Search

Aims Carpal tunnel (CT) syndrome is a recognized red‐flag of cardiac amyloidosis (CA) and increased cardiovascular (CV) morbidity. We designed this study to characterize the CV profile of patients with CT syndrome at the time of first surgery and to identify high‐risk presentations. Methods and results We retrospectively reviewed 643 patients who underwent CT surgery between 2007 and 2019. Of them, 130 patients (77 years, 45% male patients, left ventricular ejection fraction 62%) with available CV characterization within ±12 months from CT surgery were included. Abnormal loading conditions causing cardiac left ventricular hypertrophy (LVH) were investigated to distinguish explained LVH (Ex‐LVH) from unexplained LVH (Un‐LVH). LVH was found in 66 (51%) patients, 33% of them presented Un‐LVH. Compared with the others, Un‐LVH patients were older (77 and 75 vs. 70 years in Un‐LVH, Ex‐LVH, and non‐LVH, respectively; P = 0.002), had higher rates of electrocardiogram‐echo discrepancy (70%, 14.3%, and 1.6%, respectively; P

Introduction: Breast-conserving surgery (BCS) is a valid method for the reconstruction of partial breast defects, however, there is a great variety of final aesthetic outcomes depending on the location of the tumor in the breast and also on the initial breast volume and the degree of ptosis. Specifically, defects affecting the upper inner/central quadrant represent a reconstructive challenge with not always satisfactory final results. For this purpose, the authors investigated the use of the central mound technique in breast-conserving surgery. The aim of the study was to apply the central mound as an oncoplastic technique and assess the satisfaction rate of the patients. Materials and methods: This was a retrospective study that involved 40 patients (80 breast) underwent breast conserving surgery and contextual bilateral breast remodeling with central mound technique. A pre- and postoperative Breast-Q questionnaire (breast conserving therapy module) was given to all the patients before the surgery, 3 months and 9 months after. The statistical analysis with chi-square test was performed. Results: After 9 months the author found a major increase of all BREAST-Q parameters; the most valuable increments concerned the "Satisfaction with breast" and "Psychosocial well-being." None of the patients experienced a decreased in the quality of life related to the surgical procedure. Conclusion: The authors believe that this technique has useful functional and aesthetic results particularly appreciated by patients with upper pole lesion who have a slightly or moderately breast ptosis and a small cup size.

Surgical site infection in implant-based breast reconstruction is a complication with variable incidence reported in the literature. Due to potential loss of implant and reconstruction, it can have a strong psychological impact on patients. Background and objectives: This study aimed primarily at analyzing the current status of the surgical site infection (SSI), (type, time of onset, clinical presentation, pathogens and management) in patients who underwent implant-based breast reconstruction at our Breast Unit. Secondarily, we wanted to establish whether introduction of a new, updated evidence-based protocol for infection prevention can reduce SSI in implant-based breast reconstruction. Materials and Methods: A single-center retrospective study was performed primarily to evaluate the incidence and features of SSI after implant-based breast reconstruction from 2007 to 2020. In June 2020, a protocol for prevention of SSI in implant-based breast reconstruction was introduced in clinical practice. Secondarily, a data analysis of all patients who underwent implant-based breast reconstruction in compliance with this protocol was performed after preliminarily assessing its efficacy. Results: 756 women were evaluated after mastectomy and implant-based breast reconstruction for breast cancer. A total of 26 surgical site infections were detected. The annual incidence of SSI decreased over time (range 0–11.76%). Data relating to infections’ features, involved pathogens and implemented treatments were obtained. Since the introduction of the protocol, 22 patients have been evaluated, for a total of 29 implants. No early infections occurred. Conclusions: Surgical site infection rates at our Breast Unit are comparable to those reported in the literature. The SSI rates have shown a decreasing trend over the years. No SSI has occurred since the introduction of the prevention protocol for surgical site infection in June 2020.

Background Licox® PtO2 is a minimally invasive monitoring system for continuous measurement of tissue oxygen tension in all types of free tissue transfers. Our study compares two consecutive series of patients undergoing microsurgical reconstruction monitored with standard clinical bedside surveillance and with the Licox® PtO2 system regarding flap loss and flap salvage, the sensitivity, specificity, and cost-effectiveness. Methods We performed a longitudinal observational prospective study of all patients undergoing microsurgical reconstructions between 2016 and 2017. Group 1 included 43 patients that underwent standard clinical bedside postoperative flap monitoring whereas group 2 included 44 consecutive patients also monitored with Licox® PtO2 system. Flap complications such as return to theater for vascular compromise, partial and total flap loss and flap salvage rate were analyzed. Results We recorded no significant difference between the two groups regarding the rate of vascular complications (P = .31), return to the theater (P = .31), flap salvage (P = .9), partial and total flap loss (P = .36 and P = .49, respectively). When analyzing the Licox® PtO2 system monitoring group, we documented six false-positive results (13.6%) and 0 false negatives with an accuracy of 0.86, a sensibility of 1.00, and a specificity of 0.85. Conclusions This is the first study that provides statistical data about the comparison of postoperative free flap monitoring by standard clinical bedside method and Licox® PtO2 system. For the monitoring of buried flaps, the Licox® PtO2 monitoring can be used only as a supplement to other systems. Its use, compared to near-infrared spectroscopy or clinical bedside monitoring, was not found cost-efficient.

