions were performed on 270 patients; 247 unilateral flaps, including Holm vascular zones I to III, were retrospectively selected and analyzed. Tobacco use, mean blood pressure over the first postoperative 48 hours, superficial epigastric vein drainage, medial/lateral row perforator, nulliparity, crystalloid versus combined crystalloid/colloid intravenous fluid infusion therapy, and learning curve were evaluated by univariate and multivariate logistic regression analyses.Perfusion-related complications occurred 32 (12.9%) times, 79 (31.9%) patients were smokers, 48 (19.4%) showed postoperative mean blood pressure less than 75 mm Hg, 29 (11.7%) were nulliparous, and 173 (70%) had superficial epigastric vein drainage. Selected perforators were 110 (44.5%) from lateral row, 137 (55.5%) from medial row; 91 (36.8%) received crystalloid fluid infusion, whereas 156 (63.2%) combined crystalloid/colloid fluid infusion. From univariate analysis emerged significance of nulliparity, perforator row and intravenous fluid infusion for PRC. Nevertheless, multivariate model confirmed only nulliparity as a significant risk factor (P = 0.029), although variable correlations to other predictors were found: both medial row perforator and combined crystalloid/colloid fluid infusion potentially decrease the PRC risk of 11.6% and 27.6%, respectively. Learning curve did not show significant decrease of PRC risk over time.Our study first proved nulliparity as a statistically significant predictor for PRCs in DIEP flap breast reconstruction, possibly due to different superficial abdominal perfusion between pluriparous and nulliparous women, with potential weaker pattern of perforators and smaller angiosomes in the latter. The choice of medial row perforators and combined crystalloid/colloid fluid infusion might reduce PRC risk

“Suspension of the eyelid to the check ligament of the superior fornix in congenital blepharoptosis”

A new surgical procedure for the treatment of all types of congenital blepharoptosis is described: suspension of the eyelid to the check ligament of the superior fornix. This is a dynamic suspension technique by which the check ligament, which is an extension of Tenon's capsule and normally inserts into the superior conjunctival fornix, is brought forward and sutured to the tarsus, which raises the eyelid. This technique does not sacrifice or add any tissue and is simple to repeat if necessary. Sixty-two patients were operated on using the technique and followed up for a mean of 23 months (range 3 months to 9.6 years). In a group of patients not operated on before for ptosis, 50 eyelids were raised with 74% normalisation, 22% improvement, and one eyelid each that showed only slight change or overcorrection. In a group of patients with 27 eyelids operated on before using other techniques, 67% of the eyelids were normalised, 30% were improved, and only one eyelid showed no change. In conclusion, this new technique has proved to be quite successful in raising the level of the upper eyelid in congenital blepharoptosis, with results at least comparable to those of most other techniques. The advantages with the check ligament over other techniques are the minimal trauma of the surgery, its simplicity, and its repeatability

Intestinal perforation after surgical treatment for incisional hernia. iatrogenic or idiopathic?

Intestinal perforation (IP) is a life-threatening gastroenterological condition requiring urgent surgical care, which may present itself as an uncommon complication following incisional hernia repair surgery, most often because of iatrogenic traumatism occurring during the procedure. However, we report a case where a spontaneous onset can be hypothesised. A 60-years-old patient underwent repair of an abdominal laparocele, through rectus abdominis muscle plasty, 5 years after development of an incisional hernia due to exploratory laparotomy for the treatment of acute appendicitis. Xipho-pubic scar was excised and umbilicus and supra-umbilical hernia sac dissected, a linear median incision was performed along the sub-umbilical linea alba, reaching preperitoneal plane to assess any intestinal loop adherence to the abdominal wall. After limited viscerolysis, abdominal wall defect was corrected by 'rectus abdominis muscle plasty' and umbilicus reconstruction by Santanelli technique. Postoperative course was uneventful until Day 29, with sudden onset of epigastric pain, fever and bulge. Sixty cubic centimeter pus was drained percutaneously and cavity was rinsed with a 50% H2O2 and H2O V-V solution until draining clear fluid. Symptoms recurred two days later, while during rinsing presented dyspnoea. X-Ray and CT scan diagnosed IP, and she underwent under emergency an exploratory laparotomy, leading to right hemicolectomy extended to last ileal loops and middle third of the transverse, right monolateral salpingo-ovariectomy and a temporary ileostomy by general surgeon. Twenty-three days later an ileostomy reversal surgery was performed and 8 days after she was discharged. At latest follow-up patient showed fair conditions, complaining abdominal pain and diarrhoea, attributable to the extensive intestinal resection. IP following incisional hernia repair, is reported as uncommon and early postoperative complication. In our case, the previous regular postoperative course with late onset lead us to hypothesise a possible idiopathic etiopathogenesis, because of a strangulation followed by gangrene and abscess formation, which might begin before the incisional hernia repair and unnoticed at the time surgery was performed

Il consumo di autenticità nei talent shows musicali - Analisi multi-metodo e implicazioni per le ricerche sui consumi

