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Background and objectives: Hereditary spastic paraplegias (HSPs) are heterogenous genetic disorders characterized by progressive pyramidal tract involvement. SPG76 is a recently identified form of HSP, caused by biallelic calpain-1 (CAPN1) variants. The most frequently described MRI abnormality in SPG76 is mild cerebellar atrophy and non-specific white matter abnormalities were reported in only one case. Following the identification of prominent white matter abnormalities in a subject with CAPN1 variants, which delayed the diagnosis, we aimed to verify the presence of MRI patterns of white matter involvement specific to this HSP. Methods: We performed a retrospective radiological qualitative analysis of 15 subjects with SPG76 (4 previously unreported) initially screened for white matter involvement. Moreover, we performed quantitative analyses in our proband with available longitudinal studies. Results: We observed bilateral, periventricular white matter involvement in 12 subjects (80%), associated with multifocal subcortical abnormalities in 5 of them (33.3%). Three subjects (20%) presented only multifocal subcortical involvement. Longitudinal quantitative analyses of our proband revealed increase in multifocal white matter lesion count and increased area of periventricular white matter involvement over time. Discussion: SPG76 should be added to the list of HSPs with associated white matter abnormalities. We identified periventricular white matter involvement in subjects with SPG76, variably associated with multifocal subcortical white matter abnormalities. These findings, in the presence of progressive spastic paraparesis, can mislead the diagnostic process towards an acquired white matter disorder. [ABSTRACT FROM AUTHOR]

Background: With the recent safety communication issued by The Food and Drug Administration, squamous cell carcinoma breast-implant associated (BIA-SCC) has become part of the breast implant capsule related conditions. In the present paper, we review all cases of BIA-SCC currently reported in the literature. Methods: From October 2022 to February 2023, we conducted a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement. An electronic search was performed using PubMed/Medline, Scopus, and Cochrane Database. Only manuscripts written in English and featuring one or more clinical cases of BIA-SCC were included for full-text analysis. Results: Eight-hundred-sixty-seven articles were identified. After excluding duplicates, irrelevant and non-English-written papers, fifteen articles were deemed eligible for the review, featuring a total of eighteen cases. Eleven patients received bilateral breast augmentation, five bilateral or unilateral reconstruction either following mastectomy or for Poland syndrome, while in two cases the indication for implant placement was not reported. Time from implantation to clinical onset was less than ten years in three patients, over ten years in thirteen instances and not reported in two. History of capsular contracture was identified in eight patients, while complications including previous surgical revisions, implant exchange or exposure, extrusion or infection were reported in eight cases. Conclusions: The paucity of literature on BIA-SCC still hinders us from drawing definitive conclusions. Nevertheless, we can infer that early detection of symptoms is pivotal in the decision-making process for the treatment and management of this nosological entity. Level of evidence: Not gradable [ABSTRACT FROM AUTHOR]

Background: The elbow area is frequently affected by excessive sagging skin post-massive weight loss. The aim of this study is to present a brachioplasty with distal extension of incision to the anticubital surface, in order to make the transition from middle arm to distal arm/elbow more nuanced and aesthetically pleasing. Material and Methods: An observational retrospective comparative study was performed confronting two groups of female patients. All patients treated with brachioplasty between January 2015 and December 2020 due to brachial laxity following massive weight loss were included in the study. Group A consisted of patients who underwent the novel procedure and Group B comprised subjects with the standard brachioplasty technique. Demographics, including age, BMI and comorbidities were taken into account. The mean outcome measure was the Body-QTM-satisfaction with upper arms score, which was administered preoperatively and one year postoperatively. Results: In the period considered, Group A consisted of 92 patients and Group B of 78. No difference was found between groups concerning BMI and age. The groups were comparable also based on the Body-Q pre-surgery levels. The Body-Q scores at one year postoperatively were 22.80 ± 2.28 in group A and 19.50 ± 2.42 in group B. The postoperative Body-Q scores across the two groups were a higher in group A, and the result is statistically significant (p < 0.05). Conclusion: The utilization of the proposed elbow-extended technique allows an improvement of the upper limb profile, with far higher satisfaction of patients, at the price of minimal sequelae in terms of scar. The elbow area is a critical part in post-obese deformities of the brachium, and is frequently neglected. In case of skin laxity and redundancy an elbow extension of the brachioplasty incision is indicated. Results of elbow-extended brachioplasty are p valid and the additional scar well concealed and accepted by patients. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Duration and take of gluteal lipografting are unpredictable. More importantly, unsafety of intramuscular lipofilling has been recently proven. Stromal Enriched Lipograft (SEL) is likely to enhance survival of injected fat. The purpose of this study is to describe the use of SEL for gluteal augmentation through injection into the subcutaneous layer. Methods: A retrospective study was performed to assess outcomes and patient satisfaction with subcutaneous gluteal augmentation through SEL in 194 patients between 2015 and 2017. A control group (non-SEL) in which fat injection was performed through a traditional Coleman's technique between 2010 and 2013 was compared with the SEL group. Demographics and the amount of injected tissue were sought in patients' charts. Complications and aesthetic outcomes were taken into account. The mean surgical gain of hip circumference was determined. Comprehensive improvement after gluteal fat augmentation was rated on a scale of 1 to 5, in which 1 is "worse," 2 is "no change," 3 is "improved," 4 is "much improved," and 5 is "very much improved." The evaluation was made at 12 months by an independent assessor. Results: At 12 months postoperatively, the mean gain in terms of hip circumference was 3.3 cm in the SEL group and 0.9 in the non-SEL group and this outcome was statistically significant. No cases of infection or liponecrosis of the grafted area occurred. At 12 months, 75% of cases were rated as much improved or more and 16% were classified as improved. Conclusions: More research is needed, but when SEL is utilized, the increased and prolonged duration of the grafted fat is such that repeat procedures are rare, which allows to target the subcutaneous layer as the recipient site, instead of the muscular plane, with increased safety. Level of evidence: Level IV, Therapeutic study. [ABSTRACT FROM AUTHOR]

