Gabriele Delia

A FREE VEIN GRAFT CAP INFLUENCES NEUROMA FORMATION AFTER NERVE TRANSECTION

Neuroma formation is a major problem in nerve surgery and consensus about its prevention has not been reached. It has been suggested that vein covering can reduce neuroma formation in transected nerves. In this article, the Authors propose an easy and novel method of covering by nerve stump capping with a free vein graft.

The orbicularis oculi muscle flap: Its use for treatment of lagophthalmos and a review of its use for other applications

BACKGROUND The management of lagophthalmos in patients with long-standing facial palsy is difficult, since the immobility and scleral show have to be corrected to protect the vision. In this article, the authors describe the treatment of paralytic eye with a static technique using a medially based orbicularis oculi muscle flap (OOMF) from the upper eyelid in patients with lagophthalmos. PATIENTS AND METHODS From April 2006 to May 2008, five Caucasian patients with ages ranging from 45 to 71 years (mean, 61 years) were treated at the Plastic Surgery Unit of Messina University. All patients underwent orbicularis oculi muscle (OOM) transposition flap to support the lower orbicularis oculi and create a suspension of the eyelid. To validate the anatomical features of the OOM transposition flap, four fresh cadaver heads (eight eyelids) were dissected to demonstrate flap viability, feasibility and suspension effect. RESULTS We achieved resolution of the lagophthalmos and good cosmetic appearance in all cases. The distance between the upper and lower eyelid points during eye closing (as for sleep) was reduced postoperatively on the paralysed side compared to the contralateral healthy side. Follow-up time ranged from 3 to 25 months (mean, 12 months). All patients healed well with no complications of the flaps. There was no flap contraction, recurrent deformity or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible. CONCLUSIONS The authors believe that the switching of upper blepharoplasty technique from the upper eyelid to the paralysed and scarred lower lid can be used as a tool to treat lagophthalmos.

Elevator Muscle Anterior Resection: A New Technique for Blepharoptosis.

AbstractBlepharoptosis is a condition of inadequate upper eyelid position, with a downward displacement of the upper eyelid margin resulting in obstruction of the superior visual field. Levator resection is an effective technique that is routinely used to correct aponeurotic ptosis. The anterior levator resection is the procedure of choice in moderate blepharoptosis when there is moderate to good levator muscle function, furthermore, with an anterior approach, a greater resection can be achieved than by a conjunctival approach. The authors describe a modification in the Putterman technique with a resection done over a plicated elevator, plication that was suggested by Mustardè. The technique has been named as elevator muscle anterior resection. The elevator muscle anterior resection inspires from the Fasanella-Servat operation by the use of a clamp, making the operation simple and predictable.

Dorsalis Pedis Adipofascial Perforator flap for great toe reconstruction: Anatomical study and clinical applications

Defects of the dorsum of the foot can be challenging to reconstruct, none more so than the dorsum of the toe. The reverse Dorsalis Pedis Adipofascial Perforator (DPAP) flap is one possible reconstructive option for defects in this region. The aim of this study was to first demonstrate the anatomy of this flap, particularly the consistency of the perforators arising from the dorsalis pedis artery. Second, we present a clinical series based on this flap to demonstrate how it can be used. For the anatomical studies, 22 fresh cadaveric lower extremities were dissected, and injection studies were used to delineate the vascular territories. The presence of the distal perforator, distance to the first metatarso-phalangeal joint and diameter of each perforator were recorded. The cadaveric studies confirmed the presence of distal perforators to the first metatarso-phalangeal joint in 100% of limbs examined. The clinical study demonstrated the feasibility of the use of the adipofascial turn-over perforator flap for dorsal foot reconstruction. These anatomic findings provide an alternative method of reconstruction of great toe defects using the reverse DPAP flap.

Babysitting procedures in proximal nerve trunk injuries: two case reports and a review

One of the most important goals in treating proximal nerve injuries is to maintain the function of distal effectors during axonal regeneration. Babysitting, that is, connecting the injured nerve to a healthy trunk provides a bypass for distal neural regeneration or reactivation. It avoids degeneration of sensory and motor terminations, with minimal donor nerve damage. We present a technique where a nerve graft is used between ulnar and median nerve through two end-to-side sutures in the distal third of the forearm, in two different cases of proximal ulnar nerve injury. Both patients were young manual workers, the former suffered a total nerve disruption proximal to the elbow following a car accident and the latter suffered a perineurial scar from a high voltage injury at the proximal third of the forearm. The proximal injury was grafted with a sural nerve in the former and treated by neurolysis in the latter. Results were graded by the Highet-Zachary scale for both sensory and motor recovery. The outcomes of our series were compared to six other case reports in the literature (including median nerves) treated with this technique. Both clinical and experimental data show that babysitting effectively protects distal effectors.

