Acellular dermal matrix imaging features in breast reconstructive surgery: a pictorial review

Acellular dermal matrices (ADMs) are biological engineered tissues, which may provide an immunologically inert scaffold in breast reconstruction. Since the literature on imaging features of ADMs is limited, radiologists must be aware of the common imaging appearances of ADM, to differentiate normal conformation from residual or recurrent disease. Our purpose is to review the current role of ADMs in implant-based breast reconstruction, describing the normal imaging findings at ultrasound, mammography, and MRI also considering the possible changes over time. In this pictorial essay, we reviewed imaging features of ADMs described in the literature and we reported our experience in patients who underwent reconstructive surgery with human or animal ADM for newly diagnosed breast cancer.

Management of Fournier's gangrene non-healing wounds by autologous skin micrograft biotechnology: a new technique

Fournier's gangrene is an acute bacterial infection producing necrosis of the perineum and external genitalia that generally affects elderly men. Although skin grafts and flaps are the standard procedure for reconstruction, sometimes wounds can become chronic. Rigenera Protocol is a new technique based on autologous skin micrografts that reactivates and supports wound healing. A 40-year-old male with Fournier's gangrene, due to a rectal microperforation following diarrhoea, was treated with surgical debridement, negative pressure wound therapy and subsequently coverage with skin grafts. He developed non-healing wounds treated by Rigenera protocol after two months of advanced wound dressings. This technique is based on skin micrografts obtained by mechanical dermal disgregation to provide mesenchymal stem cells and extracellular matrix to the wound. The suspension injected into the wound triggers reactivation of healing without significant residual scarring on both donor site and treated area. Non-healing wounds were reduced by 15% at day 7 and by 50% after 30 days. Wounds completely healed after seventy days. The regenerated tissue appeared closer to skin graft than to scar tissue. This report shows how the use of skin micrografts through Rigenera protocol can be a useful method to reactivate wound healing resulting from Fournier's gangrene, with no discomfort for patient in a practical, safe and easy way.

Distally based fasciocutaneous sural flap for foot reconstruction: a retrospective review of 10 years experience

BACKGROUND

The treatment of soft tissue defects of the foot is a problem mainly connected to the thickness of the coverage tissues, to the poor circulation, and to the frequent involvement of muscle, tendon, and bone. The authors present their experience with the sural flap, also in some particular cases.

MATERIALS AND METHODS

The authors treated 33 patients for small- and medium-size defects of the foot, caused by work, home, and road accidents, and by venous or diabetic ulcers. In all cases, the flap was cut in its fasciocutaneous variant; an extension of the sole portion of fascia was added in 5 patients. The flap was transferred under a subcutaneous tunnel in 10 cases, with an open incision in 20 cases, and in 3 cases the pedicle was kept external for 4 weeks, then resected.

RESULTS

One patient showed a complete necrosis of the flap and another showed a superficial necrosis preserving the deep fascia; in the remaining 31 cases, the flap incorporated without any major complication. The flap provided proper coverage of the defects from both an aesthetic and functional point of view as evidenced clinically and through a baropedographic test.

CONCLUSION

The advantages of this flap include: dissection is fast and easy, it is not necessary to sacrifice important arterial pedicle or muscular units as it can be used in traumatized limbs without further damage to main arteries, and a wide rotation arc is possible. Disadvantages include the sacrifice of the sural nerve and the covering of the donor region with skin grafts.

Aesthetic role of the surgically rebuilt inframammary fold for implant-based breast reconstruction after mastectomy