Background: The demand for bilateral breast reconstructions is rising worldwide. In the UK, approximately 30% of breast cancer patients undergoing mastectomy choose autologous tissue breast reconstruction. Although the deep inferior epigastric perforator (DIEP) flap is gaining popularity, bilateral DIEP flap breast reconstruction remains a complex procedure and reliable outcome data are lacking. In the absence of clinical trials, evidence from cohort studies is needed to better inform clinicians and patients. Methods: Over a 6-year period, all consecutive patients undergoing DIEP flap breast reconstruction were prospectively included and categorized as unilateral or bilateral reconstruction for comparative analyses of outcomes and complications, with the patient as the unit of analysis. Results: Overall, 565 DIEP flaps were performed on 468 women (371 unilateral and 97 bilateral reconstructions [194 flaps]). Postoperative complications requiring reoperation were twice as likely for bilateral reconstructions (risk ratio [RR] 2.1, 95% CI 1.4-3.4, p = 0.002) and were mainly due to venous congestion (RR 3.1, 95% CI 1.2-7.5, p = 0.011). The risk of total flap loss was six times greater in bilateral reconstruction (RR 6.4, 95% CI 1.6-26, p = 0.011). The rates of revision breast and abdominal surgery were similar between groups. Conclusions: Both unilateral and bilateral DIEP flap breast reconstructions are safe, with a low risk of complications; however, bilateral reconstruction was associated with a higher risk of complications and total flap loss. This information should be highlighted to patients requesting bilateral breast reconstruction, particularly those requesting risk-reducing mastectomy and reconstruction. [ABSTRACT FROM AUTHOR]

Background: Umbilical repositioning is a main step in performing abdominoplasty. The surgical aims are minimal visible scars and a natural-appearing result. Reported techniques do not completely satisfy the aesthetic targets for all types of patients. A previous study reported a versatile technique for umbilicoplasty based on an elliptical vertical incision of the umbilical skin and a double opposing 'Y' incision on the abdominal flap to create a new umbilicus. This report describes the long-term results with this technique. Methods: A total of 111 abdominoplasties were performed. Patient satisfaction and postoperative results were evaluated over a 5-year follow-up period. A modified 5-ml syringe was used to assess the depth and volume of the umbilical stalk. Depth value variations were statistically compared using the Wilcoxon test. Results: For all the patients, a three-dimensional umbilicus with an adequate depression was created. In four cases, deepithelialization of the umbilical skin occurred. After 1 postoperative year, no significant changes in umbilical shape, dimension, depth, or appearance were observed. After 5 years, no significant changes in shape or appearance were observed. The cicatricial umbilical stenosis occurrence was 4.5%. A small significant decrease in umbilical depth was noted. Overall, the results remained satisfying at this writing. Conclusions: The reported technique is easy to learn, simple to perform, and stable over time. It gives a natural depth appearance, ensures optimal position, pulls scars deeply, and allows achievement of different shapes according to the patient's habitus. [ABSTRACT FROM AUTHOR]

In the original article Justin C. R. Wormald's middle initials were incorrect. They are correct as reflected in this erratum. The original article has also been corrected. [ABSTRACT FROM AUTHOR]