Exosomes and Signaling Nanovesicles from the Nanofiltration of Preconditioned Adipose Tissue with Skin-B® in Tissue Regeneration and Antiaging: A Clinical Study and Case Report

Background and Objectives: This three-year clinical trial aimed to demonstrate that only the signaling vesicles produced by ADSCa, containing mRNA, microRNA, growth factors (GFs), and bioactive peptides, provide an advantage over classical therapy with adipose disaggregate to make the tissue regeneration technique safer due to the absence of interfering materials and cells, while being extremely minimally invasive. The infiltration of disaggregated adipose nanofat, defined by the Tonnard method, for the regeneration of the dermis and epidermis during physiological or pathological aging continues to be successfully used for the presence of numerous adult stem cells in suspension (ADSCa). An improvement in this method is the exclusion of fibrous shots and cellular debris from the nanofat to avoid inflammatory phenomena by microfiltration. Materials and Methods: A small amount of adipose tissue was extracted after surface anesthesia and disaggregated according to the Tonnard method. An initial microfiltration at 20/40 microns was performed to remove fibrous shots and cellular debris. The microfiltration was stabilized with a sterile solution containing hyaluronic acid and immediately ultrafiltered to a final size of 0.20 microns to exclude the cellular component and hyaluronic acid chains of different molecular weights. The suspension was then injected into the dermis using a mesotherapy technique with microinjections. Results: This study found that it is possible to extract signaling microvesicles using a simple ultrafiltration system. The Berardesca Scale, Numeric Rating Scale (NRS), and Modified Vancouver Scale (MVS) showed that it is possible to obtain excellent results with this technique. The ultrafiltrate can validly be used in a therapy involving injection into target tissues affected by chronic and photoaging with excellent results. Conclusions: This retrospective clinical evaluation study allowed us to consider the results obtained with this method for the treatment of dermal wrinkles and facial tissue furrows as excellent. The method is safe and an innovative regenerative therapy as a powerful and viable alternative to skin regeneration therapies, antiaging therapies, and chronic inflammatory diseases because it lacks the inflammatory component produced by cellular debris and fibrous sprouts and because it can exclude the mesenchymal cellular component by reducing multiple inflammatory cytokine levels.

Indications for and Limitations of Reconstruction of Auricular Defects with the "Mid-moon Flap" and Evaluation of Outcome by the Aesthetic Numeric Analogue Score

A variety of skin grafting techniques and local flaps have been described for medium-sized auricular defect reconstruction. Despite this, the reconstruction of a medium-sized auricular defect starting from the opposite surface is not yet reported in the literature. In the present article, the authors describe a novel surgical approach, the "mid-moon flap" technique, used for 87 patients in that kind of reconstruction. Eighty-seven patients presenting tumors located on the pinnal surface were enrolled in this study. The patient distribution included 68 men and 19 women, aged from 52 to 94 years, with a median age of 77.4 years. For all the patients, a customized cutaneous flap, named the mid-moon flap, was performed for auricular defect reconstruction. Histopathology reports confirmed the diagnosis of malignant tumors, with complete excision of the lesions in all cases. Follow-ups ranged from 6 to 36 months, with a mean of 18 months. There were no recurrences of the malignancy during the study, and the aesthetic outcome was globally considered good. The authors reported that the mid-moon flap technique is most appropriate for medium-sized auricular defects for two principal reasons: it covers the recipient area very well and, at the same time, leaves almost imperceptible relics on the donor area without causing any morphofunctional alteration of the ear.

Use of hyperoxidized oils-based medical devices for the wound healing in post-surgical patients

Postoperative injuries of the lower limb represent a challenging complication after surgery. The use of advanced dressings, local flaps, reconstructions with grafts or dermal substitutes represent the most common therapeutic solutions. With the present paper, we describe a case of a postoperative wound of the leg treated with the use of hyperoxidized oils-based medical device: NOVOX©. An 88-year-old woman presented in September 2022 an ulcer on her left leg, on the external malleolus. Authors decided to treat the lesion with NOVOX© in the form of a dressing pad. The controls initially lasted every 48 hours, subsequently every 72 hours and in the last month only once a week. The progressive clinical examination showed a global reduction of the wound area. According to our experience, the novel oxygen-enriched oil-based dressing pad (NOVOX©) is simple to use, secure, and successful in treating old patients receiving postoperative therapy for leg ulcers.

Gonadal vein leiomyosarcoma, from clinical practice to a literature review: surgical, oncological and histopathologic correlation

BACKGROUND AND AIM

Vascular leiomyosarcomas are rare and generally originate from the muscular wall of the inferior vena cava. Leiomyosarcomas originating from the wall of the gonadal veins are rare and just about ten cases are described in literature. In the present paper, we have described a case of a LMS originating from the left gonadal vein.

