Aurelio Portincasa

Sedation analgesia during office-based plastic surgery procedures: Comparison of two opioid regimens

Background: The combination of sedative and analgesic drugs is increasingly being used during minimally invasive surgery. The authors compared the clinical efficacy of two different fentanyl regimens, in combination with midazolam, for sedation analgesia in patients undergoing office-based plastic surgery procedures under local anesthesia. Methods: One-hundred patients were randomized into two groups of 50 subjects each. Group F1 received a fentanyl bolus of 0.7 &mgr;g/kg before infiltration with local anaesthetics; group F2 received the same bolus plus 0.6 &mgr;g/kg fentanyl every 45 minutes. All patients received a midazolam bolus of 0.05 mg/kg plus continuous infusion 0.08 mg/kg per hour. Results: High-quality analgesia was obtained in every group, without significant differences between the two fentanyl regimens. Group F2 was associated with lower intraoperative mean blood pressure and SpO2 values compared with group F1. No differences were detected between the two groups in perioperative side effects or postoperative pain. Conclusion: Higher doses of opioid did not improve the quality of perioperative patient comfort but acted synergistically with the sedative drugs, amplifying the hemodynamic and respiratory side effects.

Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: Results from a long-term longitudinal cohort study.

Few studies of long-term outcome of hypospadias treatment in terms of voiding, surgical complications, sexual functioning, intimate relationships and cosmetic results have been investigated and contrasting results have been obtained so far. The aim of our study is to investigate the long-term outcome of urinary and sexual function, cosmesis and the quality of intimate relationships in a series of hypospadias. In this study, 42 patients who underwent surgery for hypospadias were prospectively followed for 15 years. Medical records provided the hypospadias data, the number of reconstructive operations and the reconstruction technique that was used. Patients underwent physical examination, including penile length measurement and completed International Prostatic Symptoms Score (I-PSS), International Index Of Erectile Function (IIEF 15) and the Penile Perception Score questionnaire (PPPS). Twenty patients agreed to participate in the study. At the enrolment, the median value of HOSE was 13, as regards PPPS, 18/20 (90%) were satisfied, while in 1998 only 80% were satisfied. No significant statistical difference has been reported from the results obtained at enrolment and those obtained at follow-up, in terms of PPPS (P = 0.81), IPSS and IIEF-15. Penile length was 6.5 cm flaccid and 10.5 cm stretched. Our data show how cosmesis, function and psychosexual development for these patients are highly connected to surgical outcome, which is understood to be a decrease in penile size.

Discussion: Surgical Management of Gynecomastia—Subcutaneous Mastectomy and Liposuction

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Morphostructural changes in transferred fasciocutaneous free flaps: a preliminary clinical and immunohistochemical report

Many local factors, yet to be investigated, can promote changes in tissue transferred by microsurgical technique into the recipient site. Several studies have attempted to assess the nature of modifications that occur in the vascular network of such a flap after transfer. Although these investigations have interesting conclusions, the majority of them were based only on indirect evaluations. The aim of this study was to detect, by histological and statistical analysis, the morphostructural changes that occurred in fasciocutaneous free flaps transferred to the cephalic region or to the lower limb. Patients were enrolled in this study only when neither local inflammatory reactions nor systemic diseases were observed at the time of biopsy. Six patients consented to undergo biopsy at both the donor and the recipient area of a previously transferred fasciocutaneous free flap. Three flaps were used for facial reconstruction, and three others for lower limb reconstruction. Standard staining and immunohistochemical investigations were performed. The sections were also analysed by specific software. Statistical analysis of the data was performed using the students t-test and Fishers test. In five out of six transferred flaps (83%), there was increased microvascularity compared to the donor area. It was correlated to the neoangiogenesis in the dermal layer of the flaps. In five recipient sites there were more new vessels. In particular, a higher score of angiogenesis was observed both in the cheek (one flap) and in the non weight-bearing area of the foot (two flaps) (P<0.001). Some differences in microvascularity between the donor and the recipient site in the same flap were related to the specific recipient site. This represents the first demonstration of adaptation of fasciocutaneous free flaps to the recipient area, as well as to their new function, at both the macroscopic and microscopic level.

Skin-reducing mastectomy and direct-to-implant reconstruction in giant phyllodes tumour of breast: case report

Highlights • We present a singular case of early breast cancer and reconstruction with prosthesis.• The giant phylloides tumors are often malignant, but in this case the histological examination has been atypical.• The technique we offer allows for effective reconstruction in a single time.• Few cases in literature have dealt with this issue.

Surgical Approach to Head and Neck Cancer and Postoperative Complications : Are All Patients Eligible?

GUIDELINES Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor. Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/. We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

Management of Nipple-Areolar Complex Complications in Nipple-Sparing Mastectomy with Prosthetic Reconstruction

One of the most observed complication in nipple-sparing mastectomy (NSM) and immediate reconstruction with implants/expander is the partial or total necrosis of the nipple-areolar complex (NAC). The aim of this chapter is to provide the main notions about management of the nipple-areolar complex complications in NSM. Nipple-sparing mastectomy, although in case of necrotic complications to the NAC, is a valuable surgical option. The proper management of these complications is an important factor for achieving optimal result.

A rare case of Brooke-Spiegler syndrome: integrated surgical treatment of multiple giant eccrine spiradenomas of the head and neck in a young girl

Highlights • The authors present a rare case of multiple giant eccrine spiradenomas of the head and neck.• A young girl presented with multiple swellings over the head and neck.• The patient had a psychological trauma with a negative impact on her social life.• There is need to establish a surgical protocol for the treatment of adnexal tumors.• Our integrated surgical approach showed excellent aesthetic and functional results.

Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy

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LOP28: Hyaluronic acid nerve guide for peripheral nerve injury repair up to 2cm

Results: Using HPLC measurement we were able to detect different amounts of doxorubicin, vincristine, and vinblastine in exosomes and cell culture, patients supernatants. We confirmed significant inhibitions of exosome release occurring at nontoxic concentrations of the drugs. Diminished exosome release was associated with increased efficacy of immunochemotherapy. Also, silencing of ABCA3 by lentiviral shRNA constructs reduced exosome release from the cell line models Balm-3, Su-DHL-4, and OCI-Ly1. Concordantly, silencing ABCA3 also increased the susceptibility of the lymphoma cells to immunochemotherapy. Conclusion: We here found that exosomes participates in resistance to chemotherapy. Both pharmacological blockade and silencing of ABCA3 enhanced the susceptibility of target cells to cytotoxic agents.