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Surgical site infection (SSI) produces considerable morbidity and increases health care costs. One of its causes is microbial adherence to the surgical sutures surface. A strategy to avoid microbial colonization is the use of antimicrobial-impregnated sutures. Recently absorbable sutures treated with chlorhexidine (CHX) have been developed. Our study purpose was to compare CHX-coated and uncoated suture in elective plastic surgery.We conducted a randomized, double-blind, single-centre controlled trial of 18 patients undergoing elective bilateral mammary surgery and 18 patients undergoing skin lesions removals. Patients were divided into 2 groups receiving antibacterial-coated (study group) and uncoated (controlled group) sutures for wound closure. Patients were evaluated for scar results and signs of SSIs were monitored over a period of 30 days (or 1 year in case of prosthetic surgery). Statistical comparison was performed using dependent t-tests for paired samples.For patients undergoing mammary surgery, based on Vancouver Scale, there were no significant differences between the two groups. We noticed that in 8 patients the vertical scars belonging to the control group were larger than the contralateral 8 vertical sutures belonging to the study group. For patients undergoing skin surgery, surgical wounds treated with uncoated sutures were significantly more erythematous than the ones belonging to the study group (Media: 0,8333% vs. 1,5556%, respectively; standard deviation: 9,235 vs. 0,6157; 95%; p=0.0092).No wounds infection was reported between the two groups. Based on our experience, we conclude that the use of CHX-coated sutures should be considered in case of inflamed lesions removal. Further studies are needed to validate our results.

Surgical site infections (SSIs) are the third most common hospital-acquired infections and account for 14% to 16% of all such infections, and suture material may play a role in SSI rate. Given this risk of infection, sutures with antimicrobial activity have been developed. Both in vitro and in vivo experiments have shown that triclosan-coated sutures (TCS) are effective in the prevention of SSIs. Our aim is to analyze currently available RCTs, comparing the effect of antimicrobial-coated suture (ACS) with uncoated suture on the occurrence of SSIs following surgical procedures, we highlighted major contributions of most significant studies and evaluate the current "state of the art" on antimicrobial-coated sutures.We reviewed 15 RCTs comparing antimicrobial-coated sutures with conventional sutures and assessing the clinical effectiveness of antimicrobial sutures to decrease the risk for SSIs. We focused our attention on each variable in all the analyzed study.Our selected RCTs, produced controversial results: 7 RCTs demonstrated a significant benefit, on the contrary, 8 RCTs presented a comparison in which there was no difference.On the basis of our selected trial results and the heterogeneous findings of our 7 selected meta-analyses, we conclude that even though the question of whether TCSs could reduce the occurrence of SSI remains still open, the antimicrobial suture was effective in decreasing the risk for postoperative SSIs in a broad population of patients undergoing surgery. Alternative substances are becoming clinically relevant, such as Chlorhexidine (CHX) coated sutures and only 6 in vivo scientific studies evaluated them. In vivo studies, large and comparative clinical research trials are necessary to validate the efficacy of CHX-coated sutures thus allowing their use in clinical practice.

Aim: Cleft nose is an important sequela after primary cheiloplasty in cleft lip patients. Not touching the cleft lip nose in primary cleft lip repair was dogmatic in the past, although it meant severe functional, aesthetic, and psychologic problems for the child. Authors present their experience in one step lip, septum and nasal tip repair for this patients population. Methods. From March 2012 to January 2013, during charity missions organized in Africa, 56 patients affected by cleft lip deformity and sequelas of previous cleft lip surgery were operated. Results: Two complications were recorded. A good nostril symmetry was reached in all the cases. Conclusion: Authors present their experience in one step lip, septum and nasal tip repair for unilateral cleft lip patients. The big lack of this study is the absence of a long follow-up due to the surgery performed during charity missions. Thanks to the recent papers published in literature we can state that primary septal repositioning is a safe adjunctive technique to primary lip closure, although this operation reduces the psychosocial consequences of an otherwise uncorrected cleft nose deformity, it does not necessarily eliminate the need for a future operation.

The origin of the muscolocutaneous latissimus dorsi flap dates back to 1906 when Igino Tansini, an Italian surgeon, described a procedure to reconstruct the mastectomy defect. After a detailed study of Tansini's original description and drawings, new insights about the pedicle of its compound flap have been found, showing that it has the same pedicle of the scapular flap. In the end, Tansini's flap should be more correctly considered as a compound musculocutaneous scapular flap.

