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Objective: The burden of chronic wounds did not disappear during the Covid-19 pandemic, so new ways to address healthcare practitioner (HCP) education had to evolve. The Teach, Try, and Talk (T3) programme was conceived in 2021 with HCPs in southern Europe (Italy, Spain and Portugal). Method: Virtual education sessions with experienced HCP guest speakers were held and a five-layer hydrocellular polyurethane foam dressing (HPFD) was introduced as a way of reducing dressing change frequencies and improving clinician satisfaction. HCPs recorded their experience of the HPFD using an online form and participated in a further virtual session with experienced HCPs to discuss the results. Results: There were a total of 190 responses. A significant dressing change reduction from 3.6 changes per week to 1.8 with the HPFD (pConclusion: The T3 programme is a highly successful method of training delivery and practice improvement across a variety of healthcare settings in southern Europe, helping support HCP engagement and ongoing development in challenging times during the Covid-19 pandemic. The programme can be adapted considering the needs of different HCPs and payor and/or healthcare systems.

In this article, we reported a single case of ischemic fasciitis in a young woman with a progressive immobilization due to a multifocal demyelinating disease of central nervous system, which appeared on an extensive pressure ulcer of the sacral region treated with 10 days of negative-pressure wound therapy (NPWT). Wound examination revealed a significant nontender brown neoformation (9 cm in length × 10 cm in width × 7 cm in height), fixed to the sacrum, presenting hard consistency, and grown in the central portion of the sacral pressure sore. The histologic examination showed central fibrinoid necrosis, and vascular and atypical fibroblastic proliferations, and a diagnosis of ischemic fasciitis was made. Ischemic fasciitis is a rare benign proliferation of atypical fibroblasts that occurs in physically weak patients with reduced mobility. In the literature, the relationship between the use of NPWT on pressure ulcers and the development of ischemic fasciitis is, to the best of our knowledge, not described yet.

The COVID-19 pandemic deeply impacted the capacity of the health systems to maintain preventive and curative services, especially for the most vulnerable populations. During the pandemic, the wound healing centres in Italy assisted a significant reduction of the frequency of their hospital admission, since only urgencies, such as severe infections or wound haemorrhagic complications, were allowed to the hospital. The aim of this multidisciplinary work is to highlight the importance of a new pathway of wound care with patient-based therapeutic approach, tailored treatments based on the characteristics of the wound and fast tracks focused on the outpatient management, reserving hospital assessment only for patients with complicated or complex wounds. This analysis highlights the point that patients with chronic wounds need to be critically evaluated in order to find the best and most appropriate care pathway, which should vary according to the patient and, especially, to the characteristics of the wound. Moreover, the most adequate topic antiseptic should be started as soon as possible. An appropriate and correct management of the wound care will allow to link the knowledge based on years of clinical practice with the new challenges and the need to visit patients remotely, when possible.

Coverage of the heel defects usually represents a challenge for the proper reconstructive requirements of the weight-bearing area of the foot. The presence of multiple limb amputation may represent a further concern for conventional free flap donor sites and the patient’s functional limitation, thus making reconstruction even more challenging. Amputee patients may be subjected to a higher risk of foot ulcerations and choosing the more appropriate reconstructive option in such patients is crucial. Here we describe the application of the medial plantar flap as a first-line option in a 66-year-old amputee patient with a squamous cell carcinoma arising from chronic ulceration on the left heel, that was successfully treated with limited functional limitations and excellent anatomical contour of the foot. Despite its use has been widely described for heel reconstruction, we believe that medial plantar flap would deserve greater relevance in the reconstructive scenario in such challenging cases.

INTRODUCTION Breast reduction is one of the most common procedures performed by plastic surgeons worldwide. Despite that several techniques have been proposed for management of ptotic or hypertrophic breasts, most of them often deal with too large breast bases, poor breast projection, persistent "dog ears," and a certain percentage of bottoming out. Lower-pole shaping of the breast remains one of the challenge of vertical mammoplasty. MATERIALS AND METHODS The authors report their 5-year-long experience with a modification of the vertical scar technique, the "arrow flap," in which they harvest a double lateral glandular and cutaneous flap, to tighten and better shape the base of the breast and to improve the breast projection with a "double-bra" effect. From April 2015 to February 2019, 75 patients with moderate to severe macromastia/breast ptosis underwent bilateral reduction mammoplasty. RESULTS Postoperative outcomes showed an overall satisfactory results and low incidence of complications. Two patients presented with an asymmetry between the 2 breasts, and no nipple-areola complex necrosis occurred. One patient reported a wider vertical scar, whereas no bottoming out was observed. CONCLUSIONS All patients reported a stable and durable projection of the breast, with pleasant cosmetic results. By combining short scars and narrow base, we can obtain a pleasant lower pole reshaping of the breast, even in that challenging cases of large and squared breast. The authors believe that this technique provides a useful surgical option, increasing the versatility of the superior pedicle vertical mammaplasty both for mastopexy and breast reduction, even in cases of severe macromastia.

The real benefit of using drains for reducing the risk of complications in sentinel lymph node biopsy (SLNB) has not been investigated yet. We aimed to evaluate the role of drain after SLNB and to determine if a correlation exists between drains and early complications.This is a retrospective study of patients who underwent SLNB for melanoma from 2016 to 2021. Patients were dichotomized into two groups according to the use of drain. The between-group comparison (drainage group versus no drainage group) was performed by using Mann-Whitney U test and chi-square test. A regression analysis was conducted to identify predictors of complications.Of 218 individuals analyzed, 18 (8.4%) had postoperative complications. The most common complications were seroma (5.1%) and wound dehiscence (1.4%). The between-group analysis showed no significant differences in complication rate, whereas the operative time was significantly higher in the drainage group (Drainage use in SLNB prolonged hospital stays and duration of postoperative antibiotic therapy, thus resulting in higher costs. The preemptive use of drainage is suggested in selected settings of patients.

Sarcomatoid melanoma is an extremely rare pattern of malignant melanoma, and only few cases have been described throughout the literature. We herein report a case of a patient with newly diagnosed, metastatic giant sarcomatoid melanoma of the arm. The patient underwent surgical removal of the huge mass, and NGS sequencing demonstrated BRAF V600E mutation. In view of histological, immunohistochemical and molecular findings, a combined BRAF/MEK inhibitor (BRAF/MEK-i) therapy was prescribed as first line treatment. A complete response (over one year) to targeted therapy was obtained, and no adverse events have been reported. The patient maintained a full range of shoulder and elbow movements, and she is able to live independently and resume her daily activities. We therefore recommend that all patients with undifferentiated melanomas, sarcomatoid cutaneous malignancies or other mesenchymal tumours, should undergo BRAFV600E mutation testing.

