Giovanni Zabbia

The Face Lift SMAS Plication Flap for Reconstruction of Large Temporofrontal Defects: Reconstructive Surgery Meets Cosmetic Surgery

Background: Reconstruction of large defects in the temporal region can be performed with skin grafts or pedicled or free flaps. Results are often not optimal because of the patch of a skin graft, lack of availability of local flaps, and distant skin from free flaps. A technique for reconstruction of these defects with local tissue is presented in this article that uses superficial musculoaponeurotic system (SMAS) plication to allow wide advancement of a cervicofacial flap. Methods: Once the defect is outlined, a face-lift–like skin incision is used to raise the flap. The SMAS is plicated with two purse-string sutures that relieve tension on the flap and allow maximal advancement. Thirteen face-lift SMAS plication flaps were used in 12 patients (mean age, 70.2 years) after cancer resection, which was bilateral in one case. Defects up to 8 cm in largest diameter can be closed. In one case of an 8 × 6-cm defect, a 1 × 1.5-cm skin graft was necessary. Results: All flaps healed uneventfully, and no reoperation was necessary. Scars are almost completely hidden and the cosmetic result is satisfactory. The asymmetrical face-lift effect fades out within 6 months. Conclusions: The face-lift SMAS plication (FLISP) flap allows reconstruction of large defects in the temporal region with a local flap providing an excellent cosmetic result and avoiding the need for distant tissue and multiple scarring. This flap provides an example of how reconstructive surgery and cosmetic surgery are complementary and can be mutually beneficial.

Basal Cell Carcinoma Arisen on Rhinophyma: Report of Four Cases

Rhinophyma is characterized by progressive hyperplasia of nasal sebaceous glands, with fibrosis, follicular plugging and telangiectasias. The term “rhynophyma” derives from the Greek words rhino (meaning nose) and phyma (meaning growth). It is considered the final stage of acne rosacea. Though rare in occurrence, malignant tumors can grow over rhinophymatous skin, with basal cell carcinoma (BCC) being the most commonly reported tumor. Although a rare event, the development of BCC should always be sought in presence of rhinophyma, and also small changes of the skin lesion characteristic that it represent. We report four cases of BCC arising on rhinophyma observed between 1998 and 2012. We recommend the need for a histologic examination of the suspicious lesions or all surgically removed tissue in patients with rhinophyma.

Retrospective analysis in lower limb reconstruction : propeller perforator flaps versus free flaps

Background Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery, University of Palermo. In these patients, we evaluated location and causes of defects, types of flaps used, recipient vessels, complications, time to healing, and aesthetic outcome. Results A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four). Recovery time and hospitalization period were eventually shorter in patients with FFs, due to lower rate of complications and revision surgery. Conclusion In the past years, our indications for reconstruction with PPFs in the lower limb have become more restricted, while we favor reconstruction with FFs. Recommendations are provided to orient surgical treatment in small, medium, and large lower limb defects.

Seeding nerve sutures with minced nerve-graft (MINE-G): a simple method to improve nerve regeneration in rats

Abstract Background: The aim of this study was to assess the effect of seeding the distal nerve suture with nerve fragments in rats. Methods: On 20 rats, a 15 mm sciatic nerve defect was reconstructed with a nerve autograft. In the Study Group (10 rats), a minced 1 mm nerve segment was seeded around the nerve suture. In the Control Group (10 rats), a nerve graft alone was used. At 4 and 12 weeks, a walking track analysis with open field test (WTA), hystomorphometry (number of myelinated fibers (n), fiber density (FD) and fiber area (FA) and soleus and gastrocnemius muscle weight ratios (MWR) were evaluated. The Student t-test was used for statistical analysis. Results: At 4 and 12 weeks the Study Group had a significantly higher n and FD (p = .043 and .033). The SMWR was significantly higher in the Study Group at 12 weeks (p = .0207). Conclusions: Seeding the distal nerve suture with nerve fragments increases the number of myelinated fibers, the FD and the SMWR. The technique seems promising and deserves further investigation to clarify the mechanisms involved and its functional effects.