Introduction: Gradual increase in the elderly population in recent years is posing great health challenges and ulcers are one of the major challenges for the patients that are bedridde due to hematologic issues. They are commonly affected by ulcers. Beyond standard treatments, new approach to treat skin ulcers has become the application of topical growth preparations as PRP. Case Report: We are reporting a case of a 62-year-old male patient affected by non-Hodgkin Linfoma with paraparesis due to a compression over the bone marrow caused due to Linfoma. The prolonged bedridden condition had led to a voluminous class III-IV decubitus ulcer in the sacral region of 20 x 15 cm. We performed a standard medication for the injury for 5 weeks, which consisted in traditional disinfection, cleansing with physiological solution and application of topic collagenase. There was improvement and the wound started healing gradually, when treatmented with 8 cycles of piastrinic gel therapy. After six weeks of PRP treatment, the patient exhibited tremendous improvement. Production of hemocomponent: The platelet gel was obtained by autologous automatic procedure with multicomponent collection. The platelet count was significantly high and the WBC count was 10 times higher than baseline values of peripheral blood. Cryoprecipitate was obtained and mixed with leucoplatelet concentrate for enrichment and then splitted into 8 small bags. We succeed to reach a high cellular concentration without G-CSF patient stimulation and the procedure was well tolerated by the patient. Discussion: PRP method consists of collection and concentration of platelets that can release powerful growthfactors and there by cure the wound. Its positive effect is due to released lipoxins, antimicrobial effects, recruitment of undifferentiated cells and promotion of type I collagen formation and MMPs gene expression. It is a cheap and minimally invasive method. A quick review of literature and medical cases reveled the proofs for skin ulcers treated with PRP. This is helpful in treating the present case affected with skin ulcersand the study discusses how this can be managed through PRP application.Conclusion: The study concludes that it is possible to reduce the diameter of the soer and clear the bottom by applying PRP for a patient suffering from non-Hodgkin Linfoma. The study couold prove this treatment as safe with no risk of infection and it improves the quality of life of the patient. This study could establish that PRP application ensures faster healing with minimal or no hospitalization and very low medication.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Los cirujanos plásticos nos enfrentamos cada vez con más frecuencia en nuestra consulta a pacientes que desean o necesitan retirar sus implantes mamarios. Algunas de estas pacientes rechazan la idea de un reemplazo protésico, pero son exigentes con el resultado cosmético postoperatorio. Describimos la técnica empleada en 68 casos consecutivos y los resultados que hemos obtenido al tratar las secuelas en la mama tras la retirada de los implantes, fundamentalmente una disminución de volumen asociada a ptosis y excedente cutáneo. Esta técnica se basa en la extracción de los implantes y correccion mamaria simultanea con colgajo dermoglandular inferior que denominamos "autoprotesis" asociado a injerto graso simultáneo. Los resultados logran mejorar la forma, proyección y conificacion de la mama tras la retirada de los implantes, con un alto grado de satisfacción por parte de las pacientes. Plastic surgeons are frequently faced during consultation with patients who want or need breast implant explantation. Some of these patients reject the idea of a prosthetic replacement, but are demanding with the postoperative cosmetic result. We describe the technique used in 68 consecutive cases and our results to deal with breast alterations after breast implant explantation, leaving a decreased mammary volume, ptosis and a loosy cutaneous excedent. With this technique of explantation and simultaneous breast correction with de-epithelialized dermoglandular flap, "authoprosthesis", associated with simultaneous fat grafting, we can get a good result regarding the shape, projection and coning of the explanted breast, with high patient satisfaction.

The aim of this paper was to report our experience using VarioscopeÒM5 in hypospadia surgical correction. To suggest the use of microsurgical principles that can result in the successful repair of hypospadias with a few complications.Forty-three patients (age 12-16 months), affected by hypospadia, underwent longitudinal dorsal preputial island flap (Scuderi's technique) surgical procedure. All the procedures were performed with Varioscope®M5. This new device is a head-mounted miniaturized microscope which combines a microsurgical microscope illumination and magnification with the freedom of loupes.In 39 (91.1%) of the patients the postoperative course was uneventful. One patient (2.3%) developed urethral fistula and a second intervention was necessary to correct it. He was affected by fourth degree hypospadia. In 3 patients (6.6%) we observed a mild stenosis. Urethral strictures were dilated during multiple sessions, by weekly introduction of catheters of progressively increasing caliber. At 3 months after surgery all urethral strictures had been solved by non surgical treatment, thus decreasing complication rate of the surgical procedure from 8.9% to 2.3%. Evaluation of flow rate was repeated at 3 weeks, 6 and 12 months. The aesthetic outcome was evaluated by the parents on a VAS scale. Results were judged optimal (8-9 out of 10).In order to achieve a better aesthetic and functional outcome and to reduce complications we deem a perfect flap dissection and anastomosis necessary. A well lighted and magnified surgical field is essential to achieve the best result due to the small anatomical structures involved in the surgical technique we have adopted. The Varioscope®M5 offers essential advantages in this regard.

