Presentation of the new Chapter on Regenerative Medicine and Surgery

Surgical outcome of the patient with open proximal phalangeal fracture with bone defect due to dog bite injury treated with vascularized bone graft: a case report Abstract A dog bite injury involving joints and bones has poor prognosis. We described a case of open proximal phalangeal fracture with bone defect of the left index finger due to dog bite injury. The patient was treated successfully with a pedicled second metacarpal vascularized bone graft based on the second dorsal metacarpal artery following debridement and external fixation. Subsequently, extensor tendon tenolysis wrapped with adipofascial flap based on the first dorsal metacarpal artery was performed. After obtaining supple joint of the finger, flexor tendon tenolysis was performed. The postoperative course was uneventful, without infection. Nineteen months after the last operation, there was slight pain in the finger at power grip, but no disability in activities of daily life and work. The total active motion of the left index finger was 245°, and plain radiography showed bony union without osteoarthritic change. Good clinical outcome was obtained through a combination of staged surgery. Level of evidence: Level V, therapeutic study.

Strattice reconstructive tissue matrix to maintain nipple projection—what do patients think? Abstract Background One of the main challenges in nipple reconstruction is achieving and maintaining nipple projection. We describe a novel use of banked Strattice to provide an internal scaffold and improve long-term projection following nipple reconstruction. We assess patient and partner satisfaction with the technique compared with routine reconstruction. Methods All patients who underwent nipple reconstruction in our unit by a single surgeon between 1/1/11 and 29/4/16 were identified retrospectively and asked to complete a satisfaction questionnaire relating specifically to their reconstruction. Those who underwent reconstruction with Strattice were compared with those that had local flaps alone. Results Sixty-four patients and 73 nipples were reconstructed during the study period. Eighteen nipples were reconstructed on 14 patients using Strattice. Fifty-seven patients responded to the questionnaire (90.5%). One patient developed an infection requiring removal of the banked matrix. Patients had a statistically significant increased degree of satisfaction when Strattice was used to augment their reconstruction (Mean ± SEM score 8.06 ± 0.20 versus 5.83 ± 0.16 for no Strattice; p < 0.0001). This was also the case when undressed (7.59 ± 0.15 vs 5.69 ± 0.16) but did not reach statistical significance when the patient was dressed (6.85 ± 0.19 vs 6.44 ± 0.11; p = 0.08). Patients’ partners also rated the reconstruction more highly when Strattice was used (7.71 ± 0.14 versus 6.33 ± 0.19 for no Strattice). Conclusions Our study demonstrates that the use of Strattice in nipple reconstruction can lead to significantly increased rates of satisfaction among women undergoing the final stage of breast reconstruction. Level of Evidence: III Therapeutic study.

Reversed abdominoplasty as a reconstructive option on a patient with a basal cell carcinoma of the intermammary region Abstract The reversed abdominoplasty is an aesthetic procedure not very commonly used nowadays. It is used more often on patients with skin excess and lipodystrophy of the upper abdominal wall. Regardless of its low rate of complications, it implies perceptible inframammary scars that stretch along the midline. Basal cell carcinoma is the most common skin cancer. It is located mostly in areas of high sunlight exposure such as the face or ears. However, it can appear in uncommon locations like the intermammary area. The authors report the case of a 65-year-old female with a 3-cm nodular basal cell carcinoma of the inferior intermammary region. As the patient had supraumbilical lipodystrophy, we used a variation of reversed abdominoplasty to reconstruct the defect after tumour resection. One year after surgery, there were no complications or cancer recurrence. The scars were aesthetically good and body contour was improved. This clinical case shows the intimate relation between aesthetical and reconstructive surgery. The application of aesthetic surgery techniques in the field of skin oncology (‘oncoplastic’ techniques) can give significant improvement in the final result with minimal morbidity and without compromising treatment safety. Level of evidence: Level V, therapeutic study.

An index case of primary osseous PEComa in a paediatric craniofacial skeleton Abstract Perivascular epithelioid cell tumours, known as PEComas, are a family of tumours with immunoreactive melanocytic and smooth muscle markers. They are a rare heterogeneous group in adulthood and childhood with primary osseous PEComas representing an even rarer subgroup. The clinical behaviour is not well understood and the treatment options vary. We present an index case of a primary osseous PEComa of the craniofacial skeleton in a 3-year-old girl. Level of evidence: Level V, diagnostic; therapeutic; risk/prognostic study.

