Anna Brafa

Octyl-2-Cyanoacrylate Adhesive for Skin Closure and Prevention of Infection in Plastic Surgery

No complete scientific study has yet investigated the incidence of surgical-site infections in plastic surgery operations. However, it has been noted that in the case of wound infection, the aesthetic and sometimes the functional results become invalidated by delay and an alteration of the healing processes, thus necessitating surgical correction. This study aimed to evaluate the effectiveness of applying tissue adhesive on surgical wounds in plastic surgery as a protection capable of reducing the onset of infection, and to verify the existence of a statistically significant difference between treated and untreated wounds, and to determine patients’ satisfaction with their cicatricial results.

Multi-potent progenitors in freshly isolated and cultured human mesenchymal stem cells: a comparison between adipose and dermal tissue.

Mesenchymal stem cells (MSCs) from human adult adipose tissue (A-MSCs) have a better differentiative ability than MSCs derived from the derma (D-MSCs). To test whether this difference is associated with differences in the content of multi-potent progenitors in A-MSCs, the number and the differentiative properties of multi-potent progenitors have been analyzed in various preparations of A-MSCs and D-MSCs. Adipogenic and osteogenic differentiation performed on colony-forming units have revealed that adipogenic and osteogenic progenitors are similar in the two populations, with only a slighty better performance of A-MSCs over D-MSCs from passages p0 to p15. An analysis of the presence of tri-, bi-, uni- and nulli-potent progenitors isolated immediately after isolation from tissues (p0) has shown comparable numbers of tri-potent and bi-potent progenitors in MSCs from the two tissues, whereas a higher content in uni-potent cells committed to adipocytes and a lower content in nulli-potent cells has been observed in A-MSCs. Furthermore, we have characterized the progenitors present in A-MSCs after six passages in vitro to verify the way in which in vitro culture can affect content in progenitor cells. We have observed that the percentage of tri-potent cells in A-MSCs at p6 remains similar to that observed at p0, although bi-potent and uni-potent progenitors committed to osteogenic differentiation increase at p6, whereas nulli-potent cells decrease at p6. These data indicate that the greater differentiative ability of A-MSC populations does not correlate directly with the number of multi-potent progenitors, suggesting that other factors influence the differentiation of bulk populations of A-MSCs.

Late-onset gluteal Escherichia coli abscess formation 7 years after soft tissue augmentation with Bio-Alcamid™ in a HIV-positive patient

In 2002, a 41-year-old woman had been treated for severe buttock lipodystrophy resulting from highly active antiretroviral (HAART) therapy medication. During a single session the loss of subcutaneous fatty tissue had been compensated by injections of an undefined quantity of polyalkylimide 4% (Bio-Alcamid , Polymekon Biotech Industry, Milan, Italy). The post-treatment course had been uneventful and the patient had initially been satisfied with the result of this treatment. Seven years later, the patient presented with a redness and swelling of the area (Figure 1) by our unit. The area was hard and extremely painful on touch. All previous antibiotic therapies led only to temporary relief of these symptoms. A bedside drainage of the abscess was performed through a 20-gauge intravenous cannula that was inserted in the thin collagen capsule

Abdominoplasty as a reconstructive surgical treatment of necrotising fasciitis of the abdominal wall

OBJECTIVES Necrotising fasciitis (NF) is a potentially fatal, uncommon infection of the soft tissue with rapid progression. This article presents one case of NF of the abdomen wall, describing the presentation, diagnosis and long-term successful treatment. METHODS The defect of the abdominal wall was treated with medical support (antibiotics broad-spectrum coverage), V.A.C. therapy and plastic surgery procedures. RESULTS The coverage of the abdominal wall defect has been achieved by abdominoplasty-type advancement flaps in one step with the preservation of the umbilicus. One month after the surgical procedure, the patient returned to a normal lifestyle with a good quality of life. CONCLUSION The success of this case should be attributed to an early diagnosis, aggressive debridement and a good intensive medical management; these elements are essential to a better prognosis for NF.