Il progetto consiste nella creazione di un opuscolo informativo, all’interno del quale sono spiegate le principali informazioni relative la gestione del paziente portatore di Lesioni da Pressione. Le nozioni espresse sono alla base del percorso terapeutico, in quando sono indirizzate a lettori non esperti nel campo delle medicazioni difficili. Viste le esigenze del pubblico di assistere a questa tipologia di pazienti, in molti casi in maniera autonoma per quanto riguarda la medicazione vera e proprio, si è ritenuto necessario fornire del materiale per aumentare le conoscenze dei caregiver informali. Lo scopo ultimo è proprio quello di fornire un metodo semplice e sicuro di apprendimento per i cittadini che si occupano della gestione del paziente e delle relative medicazioni; considerando sempre un affiancamento da parte di professionisti. Gli obiettivi che ci si pone con il progetto sono: valutare e visualizzare quelli che sono gli aspetti importanti per i soggetti aventi Lesioni da Pressione, questo comprende la definizione, prevenzione, classificazione e trattamento; l’importanza della continuità assistenziale per questa tipologia di paziente; informare il cittadino su cosa sono le lesioni da pressione (quali sono le accortezze quotidiane da dover attuare per evitare il peggioramento o lo stallo della condizione) ed infine il trattamento vero e proprio tramite l’insegnamento delle medicazioni difficili e della loro applicazione in base ai diversi casi (essendo un argomento vasto e materia di specializzazione in ambito infermieristico si tratterà in maniera semplificata in modo da dare informazioni basilari ma utili). Per la creazione dell’opuscolo è stata effettuata una revisione della letteratura che vede la consultazione di due linee guida, undici articoli e due testi.

La guarigione delle ferite è un processo complesso che coinvolge molte interazioni sinergiche tra diverse linee cellulari, citochine, enzimi e fattori di crescita. Negli ultimi anni sono stati introdotti diversi biomateriali e medicazioni bioattive che si ritiene svolgano un ruolo attivo nella guarigione delle ferite. Sia il collagene che l’Acido Ialuronico (AI) sono stati ampiamente adottati per la gestione delle ferite e la sua combinazione, utilizzata come medicazione bioattiva, è stata studiata. Abbiamo riportato la nostra esperienza clinica con una medicazione avanzata composta da AI più collagene eterologo di tipo I applicato su ferite acute e croniche di diversa eziologia in una coorte retrospettiva di 30 pazienti. Tutti i pazienti inclusi avevano ferite cutanee portate a guarigione completa per seconda intenzione, e tutte le ferite sono state trattate utilizzando Bionect Pad® (BP). Se necessario, alcuni casi sono stati gestiti con trattamenti combinati al fine di ottenere un’adeguata preparazione del letto della ferita prima dell’applicazione di BP. Trenta pazienti con età media di 60,2 anni sono stati trattati per ferite di diversa eziologia. La tipologia di ferite trattate includeva ulcere venose, ferite post-traumatiche, complicanze di ferite chirurgiche, lesioni da decubito, ustioni, ulcerazioni peristomali e ulcerazioni cutanee dopo radioterapia. Il tempo medio di guarigione è stato di 31 giorni (range: 21-76 giorni). Sulla base dei nostri risultati incoraggianti, riteniamo che tali medicazioni bioattive possano essere considerate un’alternativa utile e affidabile ad altri metodi di trattamento ben noti e consolidati, come le matrici dermiche acellulari o altre medicazioni avanzate, in casi selezionati.

Presso la Struttura Organizzativa Dipartimentale (S.O.D.) Clinica di Chirurgia Plastica e Ricostruttiva di Ancona sono stati trattati con miele medicale consecutivamente, nell’arco di 24 mesi, 75 pazienti affetti da lesioni cutanee croniche. Nell’articolo vengono descritti gli ottimi risultati ottenuti in termini di riduzione dei tempi di guarigione delle lesioni trattate, e vengono descritte le caratteristiche chimiche e fisiche del miele medicale che ne spiegano in forma scientifica l’azione.

Background Heel reconstruction represents a challenge for all plastic surgeons due to the anatomical and functional features of this weight-bearing area. In the last decade a combined use of acellular dermal matrices and skin grafts has been proposed as a reliable and less invasive alternative for complex wound management; nevertheless only a few cases have been reported in the literature. Methods We describe the long-term outcome of 2 cases of severe degloving trauma of the plantar region with massive soft tissue defects of the foot, that underwent surgical reconstruction with artificial dermis and skin grafts. At the fifth year of follow-up, both patients underwent a clinical and a computerized gait analysis to study their functional outcomes and the kinematics of their gait. Results Both patients recovered functional ambulation and returned to their own work and vocational activities, showing a symmetric gait and parameters of upright posture fully comparable to normality. Conclusions Despite the initial concerns about the use of acellular dermal matrices and skin grafts for this kind of injury, they seem to be a simple and safe alternative for weight-bearing reconstruction of the degloved foot. The authors believe that the current study yields useful information and reassurance about their long-term reliability.

Gorlin-Goltz syndrome is mainly characterised by the development of numerous multicentric and relapsing cutaneous basal cell carcinomas (BCCs). A major problem for patients with Gorlin-Goltz syndrome is the large amount of BCCs that can invade the deep underlying structures, especially the face. Here, we describe the case of a 23-year-old male affected by Gorlin-Goltz syndrome. He had recurrent BCCs on a hairless scalp and dorsum since he was 17 years old and underwent four surgical procedures to excise BCCs, including a reconstruction with anteromedial thigh perforator flap. For each of the surgical procedures, a phenotypic study on peripheral blood mononuclear cells using flow cytometry was performed on the same day of surgery, and on days 7, 14 and 21 after surgery. The role of the tumour-specific cytolytic immune response as a potential future treatment of syndromic BCCs and its trend in relation to surgical ablation of large portions of tumour tissue was examined, and the cosmetic and therapeutic results are shown.

