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Scopo: The use of scaffolds and autologous skin cell suspension grafts represents an efficient alternative to reconstructive plastic surgery in the trauma department. In our twelve months of experience, we have used bovine scaffolds and autologous skin cell suspension on injuries of traumatic nature in patients who couldn't undergo reconstructive surgery because of probable therapeutic failure. Patients were ineligible for surgery due to the following criteria: elderly age, comorbidities (decompensated diabetes, infections, vasculopathy, venous insufficiency, heart disease, obesity), allergies, systemic therapies with glucocorticoids or chemotherapy, areas damaged by skin aging and patient's lack of consent to surgery. Resorting to scaffolds combined with autologous skin cell suspension grafts represents a therapeutic solution that despite the absence of donor site morbidity allows the coverage of areas damaged by tegumental loss, with excellent effective and aesthetic results. Metodi: The treatment, following debridement, demanded the urgent use of scaffolds and grafts of autologous skin cell suspension. The "Wound Bed Preparation" (WBP) is an essential requirement for their correct use. Risultati: Presentation of 3 cases. Conclusioni: Scaffolds and autologous skin cell suspension grafts represent the solution for those traumas where reconstructive surgery is hindered by factors that predict reparative failure, thus reducing the increase in the risk of major amputations. [ABSTRACT FROM AUTHOR]

Aim: Scaffolds are stable resources for reconstructive surgery in trauma as well. From February 2020 to February 2022, we studied a group of patients (25), who on admission to the trauma center of our local health care service, presented an AIS > 3 (Advanced Injury scale), concomitant with severe tegumental injuries, resorting to "Damage Control". The early use of major reconstructive surgery on limb injuries determines the outbreak of fatal complications. ("Double Hit"). In the early stages of polytrauma management, we associated the use of scaffolds with the Negative Pressure Wound Therapy obtaining an improvement in wound healing and bone coverage, defined as "inert" over time. The critical conditions of patients with traumatic injury of ortho-plastic nature have forced us, in compliance with the indications of the Damage Control technique, to pursue an early reconstructive approach with bovine and porcine scaffolds, associated with Negative Pressure Wound Therapy. This Wound Care solution implementing the necessary bone "coverage" is achievable without causing additional stress for the body. Method: Scaffolds and Negative Pressure Wound Therapy lasted for an average of 22 days. Results: There were 24 recovery cases, with low bone infections (3 cases) and one amputation due to necrosis. Conclusion: In conclusion, the combination of scaffolds and Negative Pressure Wound Therapy represents a possible solution for those ortho-plastic traumas, in which the major surgical reconstructive approach is prevented by the severity of the patient's conditions, reducing the risk of sepsis and the related increase in major amputations. [ABSTRACT FROM AUTHOR]

Introduction: Prognosis of thyroid cancer is strictly related to loco-regional metastases. Cervical lymphadenectomy has a specific oncologic role but may lead to significant increase of morbidity. Aim of the study is the analysis of surgical morbidity in cervical lymphadenectomy for thyroid cancer.Methods: We retrospectively analyzed 1.765 thyroid cancers operated over a period of 25 years at S. Maria University Hospital, Terni, University of Perugia, Italy. Type of lymphadenectomy, histology and complications were analysed.Results: A prevalence of differentiated and medullary cancers was observed (respectively 88% and 7.2%). Central lymphadenectomy was carried out in 425 patients, lateral modified and radical lymphadenectomy respectively in 651 and 17 cases. Following central neck dissection we observed: bilateral and unilateral temporary recurrent nerves palsy respectively of 0.7% and 3.5%, unilateral permanent palsy in 1.6% of cases, temporary and permanent hypoparathyroidism respectively in 17.6% and 4.4%. After lateral neck dissection we observed: intra and post-operative haemorrhage respectively in 2% and 0.29%, respiratory distress in 0.29%, lesions of facial nerve in 0.44%, of vagus in 0.14%, of phrenic nerve in 0.14%, of hypoglossal nerve in 0.29%, of the accessory nerve, transient in 1.34% and permanent in 0.29%, permanent lesion of cervical plexus in 0.29%, salivary fistula in 0.14% and chylous fistula in 1.04% of patients. Student's t test was used to compare groups when appliable.Conclusion: Central and lateral cervical lymph node dissection are associated to severe morbidity. Correct indication, surgical expertise, high volume of patients and early multidisciplinary management of complications is the key of an acceptable balance between oncologic benefits and surgical morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Thoracic duct fistula at the cervical level is a severe but rare complication following thyroid surgery, particularly associated to lateral dissection of the neck and to mediastinal goiter.Methods: we retrospectively analyzed chylous fistulas observed in a cohort of 13.224 patients underwent surgery for thyroid disease since 1986 to 2014, in the Unit of Endocrine Surgery, S. Maria University Hospital, Terni, Italy.Results: We observed 20 cases of chylous fistula. Thirteen patients underwent primary surgery in our institution while the remaining 7 cases had been referred to our Department from other hospitals for an already diagnosed lymphatic leak. Surgical procedures carried out included total thyroidectomy for mediastinal goiter in 4 patients, total thyroidectomy for cancer in 2 patients, unilateral functional lymphadenectomy in 11 patients and bilateral in 3. Intraoperative repair was carried out in 4 cases. Of the remaining 16 cases, 4 of the 6 fistulas with low flow leakage healed in about 30 days of conservative treatment, 2 cases instead required surgical repair. All 10 patients with "high-flow" fistula underwent surgery. Despite surgery was performed later, postoperative course in patients with late surgical repair is similar to what observed in those patients with early surgical repair. Both groups underwent cervical drainage removal in post-operative day 4.Conclusion: Healing of a cervical chylous fistula can be achieved by conservative medical therapy (nutritional and pharmacological) but in case of therapeutic failure with rapid decrease of general condition, the surgical approach is necessary. In our experience, duct ligation after unsuccessful conservative treatment, is the only resolutive treatment. [ABSTRACT FROM AUTHOR]