Vascular Grafts and Flow-through Flaps for Microsurgical Lower Extremity Reconstruction

Background The use of vascular grafts is indicated in case of insufficient pedicle length or for complex defects involving both soft tissues and vessels. Venous grafts (for both venous and arterial reconstructions) and arterial grafts (arterial reconstruction) can be used. This study retrospectively evaluated the needs for vascular reconstruction and its results in a clinical series of lower limb reconstructions with microsurgical free flaps. Materials and Methods From 2010 to 2015, a total of 16 vascular grafts or flow‐through flaps were used in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction (8%). Arterial reconstruction was performed in seven cases (six flow‐through flaps, one arterial graft), combined arterial and venous reconstruction in four cases (three vein grafts, one combined venous/arterial graft), and venous reconstruction in one case (one venous graft). The rate of complications and donor‐site morbidity related to vascular graft harvest were evaluated. Results Reconstruction was successful in all cases, despite an overall complication rate of 17 and 8% of surgical revision. Donor‐site morbidity, subjectively evaluated, was minimal with respect to functional deficits and aesthetic outcome. Indications for the different types of grafts are discussed. Conclusion The use of vascular grafts is needed in a relevant percentage of microsurgical reconstruction cases. Venous and arterial vascular grafts, transient arteriovenous fistulas, and “flow‐through” microsurgical flaps showed a safe reconstruction comparable to microsurgical reconstructions without the use of grafts. Donor‐site morbidity secondary to vascular graft harvest is minimal, and in almost 70% of cases no additional scars are needed.

A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap

Patient: Female, 82 Final Diagnosis: Giant basal cell carcinoma Symptoms: Anemia Medication: — Clinical Procedure: — Specialty: Plastic Surgery Objective: Rare disease Background: Basal cell carcinoma (BCC) greater than 5 cm in diameter is called giant basal cell carcinoma (GBCC), or super giant basal cell carcinoma if it has a diameter larger than 20 cm. Giant BCC only accounts for 0.5% of BCCs and super giant BCC is exceedingly rare. On account of their rarity, there are no established guidelines for GBCC treatment. Case Report: We describe a peculiar case of an 82-year-old woman with a GBCC carcinoma of the lower abdominal wall. The tumor was surgically removed with ipsilateral inguinal lymph nodes and the abdominal wall was reconstructed immediately with a pedicled deep inferior epigastric artery perforator (DIEP) flap. Conclusions: Treatment of giant basal cell carcinoma is often difficult, especially in elderly patients with poor general health and multiple pathologies. The pedicled DIEP flap is rotated to cover the loss of substance without tension, and it is easy to harvest and transfer. This flap allowed a good result without local or systemic complication. We present this report as a reminder of the occasional occurrence of extremely aggressive BCCs. We believe that, especially for rare tumors like these, it is very useful for the entire scientific community to publish these cases and the therapeutic strategies used to treat them.

Basal cell carcinoma on rhinophyma: a case series analysis

BackgroundSeveral authors described the presence of malignant tumors that rarely can grow hidden over rhinophymatous skin. Basal cell carcinoma (BCC) is the most commonly reported tumor and it should always be sought and diagnosed in presence of a rhinophyma.MethodsBetween 1998 and 2012, 56 cases of rhinophyma were treated at our department. There were 54 males and 2 females with an age range between 34 to 87 years. In all cases of major or moderate degree, scalpel decortications was executed, while in cases of suspicious lesions, a biopsy and histological examination was also indicated.ResultsIn this series, six cases of BCC were diagnosed and treated showing an incidence rate higher than 10 %.ConclusionsOur results support the need of histological examination of the surgically removed tissue in patients with rhinophyma.Level of Evidence: Level IV, therapeutic study.