[Regeneration and rehabilitation. Plastic surgery practice in a rehabilitation centre.].

Objectives: Regenerative Surgery aims at the restoration of the loss of structures and functions of the body using four innovative approaches: physical energies, biomaterials, cell products and stem cells.

Methods: The Authors provide an overview of their experience with Regenerative Surgery procedures at the Plastic Surgery Unit of the University of Pavia, Istituti Clinici Scientifici Salvatore Maugeri, in a 10 years period, from 2007 to 2017, for the treatment of extensive acute soft tissue loss, chronic ulcers, disabling scars and degenerative pathologies with different aethiology.

Results: Regenerative Surgery is a well-established and effective practice in a modern Plastic Surgery Unit.

Versatile use of dermal substitutes: A retrospective survey of 127 consecutive cases.

Background: Dermal substitutes are currently largely used for the treatment of huge skin loss in patients in critical general health conditions, for the treatment of severe burns and to promote the healing process in chronic wounds.

Aims: The authors performed a retrospective assessment of their experience with bioengineered skin to possibly identify the most appropriate clinical indication and management for each substitute.

Materials And Methods: The study involved 109 patients with 127 skin defects repaired with dermal substitutes over a 9 years period, from 2007 to 2016.

Long term assessment of intralipotherapy in Madelung's disease.

Madelung's disease is characterised by multiple symmetric abnormal fat masses in the head, neck and upper limbs. Surgical excision or liposuction is the only realistic available option, although palliative in nature. The serial intralipotherapy with phosphatidylcholine/deoxycholate has been proposed as a non-invasive treatment of Madelung's disease.

[Safety of use assessment in a radio-frequency medical device].

The authors assessed the operating safety physical parameters of a bipolar radiofrequency device for aesthetic purposes. According to both Italian and EU guidelines, the authors considered: magnetic field environmental emission levels, electricity induced in the opertator's limbs, operator's exposure and radiofrequency specific absorbance rate (SAR) in treated tissues. Measurements were carried out with isotropic sensors and an inductive current indicator.

The biological effects of quadripolar radiofrequency sequential application: a human experimental study.

Objective: An experimental study was conducted to assess the effectiveness and safety of an innovative quadripolar variable electrode configuration radiofrequency device with objective measurements in an ex vivo and in vivo human experimental model.

Background Data: Nonablative radiofrequency applications are well-established anti-ageing procedures for cosmetic skin tightening.

Methods: The study was performed in two steps: ex vivo and in vivo assessments.

[Update on electrical safety of equipment used in surgery and interventional medicine].

Update on electrical safety of medical equipment used in Surgery and Interventional Medicine. Expanding on the theme of relevant operating safety has become extremely topical as a result of the broad diffusion of electro-medical equipment in medical and surgical practice. This aspect is related to the technical features of the equipment, to regulations to be observed inside medical facilities, to the correct use of the equipment.

Study to determine whether intraoperative frozen section biopsy improves surgical treatment of non-melanoma skin cancer.

Skin cancers are the most common types of cancer and their incidence has shown an increase of ∼4 to 8% per year over the last 40 years. The majority of skin cancers (∼97%) are non-melanoma skin cancers, mainly represented by basal cell (80%) and squamous cell carcinomas (20%). The use of intra-operative frozen section remains controversial in the surgical treatment of non-melanoma skin cancer, being commonly considered an optional tool, the reliability and effectiveness of which remain questionable.

The role of rehabilitative camouflage after cervicofacial reconstructive surgery: a preliminary study.

A randomized, prospective, controlled study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy, to evaluate the psychological benefits from corrective medical camouflage (CMC) following surgical treatment for skin cancer of the face. Twenty-four female patients, following recovery from facial skin cancer surgery, were enrolled in the study over a period of 1 year. The study was performed using two health-related quality of life tests, the Satisfaction Profile (SAT-P) test and the Body Uneasiness Test (BUT).

Hyaluronan-induced cosmetic reconstruction of the nostril.

Tissue loss of the nostrils presents a considerable surgical challenge due to the greatly reduced availability of local tissue within such a peculiar anatomical region. The traditional reconstructive methods, such as direct suture, secondary healing, skin grafts, and local skin flaps, have shown poor provision of desirable cosmetic outcomes in this area. The authors propose an innovative and alternative method of cosmetic reconstruction of small skin defects of the nostril based on a hyaluronan-induced skin regeneration.