The inframammary fold (IMF) represents one of the most important anatomic landmarks in defining a woman's breast ptosis and inferior quadrant shape. Therefore it is important to preserve it, if this is oncologically safe, at the time of excisional surgery. If it is sacrificed, dislocated cranially or caudally, or there is a thick panniculus adiposus with a poor definition of the fold, it is necessary to recreate it. We present our experience in the reconstruction of the IMF in patients suffering from post-oncologic mastectomy, reconstructed with silicone implants. From January 2000 to May 2004 at the Plastic Surgery Department of the University of Turin, 74 reconstructions of the IMF were performed through Nava's technique, partially modified by us. We believe that IMF reconstruction, through fixation of cutis, subcutis and fascia superficialis to VI rib, along with capsulectomy of periprotesic pocket inferior quadrants, is a milestone for achieving, in selected cases, a good aesthetic result in terms of shape, ptosis and projection of inferior pole. The comparison between patients' opinions (obtained through questionnaires) and surgeon's, at 1 year after the reconstruction, shows that both are satisfied with the achieved outcome in terms of shape, projection, symmetry, ptosis and IMF definition. Another comparison was made between cases of fold preservation and cases of fold reconstruction, with a remarkable similarity of aesthetic satisfaction. The technique proposed here appears to be the current method of choice for IMF reconstruction in all cases where it is necessary to recreate or redefine it.

Congenital mammary asymmetry. Classification and surgical treatment

AIM OF THE STUDY

The Authors intend to guide the choice of surgical treatment for mammary asymmetry, according to specific form of asymmetry.

MATERIAL AND METHODS

Possible types of symmetryzation surgery are listed. First Author's personal technique is described and some clinical cases are presented.

DISCUSSION

Regardless to specific surgical needs for the single case, a generally valid concept is the necessity of a surgical moulding meant to obtain the same volume for both breasts before positioning of implants. This allows a longer lasting symmetry between breasts, as aging modifications bilaterally occur at equal speed if the adipo-glandular structures obtained have the same volume.

Surgical treatment of rhinophyma: a comparison of techniques

Rhinophyma is a rare disease that primarily affects Caucasian men in the fifth to seventh decades of life, characterized by a progressive thickening of nasal skin, which produces a disfiguring soft-tissue hypertrophy of the nose. Severe cosmetic deformity and impairment of breathing may coexist, making the surgical treatment necessary. The authors are conscious that in literature there is not agreement about the ideal treatment of rhinophyma, nevertheless they wish to give their contribution according to their experience with different treatment modalities such as the scalpel, the electrocautery, the dermabrader, and the carbon dioxide laser. The authors believe the scalpel, in association with bipolar electrocautery and local infiltration of dilute epinephrine to reduce bleeding, is the safest means to preserve the underlying sebaceous gland fundi and permit a spontaneous re-epithelialization scarring-free.

Augmentation mammaplasty with a new cohesive gel prosthesis

We present our experience with augmentation mammaplasty on 14 patients with a thin chest wall and poor subcutaneous tissue. Thanks to Polytech Silimed code 20675, a new anatomical prosthesis filled with "soft" cohesive gel, the lodging in a subglandular position was possible without anomalous salience in the upper pole, and a more natural mammary profile was achieved without capsular contracture, dislocation, or misplacement of the mammary implants.

[Cranioplasty with polymethylmethacrylate. The clinico-statistical considerations]

BACKGROUND

The main purpose of the reconstruction of the cranium is the protection of the brain. Besides we have to consider important functional and aesthetic necessities in order to achieve satisfactory results.

METHODS

Thirty-six clinical cases, operated from November 1991 to June 1996, in which the reconstruction of the cranial vault is carried out by a polymethylmethacrylate acrylic resin are analysed. The causes and locations of the most common bone defects and the main indications for reconstruction are examined. While the repair of the osseous gaps caused by neoplasms is immediate, in the traumatic occurrences, in order to reduce the probability of infectious complications, an average time of 11 months elapsed from the first operation. The surgical technique, with slightest alterations, is the same in all the presented cases, preparing the acrylic resin straight on the operating table. The resin, moulded and adapted to the defect until its complete hardening, presents, thanks to its properties, manifold advantages (and few real disadvantages).

RESULTS

The results, in terms of complications, are very satisfactory, with an infectious rate of 2.7%. Besides, in one third of the patients, a considerable clinical improvement after the repair has been observed.

CONCLUSIONS

According to personal experience, it is possible to affirm that polymethylmethacrylate, with its remarkable plasticity and stability in time, can always guarantee a satisfactory functional and aesthetic result.