Mara Buoro

Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study.

The authors performed an anatomic study on 16 thighs of 11 fresh white cadavers at the Ludwig–Maximilian University of Munchen, Germany. They analyzed the anatomic pattern and caliber of both the lateral circumflex femoral arterial system and the perforators nourishing the anterolateral thigh flap. They found regularly a majority of musculocutaneous perforators, mainly in the central third of the thigh, arising from the descending branch of the lateral circumflex femoral artery. Despite the small number of cadavers, they identified several differences in the anatomy of the lateral circumflex femoral arterial system. These variabilities, especially regarding the descending branch and its perforators, could have clinical importance. They also suggest new dissection studies by comparing white and oriental anatomy. Their aim is to establish whether any difference in the variability of the lateral circumflex femoral arterial system could increase the popularity, currently greater in Eastern Europe, of the anterolateral thigh flap.

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.

Ultrasound Assisted Liposuction for the Palliative Treatment of Madelung's Disease: A Case Report

Abstract. Benign Symmetric Lipomatosis (Madelungs disease) is a rare disease, characterized by massive fatty deposits in the neck, the shoulders, and the upper extremities. The deformity is associated with chronic alcohol use, malignant tumors of the upper airways, neuropathy, diabetes mellitus, hyperlipidemia, and other metabolic disorders. Although the deformity is prone to recurrence, surgical removal via lipectomy or liposuction provides the only way of palliation. This paper describes the treatment of a 51-year-old man with a history of alcoholism and liver cirrhosis. He reported masses in his cervical and facial regions that had gradually enlarged over a period of 6 years. He also developed respiratory symptoms due to the fatty compression of his upper airways. Our experience with ultrasound-assisted liposuction for the palliative treatment of this disease is reported.

A Case of Life-Threatening Sepsis After Breast Augmentation by Fat Injection

Abstract. A case is presented in which an aesthetic breast augmentation by fat injection led a young woman to a life-threatening sepsis due to bilateral mammary abscesses. Immediate and late complications of this procedure are considered; infection is the frightful complication that can lead to septic shock, affecting survival, aesthetic outcome, and reconstruction possibilities of the patients breasts.

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.

Ultrasound-Assisted Lipolysis of the Omentum in Dwarf Pigs

Abstract. Successful surgical treatment of medium degree obesity by subcutaneous liposuction has been reported in the literature. In obesity, most adipose tissue is visceral, mainly omental, and the resection of omentum is a mutilating procedure for the intestinal tract. Because of this, we planned to reduce omental adipose tissue by an apparently conservative approach: ultrasound-assisted lipolysis.The purpose of this study was to assess the feasibility and safety of this procedure in an animal experimental model, drawing clinical and autoptic patterns.We chose pigs because they are functionally analogous to humans, although they store less fat in the omentum, whose structure looks like a veil.Four male dwarf pigs were fed, since weaning, with hyperlipidic fodder. When they were eight months old, they were operated on under general anesthesia in our laboratory for experimental surgery. After laparotomy, the omentum was delivered and treated with ultrasound for 1 hour. Before and just after the sonication, biopsies were drawn from omentum and processed for histologic findings.After 50 days, the surviving animals were sacrificed and autopsied; specimens from omentum, liver, and spleen were histologically processed.Two animals died during the operation, while the two surviving animals were in good general condition.Macro and microscopic observations demonstrated that the ultrasound can liquefy omental fat, sparing its fibrous network in the immediate time; during the postoperative period, an intense inflammatory reaction developed; macroscopic observation evidenced fibrous adhesions of the omentum to the surrounding organs; the connective tissue network was thickened and the whole omentum was twisted on itself.The high mortality rate could be due either to the surgical learning curve or to casualty or to lethal effects of ultrasound on the cardiac conductive system; the inflammatory peritoneal reaction could be specifically due to ultrasound or to surgical handling.