Stefano Chiummariello

An approach to managing non-melanoma skin cancer of the nose with mucosal invasion: our experience

Conclusions. The absence of recurrences after final nasal reconstruction demonstrates the reliability of our three-stage strategy and the necessity to delay nasal reconstruction, focusing attention on oncological safety for nasal non-melanoma skin cancer (NMSC) with mucosal invasion. Objectives. To validate a therapeutic strategy aimed at oncological safety and minimization of possible recurrences after full-thickness excision of nasal NMSC with mucosal invasion. The strategy was divided into three stages: surgical excision with clinically safe perilesional skin margins and extemporary frozen section histological control; 8–15 months follow-up leaving the nasal defect unreconstructed with a ‘wait and see’ strategy; new extemporary histological control of defect margins and, if negative, definitive reconstruction. Patients and methods. Twenty patients affected by nasal NMSC with mucosal invasion were treated and followed up. Results. Basal cell carcinoma was the most common lesion (75%), followed by squamous cell carcinoma (25%). Ultrasonography excluded lymphatic involvement for SCC. Before final reconstruction, extemporary histological examination revealed the presence of tumour cells in three patients. After tumour extirpation, these patients were resubmitted to a new follow-up period before reconstruction. No recurrences were observed after definitive nasal reconstruction in all patients during the 5-year follow-up.

Correction of Hypospadias With a Vertical Preputial Island Flap: A 23-Year Experience

PURPOSEnWe report our experience using the preputial island flap technique (Scuderi procedure) to correct penile hypospadias.nnnMATERIALS AND METHODSnA total of 152 patients underwent repair between 1982 and 2004. Nine patients (6%) had proximal hypospadias, 46 (30%) had mid penile hypospadias and 97 (64%) had distal hypospadias. A total of 146 patients (96%) had not previously undergone surgical treatment, while 6 (4%) had undergone surgery.nnnRESULTSnAfter the primary repair 3 patients had fistula and 10 had mild stenosis. The immediate success rate was 91.4% (139 of 152 patients), which later increased to 98% (149 of 152) after nonsurgical treatment of the stenoses.nnnCONCLUSIONSnPreputial island flap urethroplasty is a versatile operation that corrects hypospadias and is particularly indicated if there is associated severe penile curvature, with a low complication rate and superior cosmetic results.

Clinical and morphological characteristics of head-facial haemangiomas

BackgroundHaemangiomas of the head or face are a frequent vascular pathology, consisting in an embryonic dysplasia that involves the cranial-facial vascular network. Haemangiomas show clinical, morphological, developmental and structural changes during their course.MethodsThe clinical characteristics of head-facial haemagiomas were studied in 28 individuals (9 males and 19 females) admitted in our Hospital. Sixteen of these patients(n = 16) underwent surgery for the removal of the haemangiomas. All the removed tissues were transferred in experimental laboratories for the staining of microanatomical details, somatic and visceral nerve fibres, adrenergic and catecholaminergic nerve fibres. Beta-adrenergic receptors were died with a fluorescent method. All results were submitted to the quantitative analysis of images and statistical evaluation of the data.ResultsThe morphological results revealed numerous micro-anatomical characteristics of the haemangiomatous vessels. The somatic and visceral nerve fibres were poor and located exclusively in the adventitial layer. There was a marked decrease of adrenergic nerve fibres in the haemangiomatous vessels. The fluorescence of catecholaminergic nerve fibres and the overall area of fluorescent structures were also decreased in haemangiomatous vessels. Beta adrenergic receptors are strongly decreased in haemangiomatous vessels. The morphometrical analysis of images and statistical evaluation of the data confirmed all our experimental results.ConclusionThe catecholaminergic innervation of the human haemangiomatous vessels comprises nerve fibres containing the main catecholaminergic neurotransmitters that are sympathetic in nature. These neurotransmitters are closely related to beta-adrenergic receptors.The sympathetic nervous system plays a key role in the control of the vascular bed flow and vascular motility in both normal and haemangiomatous vessels.

Postoperative Management of Ala Nasi Surgery: A New Device

Full-thickness ala nasi cancer excision and reconstruction by pedicled flap may result in postoperative local narrowing caused by scar contracture and constant inspiratory forces. To guard against postoperative contracture and narrowing of the ala nasi, we use a nasal stent to serve as a mechanical barrier to inward scarring. The stent is fashioned from a standard rubber connector for silicone drainage tubes. A segment of the connector is then cut with heavy scissors to create a 2-cm-long soft cylinder. The stent is kept in place by the nostril margin and a downward double-knot stitch (Nylon 3/0) externally fixed on the stent, and the remaining thread attached to the dorsum of the nose by a steristrip. We usually coat the stent with an antibiotic cream and keep it in place for 1 month postoperatively, with weekly cleaning. We consider this method simple and safe for the management of postoperative ala nasi reconstruction surgery.