New application of purse string suture in skin cancer surgery.

Closure of large wounds may require full-thickness skin grafts, but their use is burdened by donor tissue availability and morbidity; the use of the purse string technique is an elegant way to overcome this problem. The study highlights the gain in terms of graft donor site morbidity and oncological radicality. The study included a group of 47 patients who underwent surgical excision for skin cancer and whose wounds were covered using a purse string suture and a skin graft.

An Alternative Treatment Strategy for Complicated Chronic Wounds: Negative Pressure Therapy over Mesh Skin Graft.

Extensive skin defect represents a real problem and major challenge in plastic and reconstructive surgery. On one hand, skin grafts offer a practical method to deal with skin defects despite their unsuitability for several complicated wounds. On the other hand, negative pressure wound therapy (NPWT), applied before skin grafting, promotes granulation tissue growth.

New lift: the art of facial rejuvenation with minimal incisions rhytidectomy.

Objective: The new lift is a procedure for facial rejuvenation with minimal incision, giving the patient a significant improvement of mid face and neck, with limited dissection and minimal scars. A further "One-stitch" of anchorage to the deep temporal fascia is required to hold tissues. By a minimal surgical access, we get a suitable cheek lift with the improvement of nose-labial folds, mandibular edge and neck contour.

Effect of enzymatic debridement with two different collagenases versus mechanical debridement on chronic hard-to-heal wounds.

A chronic ulcer is usually defined as an injury that does not spontaneously evolve towards healing and does not progress through normal healing stages such as inflammation, proliferation and remodelling. This study was designed in order to compare two types of collagenases with mechanical debridement alone. It was thus possible to evaluate their differences in terms of pain and debridement efficacy.

Female pseudohermaphroditism: strategy and bias in a fast diagnosis. How tricky could be a diagnosis with a wrong anamnesis.

Aim: Congenital genitalia anomalies are a spectrum of malformation, difficult to classify because similar or identical phenotypes could have several different aetiology; therefore it's essential to assess an efficient diagnostic algorithm for a quick diagnosis and to develop an efficient therapeutic strategy. The aim of this study is to underline the importance of imaging in case of ambiguous genitalia due to its high sensitivity and specificity in detecting internal organs and urogenital anatomy.

Material Of Study: We report a case of a young girl affected by a complex genitor-urinary malformation with an initial wrong anamnesis that led to a tricky diagnosis.

Comparative analysis between minimal access versus traditional accesses in carpal tunnel syndrome: a perspective randomised study.

Introduction: Carpal tunnel decompression with division of the transverse carpal ligament has been a highly successful procedure for the treatment of carpal tunnel syndrome. The standard longitudinal incision technique, with a long curvilinear incision, has been the optimal treatment procedure for surgical decompression of the median nerve, for many surgeons. The aim of this study was to compare the traditional open carpal tunnel release (TOCTR) technique with the minimal-access carpal tunnel release (MACTR) technique for the treatment of carpal tunnel syndrome (CTS), presenting our experience.

The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study.

Background: Perforator flaps have become the choice of most reconstructive surgeons because they have decreased donor-site morbidity. Among these flaps, the free anteromedial thigh flap has not yet become a first-choice flap because of the inconstant anatomy of its pedicle. This study aimed to describe the anatomy from different perspectives to highlight common patterns and simplify the flap's application in clinical cases.

The use of botulinum toxin in the treatment of plunging nose: cosmetic results and a functional serendipity.

Introduction: Muscles of the nose are active in facial movements both with the other facial muscles. An active depressor septi muscle (DSN) can accentuate a drooping nasal tip and shorten the upper lip on animation, especially during smiling. Paralysis of the DSN allows the tip of the nose to be lifted up.

Correction of tuberous breast with small volume asymmetry by using a new adjustable implant.

Background: The tuberous breast syndrome is a rare anomaly of breast shape, which can be associated to volume breast asymmetry. We report our caseload in the correction of tuberous breasts with small volume asymmetry by using the Muti's technique associated to the implantation of a new adjustable implant.

Aim: Purpose of the study is to evaluate the efficacy of treating tuberous breast deformity with two different types of implants (a textured round high profile cohesive I implant in the larger breast and a Spectra™ implant in the smaller breast).

A new association between hyaluronic acid and collagenase in wound repair: an open study.

Background: Most ulcers occur with slough and need debridement treatment. Surgical treatment is usually performed but many patients need an additional chemical therapy to promote healing process. This type of wound bed preparation is slower than surgical one, but it is essential in those patients who are not eligible for surgery because of systemic diseases.

Metatypical carcinoma of the head: a review of 312 cases.

Background: Metatypical cell carcinoma (MTC) is a quite rare malignancy accounting for 5% of all non melanoma skin cancers, with features of basal cell carcinoma and squamous cell carcinoma. It can be described as coexistence of basal cell carcinoma and squamous cell carcinoma with no transition zone between them.

Aim: Our review identified a correlation between gender and MTC affected region.

Nasal reconstruction with the two stages vs three stages forehead flap. A three centres experience over ten years.

Introduction: In nasal reconstruction all anatomic layers as cover, lining, and support, have to be replaced to restore proper aesthetics. Forehead skin has been acknowledged as the best donor site to resurface the nose. Traditionally forehead flap reconstruction is performed in two stages, but Millard described an intermediate third stage between flap transfer and pedicle division.

Secondary lipofilling after breast reconstruction with implants.

Background: Several Authors have reported on the use of lipoinjection as a low-risk and low-morbidity procedure that gives good results for the correction of soft-tissue defects.