Prontosan® Debridement Pad (PDP; B. Braun) è un nuovo presidio disegnato per migliorare il processo di debridement meccanico. In questo lavoro riportiamo i risultati di un complesso progetto condotto al fine di sviluppare consenso tra gli esperti sul migliore modo di impiegare questa nuova tecnologia nella pratica clinica. Il progetto si è articolato in tre fasi. Nella prima è stata condotta una estesa revisione della letteratura che ha condotto ad identificare, analizzare criticamente e a riassumere in formato strutturato 27 studi clinici pertinenti. Nella seconda fase le evidenze disponibili sono state discusse in modo sistematico con un pannello di 10 esperti, i quali hanno formulato 12 raccomandazioni per l'impiego clinico del PDP. Queste raccomandazioni sono state quindi sottoposte a votazione formale attraverso il metodo GRADE. Infine, nei mesi successivi, 13 casi clinici provenienti dalla pratica clinica routinaria e trattati in accordo con le raccomandazioni stabilite sono stati raccolti e vengono qui presentati. Nel complesso, i dati disponibili in letteratura e quelli raccolti dalla pratica clinica confermano l'efficacia del PDP come strumento per il debridement meccanico, offrendo vantaggi significativi per una ottimale Wound Bed Preparation e per il controllo del dolore. Il nostro progetto può inoltre essere utile per ottimizzare l'impiego pratico di questo nuovo promettente dispositivo. Prontosan® Debridement Pad (PDP; B. Braun) is a new device designed for mechanical debridement. This paper summarizes the results of a complex initiative aimed to develop consensus among a panel of wound care experts about the optimal use of this new technology. An extensive review of the literature found 27 pertinent papers, which underwent a formal process of critical appraisal and evidence extraction by two independent methodologists. Results are displayed in an evidence report. 12 practical recommendations, concerning management of acute and chronic wounds, have been developed and approved. Main point of strength of this project is the use of a systematic approach to literature review, evidence synthesis and presentation, development and measurement of expert consensus. Moreover, expert panel provided further clinical data, through the reporting of 13 clinical cases managed according to abovementioned recommendations, with a particular focus on burns and chronic ulcers treatment, both in adult and pediatric patients. Overall, results from literature review and from clinical experience confirm that the combined system Prontosan® Solution and PDP is a promising tool useful in the critical phase of debridement in acute and chronic wounds treatment. Efficacy in debris removal and pain reduction are the main points of strength. Our project may contribute to optimize clinical use of this innovative device.

Highlights • Giant basal cell carcinomas are rare and potentially aggressive tumors. • Aggressive surgical resection with suggested wide free margins is suggested. • Soft tissue reconstruction for back lesions may be challenging. • The O-Z flap represents a safe and reliable alternative for back reconstruction., Introduction Giant basal cell carcinomas are rare and potentially aggressive skin malignancies that are infrequently reported in the Literature, and they usually require aggressive surgical resection and immediate soft tissue reconstruction with skin grafts or flaps. The large size of GBCCs has relevant implications not only for the metastatic potential, but even for the reconstructive challenging due to the possible limited availability of tissues for flap coverage. Presentation of case We report the peculiar case of an old patient who underwent to GBCC resection of the back measuring 16 × 13 cm, and immediate reconstruction with a large O to Z flap harvested from the back; one-year follow-up examination revealed a satisfactory result and no recurrence of the disease was observed. Discussion The review of the Literature showed that reconstructive options are mainly determined by the site and extent of the defect, exposed structures and patient characteristics and comorbidities, and previous series reported the use of skin grafts only, pedicled myocutaneous or perforator flaps, exclusively free flaps and a combination of techniques. Therefore, in this scenario local flaps such as O-Z flaps are less invasive procedures, that usually have lower rate of postoperative complications and shorter hospitalization compared to more complex procedures. Conclusions Despite the use of O-Z flap is quite unusual for back reconstruction, we believe that this flap represents a valid and safe alternative in selected cases, particularly in the elderly and medically compromised patients with multiple comorbidities.

Background:. Despite the fact that dermal substitutes are widely used in reconstructive surgery, there have been no studies focused on predictors of complications or delayed matrix take. We propose an algorithm for management of soft tissue reconstruction with Integra dermal matrix, based on our 5-year-long clinical experience. Methods:. An estimated 111 patients who underwent Integra reconstruction of full-thickness soft tissue defects of different anatomical sites and etiology were enrolled, and dichotomized in two groups according to complications. Participants were further studied according to the wound healing strategy: healing by secondary intention, skin graft (STSG), and flap surgery. A regression analysis was conducted in the whole sample to identify possible predictors of complications. Results:. No significant differences according to complications were observed. The between-group statistical analysis showed significant differences in age, comorbidities, defect area, diagnosis, and defect site. The regression analysis revealed that the timing of split-thickness skin graft (STSG) was not influenced by age, comorbidities, body mass index (BMI), defect area, site, wound etiology, and risk factors in the subjects who underwent a two-step reconstruction. Healing by secondary intention is recommended for small post-oncological defects of the head, especially in elderly and multimorbid patients. Variables that may interfere with dermal substitutes’ incorporation are independent of the timing of STSG placement; therefore, no predictors of complications or delayed matrix take were identified. Conclusions:. Our findings showed that Integra can be used in a wide range of patients regardless of their general features, thus acting as a useful alternative to conventional reconstructive techniques in selected cases.

Lo scopo di questo articolo è valutare i risultati ottenibili trattando lesioni difficili attraverso la combinazione di ossigenoterapia iperbarica (OTI) e terapia a pressione negativa (TPN). Individuare le modalità con cui queste possano agire in sinergia coadiuvandosi, al fine di ottimizzare la rigenerazione dei tessuti e favorire la guarigione come qualità e tempi più brevi. Sono stati presi in analisi i dati di tre pazienti trattati presso il Centro Iperbarico di Ravenna che presentavano ferite agli arti inferiori aperte da più di sei settimane. È stato eseguito l’assessment iniziale della ferita e applicato un approccio multi terapeutico OTI e TPN per un periodo compreso tra 3-6 settimane. I pazienti presi in analisi sono giunti a guarigione completa entro 10 settimane di trattamento rispetto alla media di presa in carico per 28 settimane degli altri pazienti trattati presso la stessa struttura (dato reale) e alla media di 12 settimane previste nelle linee guida (benchmark). Le due terapie associate hanno prodotto un esito positivo che avrebbe richiesto tempi e costi maggiori se fossero state utilizzate singolarmente. The purpose of this work is the evaluation of the results obtaineble by treating hard to heal wounds with the combination of Hyperbaric Oxygen Therapy (HBOT) and Negative Wound Pressure Therapy (NWPT). Identify how HBOT and NWPT can act in synergy, in order to optimize tissue regeneration and promote a good quality healing and in shorter time. The study analyzes data of three patients affected, for more than six week, by lower limb wounds and treated at the Hyperbaric Center of Ravenna. The initial wound assessment was performed and a multi-therapeutic approach, HBOT and NWPT, was applied over a period of 3-6 weeks. The patients underwent to a complete healing after a maximum of 10 weeks of treatment compared to the 28-weeks average of other patients treated at the same facility (real data) and the 12-weeks average expected in the guidelines (benchmark).The combination of the two therapies, has led to a positive result saving time and money; the individual use of them would have required more time and costs.

