Roberto Cuomo

Cellulite treatment: a comprehensive literature review

An effective and long‐term treatment of cellulite has not been well established. To our knowledge, no review has analyzed the whole range of treatments for this condition. We conducted a review of in vivo studies on humans adopting the key words “cellulite” and “treatment.” The studies were included according to eligibility criteria. We performed an analysis to estimate the overall effect of cellulite treatments from clinical studies. Medline library was screened up to December 2014 to identify eligible studies. We included 73 original studies in the present review. All of them were clinical studies, in most of them, only women were recruited. Above the studies searched up, 66 tested the effectiveness of an exclusive treatment performed without the association to other procedures: 11 topical agents, 10 shock‐wave therapy, 10 radio frequency, eight laser therapy, five oral therapy, four manual massage therapy, three carbon dioxide therapy, two compressive therapy, two infrared therapy, one dermabrasion, and 11 devices that use an association of multiple treatments. Seven papers tested a combination of two or more treatments. The mean difference of clinical morphologic features and ultrastructural changes between the treated group and the controlled showed significant heterogeneity between studies. It is still difficult to indicate an exclusive and effective single treatment for this condition. Our analysis purposed to obtain a complete overview of the available treatments in cellulite reduction.

Carbon dioxide therapy and hyaluronic acid for cosmetic correction of the nasolabial folds

The main application of hyaluronic acid filling, in esthetic medicine, is the augmentation of soft tissues. The carbon dioxide therapy, instead, improves quality and elasticity of the dermis and increases the oxygen release to the tissue through an enhancing of the Bohrs effect. The aim of the study was to compare the efficacy, tolerability, and effect duration of hyaluronic acid fillers and the use of carbon dioxide therapy plus hyaluronic acid in the cosmetic correction of nasolabial folds.

Modified Arrow Flap Technique for Nipple Reconstruction

To the Editor: Nipple reconstruction is the final surgical step for the treatment of breast cancer. Nowadays, breast reconstruction after mastectomy usually consider a using autologous fat graft (1), flaps or implants. Nipple reconstruction is an important part of the reconstructive path. The positive effects of this surgical procedure on the psyche of the woman have already been discussed in the past (2). Unfortunately, the reconstruction of the nipple is subject to a very important problem: a not predictable projection loss in time. Many authors tried to solve this problem and many techniques have been described, over the years, for the reconstruction of the nipple, with not always proven efficacy.

Complications associated with medial thigh lift: A comprehensive literature review

Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications. Our aim was to consider the complications and outcomes according to the performed technique, through a wide and comprehensive review of the literature. A search on PubMed/Medline was performed using “medial thighplasty”, “medial thigh lifting” and “technique” as key words. As inclusion criteria, we selected the clinical studies describing techniques of medial thighplasty. We excluded the papers in which complications related to medial thighplasty were not specified. We also excluded literature-review articles. We found 16 studies from 1988 to 2015. Overall, 447 patients were treated. Different techniques were applied. Complications were observed in 191/447 patients (42.72%). The most frequent complications were wound dehiscence(18.34%) and seroma (8.05%). No major complications, such as thromboembolism and sepsis, were observed. Minor complications occurred in a high percent of patients, regardless of the performed surgical procedure. Patients should be informed about the possible occurrence of wound dehiscence and seroma, as common complications associated with this surgical procedure.

Tendon Transfer Surgery: Focus on…

ABSTRACT Median and Ulnar nerve palsy is a devastating condition that compromise hand function. A procedure of tendon transfer may be helpful to restore the movements by linking palsy muscles to other muscles able to contract. Scientific discoveries and technological innovations have profoundly changed this kind of surgery; studies on sarcomeres, for example, changed the concept of tensioning. To date we know that muscle strength and its contraction capacity depends on many factors (not only tensioning) such as sarcomeres length, cellular cytoskeleton and extracellular matrix composition: all of these factors interact together and in a ways not still fully understood, determining the complex concept of “movement.” Technology made possible the production of smaller and more complex prostheses so to open new frontiers for modulation of the tendon length during grasping. These devices, currently studied on computer models, on cadaver or on animals, behaved great impetus to research but are still not suitable for implantation in humans. Challenges are still numerous: for example obtain more biocompatible implantable device, find new surgical approach, new ways to obtain better results for this kind of patients.

Superior Pedicle Mammaplasty without Parenchymal Incisions after Massive Weight Loss.

