Stefano Scamoni

Our experience of nipple reconstruction using the C-V flap technique: 1 year evaluation

There are several procedures available for nipple and areola reconstruction after radical mastectomy, many of them providing good results. This study presents a 1 year evaluation of nipple and areola reconstruction, using the C-V flap technique and areola tattooing. Twenty-nine patients who underwent breast reconstruction with implants in our department, between January 2006 and January 2007, were evaluated and asked to return to conduct a follow-up control. They all completed a questionnaire focusing on patient satisfaction using a 1-10 point visual scale. Nipple measurements were taken with a calliper: the average nipple projection of the reconstructed nipple after 1 year was 3.52 mm, compared to 4.96 mm for the native nipple. The fading of colour of the tattooed areola and the match with the native areola were estimated with computer software (Adobe Photoshop). The technique results were simple, reliable and safe; overall patient satisfaction with the procedure was good.

Acellular dermal matrices and radiotherapy in breast reconstruction: a systematic review and meta-analysis of the literature.

The increasing use of commercially available acellular dermis matrices for postmastectomy breast reconstruction seems to have simplified the surgical procedure and enhanced the outcome. These materials, generally considered to be highly safe or with only minor contraindications due to the necessary manipulation in preparatory phases, allow an easier one-phase surgical procedure, in comparison with autologous flaps, offering a high patient satisfaction. Unfortunately, the claim for a higher rate of complications associated with irradiation at the implant site, especially when the radiation therapy was given before the reconstructive surgery, suggested a careful behaviour when this technique is preferred. However, this hypothesis was never submitted to a crucial test, and data supporting it are often discordant or incomplete. To provide a comprehensive analysis of the field, we searched and systematically reviewed papers published after year 2005 and registered clinical trials. On the basis of a meta-analysis of data, we conclude that the negative effect of the radiotherapy on the breast reconstruction seems to be evident even in the case of acellular dermis matrices aided surgery. However, more trials are needed to make solid conclusions and clarify the poor comprehension of all the factors negatively influencing outcome.

Treatment of primary axillary hyperhidrosis with botulinum toxin type a: our experience in 50 patients from 2007 to 2010.

Background. Local injections of Botulinum toxin type A (BTX-A) are an effective and safe solution for primary bilateral axillary hyperhidrosis. Traditional treatments are often ineffective and difficult to tolerate. This study was performed to assess the efficacy and safety of Botulinum toxin type A in the treatment of these diseases and to evaluate the reliability of patients subjective rating in the timing of repeat injections. Methods. From 2007 to 2008, we included in the study and treated a total of 50 patients, and we used the Minors iodine test and the hyperhidrosis diseases severity scale as initial inclusion criteria and also for evaluating the followup, comparing to patients subjective rating. We used also a specific questionnaire to evaluate the level of pain, the onset of the effect, any eventual adverse effect of the treatment, the onset of compensatory hyperhidrosis, and the global grade of satisfaction. The data were analyzed using standard statistical methods. Results. 88% of patients were totally satisfied and all patients repeated the treatment during all the study. The symptom-free interval was in median 6 months with an average improving of HDSS of 1.5 points. In 86%, there was a complete accordance between the subjective patients demand of the repetition of the treatment and the positivity to Minor test and HDSS. No major side effects happened. Conclusion. Local injections of Botulinum toxin type A (BTX-A) result in an effective and safe solution for bilateral axillary primary hyperhidrosis for the absence of significant morbidity, side effects, and lack of efficacy or duration. The only defects are the need of repetition of the treatment and relative costs.

Reconstructive management of degloving trauma of male external genitalia using dermal regeneration template: A case report

Traumatic injuries of male external genitalia are rare and not usually life threatening; however, they can have psychological repercussions. The reconstructive management of these lesions is challenging and articulated. We report the case of a 38-year-old farmer suffering from a degloving wound on the external genitalia. The first reconstructive step used to treat the wound was the incorporation of a dermal regeneration template (Integra(®)) and accordingly partial-thickness skin grafts and local flaps. The follow-up 16 months after the first treatment was satisfying; sexual function had been restored.

