Candiani P

Congenital infiltrating lipomatosis of the face related to cytomegalovirus infection

A case of congenital infiltrating lipomatosis of the face is presented, associated with a congenital cytomegalovirus infection.

Preliminary clinical experiences with the use of immunomodulators in burns

The remarkable progress achieved in control of infections in burned patients has significantly increased survival rates. Nevertheless, septic complications are still the leading cause of death in these patients. The immunologic disturbances present after severe burns certainly play a key role in susceptibility to infection, and in particular the impairments of the phagocytic system warrant major investigative efforts in order to increase host defenses. Determination of phagocytic and microbicidal capacity of neutrophils from burned patients evidenced a marked functional impairment of these cells. The alterations recorded were partly due to intrinsic (cellular) defects, and partly to extrinsic (serum) defects. Indeed, opsonic factors are known to be reduced in these patients, but also phagocytosis-inhibiting factors such as immunocomplexes have been detected in the patients we have studied. Administration of the immunomodulating agents methysoprinol and timostimoline were found to be effective in partially restoring neutrophil function. Rational immunotherapy in burned patients will consist of replacement of humoral mediators, clearance of inhibitory factors and stimulation of the cellular effectors of immunity.

Experience with the skin stretching device

The skin stretching device was designed to harness the biomechanical properties of the skin in order to close large cutaneous defects by direct closure, without the need of other more complicated techniques such as skin grafts or flaps. The authors present their experience with 31 patients in whom the device was used to repair defects produced by excision of lesions of different nature, size, and body areas, six cases are presented. The main defect of the method, i.e. the increase of intraoperative time to allow for tissue stretching, should be avoidable most of the time by applying the device preoperatively under local anesthesia. The importance of not undermining during this procedure is stressed; the objective parameters to evaluate are analyzed, such as colour and tension of the skin. The complication rate was very acceptable, there was only one infection and one marginal necrosis that healed without further interventions. The described technique appears safe and easy to perform, and produces a good short-term result.

Transaxillary submuscular augmentation mammaplasty

At least three different implant pockets for transaxillary submuscular (TASM) augmentation mammaplasty have been reported in the literature. To verify and clarify the features of the anatomical structures involved in a TASM procedure the authors studied the anatomy of the anterior thorax in operated and unoperated breasts of ten fresh female cadavers. In particular, some fascial and muscular observations are stressed, demonstrating that TASM augmentation mammaplasty always leads to a pocket where the upper one-third of the prosthesis is covered by the pectoralis major muscle, while the inferior two-thirds lies in a subglandular/subcutaneous plane.

Malignant change in giant congenital nevocellular nevi: our experience

SummaryWe present our experience in the surgical management of giant congenital nevocellular nevi (GCNNs). From 1983 to 1992, 13 cases were treated of which 11 were children and 2 were adults. The size of the lesions ranged between 3 and 60% of the body surface. All these patients underwent excision and skin grafting. In 6 cases, skin expansion was used. The patients were seen subsequently every 6 months with a 12 months minimum follow-up. In 2 pediatric patients, malignant degeneration of the lesion occurred: in the first case, a highly invasive nodular melanoma, in the second case, a lesion corresponding to minimal deviation melanoma. Our personal experience has shifted our attitude to the treatment of GCNN to a more aggressive approach. Early and radical excision of all the lesion is currently our first priority; esthetic refinements by means of skin expansion or other techniques are now delayed to subsequent procedures.