Andrea Mori

Adipofascial anterolateral thigh free flap for tongue repair

With the advent of microsurgery fasciocutaneous free flaps have become a well known and accepted option for the repair of tongue defects. Many authors have tried to recover tongue function by modifying this approach. An innovative method for the repair of tongue defects using an adipofascial anterolateral thigh free flap is presented in this paper. The results are compared with those of tongue reconstructions implementing traditional fasciocutaneous free flaps performed at our institution. The histological features of the flaps were investigated postoperatively. Although this preliminary report has to be confirmed by further experience, it seems to solve many tongue-reconstruction related problems.

Autologous lipofilling: coenzyme Q10 can rescue adipocytes from stress-induced apoptotic death.

Background: Autologous fat transplantation (or lipofilling) is an excellent technique for correction of cosmetic defects. The success of the procedure relies strongly on the techniques of harvesting and transferring viable adipocytes. The purpose of this study was to evaluate effects of two harvesting methods and coenzyme Q10 on the viability and apoptotic death of adipocytes collected for autologous lipofilling. Methods: Human adipose tissue from six patients was collected by Luer-Lok syringe according to Coleman’s technique or by means of an aspirator with a 680-mmHg vacuum. Half of each sample collected using Coleman’s technique was treated with 10 &mgr;M Coenzyme Q10, and the other half served as untreated control. Viability and apoptosis were assessed by immunoenzymatic, biochemical, and morphological methods. Results: The harvesting of adipose tissue by aspirator reduced the viability and increased apoptotic death significantly more than harvesting tissue using Coleman’s technique. Biochemical and morphological analyses confirmed that treatment of adipose tissue with coenzyme Q10 reduced and even inhibited apoptotic death of harvested adipocytes. Conclusion: Coenzyme Q10 can rescue adipocytes from stress-induced apoptotic death.

A novel combined surgical approach to head and neck dermatofibrosarcoma protuberans

INTRODUCTION The surgical management of dermatofibrosarcoma protuberans has historically been a challenge, particularly in the head and neck and other aesthetic areas. The current priority is to achieve local oncologic control and a good reconstructive outcome. Here, we present our experience using a novel combined approach with a dermal regenerative template, sub-atmospheric pressure and skin graft. MATERIALS AND METHODS Five patients presenting at the Department of Plastic and Reconstructive Surgery of the University of Florence between January 2010 and October 2011 were included in the study following Institutional Review Board approval. All patients underwent a wide local excision of dermatofibrosarcoma protuberans affecting the head and neck. RESULTS The combined approach using the negative-pressure device, a dermal regenerative template and skin grafting proved effective in the management of this type of sarcoma with a good aesthetic and functional outcome, particularly on the neck or the supraclavicular region. CONCLUSION Although the present multi-step technique requires patient compliance, it results in good local oncologic control of the resection margins. It is possible to perform a wider excision in the event of positive margins without interfering with the last reconstructive outcome.

Cutaneous Carcinosarcoma: Report of a Case with Myofibroblastic Sarcomatous Component

Carcinosarcoma is a rare biphasic tumor combining malignant epithelial and mesenchymal elements, which may occur in several anatomical areas, including the skin, where a total of 42 cases have been reported up to 2005. It occurs primarily in elderly patients on sun-damaged skin, and the lesion either develops rapidly or has been present for years and increases suddenly in size. One case has been described in association with nevoid basal cell carcinoma syndrome. Histologically, the epithelial component can be of epidermal type (basal or squamous cell carcinoma; 57% of reported cases) or adnexal type (spiradenocarcinoma, porocarcinoma, proliferating tricholemmal cystic carcinoma, or matrical carcinoma; 43% of reported cases), while the mesenchymal component can show osseous, cartilagenous, or more rarely, skeletal or smooth muscle differentiation; no differentiation in nerve tissue has been as yet shown.

The retroangular flap in facial reconstruction: the exhaustive point of view.

further refinement. We describe a simple modification of suture techniques (antihelix mastoid sutures) that can be used to reinforce the repair of a prominent ear. The combined technique presented is safe, easy to perform, and can be used for treating patients with any magnitude of defect. Forty-four patients with prominent ears (80 ears) underwent otoplasty performed by the senior author at the Iaso Hospital of Athens between 2007 and 2009. Inclusion in this study required the use of at least one antihelix mastoid suture. Typically, a row of three or four 3-0 Prolene (Ethicon, Inc., Somerville, N.J.) sutures on a round-bodied needle was inserted to recreate the fold of the antihelix (in the fashion of Mustardé), starting caudally. The ends were not cut and an artery clip was applied to each suture. Another suture, 2-0 or 3-0 Prolene, was then placed between the concha and the mastoid periosteum to decrease the concha-scaphoid angle (in the manner of Furnas). With the sutures (at least one) that were used to recreate the antihelix fold, a second bite was taken on the mastoid periosteum and was tied with the desired tension (Fig. 1). In all of our patients, we did not overcorrect, but we attempted to achieve a natural appearance (Fig. 2). The concept of this extra bite of mastoid periosteum is to approximate the antihelix to the mastoid with a second secure and tight knot. The ear deformity is almost invariably greater at the superior pole than inferiorly, and therefore this extra knot is more useful at the upper pole of the ear. Patients were invited to a follow-up clinic (1 month and 1 year after surgery), where recurrence and suture extrusion were evaluated. The clinical recurrence rate was 1.25 percent (one ear). This one patient had undergone revision surgery. The suture extrusion rate was 7.5 percent (six ears), three of which required local anesthetic procedures for removal of sutures. There was no hematoma or skin necrosis. Patients were generally satisfied with the results in terms of shape and symmetry. It seems that this variation maintains a relatively simple and safe otoplasty that avoids irreparable complications and has a reproducible final cosmetic outcome. DOI: 10.1097/PRS.0b013e3182419b07