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The occurrence of pressure ulcers has an important influence on the patient’s quality of life [1].

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Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical-related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena™ (KCI USA, Inc., San Antonio, TX) and Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new investigation on possible prophylactic measures to prevent complications via application immediately after surgery in high-risk, clean, closed surgical incisions. A systematic review was performed to evaluate INPWT's effect on surgical sites healing by primary intention. The primary outcomes of interest are an understanding of INPWT functioning and mechanisms of action, extrapolated from animal and biomedical engineering studies and incidence of complications (infection, dehiscence, seroma, hematoma, skin and fat necrosis, skin and fascial dehiscence or blistering) and other variables influenced by applying INPWT (re-operation and re-hospitalization rates, time to dry wound, cost saving) extrapolated from human studies. A search was conducted for published articles in various databases including PubMed, Google Scholar and Scopus Database from 2006 to March 2014. Supplemental searches were performed using reference lists and conference proceedings. Studies selection was based on predetermined inclusion and exclusion criteria and data extraction regarding study quality, model investigated, epidemiological and clinical characteristics and type of surgery, and the outcomes were applied to all the articles included. 1 biomedical engineering study, 2 animal studies, 15 human studies for a total of 6 randomized controlled trials, 5 prospective cohort studies, 7 retrospective analyses, were included. Human studies investigated the outcomes of 1042 incisions on 1003 patients. The literature shows a decrease in the incidence of infection, sero-haematoma formation and on the re-operation rates when using INPWT. Lower level of evidence was found on dehiscence, decreased in some studies, and was inconsistent to make a conclusion. Because of limited studies, it is difficult to make any assertions on the other variables, suggesting a requirement for further studies for proper recommendations on INPWT.

According to the literature, incisional closure complications may range from postoperative surgical site infections, representing 17-22% of health care-associated infections, surgical wound dehiscence and formation of haematomas or seromas, and can lead to delayed or impaired incision healing. These kinds of situations are more common when wounds are closed under tension or in specific patient morbidities. Obesity, in particular, is associated with an impaired blood flow to tissues, predisposing the patient to increased risk of wound complications by various mechanisms. Incisional complications can become relevant economic burdens for health care systems because of an increase in the average length of hospital stay and readmissions, and additional medical and surgical procedures. Thus, a preventive therapy may have a critical role in the management of healing. Negative pressure wound therapy (NPWT) technology as delivered by Prevena™ Customizable™ (Kinetic Concepts Inc., San Antonio, TX) has recently been the focus of a new investigation, as a prophylactic measure to prevent complications via immediate postoperative application in high-risk, clean, closed surgical incisions. The authors present a 62-year-old class II obese female, who underwent bilateral inguinal dermolipectomy. Prophylactic NPWT as delivered by Prevena™ was performed successfully over surgical incisions. Cosmetic and therapeutic results are shown.

Negative pressure wound therapy (NPWT) is becoming routine for the preparation of wounds prior to grafting for wound closure. With this purpose, we have been using both foam and gauze-based NPWT obtaining similar proportions of closed wounds and observing less pliable scar tissue on the foam-treated patients. The aim of this study was to compare this two different fillers and to identify if there are different indications for their use according to anatomical areas in relation to the type of granulation and scar tissue obtained. Both foam and gauze patients were compared in terms of depth and wound location, patients' age, and comorbidities. All foam patients were treated at 125 mmHg for an average of 25 days before skin grafting, while gauze patients were treated at 80 mmHg for an average of 21 days before skin grafting. Biopsies of granulation and scar tissues were taken and stained with hematoxylin-eosin and Masson's trichrome stainings, investigating vascular endothelial growth factor (VEGF) and metalloproteinase (MMP). An ultrasound analysis of the closed wounds was also conducted. Histological, immunohistochemical, and ultrasonographical results after gauze-based NPWT showed a minor tissue thickness and disorganization and less sclerotic components. These results support the hypothesis that different fillers generate different scar tissues. The choice of the filler to apply negative pressure should be dictated by the anatomical areas affected by the lesion. Level of Evidence: Level IV, therapeutic study.

Background Breast implants are widely used and at times might cause inflammation as a foreign body, followed by fibrous capsule formation around the implant. In cancer, the inflamed stroma is essential for preservation of the tumor. Mesenchymal stem cells can be recruited to sites of inflammation, and their role in cancer development is debated. The authors assessed the effects of inflammation caused by breast implants' effects on tumor. Methods Mesenchymal stem cells were isolated from the fibrous capsules of women who underwent a second operation after 1 year (presenting inflammation) or after 20 years (not presenting inflammation) since initial surgery. After characterization, cells were co-cultured with MCF7, a breast cancer cell line. The expression of genes involved in oncogenesis, proliferation, and epithelial-to-mesenchymal transition was investigated, followed by Western blot analyses. Results After co-culture with mesenchymal stem cells from the inflamed capsule, MCF7 induced a dose- and time-dependent increase in proliferation. Polymerase chain reaction analyses revealed a dysregulation of genes involved in oncogenesis, proliferation, and epithelial-to-mesenchymal transition. The subsequent evaluation by Western blot did not confirm these results, showing only a modest decrease in the expression of E-cadherin after co-culture with mesenchymal stem cells (both derived from inflamed or control capsules). Conclusion These data indicate that inflammation caused by breast implants partially affects proliferation of MCF7 but does not influence key mechanisms of tumor development.