METHODS

A 44-year-old woman presented in March 2020 pain symptoms at the level of the left renal lodge. The subsequent CT and the biopsy confirmed the diagnosis of G2 grade LMS. The mass was then removed en bloc from the posterior and inferior pancreatic plane, from the aortic plane and from the retroperitoneal plane, post chemoteraphy.

RESULTS

Pathologic report revealed a typical leiomyosarcoma, moderately differentiated G2 with minor dedifferentiated areas of pleomorphic leiomyosarcoma.

CONCLUSIONS

The LMSs originating from gonadal veins represent an uncommon oncologic challenge. The radical en bloc excision represents the therapeutic gold standard.

Wounds morphologic assessment: application and reproducibility of a virtual measuring system, pilot study

BACKGROUND AND AIMS

Assessment of wounds morphology can be considered, in the everyday medical activity, the first step for the correct pathway of diagnosis. Authors present a pilot study focused on the statistical analysis of 32 cases of wounds measurements conducted by both the traditional method (paper ruler) both the digital smartphone analysis.

MATERIALS AND METHODS

32 lesions were morphologically evaluated. All the enrolled patients were evaluated by both the traditional method (paper ruler) both a digital smartphone analysis based on the app imitoMeasure. The extracted data were compared to the traditional measurements and a statistical analysis was based on intraclass correlation coefficients (ICC).

RESULTS

Three morphological parameters were evaluated: width (expressed in cm), length (expressed in cm) and area (expressed in cm2). The area (expressed in cm2) was found to be the less comparable, but the data were close in this case, too.

CONCLUSION

The present study shows that the digital measuring systems should be easily addressed as versatile tools that could be applied in daily clinical practice in the future.

The modified TIME-H scoring system, a versatile tool in wound management practice: a preliminary report

Background and Aims:

The concept of WBP (wound bed preparation) has revolutionized the way to diagnose and correctly identify the best therapeutic path about the widespread clinical problem of difficult wounds. Starting from the modified TIME-H, authors conducted a preliminary study with the aim of assessing the impact of skin lesions and soft tissues for the surgical patient.

Materials and Methods:

38 patients were preliminarily evaluated. The patients were classified according to the lesion examined, in particular among those who had an infectious or vascular etiology (SSTIs), and patients with surgical site lesions (SSI) and assigned to one of three categories prognosis: favorable (with healing expected within 12 weeks) (0-3A, 0-1B), intermediate (with healing expected over 12 weeks) (4-6A, 2-4B) and uncertain healing (7-8A, 5-8B).

Results:

At the end of the one-year observation period, authors established the healing prediction rate among the studied lesions: the surgical site lesions presented the highest percentage of predictivity (88%), followed by the mixed etiology (72%) and the infectious/vascular injuries (63%).

Conclusion:

This modified-TIME-H can be considered as a versatile and useful scoring tool that should be used in daily clinical practice for the study and treatment of chronic wound diseases.

Effects and Changes on Voice After Rhinoplasty: A Long-Term Report

Introduction

Vocal changes after rhinoplasty have been poorly investigated, although this surgical procedure is nowadays one of the most requested. The production of voice largely depends on the anatomy and the size of the pyramid and the nasal cavity. The authors report 51 cases of both closed and open rhinoplasty and propose a 2-year report to analyze potential effective changes on voice.

Materials and Methods

Fifty-one patients were enrolled and evaluated from September of 2012 to January of 2018. All patients were studied before and 2 years after surgery. Vocal changes were assessed with an objective and a subjective evaluation. The first one allowed to perform the measurement of the intensity and frequency of vowel sound ("a") and nasal consonant sounds ("n" and "m"). For the subjective evaluation, our modified version of Voice Handicap Index Score allowed us to evaluate every single characteristic of the personal perception of voice.

Results

The objective evaluation showed an increased frequency of production of the consonant sounds in 62% of cases and an increased frequency of production of the vowel sound in 68% of cases. The subjective evaluation allowed us to notice significant changes after surgery (P = .044). No significant differences were noticed between closed and open approach.

Conclusion

Reduction rhinoplasty technique proved to induce several alterations on vocal pattern. The surgeon should always inform patients about the potential effects on the voice, particularly when such changes may produce influences on the working life.

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Background

Chest wall resection and reconstruction (CWRR) is quite challenging in surgery, due to evolution in techniques. Neoplasms of the chest wall, primary or secondary, have been considered inoperable for a long time. Thanks to evolving surgical techniques, reconstruction after extensive chest wall resection is possible with good functional and aesthetic results.

Methods

In our single-center experience, seven cases of extensive CWRR for tumors were performed with a multidisciplinary approach by both thoracic and plastic surgeons. Patients have been retrospective analyzed.

Results

Acceptable clinical and aesthetical results have been recorded, with a smooth post-operative course and a low rate of post-surgical complications. Two early complications and one late complication (asymptomatic bone allograft fracture on the site of the bar implant) were recorded. Neither postoperative deaths nor local recurrences were registered after a median follow-up period of 13 months.

