Alessandro Thione

Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study.

The authors performed an anatomic study on 16 thighs of 11 fresh white cadavers at the Ludwig–Maximilian University of Munchen, Germany. They analyzed the anatomic pattern and caliber of both the lateral circumflex femoral arterial system and the perforators nourishing the anterolateral thigh flap. They found regularly a majority of musculocutaneous perforators, mainly in the central third of the thigh, arising from the descending branch of the lateral circumflex femoral artery. Despite the small number of cadavers, they identified several differences in the anatomy of the lateral circumflex femoral arterial system. These variabilities, especially regarding the descending branch and its perforators, could have clinical importance. They also suggest new dissection studies by comparing white and oriental anatomy. Their aim is to establish whether any difference in the variability of the lateral circumflex femoral arterial system could increase the popularity, currently greater in Eastern Europe, of the anterolateral thigh flap.

The medial sural artery perforators: Anatomic basis for a surgical plan

We performed an anatomic study on 20 fresh lower limbs. Resin was injected in the popliteal artery. Medial sural artery perforator flaps were sculptured according to anatomic markings. On average, length of flaps was 12.9 cm, width was 7.9 cm; all 38 perforators were musculocutaneous: 1 perforator was always found (on average, 1.9 per flap). All perforators gathered between 7 and 18 cm from the popliteal crease; 34.2% of perforators arose on the midline of the medial head of gastrocnemius muscle; before entering the fascia, the perforator artery diameter was on average 0.5 mm. Two configurations of the intramuscular course of perforators were found. Sixty-six percent of perforators originated from the lateral branch of the medial sural artery, 34% from the medial one. These results improve the anatomic knowledge of the medial posterior calf region and allow us to describe a convenient plan to make flap sculpturing easier.

Surgical Aspects of a Lower Face, Mandible, and Tongue Allotransplantation

Face transplantation is a novel treatment for the reconstruction of massive facial defects. To date 13 cases have been performed. The technical aspects of a composite lower face transplantation including the tongue, floor of the mouth, and most of the mandible are detailed. The transplantation was performed in August 2009 in an HIV-positive, postoncologic patient. A preparatory surgery for nerve identification was performed. Facial composite tissue was procured after cardiac cessation. Revascularization was performed to the right subclavian artery with an internal shunt between the internal carotid arteries. At 16 months posttransplantation the patient is swallowing, without evidence of malignancy recurrence or HIV replication.

Perioperative ischemic injury and fibrotic degeneration of muscle in a forearm allograft: functional follow-up at 32 months post transplantation.

Allografts of the forearm are still uncommon in the field of composite tissue allograft transplantation. In November 2007, a right-hand allograft and a left-hand/full-length forearm allograft were transplanted in a 30-year-old man who lost both hands and the vision in his left eye due to an explosion. The patient underwent alemtuzumab and steroid induction therapy. Tacrolimus, mycophenolate mofetil, and low doses of steroids were given to prevent rejection. The allografts were rejected 3 times, but these episodes were controlled successfully. The immunosuppressive regimen was switched from tacrolimus to sirolimus because of increased serum creatinine. The left allograft showed a flexion contracture due to muscle fibrosis that was conjectured to be associated with a perioperative ischemic injury and permitted only a Moberg-type key pinch. In contrast, an excellent grade of function was observed in the right allograft. The Disabilities of the Shoulder, Arm, and Hand score improved from 70.83 to 36.6 and intrinsic musculature returned to both allografts. The patient was able to work 2 years after transplantation. This is the first report of an ischemic injury related to the successful allotransplantation of a composite tissue.

Kidney transplants in HIV-positive recipients under HAART. A comprehensive review and meta-analysis of 12 series