Carbon Dioxide: Maybe Not the Only One but an Efficient and Secure Gas for Treating Local Adiposities

Currently, carbon dioxide therapy represents an evidencebased and mini-invasive method for treating local adiposities. Many studies [1–3] performed on both women and men have already demonstrated its effectiveness in decreasing local fat in several anatomical areas. Recently, Balik et al. [4] compared the effects of both CO2 and breathable air injection on subcutaneous tissue in a sample of 28 experimental rats. They concluded that the mechanical effects are the same for both gas injections and the changes in microcirculation documented on laser Doppler flow examination are not statistically significant. With respect their article, we would like to make a few comments. We evaluated in a cohort of 48 [5] and 42 patients [6] the effects of CO2 therapy from a histological (through biopsies of tissues performed after the therapy) and a biochemical point of view by showing changes in the laser Doppler signal in association with the assessment of the concentration of transcutaneous oxygen tension (tcPO2). Both these methods are mandatory to evaluate CO2 effects on the microvascular network [3, 7]. Lee [8] confirmed our findings with a study protocol evaluating some anthropometrical parameters on 101 patients (divided per age) after treatment with CO2 injected in several body areas. Furthermore, the gas injection mode of Balik’s study is not comparable to the described protocols for the treatment of local adiposities by CO2 therapy. Medical CO2 injection treatments in previous clinical studies were administered through certified equipment that guarantees both constant gas delivery and electronic flow control. The paraphysiological hyperoxia that underlies the metabolic CO2 effects needs to be evaluated by following a particular treatment timing. This was not done in Balik’s study and therefore the inefficacy of these methods is not clear in the discussion. The data related to tissue oxygenation certainly need further biochemical studies. Moreover, microvascular effects were not completely and correctly evaluated and not demonstrated by using the previously cited association of laser Doppler flow and tcPO2. In addition, it is important to point out that in our studies, tcPO2 data are constant and highly significant (P \ 0.01), whereas laser Doppler flow evaluations are significant (P \ 0.01) but not constant [5]. These results depend on some technical situation (i.e., patient immobility, constant temperature) not easily reproducible in animal models. The histological data presented by Balik et al. showed direct lipoclasic effects of the studied gas. We also found these effects in our studies but they could not be assessed in humans. It is clear that before demonstrating the effectiveness of an alternative gas (e.g., ambient air) in reducing local adiposities, it is necessary to test its security and absence of toxicity. Because of the proven safety and daily use in laparoscopic surgery [9, 10], CO2 has been injected on voluntary patients after informed consent and the approval of the local ethics committee. The aim of our study was to evaluate both the effectiveness and safety of CO2 injection treatments. In our opinion, CO2 therapy combines the characteristics previously cited (Fig. 1). C. Brandi M. Campana (&) F. Russo A. Brafa G. Nisi L. Grimaldi C. D’Aniello Department of General and Specialistic Surgery, Plastic and Reconstructive Surgery Unit, ‘‘Santa Maria alle Scotte’’ Hospital, University of Siena, Viale Bracci 1, 53100 Siena, SI, Italy e-mail: matteocamp@gmail.com

Selective capsulotomies of the expanded breast as a remodelling method in two-stage breast reconstruction

Abstract The two-stage breast reconstruction with tissue expander and prosthesis is nowadays a common method for achieving a satisfactory appearance in selected patients who had a mastectomy, but its most common aesthetic drawback is represented by an excessive volumetric increment of the superior half of the reconstructed breast, with a convexity of the profile in that area. A possible solution to limit this effect, and to fulfil the inferior pole, may be obtained by reducing the inferior tissue resistance by means of capsulotomies. This study reports the effects of various types of capsulotomies, performed in 72 patients after removal of the mammary expander, with the aim of emphasising the convexity of the inferior mammary aspect in the expanded breast. According to each kind of desired modification, possible solutions are described. On the basis of subjective and objective evaluations, an overall high degree of satisfaction has been evidenced. The described selective capsulotomies, when properly carried out, may significantly improve the aesthetic results in two-stage reconstructed breasts, with no additional scars, with minimal risks, and with little lengthening of the surgical time.