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Background. In alloplastic breast reconstruction, the choice of implant positioning and the selection of periprosthetic devices is a critical and challenging decision. Surgeons must navigate between various biologic and synthetic meshes, including acellular dermal matrices (ADM). This study aimed to propose a simple selection tool for periprosthetic devices in prepectoral breast reconstruction. Methods. Patients scheduled for mastectomy followed by implant-based breast reconstruction between September 2019 and December 2023 were included. Preoperative risk assessments were performed using the Pre-Bra Score, and only those deemed suitable for prepectoral implant placement were selected. Mastectomy flap thickness was used as an independent criterion, and only cases with flap thicknesses less than 1 cm were included. Results. A total of 70 cases with an average flap thickness of 0.7 cm (range, 0.4-0.9 cm), as measured by preoperative contrast-enhanced spectral mammography (CESM), underwent prepectoral reconstruction with ADM covering the implant. Of these, 25 patients (35%) received direct-to-implant reconstruction, while 45 (65%) underwent two-stage reconstruction with a temporary tissue expander. Postoperative complications were recorded during a minimum follow-up period of 6 months. Over an average follow-up duration of 17.5 months (range 6-36 months), no major complications were observed. Minor complications occurred in seven patients: infection (1.28%), seroma (3.85%), and superficial skin necrosis (1.28%). Additionally, 21 patients (30%) experienced rippling, and secondary lipofilling was scheduled. Conclusions. The incidence of rippling was reduced by 40% through ADM in this patient subgroup, reducing the need for secondary aesthetic refinements.

Patellofemoral arthroplasty (PFA) has emerged as an alternative bone-preserving surgical option for treating isolated symptomatic patellofemoral osteoarthritis that better replicates the natural knee kinematics compared with total knee arthroplasty. Achieving successful outcomes in PFA relies on meticulous patient selection, proper surgical technique, and appropriate implant choice and placement. Recent advancements in inlay trochlea implants, allowing for customized and anatomic joint line reconstruction with less bone resection, have demonstrated significant improvements in functional outcome scores and pain relief. This Technical Note aims to provide insights into the surgical technique of PFA with inlay implants, highlighting key considerations and potential challenges. It also assists surgeons in making informed decisions regarding the choice between standard and dysplastic inlay implants, while suggesting concurrent procedures to optimize tracking and overall outcomes., (© 2024 The Authors.)

Purpose: The radial forearm free flap (RFFF) remains a workhorse in microsurgical reconstruction. Its failure is primarily due to problems with venous drainage; for this reason, controversy on venous anastomosis patterns still exists. This manuscript describes our experience in using a communicating vein to overcome the complications of venous drainage of the RFFF., Methods: Following a review of the vascular anatomy of the RFFF, we retrospectively review the use of the communicating vein and report our results, with the aim of overcoming the dichotomy "superficial versus deep venous system" and "single versus double anastomosis" and discussing the evidence of advantages in using a single microanastomosis with a communicating vein., Results: Our retrospective review included a total of 123 patients in which a RFFF was performed to reconstruct intraoral defects, performed with a single venous anastomosis using the communicating vein. Four patients (3.25%) required a return to theatre for revision of the venous anastomosis and one case resulted in flap failure due to arterial insufficiency (0.81%)., Conclusions: Our series highlights the constant presence of the communicating vein, although with variations of origin and course that did not preclude the possibility to correctly perform the anastomosis. Advantages of a single microanastomosis with the communicating vein include ease, speed, reliability and versatility in planning the anastomosis. Based on our results, the use of the communicating vein showed comparable and, in some cases, more favourable results when compared to venous anastomotic complications reported in the literature., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Complete reconstruction of the hamate bone has been reported in the literature mostly following cancer excision or avascular necrosis. For the exiguity of the tissue deficit, bone grafting has usually been used as treatment option for its rapidity and easiness to perform, even if a variable amount of bone resorption may occur. In traumatic cases, microbial contamination may jeopardize the success of a well performed bone graft and vascularised bone grafts may represent a better reconstructive option. Here we describe the first case reported in the literature of a patient underwent complete hamate reconstruction following trauma with an osseous medial femoral condyle free flap as vascularized arthrodesis between the capitate and the 4th MTC base, in order to stabilize the 4th and 5th finger and the ulnar carpo-metacarpal joint., (© 2022. The Author(s).)

Background: Most unstable hand fractures in children are treated by closed methods. If osteosynthesis is required, Kirschner (K)-wires are commonly used, though they carry a risk of injury to the physis. We have been using a mini external fixator system (MEFS) for the treatment of unstable periphyseal fractures of the hand. The aim of this study is to describe the application and report the outcomes of MEFS for the treatment of periphyseal fractures of the hand. Methods: We retrospectively reviewed all the patients with periphyseal fracture of the hand treated with MEFS from March 2010 to December 2019. Data with regard to age, sex, hand dominance, digit and bone injured, mechanism of injury, medical records and related radiographs were collected. Salter-Harris classification was used to classify epiphyseal fractures and the Al-Qattan classification for categorising neck fractures. Range of motion and residual deformity of the affected fingers were evaluated during follow-up and at 3 months postoperatively. Results: Fourteen periphyseal unstable fractures were treated using closed reduction and MEFS. Only one patient with a fracture of the neck of the proximal phalanx of the little finger required revision surgery. No patient had pin site infection or pin loosening and the device was well tolerated by all patients. All fractures united and all the patients recovered a full range of motion at final follow-up. Conclusions: The MEFS is a reasonable alternative for unstable periphyseal fractures with good outcomes and avoids the risk of iatrogenic physeal injury from K-wire fixation. Level of Evidence: Level IV (Therapeutic).

Background: The ear is one of the face areas most affected by skin cancers, and the surgical reconstruction is often challenging because of tumor- and patient-related factors. Reconstructive options are essentially skin flaps and grafts or their combinations. The use of preauricular translocation (PAT) flap for auricular reconstructions is constantly increasing., Aim and Methods: This retrospective study reports the comparison between the PAT flap and the full-thickness skin grafts (FTSGs) for surgical auricular defect reconstruction in elderly population (≥65 years) that typically shows poor compliance in the postoperative wound care management., Results: A total of 52 FTSGs (Group A) and 39 PAT (Group B) were performed between April 2007 and July 2020. The aim was to investigate, compare, and define advantages and disadvantages of both techniques. Visual Analogue Scale (VAS) was used to evaluate the overall patients' satisfaction. The mean surgical and healing times were longer in Group A (p < 0.05). No complications occurred in the PAT group, and all the flaps survived. In the FTSG group, the overall complication rate was 17.3% (four partial and three total graft failure, and two graft infections). T test was used to compare the VAS scores: Patients with PAT flap were more satisfied than those with FTSG (p < 0.05)., Conclusions: Preauricular translocation flap is a reproducible, safe, and quick option for auricular defects reconstruction in the ≥65 years population, associated with an easier patient management, high patient satisfaction, and excellent aesthetic result., (© 2021 Wiley Periodicals LLC.)