Introduction Actinic keratosis (AK) is a cutaneous intraepithelial neoplasm appearing within areas referred as ‘fields of cancerization’. AK can progress to invasive squamous cell carcinoma. Treatments that target both clinically visible and subclinical AKs in cancerization fields are able to reduce the risk of malignant progression. Ingenol mebutate gel is a new effective topical therapy for AK, used once daily for 2 or 3 days depending on the location of lesions. Case description Three elderly patients with multiple non-hypertrophic AKs within a contiguous 25-cm2 treatment area on the face or scalp were treated with ingenol mebutate 0.015 % gel once daily for three consecutive days and followed up over a period of 57 days. Discussion and Evaluation Although individual local responses to treatment varied, all patients had total clearance of AK lesions without any sign of recurrence. In addition, all patients said that they were satisfied with the effectiveness of ingenol mebutate treatment and the aesthetic outcome, and would be prepared to use this agent again to treat AK in the future, if necessary. Conclusions These three cases demonstrate that ingenol mebutate 0.015 % gel is effective and well tolerated in a clinical setting, with effective clearance of AK lesions present on the face and scalp, and good patient acceptability.

Wound healing is a systemic response to injury that impacts the entire body and not just the site of tissue damage; it represents one of the most complex biological processes. Our knowledge of wound healing continues to evolve and it is now clear that the wound microenvironment plays a crucial role. The interactions between cells and the surface microenvironment, referred to as the "biofilm," contributes to skin homeostasis and healing. Understanding the functional complexity of the wound microenvironment informs how various factors such as age, ischemia, or bacterial infections can impair or arrest the normal healing processes, and it also allows for the possibility of acting therapeutically on healing defects with microenvironment manipulation. Microbes represent a particularly important factor for influencing the wound microenvironment and therefore wound healing. Moreover, the role of infections, particularly those that are sustained by biofilm-forming bacteria, is mutually related to other microenvironment aspects, such as humidity, pH, metalloproteinases, and reactive oxygen species, on which the modern research of new therapeutic strategies is focused. Today, chronic wounds are a rapidly growing health care burden and it is progressively understood that many non-healing wounds might benefit from therapies that target microorganisms and their biofilm communities. There is no doubt that host factors like perfusion impairments, venous insufficiency, pressure issues, malnutrition, and comorbidities strongly impact the healing processes and therefore must be targeted in the therapeutic management, but this approach might be not enough. In this article, we detail how bacterial biofilms and related factors impair wound healing, the reasons they must be considered a treatment target that is as important as the host's local and systemic pathologic conditions, and the latest therapeutic strategies derived from the comprehension of the wound microenvironment.

Background/Objective: This study aims at the evaluation of the efficacy and safety of a combination therapy based on pidobenzone 4% and fractional CO2 laser or cryotherapy in the treatment of solar lentigines and the prevention of eventual posttreatment hyperchromia. Methods: Efficacy was clinically evaluated by grading the pigmentation level with the Skin Tone Color Scale (STCS), and by grading patients' impression through a Visual Analog Scale (VAS). Results: Our study shows that the associated treatment was safe and that it improves the therapeutic results on solar lentigines and prevents postiatrogenic hyperpigmentation compared with physical therapy alone. Conclusion: The combination of cryotherapy and pidobenzone 4% has been found to be the most useful treatment.

Capsular contracture is one of the most frequent complications following breast augmentation where the capsule begins to squeeze or contract upon itself. The incidence of this phenomenon varies between 0.5 and 30 %, according to the experience of the plastic surgeon. The authors discuss the use of periprosthetic fat transfer in capsule contracture following breast reconstruction. Lipofilling fits well with the breast tissue over time and it adapts to the patient in a very natural way following weight and structural changes. There is still a lack of standardization in the techniques used, but trends towards time management and simplification of technique are appearing. Two cases are described.

We investigated the efficacy of the peptide s-thanatin alone and in combination with tigecycline in an animal model of sepsis induced by cecal ligation and puncture. Adult male Wistar rats were randomized to receive intravenously isotonic sodium chloride solution, 5 mg/kg s-thanatin, 2 mg/kg tigecycline, 5 mg/kg s-thanatin combined with 2 mg/kg tigecycline. The experiment was also performed with administration of the drugs 360 min after the surgical procedure to better investigate the clinical situation where there is an interval between the onset of sepsis and the initiation of therapy. Lethality, bacterial growth in blood, peritoneum, spleen and liver, and NO indices were evaluated. All compounds reduced the lethality when compared to control. In all experiments, the compounds reduced significantly bacterial growth and lethality compared with saline treatment. Treatment with s-thanatin resulted in significant decrease in plasma NO levels compared to tigecycline and control group. The combination between s-thanatin and tigecycline proved to be the most effective treatment in reducing all variables measured. S-thanatin may have potential therapeutic usefulness alone and when associated to tigecycline in polymicrobial peritonitis.

Introduction Surgical site infections are the second most common cause of nosocomial infections and, typically, gram-positive pathogens are involved. Materials and methods A mouse model was used to investigate the efficacy of different methods for the treatment of wound infections. A full thickness wound was established on the back subcutaneous tissue of adult male BALB/c mice. A small gauze was placed over each wound and then inoculated with 5 × 10 7 colony-forming units of Staphylococcus aureus . The study included a control group that did not receive any treatment and four contaminated groups treated, respectively, with: (1) drug-free Allevyn (Smith and Nephew Healthcare, Yorkshire, United Kingdom), (2) teicoplanin-soaked Allevyn, (3) drug-free Allevyn and daily intraperitoneal teicoplanin (7 mg/kg) and, finally, (4) teicoplanin-soaked Allevyn and daily intraperitoneal teicoplanin (7 mg/kg). Main outcome measures were quantitative bacterial culture, assessment of vascular endothelial growth factor (VEGF) plasma levels, histological examination with assessment of microvessel density, and of VEGF expression in tissue sections. Results Data analysis showed that strong inhibition of bacterial growth was achieved in any group treated with intraperitoneal teicoplanin. However, the highest inhibition of bacterial growth was obtained in the group that received teicoplanin-soaked Allevyn and intraperitoneal teicoplanin. Histological examination showed that each treatment modality was able to reduce the delay in wound repair. The most effective treatment appeared to be the local application of teicoplanin-soaked hydro gel foam. The tissue effects were associated with an increase in neovascularization and VEGF expression by endothelial cells and fibroblasts in the granulation tissue. Bacterial colonies also were reduced, especially when teicoplanin was given parenterally. Conclusions Soaking a hydro cellular foam with an antistaphylococcal agents, such as teicoplanin, may be useful for the management of infected wounds.