Conclusions

Surgical planning is most effective when it is tailored to the patient. Specifically, in the treatment of selected chest wall tumors, the multidisciplinary approach is considered mandatory when an extensive demolition is required. Indeed, here, the radical wide en-bloc resection can lead to good results provided that the extent of resection is not influenced by any anticipated problem in reconstruction.

Oculonasal Synkinesis: Video Report and Surgical Solution of a Rare Phenomenon

BACKGROUND

Synkinesis represents involuntary muscular movements that occur in association with voluntary contraction of other muscle groups. Oculonasal synkinesis is a rare phenomenon.

OBJECTIVES

In a series of videos, the authors present clinical findings and surgical correction of oculonasal synkinesis.

METHODS

Two women who underwent surgical procedures to correct oculonasal synkinesis were evaluated in a prospective study. One patient presented with bilateral synkinesis after 2 previous rhinoplasties. She underwent open rhinoplasty in our office. The other patient had unilateral synkinesis of the left side and received endonasal rhinoplasty.

RESULTS

The patients' mean age was 27.5 years, and follow-up was conducted for 6 months. Both patients experienced complete, stable resolution of synkinesis after surgical correction. No complications were recorded.

CONCLUSIONS

Patients with oculonasal synkinesis may not notice it preoperatively and may regard these muscle movements as an unfavorable result of rhinoplasty. Therefore, careful preoperative evaluation is crucial.

Poland syndrome: an algorithm to select the appropriate chest wall surgical reconstructive treatment

AIM

Poland syndrome is a constellation of rare congenital anomalies of the chest wall, with or without alterations to the ipsilateral superior extremity. Actually Foucras' classification is commonly used to choose the most appropriate surgical treatment, but often only a radiological classification proves unsatisfactory in order to achieve the best aesthetic result.

MATERIAL AND METHODS

Since November 2006 in our institute have been treated 6 patients (3 M, 3 F) with Poland Syndrome affected by only chest wall and/or breast deformities.

RESULTS

We treated 6 patients opting for different surgical procedures, depending on the deformity detected. We experienced only one procedural complication, a fat necrosis with superior migration of the prosthesis, successfully managed.

DISCUSSION

Surgical alternative treatments of the Poland's abnormalities of the chest wall are independent from the corrective surgery of the ipsilateral affected forearm ad hand. Surgeons should be able to develop an operative plan to address aesthetic goals while preserving muscular functionality. Indeed surgical techniques should be minimally invasive and possible available in every hospital structure.

CONCLUSIONS

This study has been designed to review a series of surgical options of breast reconstruction in patients with Poland Syndrome in order to develop a new flow chart to plan the best surgical choice analyzing only breast/chest wall deformities according to Blondeel's point of view about reconstruction of the new breast and thoracic wall.

KEY WORDS

Breast reconstruction, Poland syndrome.

The role of plastic surgeon in complex cephalic malformations. Our experience

AIM

Our aim is focused on the field of action of plastic surgery in the cephalic malformation and on description of the surgical indications and techniques for their correction.

MATERIAL OF STUDY

We looked at 27 patients from 2006 to 2012 with cephalic district deformities. All patients underwent surgical and rehabilitative treatments.

RESULTS

After a median follow-up from one to five years, in most cases we reached both morphological and functional reconstruction, alone or in a surgical team together with other surgical disciplines.

DISCUSSION

The correction of craniofacial malformations makes use of a surgical discipline particularly demanding, which must associate a basic surgical training with a learning techniques specific to the area and a knowledge of craniofacial malformation.

CONCLUSIONS

The surgical treatment of craniofacial malformations can be seen only through a joint neurosurgical and plastic-maxillo-facial surgery, guided by knowledge of the malformation, under the close supervision of anesthetists and pediatricians. This surgery is not limited to remodel the morphology but has its bases on the recovery of the functions, maintained by rehabilitation treatment.

Evaluation of negative pressure vacuum-assisted system in acute and chronic wounds closure: our experience

Negative-pressure therapy or vacuum-assisted closure (VAC) has been used in clinical applications since the 1940's and has increased in popularity over the past decade. This dressing technique consists of an open cell foam dressing put into the wound cavity, a vacuum pump produces a negative pressure and an adhesive drape. A controlled sub atmospheric pressure from 75 to 150 mmHg is applied. The vacuum-assisted closure has been applied by many clinicians to chronic wounds in humans; however it cannot be used as a replacement for surgical debridement. The initial treatment for every contaminated wound should be the necrosectomy. The VAC therapy has a complementary function and the range of its indications includes pressure sores, stasis ulcers, chronic wounds such as diabetic foot ulcers, post traumatic and post operative wounds, infected wounds such as necrotizing fasciitis or sternal wounds, soft-tissue injuries, bone exposed injuries, abdominal open wounds and for securing a skin graft. We describe our experience with the VAC dressing used to manage acute and chronic wounds in a series of 135 patients, with excellent results together with satisfaction of the patients.