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In this paper, we describe our experience in treating migraine headache localized in the occipital area. Using our minimally-invasive approach, from June 2011 till January 2022, we have performed MH decompression surgery over 232 patients with occipital migraine trigger site. After a mean follow-up of 20 months (range, 3-62 months), patients complaining for occipital MH had 94% positive surgical outcome (86% complete MH elimination). Only rare minor complications were reported (e.g., oedema, paresthesia, ecchymosis, and numbness). Presented, in part, at the XXIV Annual Meeting European Society of Surgery (Genoa, Italy, May 28-29, 2022), at the Celtic Meeting of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), (Dunblane, Scotland, September 8-9, 2022), at the Fourteenth Quadrennial European Society of Plastic, Reconstructive and Aesthetic Surgery Conference, (Porto, Portugal, October 5-7, 2022), at the 91st Annual Meeting of the American Society of Plastic Surgery, (Boston, USA, October 27-30, 2022), and at the 76 BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgery) Scientific Meeting, (London, UK, November 30 – December 2, 2022). [ABSTRACT FROM AUTHOR]

OBJECTIVE: The idea to treat migraine patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 11-year experience in migraine surgery. PATIENTS AND METHODS: From June 2011 till December 2021, we have performed MH decompression surgery over 527 patients with either frontal (90 pts), occipital (232 pts) or temporal (205 pts) migraine trigger sites. RESULTS: The surgical procedure elicited a positive response in: (a) occipital trigger site, 95% of patients (86% complete recovery); (b) frontal trigger site, 87% of patients (32% complete recovery); (c) temporal trigger site, 88% of patients (50% complete recovery). CONCLUSIONS: The described techniques allowed us to obtain a high rate of positive results with a low percentage of minor complications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Vitiligo is a chronic acquired pigmentary skin disorder characterized by well-defined asymptomatic white macule as a result of loss of functional melanocytes in the epidermis. The psychological burden experienced by patients is of great interest and consequently research of the best medical approach is constantly developing. This review focuses on surgical approach and the combination of surgery and phototherapy. In addition, reflectance confocal microscopy (RCM) could be useful to discriminate between stable or active vitiligo and to evaluate efficacy of therapy. MATERIALS AND METHODS: We searched PubMed with the following keywords: (vitiligo[ Title/Abstract]) AND therapy[Title/Abstract]) AND surgery[Title/Abstract]) AND phototherapy[ Title/Abstract]) AND reflectance confocal microscopy[ Title/Abstract]). RESULTS: To date, surgery is an effective therapeutic approach in stable vitiligo. Phototherapy, which is the most effective medical option, can improve the results obtained with surgery if performed in combination. Preliminary data show that RCM help physician in evaluating stability of vitiligo and is also useful to monitor clinical response. CONCLUSIONS: Vitiligo is a psychosocially debilitating disease requiring a multidisciplinary approach. Even if a standard management could not be stated, combination of surgery and phototherapy in stable vitiligo could lead to great improvement than monotherapy. RCM is a modern tool which should be used in order to perform surgery and phototherapy properly and to subsequently evaluate efficacy on a microscopic level. [ABSTRACT FROM AUTHOR]

