Christian Mortarino

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.

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.

A simple and effective technique for improving the appearance of pin-site scars

The use of an external fixator in reconstructive surgery may leave retracted and depressed scars where pins have passed through the skin; these scars do not resolve or improve spontaneously and, at the end of the reconstructive surgery, patients complain about them (Fig. 1). In 1994, Saleh and Howard described a method of surgical revision combining W-plasty and a buried dermal island to improve pin scars. In 2002, Oznur and Aycan proposed a simple elevation procedure by scissors, making a 1-cm-longitudinal incision, arguing that controlled haematoma formation helps to elevate the depressed area, having experience only with scars of the thigh. We describe a new, simple, but really effective method based on lipofilling according to Coleman. Our technique can be performed at an outpatient clinic under local anaesthesia. All of the adhesions of pin-site scars are cut off with a simple needle, NoKor needle 16G 1.6 mm 25 mm, in a blind fashion by a 2–3-mm incision made with the needle, obtaining the elevation of the dimpled area easily. At this point, the scar area is treated with an injection of adipose tissue, usually harvested from abdominal subcutaneous fat (any fat donor site could be used), obtained by conventional superwet syringe liposuction and processed according to Coleman’s technique, filling the dead space created by the needle completely with a mild overcorrection (2–4 ml of fat tissue for each scar is enough). No stitches are needed and no more scars are provoked. Immediately at the end of the surgery, no more dimpling and retracted areas are visible, solving the major complain (Fig. 2); moreover, the clinical appearance and subjective patient feelings