BACKGROUND Kidney transplantation is being introduced gradually for the treatment of end-stage renal disease in patients who are human immunodeficiency virus (HIV) positive. Our aim was to review the outcomes of kidney transplantation in HIV-positive recipients who were being treated with highly active antiretroviral therapy (HAART). METHODS Eligible papers were English language manuscripts, published between July 2003 and April 2009 and available through Medline, that described three or more recipients of kidney transplants who were HIV positive and undergoing HAART. The regimens for induction and maintenance therapy, organ rejection, patient survival, CD4 counts, HIV progression, infectious complications and deaths were recorded. The survival at 1 year, organ rejection and infectious complications were evaluated using a random effects model with 95% confidence intervals (CI). RESULTS Twelve case series met the defined criteria. Induction therapy consisted most commonly of the administration of anti-CD25 monoclonal antibodies, and triple immunosuppressive therapy was used most commonly for maintenance. Among the 254 patients, 1-year survival was 0.93 (95% CI, 0.90-0.96), organ rejection was diagnosed in 0.36 (95% CI, 0.25-0.49) and infectious complications occurred in 0.29 (95% CI, 0.17-0.43). The CD4 counts decreased after transplantation but recovered later. Acquired immune deficiency syndrome (AIDS)-defining infections occurred in three patients. CONCLUSIONS Kidney transplantation appears to be safe in patients undergoing HAART. However, larger series of patients are needed to determine the best protocols for the induction and maintenance of immunosuppression.

Successful breast reconstruction with a perforator to deep inferior epigastric perforator flap

The authors report their experience with deep inferior epigastric perforator (DIEP) flap breast reconstruction in which an unusual recipient site was used. Successful anastomosis between a suitable perforating vessel from the internal mammary axis and the deep inferior epigastric bundle was performed, and the advantages of this alternative recipient site (perforator to the DIEP flap) are examined.

Ultrasound Assisted Liposuction for the Palliative Treatment of Madelung's Disease: A Case Report

Abstract. Benign Symmetric Lipomatosis (Madelungs disease) is a rare disease, characterized by massive fatty deposits in the neck, the shoulders, and the upper extremities. The deformity is associated with chronic alcohol use, malignant tumors of the upper airways, neuropathy, diabetes mellitus, hyperlipidemia, and other metabolic disorders. Although the deformity is prone to recurrence, surgical removal via lipectomy or liposuction provides the only way of palliation. This paper describes the treatment of a 51-year-old man with a history of alcoholism and liver cirrhosis. He reported masses in his cervical and facial regions that had gradually enlarged over a period of 6 years. He also developed respiratory symptoms due to the fatty compression of his upper airways. Our experience with ultrasound-assisted liposuction for the palliative treatment of this disease is reported.

A Case of Life-Threatening Sepsis After Breast Augmentation by Fat Injection

Abstract. A case is presented in which an aesthetic breast augmentation by fat injection led a young woman to a life-threatening sepsis due to bilateral mammary abscesses. Immediate and late complications of this procedure are considered; infection is the frightful complication that can lead to septic shock, affecting survival, aesthetic outcome, and reconstruction possibilities of the patients breasts.

Evaluation of the efficacy of polydeoxyribonucleotides in the healing process of autologous skin graft donor sites: a pilot study

Objective: The article presents the results of a pilot study performed to evaluate the efficacy of polydeoxyribonucleotides (PDRNs) in shortening the healing times of autologous skin graft donor sites. Research design, methods: Two groups of patients were studied, the PDRN group (n = 20) and a control group (n = 20). In the control group dressings were performed with non-adherent gauzes and bulky gauzes with cloramine solution, whereas in the PDRN group a PDRN ointment was spread under the same medication as the controls. Results: In the PDRN group, dressing procedures were not painful (whereas in the controls they often were), re-epithelialisation occurred earlier (12.5 vs 24.45 days) and there were no infections (9 in the controls). Conclusions: Results are encouraging for the use of PDRNs in shortening the healing times of autologous skin graft donor sites, although further studies are necessary to obtain clinically relevant results.

Improvement in Renal Function After Late Conversion to Sirolimus-Based Immunosuppression in Composite Tissue Allotransplantation

1. Abraham G, Shroff S, Matcha J, et al. Deceased donor renal transplantation program in India. Kidney Int 2010; 77: 378. 2. Li R, Chen G, Guo H, et al. Prolonged cardiac allograft survival in presensitized rats after a high activity Yunnan-cobra venom factor therapy. Transplant Proc 2006; 38: 3263. 3. Mansy H, Filobbos P, Aly TF, et al. Massive haemorrhage and rupture of renal transplant from a donor who died of snake bite. Nephrol Dialysis Transplant 1998; 13: 1018.