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Background/Objectives : Currently, there is a lack of a comprehensive classification system for soft-palate defects that provides synthetic information to guide functional reconstructive treatment. Our awareness, shaped by extensive experience, of the superiority of myomucosal flaps to fasciocutaneous flaps in functional palate reconstruction has driven us to introduce a new defect-based classification system and propose a new algorithm for reconstructing soft-palate defects using buccinator myomucosal flaps. Methods : Soft-palate defects were classified into five classes. A reconstruction algorithm employing buccinator myomucosal flaps-including axial, island, and tunnelized flaps along with their variants as described in previous studies-was utilized. Clinical records, including tumor stage, location, defect size, and details of the myomucosal flap used, were documented. Postoperative speech intelligibility, swallowing, and quality of life (QoL) were evaluated. Donor-site morbidity and complications were also assessed. Spearman's rank correlation was employed to assess relationships between clinical parameters and functional outcomes. Results : Twenty-two patients who had undergone soft-palate resection and subsequent reconstruction were reviewed. Favorable recovery of swallowing and speech was reported in all cases, with a median deglutition score of 6.04 ± 0.85 and no severe velopharyngeal insufficiency observed (speech score: 0.36 ± 0.58). Quality of life assessments indicated satisfactory recovery across physical, social, emotional, and functional parameters. Donor-site morbidity was low (average score: 8.3), with only minor complications observed. Tumor stage showed a significant correlation with speech score (r = 0.44, p = 0.04). Conclusions : The proposed classification introduces a comprehensive, simple, and user-friendly categorization of soft-palate defects, accompanied by a myomucosal reconstructive algorithm designed to guide surgeons through the reconstructive process, aiming to provide optimal functional reconstruction. The study's small sample size and monocentric design may have limited the detection of meaningful correlations, highlighting the need for larger, multicentric studies with objective methods to validate findings.

Background: The surgical treatment of lymphedema has seen advancements in recent years, with supramicrosurgical lymphaticovenular anastomosis (sLVA) gaining global acceptance. The integration of 3D exoscopes into microsurgery offers potential ergonomic and educational benefits. However, systematic evaluation of their efficacy in sLVA remains limited. Methods: A retrospective cross-sectional study was conducted comparing the use of 3D exoscopes to conventional operating microscopes (OM) in sLVA surgeries. Patient data from January 2019 to January 2024 were reviewed, with demographic, clinical, and surgical outcome variables analyzed. Ergonomic assessments were performed using Rapid Entire Body Assessment (REBA) and Rapid Upper Limb Assessment (RULA), while surgeon satisfaction was evaluated through the Microsurgical Intraoperative Satisfaction and Comfort questionnaire (MISCq). Results: An analysis of 25 patients (OM group: n = 14; exoscope group: n = 11) revealed no significant differences in age, sex, etiology, or surgical site between the two groups. Surgical time, number of incisions, and number of anastomoses showed nonsignificant variations between the OM and exoscope groups. Ergonomic assessments indicated potential benefits with exoscope use, particularly for the assistant surgeon. Survey results demonstrated comparable levels of surgeon satisfaction with both instruments, with no significant differences in image quality, contrast, illumination, magnification, visual field, ergonomic maintenance, or stereoscopic orientation. Conclusions: The study suggests that 3D exoscopes are a valuable tool for sLVA supermicrosurgery, offering comparable outcomes to traditional microscopes with potential ergonomic advantages. Their integration into microsurgical practice may contribute to improved surgical comfort and team performance. Further research is warranted to confirm these findings and explore additional factors such as cost-effectiveness and long-term patient outcomes.

Objective: Cancer-related lymphedema represents a potential complication of cancer treatment. The aim of this study is to evaluate the effectiveness of the combination of lymphatico-venular anastomosis and liposuction in the treatment of secondary lymphedema. Methods: We present a retrospective analysis of patients affected by cancer-related unilateral limb lymphedema. Inclusion criteria included previous neoplastic pathology with the consequent development of unilateral limb lymphedema, while the exclusion criteria included the presence of comorbidities and the persistence of cancer, as well as previous lymphatic surgery. The outcomes to be included were a reduction in the limb volume and lymphangitis rate, and an improvement in the quality of life. Patients' data were assessed before surgery and 1 year after surgery. Perioperative management included clinical and ultrasonographical evaluations. Under local anesthesia, lymphatico-venular anastomosis with the supramicrosurgical technique and the liposuction of the affected limb was performed in the same surgical session. Results: A total of 24 patients were enrolled in the study. One year after the surgery, an average volume reduction of 37.9% was registered ( p = 0.0000000596). The lymphangitis rate decreased after surgery from 4.67 to 0.95 per year ( p = 0.000007899). The quality-of-life score improved from 68.7 to 16 according to the LLIS scale. Conclusions: The combination of LVA and liposuction represents a valid strategy for treating cancer-related lymphedema, ensuring stable results over time. In addition, it can be performed under local anesthesia, resulting in being minimally invasive and well-tolerated by patients. This paper reports on the short-term efficacy of this combined technique.