Federico Villani

Correction of Cicatricial Ectropion by Autologous Fat Graft

BackgroundOver the past few years, treatment of burn scars with lipofilling has shown encouraging clinical results in terms of texture, color, softness, and quality of skin patterns. This clinical application has been widened to include treatment for scars resulting from surgical correction of cicatricial ectropion. In fact, although standard surgery with flaps and skin grafts can grant significant functional and cosmetic improvements, these often are not complete because of secondary surgical scars.MethodsThe case of a 43-year-old man with cicatricial outcomes from chemical burns and subsequent surgical repair of medial ectropion in the lower eyelid is reported. The scar area was treated with injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman’s technique.ResultsAt the 1-year follow-up assessment after lipostructure, the patient no longer reported xeroftalmia and epiphora. He had experienced complete functional recovery with excellent cosmetic results.ConclusionsLipostructure of cicatricial ectropion seems to complete and improve the results of the standard surgical approach, and its long-lasting benefits are in keeping with the theoretical basis of this procedure.

Distal Interphalangeal Joint Arthrodesis for Degenerative Osteoarthritis With Compression Screw: Results in 102 Digits

PURPOSE To assess objective and subjective outcomes of distal interphalangeal joint arthrodesis with a headless compression screw for degenerative osteoarthritis. METHODS We retrospectively analyzed 102 cases of distal interphalangeal joint arthrodesis performed with headless compression screws on 59 patients. We included only primary cases of degenerative osteoarthritis with a minimum follow-up of 7 months. We identified appropriate bone coaptation and hardware positioning on postoperative radiographs in all digits. The mean follow-up period was 26 months (range, 7-67 mo). RESULTS In 89 of 102 cases, patients were fully satisfied; in 9 cases, they were satisfied. Four complications occurred: 2 cases of prominent hardware, 1 complex regional pain syndrome type 1, and 1 symptomatic bony callus on the fused joint. Secondary surgery was required in each of these 4 cases. No nonunion, malunion, nail dystrophy, pseudarthrosis, or infection occurred. All arthrodeses healed. CONCLUSIONS Distal interphalangeal joint arthrodesis with headless compression screws was shown to be safe and effective in cases of degenerative osteoarthritis, with a low complication rate.

Perineural fat grafting in the treatment of painful end-neuromas of the upper limb: a pilot study.

The purpose of this study was to evaluate the effectiveness and middle-term durability of the results achieved with perineural fat grafting of painful neuromas of the upper limb. We retrospectively analysed eight patients, affected by eight neuromas, treated by neuroma excision and fat grafting around the proximal nerve stump. Clinical parameters, the disabilities of the arm shoulder and hand score, and the visual analogue scale were recorded at 2, 6 and 12 months after surgery. A reduction of 23.2% was observed in the mean disabilities of the arm shoulder and hand scores at 12 months. The spontaneous baseline visual analogue scale score showed a mean improvement of 22% at 12 months, although not this was not statistically significant. Perineural fat grafting is a quick and useful procedure and could represent a useful primary operation in the treatment of pain syndromes of neuropatic origin.

Perineural fat grafting in the treatment of painful neuromas.

Treatment of painful neuromas of the upper limb has been largely debated. The current surgical treatments spare from simple neuroma excision to proximal nerve stump relocation (into muscles, veins, and bones). Perineural fat grafting consists of neuroma excision and the creation of an autologous adipose graft wrapped around the proximal nerve stump. This technique should be prescribed to those patients suffering from terminal neuromas or neuromas in which functional reconstruction is contraindicated. The effectiveness of this technique could be addressed both to the mechanical and biological properties of the fat graft. On one hand the graft creates a gliding layer and a protective barrier, thus allowing longitudinal excursion and protection against mechanical solicitations. On the other hand the autologous adipose tissue brings neoangiogenesis, modulates the inflammatory response, and avoids scar adherences. A retrospective analysis was performed on 7 neuromas in 7 patients, treated with perineural fat grafting from June 2009 to February 2010. Pain and limb functionality were measured, respectively, with a visual acuity scale and the “Disabilities of the Arm, Shoulder, and Hand score,” preoperatively and 1 year after surgery. A mean pain reduction of 23% was recorded, without relevant complications. Improvements in limb functionality were also observed through the measurement of the Disabilities of the Arm, Shoulder, and Hand score, which improved to 18%. We believe that this technique represents a valuable and versatile option in the treatment of painful neuromas of the upper limb that could be hereafter performed for pain syndromes of neuropatic origin.

Atypical squamous cell carcinoma of the nail bed with phalangeal involvement.

Abstract We report an atypical presentation of squamous cell carcinoma (SCC) of the distal phalanx of the left thumb. On physical examination, there was no clinical evidence of a local lesion, but magnetic resonance imaging (MRI) showed multiple intraosseous cavities filled with fluid. A biopsy specimen showed a well-differentiated SCC, which was treated by amputation of the distal phalanx.

