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Nowadays, the ultimate goal of microsurgical breast reconstruction is not merely the effective transfer of vascularized tissue but the achievement of a natural, symmetric appearance. The aim of this present study was to systematically summarize the published evidence on abdominal-based free flap inset for breast reconstruction in order to provide principles and classification that could guide the surgeon in choosing the most appropriate inset technique based on patient and flap characteristics. A comprehensive review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, looking for articles on the insetting technique for free flap breast reconstruction. After screening 306 publications, 24 papers (published from 1994 to 2020) were included in the study. We identified four main breast anatomical features on which the papers reviewed focused when describing their insetting technique: breast width, breast ptosis, breast projection, and upper pole fullness. Patient body type, type of mastectomy, and reported complications are also discussed. Flap shaping and inset during breast reconstruction are fundamental steps in any reconstructive procedure. Despite the low evidence in the current literature, this systematic review provides a framework to guide the surgeon's decision-making and optimize the aesthetic outcomes of abdominal-based free flap breast reconstruction. [ABSTRACT FROM AUTHOR]

This work aims to assess lower limb free flaps spontaneous sensory recovery by comparing and analyzing a single standardized reconstructive procedure, namely the free noninnervated anterolateral thigh (ALT) flap in order to evaluate which flap or patient-related factors may predict flap reinnervation. Between January 2010 and March 2018 all nonreinnervated ALT flaps for lower limb coverage performed at our institution were screened. We excluded from the study flaps with less than 18 months of follow-up time, neurotized flaps, and those from patients who missed the last follow up. Sensory modalities that were evaluated included the two-point discrimination (2PD) test, measured in mm; and the Semmes–Weinstein monofilament (SWM) test, measured in gram. The sensory parameter results were compared and analyzed according to flap size (two groups; <160 cm2 vs. > 160 cm2), and post-op time of testing (two groups; <18–28 months vs. > 28 months). Twenty-one ALT free flaps were finally retained by this study. Our findings showed that flaps of smaller surface area showed a significantly better return in sensory discrimination 2PD and in sensory cutaneous pressure perception SWM testing. This work establishes for the first time some key quantitative data that can help predict free flap spontaneous reinnervation outcomes when using the same ALT flap. In our series, flaps surface remains the main discriminant value for a better sensory recovery. [ABSTRACT FROM AUTHOR]

Background: Traumatic earlobe is a frequently encountered problem in our practice. Numerous techniques have been published in the past decades including case reports, retrospective reviews, and prospective studies. However, to date, no study has investigated the overall complications or satisfaction rates associated with the wide spectrum of techniques. Objectives: This review aims to assess the outcomes of the various earlobe repair techniques and to provide a simplified classification system. Methods: This systematic review was performed in accordance with the PRISMA guidelines. PubMed database was queried in search of clinical studies describing surgical and non‐surgical techniques, which reported techniques, indications, and outcomes. Results: Twenty‐six studies, published from 1973 through 2019, were included. Six main technique categories were identified: These were straight‐line closure (type 1, n = 82), Z‐plasty (type 2, n = 165), flaps (type 3, n = 66), L‐specular plasty (type 4, n = 35), double‐curve specular plasty (type 5, n = 15), and non‐surgical techniques (type 6, n = 38). Z‐plasty (type 2) had the highest post‐operative infection rate of 11.5%. Conclusions: While all the techniques are generally simple and efficient, they should be chosen based on both surgeon and patient preference. Complication rates and morbidity are relatively low. [ABSTRACT FROM AUTHOR]

Post-traumatic defects of the distal third of the leg often require skipping a few steps of the well-established reconstructive ladder, due to the limited local reliable reconstructive options. In rare cases, the reconstructive plan and flap choice may encounter challenges when the patient has psychiatric illness affecting compliance with postoperative care. We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures may be preferred over a long and complex surgical reconstruction requiring good compliance with postoperative care. The medical team should be aware of the risk of postoperative collapse, focus on the prevention of pain, and be wary of drug interactions. Whenever necessary, free tissue transfer should be performed despite potential compliance issues. [ABSTRACT FROM AUTHOR]

We then elaborated a stepwise approach, combining lymphatic surgery principles and plastic surgery flap techniques, that lead to an effective treatment algorithm where surgical options were wound-tailored to guarantee the best functional outcomes. Literature outcomes of surgical treatment (specifically lymphatic ligation ± muscle flaps) were compared with conservative therapy. [2] Importantly, authors screened the literature in the aim to match patient's conditions and preoperative risk factors to the leak treatment, defining a clear treatment algorithm. [Extracted from the article]

Summary: The authors of this review present a comprehensive assessment of the techniques and indications in the treatment of the long upper lip. Setting aside the maxillofacial malformations, the review is focused on senescence as the most frequent etiology. A graphical reminder of the anatomical entities and of the upper lip proportions allows optimal preoperative planning. All current treatment options, from fillers to surgical excision and dermabrasion, are reviewed and summarized in order to provide an overview of each technique's expected results and contraindications. [ABSTRACT FROM AUTHOR]