An anterior-lateral thigh perforator flap on a recipient brachial-radial vein graft for complex wound reconstruction: A case report

A case of challenging microsurgical reconstruction of a difficult defect in a radiated upper limb is reported. A difficult wound, with tendon and bone exposition, developed on the dorsum of the forearm in a 76‐year‐old patient; she had been radiated since almost 50 years and her left hand had also been revascularized twice with venous grafts between the humeral artery and the superficial palmar arch. After failure of a local flap, an anterior‐lateral thigh perforator flap was successfully transferred with end‐to‐side anastomoses on the arterialized venous graft. Up to date follow‐up shows a good outcome. The Authors discuss the case and review the indications for microsurgical reconstruction in difficult wounds after radiation and ischemic limb conditions.

Is the adipofascial flap the key to regenerative surgery

Objectives “Form and function restoration” is the ultimate goal of reconstructive surgery, which is oriented toward regeneration rather than reparation. Recently, research in reconstructive surgery has focused on the regenerative potential of the adipose tissue. The aim of the study is to illustrate the surgical methods and show the functional and aesthetic results achieved by the reconstruction of finger soft-tissue defects using homodigital dorsal adipofascial reverse flap (HDARF). Materials and methods A total of 63 cases (45 acute and 18 elective) were included between September 2010 and August 2016. In each case, we preliminarily performed surgical debridement and then harvested an adipofascial flap from the back of the finger. Nine injured thumbs that were repaired with the flap as emergency cases were also included. The average age of the patients was 46 (range: 4–69) years. Results All flaps survived without any complications during the 24-month follow-up. Good nail regrowth through the flap and full regeneration were observed in approximately all cases. Sensitivity tests and histological analysis of biopsy samples of the regenerated fingers confirmed full regeneration of the epidermis, dermis, cutaneous adnexa, and nerves. All the patients were satisfied with the hand functionality and aesthetic appearance. Conclusion The HDARF represents a very useful alternative for the reconstruction of nailbed crushes, achieving regeneration of injured segments in deformities caused by trauma or infection.

Mastopexy with Implants

Breast ptosis occurs as a physiological downward dislocation of the breast as an effect of pregnancy and lactation in young women, or as a postmenopausal reduction of estrogen in the elderly. Certain medications, weight gain or loss, and genetic predisposition can also contribute to the development of ptosis.

Anterolateral adipofascial turnover flap of the leg: Anatomical study

AIM The aim of this study is to clearly define the vascularisation of the lateral paratibial septum of the leg, defining the basis for a vertical pedicled adipofascial flap harvested from the anterolateral aspect of the leg to cover pretibial soft tissue defects. MATERIALS AND METHODS Twelve cadaver legs (eight fixed with formalin and four fresh) were dissected. The vessels running into the lateral paratibial septum were identified. The number of vessels were noted and evaluated at the lateral border of the proximal, middle and distal thirds of the leg. In addition, an angiographic study was performed on two limbs to confirm the connection between tibialis anterior artery and the overlaying fascia through these septal vessels. RESULTS All the specimens had periosteo-septal vessels running in the lateral aspect of the tibia. The average number was 6.6. The distribution was constant in all the thirds of the leg. CONCLUSION These data are useful to propose the harvesting technique for adipofascial flap with vertical pedicle as a suitable reconstructive option to cover pretibial soft tissue defects.

Anatomical and aesthetical reconstruction of complex hair-bearing areas: a three-step procedure including implant of dermal regeneration templates, skin grafting, and hair micrografting.

AbstractReconstructive surgery of complex hair-bearing skin defects often represents a challenge for the plastic surgeon; indeed, a multistage procedure is to be planned, including a first reconstructive step including local flaps, even if pre-expanded, or for larger defects, microsurgical flaps. To date, the implant of dermal regeneration templates has been proven an effective alternative. The authors relate their results of a complex hair-bearing reconstruction of a scalp and brow defect after a friction road burn with those reported in literature, concluding that a 3-staged reconstruction (dermal template implantation, skin grafting, and finally hair micrografting) can achieve good results in this complex kind of reconstruction. Histological specimens taken 2 years later confirmed a full anatomical reconstruction of the hair-bearing areas. Finally, this paper reports the first case of brow reconstruction performed with these techniques.