Adipose-derived stem cells (ASCs) are multipotent mesenchymal stem cells (MSCs) that show definitive stem cell characteristics such as plastic adherence in culture, ability to maintain multipotency upon in vitro expansion, and self-renewal capacity. ASCs are particularly promising for use in regenerative medicine because they can be harvested easily from adipose tissue by standard liposuction, with minimal donor site morbidity. Since ASCs do not necessitate ex vivo expansion to obtain clinically significant cell numbers, it is critical to identify a standardized method that maximizes the number of ASCs collected. Based on current literature, there is no standardized method to isolate ASCs for clinical application. Furthermore, clinical studies involving ASCs often show inconsistencies in the reported results. Such studies often use research-derived isolation protocols, which are complex, time-consuming, and involve the use of chemical and animal-derived reagents. In this paper, we present an in-depth review of the available data on ASC isolation protocols. Moreover, we describe our isolation protocol that allows the collection of a ready-touse ASC pellet for clinical application. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common female cancer in Western populations, affecting 12.5% of women, with 1.38 million patients per year. Breast-conserving surgery followed by postoperative radiotherapy replaced the radical and modified-radical procedures of Halsted and Patey as the standard of care for early-stage breast cancer once the overall and disease-free survival rates of breast-conserving surgery were demonstrated to be equivalent to those of mastectomy. However, excision of >20% of breast tissue, low or centrally located cancer, and large-sized breasts with various grades of breast ptosis, result a in unacceptable cosmetic outcomes. Oncoplastic breast surgery evolved from the breast-conserving surgery by broadening its general indication to achieve wider excision margins without compromising on the cosmetic outcomes. Thus, oncoplastic breast surgery can be defined as a tumor-specific immediate breast reconstruction method that applies aesthetically derived breast reduction techniques to the field of breast cancer surgery and allows for higher volume excision with no aesthetic compromise. However, contralateral breast symmetrization should be regarded as an intrinsic component of the oncoplastic surgery. The main procedures involved are volume-displacement or volume-replacement techniques, which depend on breast size and cancer size/ location. Volume-displacement or reshaping procedures apply the plastic surgery principles to transpose a dermo-glandular flap of breast tissue into the defect site, while volume-replacement techniques use autologous tissues to replace the volume loss that follows tumor resection. Furthermore, these procedures are more complex and time-consuming than those involved in breast-conserving surgery. Based on current literature, the authors analyze the different techniques and indications of the oncoplastic breast surgery, determining its complication rate, in order to help both surgeons and their patients in the decision-making stage of breast reconstruction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the efficacy of intraoperative sustained limited expansion (ISLE) by examining the ex vivo biomechanical properties of acutely expanded skin flaps. MATERIALS AND METHODS: Fourteen fresh male cadavers were tested. On both sides of each cadaver, a 4 × 10 cm, the laterally based flap was raised at the external auditory canal of the scalp and a 15 × 8 cm, the proximately based flap was raised at the lateral arm, anterior thorax, and lateral thigh. For each body region, a flap on one side was subject to acute intermittent expansion, while the corresponding contralateral flap served as the control. Both control and acutely expanded flaps underwent stepwise loading to assess their biomechanical properties. RESULTS: No dimensional changes were observed in the acutely expanded flaps when compared to the controls. Mean stiffness and strain values were not significantly different from control values for flaps raised on the scalp, but statistically significant changes were found for those on the lateral arm, anterior thorax and lateral thigh (p < 0.05). CONCLUSIONS: ISLE produced statistically significant biomechanical improvements when applied to the flaps raised on the arm, thorax and thigh, leading to a significant gain in compliance. We suggest that the ineffectiveness of ISLE, when applied to scalp flaps, was due to the inelasticity of the galea aponeurotica. Our findings confirm the general effectiveness of acute skin expansion as means of reducing wound-closure tension after large skin excisions; at least in regions other than the scalp. [ABSTRACT FROM AUTHOR]

The complex procedures involved in the reconstructive surgery of human skin to minimize post-operative scarring are here modeled by means of an automated computational tool. A finite strain no-compression membrane model accounting for the tendency to develop wrinkling regions in the skin is presented. The constitutive behavior of the material is then described by a suitable hyperelastic incompressible potential. Transpositions of skin flaps during surgery procedures are here computationally described by a general mapping technique of the internal boundary corresponding to surgery cut. The archetypal reconstructive surgery of a Z-plasty, where a rotational transposition of the resulting triangular flaps is involved, is considered in details, along with multiple Z-plasty and rhombic flap transposition. The results are discussed in terms of optimal deformation parameters, related to stress/strain localization, displacement discontinuities and wrinkling. [Display omitted] • Skin as a soft no-compression hyperelastic membrane. • Reconstructive surgery involves complex topological manipulations. • Z-plasty, multiple Z-plasty and rhombic flap transposition are studied. • Optimal healing-related and aesthetic-related mechanical parameters are proposed. • Potentials of in-silico testing for reconstructive skin surgery. [ABSTRACT FROM AUTHOR]