Salvatore Carlucci

Distally Based Fasciocutaneous Sural Flap for Foot Reconstruction: A Retrospective Review of 10 Years Experience:

Background: The treatment of soft tissue defects of the foot is a problem mainly connected to the thickness of the coverage tissues, to the poor circulation, and to the frequent involvement of muscle, tendon, and bone. The authors present their experience with the sural flap, also in some particular cases. Materials and Methods: The authors treated 33 patients for small- and medium-size defects of the foot, caused by work, home, and road accidents, and by venous or diabetic ulcers. In all cases, the flap was cut in its fasciocutaneous variant; an extension of the sole portion of fascia was added in 5 patients. The flap was transferred under a subcutaneous tunnel in 10 cases, with an open incision in 20 cases, and in 3 cases the pedicle was kept external for 4 weeks, then resected. Results: One patient showed a complete necrosis of the flap and another showed a superficial necrosis preserving the deep fascia; in the remaining 31 cases, the flap incorporated without any major complication. The flap provided proper coverage of the defects from both an aesthetic and functional point of view as evidenced clinically and through a baropedographic test. Conclusion: The advantages of this flap include: dissection is fast and easy, it is not necessary to sacrifice important arterial pedicle or muscular units as it can be used in traumatized limbs without further damage to main arteries, and a wide rotation arc is possible. Disadvantages include the sacrifice of the sural nerve and the covering of the donor region with skin grafts.

Launois-Bensaude Syndrome: An Unusual Localization of Obesity Disease

BackgroundLaunois-Bensaude syndrome is a rare pathology consisting of adipose masses symmetrically distributed mainly in the superior part of the body. Men are especially affected between age of 30 and 60 as well as chronic alcohol abusers. Etiopathogenesis is attributable to mutations or deletions of mitochondrial DNA, and alcohol is a possible cofactor.MethodsThe current treatment of the disease is described based on the authors’ experience. Four cases treated in our department are retrospectively reviewed regarding comorbidities and type of surgery performed.ResultsA relevant and long-lasting reduction of fat bulges has been obtained in all cases with no major complications except for a mild anemia.ConclusionLaunois-Bensaude syndrome causes a functional rather than esthetic concern due to the peculiar localization of fat bulges. Currently, the only effective therapy is surgery, through lipectomy or liposuction of adipose bulges.

Selective breast reduction: a personal approach with a central-superior pedicle.

Background: Breast reduction shows a greater risk of complications in peculiar cases such as those with gigantomastia, a high degree of ptosis, obesity, smoking, cardiovascular diseases, or metabolic disorders. The authors feel that a reduction in the complication rate can be achieved by safeguarding the vascular and nervous structures of the breast as much as possible. Methods: The authors propose a breast reduction method based on a double central-superior pedicle that was used in 91 patients with a more or less elevated degree of obesity. This technique aims to remove excess tissue, preserving the noble structures of the breast. Beginning from preoperative drawings similar to the ones of Lejour, deepithelialization and wide medial and lateral skin undermining are performed. Next, the excess tissue is removed from the caudal, medial, and lateral portions of the breast and from the deep cranial portion, sparing the horizontal septum that supplies vessels and nerves to the nipple. A “handle” composed of the superior and central pedicles is obtained. After fixing the central pedicle to the thoracic wall, redundant skin is removed, and a vertical or J-shaped suture is made. Results: The authors obtained good breast shape, short scars, and optimal viability of the nipple-areola complex. The results are stable and durable, and the complication rate seems to be very low. Conclusions: The authors believe that this technique may be a valid alternative to traditional methods, especially in vast tissue resections and in cases of considerable nipple-areola complex lift. It is mainly indicated in obese and partial weight loss patients.

Role of systematic scalp expansion before cranioplasty in patients with craniectomy defects

PURPOSE Scalp management is challenging in all types of cranioplasties, particularly following decompression or in case of resorption of a repositioned bone flap. In these cases, reduction of brain volume is constantly associated with tightening of the skin cover. MATERIAL AND METHODS A retrospective analysis of 36 cranioplasties was performed. All patients showed cranial decompression or a large craniectomy. In all cases, cranioplasty was preceded by a preliminary scalp expansion. RESULTS Two patients had expander exposure. One of them underwent re-intervention, to reposition the implant. Complications of the cranioplasty phase were one case of extradural hematoma, five cases of swelling due to liquorrea, four cases of temporary forehead edema, and one case of temporal bulging due to the implant. Cranial decompression and other craniectomy procedures often produce a tightening of the scalp, which makes the cranioplasty problematic. The preliminary systematic scalp expansion performed in all patients resulted in a convenient skin excess that allowed a tension-less closure, preventing the scalp suture from falling right on the edge of the cranioplasty implant. CONCLUSION A systematic preliminary scalp expansion allows one to minimize cranioplasty complications in patients with craniectomies, to anticipate possible necrotic scalp complications in the expansion phase rather than in the cranioplasty phase, and thereby avoid implant loss.

Combination of Two Long-Pedicled Myocutaneous Flaps for Closure of a Complex Contralateral Dorsal Defect

A large and deep oncological defect has been filled up using a very long-pedicled latissimus dorsi myocutaneous flap, together with a trapezius myocutaneous flap, both harvested contralaterally to the lesion. Despite the distance of the defect from the area from which the flaps have been harvested, use of long-pedicled flaps warranted a better flap rotation with less tension and greater availability of bulky tissues. Both flaps were viable, and the recipient site healed uneventfully. The two donor sites were closed directly and healed rapidly. Therefore, a challenging complex thoracic defect was covered immediately after oncological resection through a combination of two myocutaneous flaps contralaterally harvested, which seemed safe and reliable.