Summary:. Preoperative blepharoplasty markings might be challenging, especially for young surgeons. It takes experience to carefully evaluate the amount of skin excess that can be safely removed. In the current study, we explored the use of microsurgical vascular clamps as a novel and useful tool in the preoperative upper blepharoplasty markings; they made it possible to directly visualize the amount of skin to be removed, facilitating the surgeon (especially the young surgeon) preoperative markings process. In our series, 30 patients underwent upper blepharoplasty with preoperative application of microvascular clamps with satisfactory results.

Free flap perfusion and arterial pressure management have always had a crucial role in free flap reconstruction. Blood pressure values requested can be reached either by using vasoactive agents or fluid replacement or the combination of both.1,2 In contrast to the most frequently tested phenylephrine, norepinephrine, and dobutamine,3,4 this work evaluates dopamine efficacy in perioperative blood pressure management. In our institution, dopamine infusion is the only vasoactive agent authorized in a non-intensive care unit department. This drug stimulates α- and β-adrenergic receptors with positive chronotropic and inotropic effects and reduces peripheral vascular resistance helping in this way to achieve an increase of blood pressure and free flap perfusion.5

The Mitek® suture anchors (Depuy Mitek Surgical Products,Inc.Raynham, Massachusetts) are produced in a number of differentsizes(micro, mini, GII, and Super) but we use the mini. It is composed of a body and two wings, the body being made oftitaniumalloy, and the wings of nickel-titaniumalloy, which benefits from superelasticity and its memory of shape. The packaging includes both the anchor and the insertion device, in which the anchor is already preloaded. The bottom of the anchor has a loop that contains the suture, which is charged on to the insertion device.

This book is especially focused on the surgical aspect on Gender Dysphoria. Male to female surgery is widely discussed as well as the female to male conversion. Full information on hormone administration and surgical procedures are provided. Mental health issues are also described, as well as ethics, the law and psychosocial issues. The text is extensively referenced and includes numerous photos, tables and figures to clearly illustrate information. Based on collaboration between international experts in transgender health, this book is an essential guide for health care professionals, educators, students, patients and patients’ families concerning the psychological, hormonal, surgical and social support of transgender individuals.

Total phallic construction is an important step in surgical treatment of female-to-male transsexuals (FTMT) for gender reassignment. Female-to-male gender reassignment consists of subcutaneous mastectomy, hysterectomy, salpingooophorectomy, and vaginectomy which are performed typically prior to phallic construction and insertion of penile and testicular prostheses which can be done simultaneously or at a later stage. The ideal total phallic reconstruction should create an aesthetically acceptable, sensate phallus with the neourethra permitting voiding in a urinal and enough tissue to allow for insertion of a penile prosthesis permitting sexual intercourse [ 1 ]. However, selection of the reconstructive method depends largely on patients’ desires: some of the patients prefer a reconstruction without the neourethra; others may refuse insertion of a penile prosthesis. Historically, the fi rst penile reconstructions started in the late 1930s with random pedicled oblique abdominal tube fl aps with no neourethra and optional insertion of costal cartilage to obtain rigidity [ 2 ]. Later, in the 1940s, in order to reconstruct the neourethra, the “tube-within-a-tube” concept was added to the original Borgas’ technique [ 3 , 4 ]. With the advent of axial pattern fl aps, the groin fl ap was introduced into phallic reconstruction. Because it was wedge shaped and insensate, it never gained popularity [ 5 – 7 ]. Pedicle musculocutaneous fl aps from the thigh (gracilis) led to poor results and were abandoned [ 8 , 9 ]. In 1984 Chang and Hwang published a series of 7 total phallic reconstructions by the free radial forearm fl ap which revolutionized phallic reconstruction. This fl ap offered the possibility of reconstructing a well-vascularized, sensate penile shaft of generous dimensions and neourethra using the “tube-within-a-tube” principle from the non-hirsute skin in one stage, making possible an insertion of a penile prosthesis [ 10 ]. Later, the design of this fl ap has been modifi ed to improve the aesthetic results and to reduce the complication rate (mainly connected to meatal stenosis and urethral fi stulae) and the donor site morbidity. Other microvascular reconstructions include the island lateral arm fl ap [ 11 , 12 ], deltoid fl ap [ 13 ], pedicled TFL [ 14 ] fl ap, SCIP fl ap [ 15 ], Z. M. Arnež , MD, PhD (*) Department of Medicine , Surgery and Health University of Studies of Trieste , Strada di Fiume 447 , Trieste 34149 , Italy e-mail: zoran.arnez@aots.sanita.fvg.it

Macrovascular arteriovenous shunt (MAS) between ulnar artery and its venae comitantes: The cause of arterial thrombosis and insufficiency in a distally based ulnar forearm perforator (UAP) flap used for intraoral reconstruction.

Acute orthoplastic surgery treatment of open fractures of the lower leg and foot" is the first ltalian book dealing with the multidisciplinary Ortho-Plastic approach to lower limb open fractures after trauma. lt presents the ltalian and international orthopaedic and plastic surgery experience and guides the correct methodology for these complex fractures. The present work was written and financed by the associates of the Società Italiana di Microchirurgia (SIM - Microsurgery ltalian Society)