Application of a 3D 4K exoscopic system to head and neck reconstruction: a feasibility study Abstract Background Technological advancements in surgery provide convenience and new capabilities to surgical practice. A recently developed 3D 4K exoscopic system gives the surgeon a potential alternative to the operating microscope (OM). This paper focuses on the first experience on microsurgical free flap reconstructions performed with a 3D 4K system and evaluates the potentials and pitfalls of this new technology. Methods Three consecutive cases of head and neck cancers requiring free flap reconstructions were included. Free flap harvesting and anastomosis in 2 and 3 patients, respectively, were performed using the 3D 4K exoscopic system. Results The 3D 4K exoscope provided a high quality of vision and perception of depth. The setting of the operating theater was ergonomically favorable. No case required a switch to traditional OM. Conclusions This initial experience shows that harvesting free flaps and performing microanastomoses with the 3D 4K exoscopic system are feasible. Further studies on larger series are warranted to explore if the applicability of this technology to other fields of head and neck surgery can compensate for its costs. Level of Evidence: Level V, therapeutic study

Palatal fistulas complicating osseomyocutaneous reconstruction of oncological maxillectomy defects Abstract Background Free flap reconstruction is the standard method for reconstructing large maxillary defects. Palatal fistula is an uncommon complication following reconstructive surgery. This study aims to describe the incidence, etiology, and management of palatal fistulae following reconstruction of oncological maxillectomy defects. Methods A total of 108 patients from a single institution who underwent maxillectomy surgery between 2008 and 2014 were retrospectively reviewed. Ninety-two patients had resection of the hard palate. Sixty-eight patients underwent immediate free flap reconstruction of the palate; 55 had reconstruction of the hard palate with skin, and thirteen had reconstruction of the hard palate with muscle. Results The incidence of palatal fistulae in the reconstructed palates was 12% (11 patients) in this series: five after muscular reconstruction of the hard palate and six after cutaneous reconstruction. Muscular reconstruction of the hard palate is associated with a significantly higher incidence of palatal fistulae compared with cutaneous reconstruction (p = 0.015). The Cordeiro classification, smoking, diabetes, immunosuppression, and radiotherapy were not significant risk factors (p > 0.05). Conclusions Based on our experience, we caution against attempting direct closure for established palatal fistulae, the majority of patients who had attempted direct closure of their fistulae failed to achieve resolution.

An approach to lipedema: a literature review of current knowledge of an underestimated health problem Abstract Lipedema, which has been known as an adipose tissue disorder characterized by abnormal fat deposition, mostly affects women. This condition can easily be ruled out regarding its diagnosis because it is commonly misdiagnosed as obesity. True diagnosing and optimal management of lipedema show a great importance. As patients suffer from lipedema, not only experiencing physical symptoms such as tenderness or a feeling of heaviness but also psychological symptoms such as anxiety, they cause negative influences on quality of life of a person with lipedema. This paper tries to review all aspects of lipedema from diagnosis to management and assessment options.

The role of intense pulsed light (IPL) in the treatment of meibomian gland dysfunction (MGD) Abstract Background Meibomian gland dysfunction (MGD) may result in alteration of the tear film, symptoms of eye irritation, and evaporative dry eye disease (DED). Recent studies suggest that intense-pulsed light (IPL) treatments reduce ocular signs and symptoms, through direct/indirect actions on meibomian glands. The aim of this study is to analyse and measure efficacy and safety of IPL treatment in patients affected by MGD. Methods Between September 2016 and January 2017, eleven patients were enrolled in this univariate study based on a single variable. All patients have undergone two IPL sections with Synchro FT- DEKA MELA, once a month. Ocular Surface Disease Index (OSDI), breakup time (BUT), and Schirmer Test Type I have been evaluated preop, 10 days after every treatment and followed up to 1 year. Results All patients referred to a relevant improvement of symptoms with two treatments. A reduction of epithelial damage and a modification of glandular function confirmed a statistically significant difference. Conclusions IPL could be considered as an adjunctive tool in patients suffering from MGD. The high versatility of IPL device allows customized treatment with minimum discomfort and high tolerability. Level of Evidence: Level IV, therapeutic study.

Regulatory, ethical, and technical considerations on regenerative technologies and adipose-derived mesenchymal stem cells Abstract Since the early days of molecular biology, organ and tissue regeneration represents a challenging medical goal. However, only recently the advances in the understanding of the cellular components have enabled the promise to become a reality. In this vast panorama of new technologies, stem cells have progressively established themselves as the most effective and user-friendly regenerative therapeutic tool. Scientific meetings, workshops, conferences, and forums focused on translational science of regenerative technologies are today blooming all over the world. The audience questions and, even more, the very often controversial and conflicting explanations highlight the great deal of confusion regarding this new discipline that should be considered today a real independent medical specialty, requiring long-term studies and dedication. All the technologies able to separate and concentrate the adipose tissue (AT) and the stromal vascular fraction (SVF) and their related clinical applications need to comply with a complex but still unclear regulatory frame, becoming everyday more severe and restrictive, this limiting their practical use. The aim of this manuscript is to overview the current status of the regulatory frame and few related ethical considerations and to describe the evolution in the way the adipose-derived stromal vascular fraction (SVF) is isolated, extracted, and concentrated, as well as, of the ongoing researches and related future perspectives. Considerations on the most controversial and still unclear points related to the regenerative medicine and surgery, seen from the perspective of a research group who dedicated their entire professional life to this field, are also provided. Level of evidence: Not ratable.