Circumcision is the most common procedure for phimosis. In recent years, the value of foreskin properties as well as aesthetic reasons determined to other operations preserving the foreskin. We report 5-years experience with a technique that preserve the physical foreskin appearance intact.Fifty-two patients, eligible to undergo phimosis surgery, underwent prepuce-sparing plasty and simple running suture. Evaluation of results was made with photos comparative and verified by using presence/absence of recurrence, scarring evaluation, and VAS for patient satisfaction.Forty-eight patients reported no complications. There were no cases of bleeding, infection, pathological scarring, phimosis recurrence. The scar showed a good pliability and a thin thickness. Patient satisfaction was high.The association of prepuce-sparing plasty and simple running suture highlighted an effective and easy method for the correction of acquired phimosis in adult patients, with excellent functional and cosmetic results.

Association of multiple vascular malformations of the face is a rare condition. An arteriovenous malformation (AVM) with a venous malformation as the draining vein is also a rarity. We report a case of extracranial mixed vascular malformations that deformed the normal architecture of the lower face. Removal of the AVM was followed by stability of the jaw and tongue malformation, indicating the AVM used the venous malformation as its draining vein. This approach spared the patient severe cosmetic and functional sequelae.

Most ulcers occur with slough and need debridement treatment. Surgical treatment is usually performed but many patients need an additional chemical therapy to promote healing process. This type of wound bed preparation is slower than surgical one, but it is essential in those patients who are not eligible for surgery because of systemic diseases. A collagenase derived from the bacterium Clostridium hisolyticum is the most used.To evaluate the safety and the effectiveness of a new collagenase produced by Vibrio algynoliticum.Forty patients were enrolled and daily treated for five weeks with Bionect Start® ointment. Parameters took into account were fibrin degradation and pain relief. The same team carried out treatment during the study period of five weeks.32 patients achieved a relevant reduction of the ulcer size, an improvement of the wound bed and a reduction of fibrin and exudates. Among of 32, 14 patients presented with a complete healing. Eight patients had mild or no improvements. The patients referred a remarkable pain reduction, 20 out of 40 patients reported a decrease in pain during treatment, 16 patients referred no pain at all and four patients had no significant changes.The application of this product on the lesions promotes vascularized granulation tissue and reduces formation of fibrin and exudate. Furthermore, a macroscopical margins proliferation is highlighted after a short time and an improvement of periwound skin is observed during the treatment period. Bionect Start® allowed easy removal of dressing, less pain for patient, reduction of dressing time.

Angioleiomyoma is a rare benign tumor of smooth muscle origin. It has been reported in many anatomical sites, but it is very rare in the nose. This article describes the case of a 46-year-old woman, with a subcutaneous vascular leiomyoma of the nasal tip. She reported a small painless mass. The skin which was covering it became strongly erythematous at high temperatures, with an annoying increase of the sensitivity. There are no specific imaging techniques capable of characterizing the vascular leiomyoma, however sonography represents an excellent modality for initial evaluation of this kind of lesion. We chose excision with an open rhinoplasty approach for treatment of the lesion. Obvious and disfiguring scars do not remain with this surgical approach. The patient had immediate and complete relief of her symptoms, the aesthetic result is very good and her satisfaction is complete.

A 15 years-old patient was brought to our attention in June 2010 with a complex genito-urinary malformation: fusion of the labia majora and a partial union of labia minora, common urinary and vaginal meatus and clitoromegaly. The patient had a normal sexual feminine hormonal development. After diagnostic iter the patient underwent surgery twice. No signs of hormonal deficency was shown authorizing us to approach the disease as a congenital malformation due to an abnormality of intrauterine development. So surgical treatment was carried out, considering it as the gold standard for this type of malformations. It's considerable to emphasize that the association between clitoromegaly and fusion of the lower third of the urethra with the vagina has not been previously reported in the literature.

Basal cell carcinoma (BCC) is the most common type of cancer in Europe, Australia and the U.S.A. After nasal skin cancer excision, especially if it is less than 1-2 cm in diameter, several surgical techniques can be used to reconstruct the lack of substance.In the management of our two patients we have chosen to utilize, instead, a well-known plastic surgery technique, Z-plasty, which is both easy to perform that effective to achieve excellent cosmetic results. As shown by our two clinical cases, the use of Z-plasty for lack of substance of the nose tip and bridge can be extremely effective in terms of cosmetic results. In comparison with the other reconstructive techniques, in fact, it is very easy to perform and allows to avoid or minimize the distortion of the nasal tip and wing, to orient the incision along the skin tension lines and, finally, to replace the lack with very similar structures regarding color, thickness and tissue architecture to those removed.