NPWT, also known as topical negative-pressure wound therapy, is widely used in managing and accelerating wound healing. However in wounds were slough is highly represented NPWT efficiency is low. In the patients included in this study clinical health conditions were precarious. We needed a rapid wound healing to not further compromise their health condition. So we added curity dressing to resolve the slough issue. In all the patients we observed slough reduction. This treatment provided beneficial for the patient, the surgeons and the National Health Service. Accelerating wound healing reduced hospitalization and thereby the patients achieved a reduction of risks of nosocomial infections and physical and psychological diseases.

Chronic wounds cause morbidity due to local infections, sepsis, osteomyelitis, but also increase mortality in the most severe cases and in patients with multiple comorbidities. Their increasing prevalence, associated disabilities and relevant health costs make chronic wounds a real social disease. At a time in which we hear more and more about spending reviews and reduction of health care costs, the natural evolution of Medicine and Health Care is increasingly directed towards the achievement of high quality standards while at the same time, reducing costs. It is in this framework that a hub and spoke model was used for organizing Plastic Surgery services in Ancona (Italy). In order to ensure appropriate clinical and organizational management of services, the activities of reference centres need to be widely integrated, by functional interconnections with activities of peripheral hospitals and local centres. Through a careful analysis of the Regional Reference Center for non - healing wounds in Ancona, the authors make some considerations regarding appropriate diagnostic-therapeutic-healthcare pathways and the correct use of human, material and technological resources in the area of wound healing.

Wide tissue defects located on the face and neck area often require distant flaps or free flaps to achieve a tension-free reconstruction together with an acceptable aesthetic result. The supraclavicular island flap surely represents a versatile and useful flap that can be used in case of large tissue losses. Because of its wide arc of rotation, which ensures a 180-degree mobilization anteriorly and posteriorly, the flap can reach distant sites when harvested as a pure island flap. The main vascular supply of the flap, the supraclavicular artery, a branch of the transverse cervical artery or, less frequently, of the suprascapular artery, though reliable, is not a very large vessel. In some particular cases, when too much tension or angles that are too tight are present, the vascular supply of the flap can be difficult and special care must be taken to avoid flap failure. To avoid this problem, the authors started harvesting the flap not as a pure island flap but with a fascial pedicle, thin and resistant, which ensures good reliability; also, when a higher tension rate is present, it avoids the risk of excessive traction or kinking of the vessels. Twenty-five consecutive patients with various defects located on the head, neck, and thorax area were treated in the past 2 years using the modified supraclavicular island flap. There was no flap loss or distant necrosis of the flap, and there was marginal skin deepithelialization in only two cases, which only required minor surgery. Postoperative morbidity was low, similar to the classic supraclavicular island flap, with primarily closed donor sites, except for one case, and tension-free scars. The authors show how the modified supraclavicular island flap is a reliable and safe flap that gives a good aesthetic result with low risk concerning the viability of the transferred skin. The technique, similar to supraclavicular island flap harvesting, is easy to perform and is attractive in patients at risk for poor or delayed healing such as smokers or patients with complex medical histories.

The authors present a new non-intrusive experimental procedure based on laser techniques for the measurement of mechanical properties of tendons. The procedure is based on the measurement of the first resonance frequency of the tendon by laser Doppler vibrometry during in vitro tensile experiments, with the final aim of establishing a measurement procedure to perform the mechanical characterization of tendons by extracting parameters such as the resonance frequency, also achievable during in vivo investigation. The experimental procedure is reported, taking into account the need to simulate the physiological conditions of the Achilles tendon, and the measurement technique used for the non-invasive determination of tendon cross-sectional area during tensile vibration tests at different load levels is described. The test procedure is based on a tensile machine, which measures longitudinal tendons undergoing controlled load conditions. Cross-sectional area is measured using a new non-contact procedure for the measurement of tendon perimeter (repeatability of 99% and accuracy of 2%). For each loading condition, vibration resonance frequency and damping, cross-sectional area and tensile force are measured, allowing thus a mechanical characterization of the tendon. Tendon stress–strain curves are reported. Stress–strain curves have been correlated to the first vibration resonance frequency and damping of the tendon measured using a single-point laser Doppler vibrometer. Moreover, experimental results have been compared with a theoretical model of a vibrating cord showing discrepancies. In vitro tests are reported, demonstrating the validity of the method for the comparison of different aged rabbit tendons.

Marjolin’s ulcer is a squamous cell carcinoma that develops in posttraumatic scars and chronic wounds. Suspicion of such lesions should be raised in chronic wounds demonstrating characteristic changes. We have reported the peculiar phenomenon of malignant transformation of chronic pressure sores that occurred in a paraplegic patient. The aim of this study was to cover the extensive defects by a last resort reconstructive option. Department of Plastic and Reconstructive Surgery, Universita Politecnica delle Marche, Ancona, Italy. A 40-year-old paraplegic man, with multiple hemangioblastomas of the brain and spinal cord due to Von Hippel Lindau syndrome developed pressure ulcers with unstable healing over the sacral, trochanteric, bilateral, and ischiatic areas after 15 years from neurosurgery. The biopsy result showed an invasive squamous carcinoma. Carcinomas in pressure sores are highly aggressive, and they need to be treated more radically. In our case we opted for a demolitive surgical treatment including musculocutaneous rotational flap harvested from total left thigh to cover the extensive defects. The limb was previously disarticulated. In Marjolin’s ulcer, multiple biopsies are the first-line modality for the early diagnosis as they are a safe method with high rate of accuracy. First-line treatment is surgery consisting of radical excision with lymph node dissection, if they are involved. Adjuvant radiation therapy may be used in selected patients. Management of massive pelvic defects can be a challenging problem. The pedicled lower limb flap offers a technique that can be considered as a last resort procedure for extensive defects where other options are insufficient or not available anymore. In our case the patient is disease-free after 2 years of follow-up.

Breast implants, and more generally any foreign body, promote the formation of a fibrous capsule that surrounds them completely. It is a real chronic inflammatory reaction with the production of fibrous tissue rich in collagen fibers and cells of chronic inflammation at the interface between the implant and the host. The capsule seems to be rich in MSCs, particularly active for the presence of a microenvironment characterized by high stress and inflammation. The author discusses mesenchymal stem cells and breast cancer as a paradigmatic model. The authors conclude that the preliminary data describe a reassuring scenario, where paracrine effect exerted by MSCs does not affect the aggressiveness of breast cancer cells.

A stem cell is defined by two main parameters: the ability to have many division cycles maintaining the undifferentiated state (self-renewal) and the ability to differentiate into all mature cell types (unlimited potential). The authors describe the various types of stem cells and their functions.