Tuberous breast: Morphological study and overview of a borderline entity

BACKGROUND Tuberous breasts are widely known and described. Several surgical strategies have been proposed; however, few studies explain the origin or structural alterations of this deformity. No histological studies have been performed. The present article describes a morphological and histological study of breast tissue specimens. METHODS Mammary specimens of 22 female and five male patients with tuberous breasts were histologically analyzed and compared with six specimens harvested from normal female breasts and from three cases of true ‘normal’ gynecomastia. RESULTS A high prevalence of one histological subtype was observed, with the presence of collagen fibres among few fibroblasts. Histochemical analysis highlighted alterations of the arrangement and of the quantity of collagen involving breast structures. CONCLUSIONS Results of the present study suggest that collagen deposition alterations can better explain breast parenchyma modifications. Histological features of male subjects support this theory. Additionally, the observation of two cases in male homozygous twins suggests the role of genetic influences.

Reconstruction of a full-thickness alar wound using an auricular conchal composite graft

Nasogastric intubation has become a frequently used method for alleviating gastrointestinal symptoms. Necrosis from alar pressure during prolonged nasogastric and nasotracheal intubation is common, and can result in considerable deformity if it is unrecognized. The reconstruction of full-thickness alar wounds often requires multiple challenging surgical procedures. Difficult full-thickness alar defects often require nasal mucosal replacement for lining, cartilage batten graft support for the preservation of nasal function, and skin coverage for the restoration of an aesthetically correct appearance. Free composite conchal grafting can offer a single-staged, one-step repair of difficult full-thickness alar wounds that are no larger than 1.5 cm in size. A thorough explanation of the graft design and execution is presented, as well as a case report and literature review. Free composite con-chal grafting can produce aesthetic and functional results that rival the most sophisticated flap reconstructions of the lateral ala.

Bona fide primary Merkel cell carcinoma of an intraparotid lymph node in a HIV-positive patient.

Merkel cell carcinomas are uncommon malignant tumors thought to originate from the neuroendocrine cells of the skin that mainly affects sun-exposed body areas, particularly the head and neck. In approximately 10% of cases, they present with localized lymphadenopathy without any clinical evidence or history of a primary lesion, but a truly primary lymph node Merkel cell carcinoma may occur, possibly originating from epithelial inclusions or an anomalous neuroendocrine differentiation of hematopoietic stem cells. It has been observed that Merkel cell carcinoma is more likely to affect patients whose immune status is impaired as a result of iatrogenic immunosuppression, human immunodeficiency virus infection, or hematological malignancies. This study reports the case of a bona fide primary Merkel cell carcinoma arising in an intraparotid lymph node of a patient infected by HIV that had a particularly unfavorable clinical course.

Gynecomastia and Tuberous Breast: Assessment and Surgical Approach

We read with great interest the article published by Cannistra et al. [1] about gynecomastia with severe ptosis and its treatment. We would like to point out that some forms of gynecomastia do not match properly the existing classifications [2–4]. Tuberous breast deformity can be associated with gynecomastia, with the same features as the corresponding condition in females. We suggest considering this a separate entity in male patients and we propose a specific surgical procedure. From January 2005 to January 2008 we treated six patients with gynecomastia and tuberous breasts using our technique. We combined traditional liposuction by the tumescent technique, standard maneuvers to reduce skin and gland excess, and gland redraping. About 50 ml of saline solution and 10 ml mepivacaine 2% with epinephrine 1:100,000 was injected via a 2-mm incision in the inferoexternal quadrant. Liposuction using a 2-mm blunt cannula was performed beneath the entire mammary region. A concentric circle entirely around the areola was deepithelized. A semicircular, infra-areolar incision of the dermis was made, leaving a superior dermal pedicle to the nipple-areola complex. A cone-shaped mass of breast tissue beneath the areola was resected. As with female tuberous breasts, the constricted base was released with electrocautery and radial incisions of the residual breast fibrous tissue beneath the areola were made. After hemostasis, a suction drain was placed laterally. An intradermal purse-string peripheral suture allowed areolar repositioning. Compressive elastic dressing was used to prevent seroma or hematoma. Elastic garments were kept on for 2 weeks postoperatively. At 1-year follow-up the cosmetic appearance was excellent in all patients (Fig. 1). Appropriate diagnosis is essential for treatment. Our studies on tuberous breasts in female patients suggest that

Reconstruction for failed trapeziometacarpal implant.

Trapeziometacarpal prosthesis by metallic implant is used to treat thumb carpometacarpal osteoarthritis. Many causes of failure have been described whereas revision techniques still remain a challenging surgery. In this article, we describe a revision strategy in a failed metallic cemented trapeziometacarpal implant with major first metacarpal shortening.