Aim: The purpose of this study was to review our caseload of fat grafting after breast reconstruction with prosthesis.

Patients And Methods: Between January 2008 and December 2011, 20 patients were treated for breast asymmetries with secondary autologous fat injection after nipple-sparing, skin-sparing and skin-reducing mastectomies breast reconstruction in our Departments.

Two-step surgery for a unique case of idiopathic female pseudohermaphroditism. Surgical treatment in an exceptional combined uro-genital malformation.

A 15 years-old patient was brought to our attention in June 2010 with a complex genito-urinary malformation: fusion of the labia majora and a partial union of labia minora, common urinary and vaginal meatus and clitoromegaly. The patient had a normal sexual feminine hormonal development. After diagnostic iter the patient underwent surgery twice.

Prognostic significance of tyrosinase expression in sentinel lymph node biopsy for ultra-thin, thin, and thick melanomas.

Background: Investigate if the tyrosinase mRNA expression may be predictive of the outcome on ultra-thin, thin, and thick melanoma patients.

Aim: In our study, we sought to correlate tyrosinase mRNA expression to the outcome in a group of 71 patients with thick, thin and ultra-thin melanomas.

Materials And Methods: 71 patients with melanomas underwent a SLNB (sentinel lymph node biopsy) at the "Sapienza" University of Rome.

An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction.

Objectives: The antero-lateral thigh flap (ALTF) has become one of the workhorses of reconstructive procedures of the head and neck. The cosmetic result of this flap is uncertain during the main reconstructive procedure, so free flap contouring in head and neck reconstruction following cancer ablation is usually performed at the end of therapy. To obtain an adequate symmetry of the flap a safe thinning during the primary inset or a secondary defatting may be performed.

Lichen sclerosus in patients with squamous cell carcinoma. Our experience with partial penectomy and reconstruction with ventral fenestrated flap.

Introduction: The vast majority of penile malignant tumors are squamous cell carcinomas (SCCs). After histological diagnosis of penile carcinoma, when possible, more conservative procedures are performed, otherwise it is necessary to perform a total penectomy.

Material And Methods: Ten patients, from 2006 to 2008, underwent to partial penectomy and reconstruction with ventral fenestrated flap technique; five of these patients had lichen sclerosus.

The use of negative pressure therapy and hyaluronic acid for the management of post-traumatic lower limb injury.

Management of severe limb trauma continues to challenge surgeons. Suitable treatment should be individualised for each patient, taking into consideration not only the wound extremity but also the associated injuries, age and socioeconomic status of the patient with the goal to recover function and to improve patient quality of life. The aim of this report is to present a severe degloving multiplane lower limb injury case in which a conservative treatment of the wound was performed with negative pressure therapy and dermal substitute, avoiding amputation and restoring limb function.

Contralateral spinal accessory nerve: a suitable "new" donor nerve for heterotopic nerve transfer in total brachial plexus palsy.

Patients with complete brachial plexus palsy with avulsion of 4-5 roots often have a paucity of suitable donor nerves to provide for a proper functional recovery of the upper extremity. The spinal accessory nerve is routinely employed ipsilaterally for nerve transfer to the suprascapular nerve. The purpose of this paper is to describe the clinical use of the contralateral spinal accessory nerve as a donor nerve for brachial plexus surgery.

Morbidity of selective lymph node biopsy for melanoma: meta-analysis of complications.

Background And Aim: Intraoperative lymphatic mapping and selective lymph node biopsy is accepted worldwide as the standard procedure for staging regional lymph nodes of 1-4 mm thick melanomas, as well as for other neoplasms. Although it is often stated that selective lymph node biopsy is a minimally invasive procedure associated with few complications, few data exist concerning the morbidity associated with the procedure. The present analysis was performed to evaluate the morbidity associated with selective lymph node biopsy in a long-term follow-up.

Feasibility of conservative medical treatment for pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a chronic skin disease with an incidence of 3-10 per million, and it is often associated with underlying systemic disease. A case of PG of the left leg successfully treated with local debridement and advanced and compression dressings, without systemic treatment is reported. Progression and healing of the ulcer was incredibly rapid.

[Metatypical basal-cell carcinoma (MTC) or basosquamos carcinoma (BSC): surgical therapy].

Aim: Nonmelanoma skin cancer (NMSC) is the most common cancer in the world with an incidence 18-20 times greater than that of malignant melanoma. Basal cell carcinoma, which probably arises from immature pluripotential cells, is the most common malignant tumor of the skin in Caucasian. It occurs mostly on sun-exposed areas such as neck and face.

Metatypical carcinoma. A review of 327 cases.

Introduction: Metatypical cell carcinoma is a quite rare malignancy (5% of all non melanoma skin cancers), with features of basal cell carcinoma and squamous cell carcinoma. It is described as coexistence of basal cell carcinoma and squamous cell carcinoma with no transition zone between them.

Materials And Methods: We performed a retrospective study of 327 consecutive patients, diagnosed for metatypical carcinoma.

ABCB5 in peripheral blood of a patient affected by multiple primary malignancies.

Background: Multiple primary neoplasm malignancies syndrome (MPMN), is the presence of two or more abnormal growths of tissue, occurring simultaneously. Although the number of second malignancies is increasing, due to several factors, the presence of triple or quadruple malignancies is still very rare.

Patient And Methods: We report a case of a 78-year-old man, with six primaries: a prostatic adenocarcinoma, breast cancer, two melanoma, a basal cell carcinoma, and a lymphoma in a four years period.