Antimicrobial peptides are known as immunomodulators and antibiotic enhancers. We report that administration of an antimicrobial peptide, IB-367, was efficacious in increasing the antimicrobial activity of daptomycin and teicoplanin in a mouse model of wound infection caused by meticillin-resistantStaphylococcus aureus(MRSA). Mice were assigned to seven groups: an IB-367 pre-treated group with no antibiotics given after challenge, two IB-367 pre-treated groups plus daptomycin or teicoplanin given after challenge, two groups treated with daptomycin or teicoplanin only after challenge, and two control groups without infection or that did not receive any treatment. The main outcome measures were quantitative bacterial culture and analysis of natural killer (NK) cytotoxicity and leukocyte phenotype. The wound, established through the panniculus carnosus muscle of mice, was infected by MRSA. Bacterial cultures of mice receiving antibiotics alone showed a −2 log decrease, whilst those for IB-367 plus daptomycin or teicoplanin showed a −4 log decrease. IB-367 plus daptomycin showed the highest efficacy. The higher antimicrobial effect exerted by IB-367 was associated with increased levels of NK cytotoxicity but not of NK cell number. IB-367 increased the number of both CD11b and Gr-1 cells 3 days after MRSA challenge, whereas both of these leukocyte populations were reduced at 10 days after challenge. Our data suggest that a combination of IB-367 with antibiotic exerts a therapeutic effect and may be useful for the management of staphylococcal wounds.

BACKGROUND In the last decade, perforator flaps have been introduced for the treatment of pressure ulcers as alternative to the more popular myocutaneous local flaps. We reviewed our single-team 11-year experience in order to define whether real advantages could be achieved. METHODS We analyzed 143 patients undergoing perforator flap surgery for a single late-stage pressure sore. All patients underwent the same protocol treatment. Data regarding associated pathologies, demographics, complications, healing, and hospitalization times were collected. RESULTS Ninety-three percent of 143 patients were white Caucasian, and 61% were men, with median age of 51 years. Of 143 stage 4 ulcers, 46.2% were ischial, 42.7% sacral, and 11.2% trochanteric. The most common diagnosis was traumatic paraplegia/tetraplegia (74.9%); no significant difference was found in diagnosis distribution and in ulcer location between recurrent and nonrecurrent patients. We performed 44 S-GAP, 78 I-GAP, 3 PFAP-am, and 18 PFAP-1 flaps. At 2 years' follow-up, the overall recurrence was 22.4% and new ulcer occurrence was 4.2%. Mean hospital stay was 16 days. The overall complication percentage was 22.4%, mostly due to suture-line dehiscence (14%) and distal flap necrosis (6.3%). PFAP flaps had a significant higher risk of developing recurrence than I-GAP flaps. The recurrence risk was significantly higher for subjects suffering from coronary artery disease. CONCLUSIONS Late-stage pressure sore treatment with local perforator flaps can achieve reliable long-term outcomes in terms of recurrences and complications. When compared to previously published data, perforator flaps surgery decreased postoperative hospital stay (by an average of nearly 1 week), reoperations (5.6%), and occurrences.

The occurrence of resistance or side effects in patients receiving antifungal agents leads to failure in the treatment of mycosis. The aim of this experimental study was to investigate the in vitro effects of IB-367 alone and in combination with three standard antifungal drugs, fluconazole (FLU), itraconazole (ITRA) and terbinafine (TERB), against 20 clinical isolates of dermatophytes belonging to three species. Minimum inhibitory concentrations (MICs), minimal fungicidal concentrations (MFCs), synergy test, time-kill curves, fungal biomass (FB) and hyphal damage using 2,3-bis-(2-methoxy-4-nitro-5-sulfenylamino carbonil)-2H-tetrazolium hydroxide assay (XTT) were performed to study the efficacy of IB-367. In this study, we observed that TERB and ITRA had MICs lower values for all the strains compared to IB-367 and FLU. Synergy was found in 35%, 30% and 25% of IB-367/FLU, IB-367/ITRA and IB-367/TERB interactions respectively. IB-367 exerted a fungicidal activity against Trichophyton mentagrophytes, T. rubrum and Microsporum canis at concentrations starting from 1x MIC. At a concentration of 5x MIC, IB-367 showed the highest rates of hyphae damage for M. canis 53% and T. mentagrophytes 50%; against the same isolates it caused a reduction of 1 log of the total viable count cell hyphae damage. We propose IB-367 as a promising candidate for the future design of antifungal drugs.

Vaser liposculpture is a third-generation ultrasound that is more efficient in preventing injury to nerves and vessels while being efficient in emulsifying the adipose tissue. The author describes the technique of liposculpture of the chin, cheek, and neck. The author feels that Vaser-assisted face and neck contouring should only be performed by surgeons experienced with the Vaser system for fatty tissue emulsification. At least ten cases of standard Vaser-assisted lipoplasty are recommended before moving to application to the face and neck.

Aesthetic breast augmentation is usually performed in a retromammary plane (behind the breast parenchyma), when breast parenchyma is enough to cover the implant or in case of active sport patients, or in a retropectoral plane (behind pectoralis muscle and serratus) in all other cases. In some cases, where mammary gland is mostly located on the lower pole, the implant can be partially placed behind the pectoralis major muscle and partially behind the breast parenchyma (partial retropectoral). The dual plane inverted technique consists, such as in the classical dual plane method, in positioning the prosthesis partially under the pectoralis major muscle and partially under the mammary gland. The difference, compared to the classical method, consists in covering the implant using the lower third of the pectoralis major muscle, thus leaving the implant to be covered by the mammary gland on the upper two thirds, so creating a kind of lifting of the breast, obtaining a mastopexy effect. The technique is described.

A relevant bacterial load in cutaneous wounds significantly interferes with the normal process of healing. Vitamin E (VE) is a known immunomodulator and immune enhancer. Here, it was shown that administration of VE before infection was effective at increasing the antimicrobial activity of daptomycin (DAP) or tigecycline (TIG) in a mouse model of wound infection caused by meticillin-resistant Staphylococcus aureus (MRSA). A wound was established through the panniculus carnosus of mice and inoculated with MRSA. Mice were assigned to six groups: a VE pre-treated group with no antibiotics given after MRSA challenge; two VE pre-treated groups with DAP or TIG given after MRSA challenge; two groups treated with DAP or TIG only after MRSA challenge; and a control group that did not receive any treatment. Mice receiving each antibiotic alone showed a 3 log decrease in the number of c.f.u. recovered compared with the control group, mice treated with VE plus TIG had a 4 log decrease, whilst mice treated with VE plus DAP had the largest decrease in c.f.u. recovered (5 logs). The increased antimicrobial effect seen from treatment with VE plus antibiotics was associated with increased levels of natural killer cell cytotoxicity, with a more pronounced increase in leukocyte populations in mice treated with VE plus DAP. These data suggest that treatment with VE prior to infection and subsequent antibiotic treatment act in synergy.