ABSTRACT Background: After considerable weight loss, the breast suffers significant deformation. The ptotic breast is characterized by a lack of superior pole, tissue excess in the inferior pole, down-migration of nipple-areola complex (NAC) with redundancy of skin tissue. The authors describe a mastopexy technique based on a modulated and progressive reshaping, back rotation, and suspension of mammary gland parenchyma without parenchymal incisions. Methods: Forty-five patients with bilateral moderate or severe breast ptosis underwent mastopexy from January 2011 to January 2014 with complete detachment of breast from the pectoralis major muscle and the plication of parenchyma without any parenchymal incision. Patients were followed up for one year, reporting any complication, and measuring the jugulum–NAC distance. The outcomes were assessed by the patients as well as the surgical team. Results: The aesthetic outcomes were good or excellent in all patients. The new mammary contour and the distance between the jugular fossa and the nipple were stable during this time with a good filling of upper pole. No major complications were reported. Conclusions: This technique gave good breast shape, long-term projection, and upper pole fullness, without parenchymal incisions. It restores breast shape and projection, especially in post-bariatric patients. A similar technique has not been described yet.

A case of extramammary inguinal Paget disease in a male patient: surgical treatment with an abdominal advancement cutaneous flap

Extramammary Paget disease (EMPD) is a rare neoplasm. The clinical case of a 55-year-old man with a two-year history of a pruritic, painless erythematous skin rash on the inguinal region and scrotum is described. After a delay due to improper diagnosis and improper treatments, the patient came to the attention of the Division of plastic surgery. He underwent a punch biopsy and the pathology report came back as EMPD. Surgical excision was carried out, and an abdominal advancement cutaneous flap was performed for the defect repair. This is the first description of a reconstruction after surgical removal of inguinal EMPD with a flap of this type and we think that this type of treatment can be useful and reliable for disease localization in the groin area, especially for patients that present an excess of abdominal skin. (www.actabiomedica.it)

Skin graft donor site: a procedure for a faster healing

BACKGROUND The authors want to evaluate the efficacy of fibrillary tabotamp dressing in skin graft-donor site. A comparison was made with Vaseline gauzes. Tabotamp is an absorbable haemostatic product of Ethicon (Johnson and Johnson) obtained by sterile and oxidized regenerated cellulose (Rayon). It is used for mild to moderate bleeding. MATERIALS AND METHODS 276 patients were subject to skin graft and divided into two group: Group A and Group B. The donor site of patients in Group A was medicated with fibrillary tabotamp, while the patients of Group B were medicated only with Vaseline gauze. We recorded infection, timing of healing, number of dressing change, the pain felt during and after the dressing change with visual analog scale (VAS) and a questionnaire. RESULTS Patients allocated in Group A healed faster than the Group B. Questionnaires and VAS analysis showed lower pain felt, lower intake of pain drugs and lower infection rate in the Group A than the Group B. Analysis of coast showed lower dressing change in Group A than the Group B. CONCLUSION We believe that the use of tabotamp is a very viable alternative to improve healing.

Nipple-Areola Complex Reconstruction

The reconstruction of the nipple-areola complex (NAC) is the reconstructive procedure used in patients who have undergone a non-nipple-sparing mastectomy and, in general, in all the patients who need the reconstruction or creation of the nipple for traumatic damage or congenital absence/malformation. Several methods for the reconstruction of the nipple-areola complex were described. The nipple can be reconstructed using a local flap, a local flap of material with a grafting autologous/allogeneic/synthetic inside, a skin graft, or a subdermal pocket with grafted material inside. The areola can be reconstructed using skin graft from hyperpigmented areas or tattoo. The prosthesis (internal or external) and the three-dimensional tattoo allow the reconstruction of the NAC in one time and with a single method.

Vaginoplasty: What's New From 1946 to Date Commentary on: Vaginoplasty with Acellular Dermal Matrix after Radical Resection for Carcinoma of the Uterine Cervix

“Vaginoplasty is the art of plastic repair of herniations of the urethra, bladder and rectum into the vaginal sheath”; Robert Toll defined the term “vaginoplasty” in his manuscript titled “VAGINOPLASTY” in 19461 by these word, describing surgical procedures to decrease “a sense of things dropping out”.2,3 To date “vaginoplasty” means still correcting structural defects, but still also reconstruct vagina or a part of it after cancer surgery, after malformation, or for sexchange purposes.4–7 Mayer-Rokitansky-Kűster-Hauser syndrome is one of the most important malformative diseases, which needs a surgery for vaginoplasty. This syndrome is diagnosed every year in 1/4,500 female and its etiology remains unknown. Phenotype is characterized by Mullerian duct structures agenesis and vaginal atresia is one of most common variant. Other abnormalities can involve uterus, kidneys. and skeleton.8–11 The main reason for a surgeon to perform a vaginoplasty, however, remains the cancer, in particular the uterine cervix carcinoma. Its epidemiology has undergone radical change in the last 10 years: screenings with Papanicolaou test (Pap-test) allows more and more patients to develop precancerous or early cancer, with a significant reduction in mortality. Gold standard treatment for patients with uterine cervix carcinoma at stage Ia to IIb is radical resection including a part of the vagina plus radiotherapy.12–14 Despite gold standard, surgery and radiotherapy often produce important reconstructive issues determining a narrowing of vagina with significant problems for patients.15–17