A Modified Rhomboid Flap: The “Diamond Flap”

Rhomboid flaps are frequently used in facial reconstruction to repair rhombus-shaped defects. The aesthetic and mechanical properties of these flaps make them especially useful for reconstruction of defects on the cheek, temple, lips, nose, and eyelids. Rhomboid flaps are full-thickness cutaneous local flaps with a random blood supply; they rely on the dermal–subdermal plexus of blood vessels. Limberg first described a transposition flap for closing a rhomboid-shaped defect in 1946. This flap is used to repair a defect that has a configuration of a rhombus with two opposing 60° and two opposing 120° interior angles. Dufourmentel modified this technique in 1962 to close defects with any acute angle. Quaba proposed a rhomboid flap in 1987 to coverage circular defects.

Granular Cell Tumor of the Toe: A Case Report

Granular cell tumor is a rare tumor of unknown etiology that more commonly affects the oral cavity but can also occur at other sites. The majorities of granular cell tumors are benign and present as a singular dermal nodule. We discuss a case of granular cell tumor of the fourth toe in a 54-year-old patient that was treated with conservative surgery, instead of amputation, and reconstruction with a dermal regeneration template.

Breast reconstruction by tissue expansion: What is the integrity of the chest wall?

BACKGROUND Both tissue expanders and implants are commonly used during breast reconstructions. These devices are the preferred choice of many plastic surgeons around the world during breast reconstruction due to their technical ease of use, low comorbidity and safety. However, several issues such as the integrity of the chest wall during and after tissue expansion remain unclear. Here we present a longitudinal study that shows deformities of the chest wall caused by the use of tissue expanders. PATIENTS AND METHODS A prospective longitudinal study of the chest wall in 36 patients who underwent immediate two-stage expander-to-implant reconstruction from 2010 to 2013 was conducted to evaluate the possible causes of chest wall deformity. Computed tomography (CT) scans of the chest walls were taken before the second-stage reconstruction and after 1 year. Chest wall deformities (graded from I, no deformities, to V, costal fracture) were evaluated with CT scans. RESULTS This study examined 36 breast reconstructions. Chest wall deformities were observed by a CT scan before the second-stage reconstruction. There were eight patients with grade I scores, 14 with grade II, 10 with grade III and four with grade IV. No cases of costal fracture (grade V) were observed. At the 1-year follow-up after the TE/implant change, 22 patients had the same degree of chest wall deformity. Ten patients showed an improvement and four a higher-grade deformity. CONCLUSION Chest wall deformities commonly occur after tissue expander/implant reconstruction. However, the size of the expander, reconstruction timing and filling volume are not correlated with deformity development.

A Novel Surgical Technique to Correct Intrareolar Polythelia

Polythelia is a rare congenital malformation that occurs in 1-2% of the population. Intra-areolar polythelia is the presence of one or more supernumerary nipples located within the areola. This is extremely rare. This article presents 3 cases of intra-areolar polythelia treated at our Department. These cases did not present other associated malformation. Surgical correction was performed for psychological and cosmetic reasons using advancement flaps. The aesthetic and functional results were satisfactory.

Short-Term Effects of Radiotherapy Postquadrantectomy on Internal Mammary Artery and Vein

When a tumor local recurrence occurs a possible approach can be a mastectomy with simultaneous breast reconstruction with autologous tissue. The area involved by tangential radiation portals includes also the internal mammary artery and veins, considered by the most part of plastic surgeons to be the best recipient vessels for a free flap in breast reconstruction. Internal mammary vessels receives low but not necessary insignificant doses during whole breast irradiation; arteries and veins are traditionally considered quietly resistant to the irradiation but limited data on the flux in mammary vessels after radiotherapy are available. The goal of our study (37 patients from September 2011 to February 2012) was to evaluate modifications in vascular parameters of the flux at ultrasonography in the internal mammary chain after adjuvant radiotherapy that could influence the choice of the autologous surgical technique (free or pedicled flap) and the choice of the recipient vessels in breast reconstruction. Based on the results of our study, we would recommend avoiding an irradiated recipient site when no irradiated recipient vessels are available; a preoperative ultrasound evaluation is recommended in patients underwent whole breast irradiation.

A New Algorithm for The Surgical Management of Defects of the Scalp

Scalp reconstruction is a daily challenge for plastic surgeons. The authors propose their algorithm for reconstructive surgery after ablative surgery. They considered not only the size defect but also the anatomical defect and the clinical condition of the patient to achieve the best choice for reconstruction. During the two-year period, a total of 86 procedures were performed on 78 patients. We used five different techniques for reconstruction, including primary closure, graft, local or free flap, and a dermal regeneration template. No statistical difference of complication was observed in the different groups. We consider our algorithm a useful improvement in the management of the defect at the vertex.