Human hair follicle cells, both bulge and dermal papilla cells, were isolated and cultured in a GMP cell factory, in order to obtain an in vitro hair follicle source for encapsulation end transplantation in alopecia regenerative cell therapy. An in vitro model, constituted by organotypic cultures of human skin sample, was set up to simulate the dermal–epidermal interaction between bulge cells and dermal papilla cells, evaluating the possible new follicles formation and the regenerative potentiality of these hair follicle cells. Both the bulge and dermal papilla cells show an excellent cellular proliferation as well as an abundant extracellular matrix production. The immunofluorescence investigation revealed the positivity of both cell lines to CK15 and CD200, whereas both cell lines were negative to CD71 and Oct-4. The pool of cultured bulge and dermal papilla cells was injected into the deep dermis; at day 28 of culture, some organized areas with a higher cell density can be observed: the cells self-organize into papilla-like lengthened aggregates. In samples in which the follicular cells have been seeded on the dermis surface, an epidermis-like homogeneous monolayer on the dermis surface can be seen, therefore showing a potentiality of these cells for epidermis regeneration. These data show the efficacy of a cellular isolation and amplification approach to obtain an in vitro human hair follicle regenerative source on industrial scale in a GMP cell factory. The results also proved an intrinsic potentiality of follicular cells to in vitro recreate the epidermis for tissue engineering purposes. Thus, it is feasible to produce bioengineered hair follicles in a GMP cell factory, for encapsulation and transplantation in alopecic patients.

Articular cartilage has limited repair and regeneration potential, and the scarcity of treatment modalities has motivated attempts to engineer cartilage tissue constructs. The use of chondrocytes in cartilage tissue engineering has been restricted by the limited availability of these cells, their intrinsic tendency to lose their phenotype during the expansion, as well as the difficulties during the first cell adhesion to the scaffold. Aim of this work was to evaluate the intra-articular adipose stromal vascular fraction attachment on silk fibroin scaffold to promote chondrocytes adhesion and proliferation. Physicochemical characterization has demonstrated that three-dimensionally organized silk fibroin scaffold is an ideal biopolymer for cartilage tissue engineering; it allows cell attachment, scaffold colonization, and physically cell holding in the area that must be repaired; the use of adipose-derived stem cells is a promising strategy to promote adhesion and proliferation of chondrocytes to the scaffold as an autologous human feeder layer.

Results of a national retrospective survey on Hyalomatrix PA in burn patients are reported.A total of 11 burn centers were contacted.A total of 57 patients were available. Hyalomatrix PA was used on young and adult patients, mainly in deep partial thickness and full thickness burns. In most cases, Hyalomatrix PA was applied immediately after the wound cleaning (wound debridement or escharectomy for adults, dermabrasion or debridement in young patients). After 7 days, reepithelization processes were more frequent in deep partial thickness burns. One-half of the patient population underwent grafting. After 29 days, complete closure was achieved in almost all patients. The Vancouver Scar Scale showed better values for adults, while no differences were observed for burn depth or patients undergoing grafting. No adverse reactions were recorded.Hyalomatrix PA is used in young and adults, in deep partial thickness and full thickness burns, as a temporary coverage before grafting or alone for wound healing.

We investigated the effect of topical temporin A in the management of methicillin-resistant strain of Staphylococcus aureus (MRSA)-infected experimental surgical wounds in mice. The wound, cut through the panniculus carnosus of BALB/c mice, was inoculated with 5 × 10 7 colony-forming units of MRSA. Mice were treated with Allevyn, temporin A-soaked Allevyn, Allevyn and daily intraperitoneal teicoplanin (7 mg/kg), temporin A-soaked Allevyn and daily intraperitoneal teicoplanin. Main outcome measurements were: quantitative bacterial culture, histological examination with assessment of micro-vessel density and of vascular endothelial growth factor (VEGF) expression in tissue sections, and VEGF plasma levels alike. Treatment with temporin-A associated with teicoplanin injection significantly reduced bacterial load to 0.85 × 10 1 ± 0.1 × 10 1 CFU/ml. Histological examination showed that infected mice receiving temporin A-soaked Allevyn (with or without teicoplanin) had a higher degree of granulation tissue formation and collagen deposition compared to the other treated groups. A significant increase in serum VEGF expression was observed in mice receiving temporin A topically and temporin A topically associated with intraperitoneal teicoplanin. In conclusion our results demonstrated that temporin A is effective in the management of infected wounds, by a significant bacterial growth inhibition and acceleration of wound repair process.

Ischemia/reperfusion injury is regarded as the main cause of failure in revascularization of limbs and transfer of free flaps in the so called nonreflow phenomenon. This type of damage is caused by the production of free radicals, above all, of neutrophils that release great quantities of extracellular superoxide through the action of a membrane enzyme. In our study we used 40 white rabbits. Rabbit rectus femoris muscle is perfused by a single artery and vein and is therefore a valuable model for study of ischemia-induced reperfusion injury of skeletal muscle. The objective of this study was to individualize a valid method of protection for the muscle from damage by ischemia-induced reperfusion injury. We have tested the effectiveness of WEB2170, a PAF antagonist, of hyperbaric oxygen therapy one (HBO), and of combined employment of WEB2170 and HBO. The results show that both PAF and HBO play important protective roles against damage from ischemia/reperfusion injury, and that the combined employment of both therapies has a synergistic effect. We propose therefore a new therapeutic protocol for the prevention of damage resulting from ischemia/reperfusion injury with the simultaneous employment of this PAF and HBO.

Summary: Lower-pole shaping of the breast is sometimes a difficult challenge when performing vertical mammoplasty. The problems mostly encountered are too large breast bases, persistent dog ears, which require long incision, and poor breast projection. We report a modification of the technique that we use in breast reduction so as to better shape the lower pole and to reduce revision surgery.