In seguito all'importanza raggiunta in questi ultimi anni da alcuni cantanti provenienti dai talent shows nel panorama musicale italiano, la nostra ricerca si propone di indagare questo fenomeno cercando di capire quali percezioni abbiano i consumatori a riguardo e che differenze vengono evidenziate tra questi nuovi artisti emergenti e i cantanti provenienti dal classico percorso di carriera. Abbiamo inoltre svolto uno studio teorico approfondito sul concetto di “autenticità” per poter andare ad indagare anche su come i consumatori associno questo concetto ai talent shows e ai loro prodotti, e su come venga effettuato il paragone di cui sopra, stavolta proprio in termini di “autenticità”. Per lo svolgimento della ricerca abbiamo sfruttato due differenti metodologie: abbiamo svolto un'indagine di tipo qualitativo mediante interviste in profondità su un campione ragionato di 20 soggetti suddivisi in due categorie (appassionati di musica e soggetti meno interessati); in seguito abbiamo posto le basi per un futuro esperimento, ancora non realizzato, effettuando dei test, su un campione di convenienza composto da studenti universitari, atti a raffinare alcuni concetti centrali all'esperimento definitivo

Análise da percepção da população sobre o meio ambiente em um munícipio no Oeste do Paraná

Orientador: Valéria Ghisloti IaredMonografia (graduação) - Universidade Federal do Paraná, Setor Palotina, Curso de Graduação em Ciências BiológicasInclui referênciasResumo: Visando investigar a percepção da população diante dos temas ambientais, o presente trabalho buscou produzir dados a partir de um questionário, desenvolvido e baseado na pesquisa realizada em 2012, intitulada O que o brasileiro pensa sobre o meio ambiente e o consumo sustentável. O roteiro de questões contou com 19 questões com várias alternativas, sendo aplicado com 42 pessoas de diversas faixas etárias, variando de 18 a 78 anos em um município no oeste do Paraná. Os locais escolhidos para o desenvolvimento da pesquisa foram praças públicas com atrativos culturais e recreativos na cidade e, portanto, com um grande fluxo de pessoas. A pesquisa foi realizada nos meses de dezembro de 2022 a janeiro de 2023. Os resultados apontaram que os munícipes buscam por informações referentes as questões ambientais na internet, fato que pode ser preocupante, uma vez que, na contemporaneidade, há uma grande disseminação de notícias falsas. A população reconhece alguns temas ambientais, como desenvolvimento sustentável, áreas protegidas, destruição da biodiversidade, consumo sustentável, conceito do ciclo de vida. Todavia, quando questionados sobre a conceituação dos termos, muitos respondentes não souberam desenvolver a ideia ou opinar sobre o assunto. Foi possível observar que os entrevistados estão cientes dos problemas ambientais de sua região e no Brasil, porém, as medidas que podem e poderiam ser tomadas diante desses problemas, e de quem é a responsabilidade pela solução desses problemas demonstram pouco potencial de mobilização social. Essa percepção e empatia em relação à questão ambiental e compreensão superficial de quais são as possibilidades de enfrentamento são recorrentes em outras pesquisar realizadas no Brasi

L’effetto dell’autenticità sull’attaccamento alla marca. Prime evidenze empiriche e implicazioni di marketing

Nell’ambito della letteratura che studia il consumo di autenticità da parte degli individui, si è recentemente diffusa la tendenza a utilizzare metodi quantitativi al fine di analizzare potenziali relazioni tra l’autenticità stessa e altri importanti costrutti di marketing, come l’atteggiamento o la brand extension. Il presente lavoro fa parte di un progetto più ampio che mira ad analizzare la relazione tra l’autenticità della marca e l’attaccamento del consumatore ad essa (brand attachment). Nello studio descritto in questo articolo, vengono presentati i risultati di una ricerca esplorativa basata su 20 interviste in profondità a consumatori finali e finalizzata a investigare il concetto di autenticità nello specifico ambito dei consumi di musica leggera. Tali risultati offrono utili indicazioni per lo sviluppo di una scala di misurazione dell’autenticità da impiegare in studi successivi volti a valutarne l’effetto sull’attaccamento

Guiding nipple-areola complex reconstruction.Lliterature review and proposal of a new decision-making algorithm

Background: Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient’s psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run. Methods: The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction. Results: We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope. Conclusions: No single NAR technique provides definitive results, which is why we believe there is no “end-all be-all solution”. NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated. Level of Evidence III: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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/0026

Infections in breast implants: a review with a focus on developing Countries

The risk of surgical site infection is always present in surgery; the use of prosthetic materials is linked to an increased possibility of infection. Breast augmentation and breast reconstruction with implants are gaining popularity in developing countries. Implant infection is the main complication related to breast aesthetic and reconstructive surgery. In the present paper, we reviewed the current microbiological knowledge about implant infections, with particular attention to risk factors, diagnosis, clinical management, and antibiotic prophylaxis, focusing on reports from developing countries. After breast aesthetic surgery, up to 2.9% of patients develop a surgical site infection, with an incidence of 1.7% for acute infections and 0.8% for late infections. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53%. The clinical features are not constant, and bacterial culture with antibiogram is the gold standard for diagnosis and for identification of antibiotic resistance. While waiting for culture results, empiric therapy with vancomycin and extended-spectrum penicillins or cephalosporins is recommended. Some patients require removal of the infected prosthesis. The main methods to bring down the risk of infection are strict asepsis protocol, preoperative antibiotic prophylaxis, and irrigation of the surgical pocket and implant with an antibiotic solution

Foot Reconstruction

Since the conquest of the upright position, the foot has gained more importance as an organ that supports both the lower limb and the whole body weight and that allows humans to stand up, walk, run, jump, and climb. Human evolution determined progressive changes in both the skeleton architecture and the soft tissue of the foot to cope with the new environmental requirements. From the orangutan to the chimpanzee, from the gorilla to the human, the most important modifications of the skeleton included the progressive reduction of the distal area of the phalanxes with the loss of the grasping function and the enlargement of the proximal bones (astragalus, calcaneum) to obtain a resistant yet flexible structure. See the image below