Refinements in brow reconstruction: synergy between plastic surgery and aesthetic medicine.

Objective: The purpose of this study was the introduction in clinical practice of the combined application of traditional reconstructive surgery and intense pulsed light (IPL) for the restoration of a post-traumatic eyebrow defect.

Case: The authors present a case of surgical eyebrow reconstruction with an axial temporal hair-bearing scalp island flap. A persistent localized erythema and a marked difference in hair density in comparison with the contralateral one harmed the eventual surgical outcome.

Depletion of the nasal reserve after a mole excision.

The authors present an original case report to warn of a possible severe functional complication that might follow a simple facial skin procedure. A 55-year-old woman underwent excision of a mole along the alar-facial groove, which seemingly healed without immediate complications. Ultimately the patient reported an ipsilateral nasal obstruction 2 months postoperatively.

Hyaluronic acid three-dimensional scaffold for surgical revision of retracting scars: a human experimental study.

An observational study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia - Salvatore Maugeri Research and Care Institute, Pavia, Italy, to assess the clinical and histological long-term outcomes of autologous skin grafting of fresh surgical wounds following previous repair with a hyaluronic acid three-dimensional scaffold (Hyalomatrix®). Eleven fresh wounds from surgical release of retracted scars were enrolled in this study. A stable skin-like tissue cover was observed in all of the treated wounds in an average 1 month's time; at the end of this study, after an average of 12 months' time, all of the reconstructed areas were pliable and stable, although an average retraction rate of 51·62% was showed.

Allogenic platelet gel in the treatment of pressure sores: a pilot study.

Although platelet gel is considered one of the most popular tools in the treatment of chronic ulcers, current consensus on its use is not unanimous. A prospective randomised trial was carried out at the Plastic Surgery Unit of the 'Salvatore Maugeri' Foundation Hospital of Pavia (Italy). The study involved 13 patients affected by spinal cord injury with 16 pressure sores over a period of 20 months.

Breast sculpturing: overcoming the limits of traditional approaches in breast reduction.

Background: A technique based on original refinements of the vertical breast reduction was developed in our department. The aim of the technique was the safe and aggressive sculpture of an attractive breast mound with minimal scarring and long-lasting results that is easy to perform and suitable for teaching purposes in a surgical training unit.

Methods: Fifty consecutive patients who were to undergo bilateral breast reduction were prospectively enrolled in the study.

Is breast reduction a functional or a cosmetic operation? Proposal of an objective discriminating criterion.

Classification of breast reduction as a functional or cosmetic operation is an unresolved issue. Surgical reduction of the breast is equally indicated both for correction of functional sequelae of breast hypertrophy and for a merely subjective aesthetic discomfort. Although several criteria are currently adopted by the national and international associations of plastic surgeons, none of them appears to fulfil the aim of objectively discriminating the functional from cosmetic indications.

Generation of human epidermal constructs on a collagen layer alone.

Because engineered tissues are designed for clinical applications in humans, a major problem is the contamination of cocultures and tissues by allogenic molecules used to grow stem cells in vitro. The protocols that are commonly applied to generate epidermal equivalents in vitro require the use of irradiated murine fibroblasts as a feeder layer for keratinocytes. In this study, we report a simple procedure for growing human keratinocytes, isolated from adult skin, to generate an epidermal construct on a collagen layer alone.

Does the removal of pectoralis minor impair the function of pectoralis major?

The treatment of long-standing unilateral facial palsy with cross-facial nerve graft and free pectoralis minor muscle flap to the face has been the elective choice for more than 300 patients during the last 20 years at Mount Vernon Hospital in Northwood, United Kingdom. In this study, the authors assessed the residual donor-site morbidity in the chest after the procedure. During the second stage of the operation, the medial and the lateral pectoral nerves are divided at a proximal level from the plexus.

Effect of exercise and strength training on cardiovascular status in HIV-infected patients receiving highly active antiretroviral therapy.

A routine evaluation of lipid metabolism and body fat distribution along with a careful cardiovascular risk stratification according to international guidelines are required for HIV-infected patients receiving highly active antiretroviral therapy. Intervention includes evaluation of patients for both epidemiological and clinical factors, and for anthropometric and biochemical parameters. Diet counseling, prescription of antihyperlipidemic drugs and exercise training are the cornerstones of programs devoted to protecting patients from side effects of therapies that compromise quality of life and the functions of organs like the pancreas and heart that are involved in lipid disorders.