Investigate if the tyrosinase mRNA expression may be predictive of the outcome on ultra-thin, thin, and thick melanoma patients.In our study, we sought to correlate tyrosinase mRNA expression to the outcome in a group of 71 patients with thick, thin and ultra-thin melanomas.71 patients with melanomas underwent a SLNB (sentinel lymph node biopsy) at the "Sapienza" University of Rome. Among these, 38 patients had thin melanomas, while the other 33 patients had thick melanomas. In every patient's sample histology, immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) was completed. We then correlated tyrosinase mRNA expression to the statistical analysis of the outcome of patients.Positivity of histology was found in one patient (1.4%), immunohistochemistry in five patients (7%), and tyrosinase in 52/71 (73.2%). Thickness and tyrosinase positivity were predictive for disease progression (p0.05). The median follow-up was 58.24 months. There were recurrences and/or deaths in both groups of patients.Nodal metastasis in melanoma is uncommon, especially in patients with thin melanomas. In this study, histology and immunohistochemistry were found to be non predictive for the risk of nodal metastases, while instead, tyrosinase m-RNA expression appeared to play a role in highlighting those patients with a risk of disease progression. Moreover, no differences among the thin melanoma groups of patients (0.30-0.75 mm and 0.76-1.00 mm) were observed.

Chronic venous ulcers are one of the most common medical problems today. The treatment has always been challenging and over the years many conservative and surgical alternatives have been proposed. During the past three decades, extracorporeal shock wave therapy (ESWT) has been introduced in several medical specialties. According to the clinical findings, the ESWT appears to significantly improve the healing process of chronic wounds, increasing the release of endogenous angiogenic factor from endothelial cells and fibroblasts, consequently fastening the healing process of chronic wounds. The present report describes the application of ESWT for the treatment of chronic venous ulcers in the lower limbs and compared the results with those obtained by conventional treatment on the contralateral leg.

In neonatal intensive care units, extravasation is one of the most common injuries occurring in infants as a complication of infusion therapy. These very preterm infants have immature skin which is easily damaged. They often require a longer duration of intravenous therapy, and obtaining intravenous access can be difficult. An invasive treatment should be avoided, whenever possible, particularly for very immature infants. In our Special Operative Unit for ulcers and difficult-to-heal wounds, University of Rome, we successfully treated a premature neonate, who experienced extravasation of hypertonic fluid, using dermal substitutes and products of regenerative medicine.

Keloid represents an exuberant wound healing response, usually secondary to trauma, inflammation, surgery, or burns. Spontaneous keloid formation is rare and it is controversial whether it is really spontaneous. It usually occurs in young people, and it is rare in elderly. Its main features are the infiltration of surrounding normal tissue, the rare regression and the evolution over time. We report the case of an 81 -year -old man with unexpected spontaneous keloid lesion in the right postauricular region. The diagnosis was hard to be performed because of the patient's age, the anatomical site of the lesion and the absence of skin trauma or injury history. Only the histological examination allowed us to perform the right diagnosis.

Hydroxyurea (HU) is an antitumor agent effective in the treatment of myeloproliferative disorders. It is usually well-tolerated and has low toxicity but its use is associated with several adverse cutaneous effects. Among them, leg ulcers have been noted in association with long-term administration. Poor response to traditional local and systemic therapy is a typical feature of HU-induced leg ulcers, and discontinuation of the drug is often required to achieve complete wound healing. We present a case of circumferential HU-induced leg ulcer in a patient affected by essential thrombocythemia, in which the lesion occured after the definitive suspension of the treatment. We propose a conservative management with a new collagenase (Bionect Start®) for skin lesions in this type of patient, for whom a surgical treatment could be more complicated, due to the underlying disease.

Lip cancer is the most frequent tumor of the oral-maxillary region. A high incidence of lip cancer has been reported among the Italian population over the past decade.This retrospective study analyzes epidemiological data and risk factors for lip cancer among patients who presented to our department between 2000-2010. Statistical analysis for this study was calculated employing Student T and χ-square tests.Of 540 cases, most were found among men (82%), and those aged over 45 years (84.8%). The dominant cancer type was squamous cell carcinoma of the external lower lip (predominantly in men). We recorded high rates of chronic solar exposure, and tobacco and alcohol drinking habits in patients with squamous cell carcinoma.Individuals aged over 45 years are at higher risk for lip cancer. The high association of the examined risk factors with the rate of squamous cell carcinoma confirms their role in the development of this type of tumor.