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The authors describe a new exper imental model for lymphedema of rabbit ear. The method proved to be reliable and easily reproducible. The dilatation of lymph vessels after ex perimental provocation of lymphe dema permits study of the physio pathologic basis of lymphovenous shunts created by means of micro surgery and proves to be helpful for the microsurgeon's practice. [ABSTRACT FROM PUBLISHER]

Postoperative injuries of the lower limb represent a challenging complication after surgery. The use of advanced dressings, local flaps, reconstructions with grafts or dermal substitutes represent the most common therapeutic solutions. With the present paper, we describe a case of a postoperative wound of the leg treated with the use of hyperoxidized oils-based medical device: NOVOX©. An 88-year-old woman presented in September 2022 an ulcer on her left leg, on the external malleolus. Authors decided to treat the lesion with NOVOX© in the form of a dressing pad. The controls initially lasted every 48 hours, subsequently every 72 hours and in the last month only once a week. The progressive clinical examination showed a global reduction of the wound area. According to our experience, the novel oxygen-enriched oil-based dressing pad (NOVOX©) is simple to use, secure, and successful in treating old patients receiving postoperative therapy for leg ulcers.

Background: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders., Objective: In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date., Methods: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease., Results: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson's disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD., Conclusions: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

Current knowledge indicates that the molecular cross-talk between stem cells and biomaterials guides the stem cells' fate within a tissue engineering system. In this work, we have explored the effects of the interaction between the poly(l-lactide) acid (PLLA) polymer film and human adult adipose stem cells (hASCs), focusing on the events correlating the materials' surface characteristics and the cells' plasma membrane. hASCs were seeded on films of pristine PLLA polymer and on a PLLA surface modified by the radiofrequency plasma method under oxygen flow (PLLA+O₂). Comparative experiments were performed using human bone-marrow mesenchymal stem cells (hBM-MSCs) and human umbilical matrix stem cells (hUCMSCs). After treatment with oxygen-plasma, the surface of PLLA films became hydrophilic, whereas the bulk properties were not affected. hASCs cultured on pristine PLLA polymer films acquired a spheroid conformation. On the contrary, hASCs seeded on PLLA+O₂ film surface maintained the fibroblast-like morphology typically observed on tissue culture polystyrene. This suggests that the surface hydrophilicity is involved in the acquisition of the spheroid conformation. Noteworthy, the oxygen treatment had no effects on hBM-MSC and hUCMSC cultures and both stem cells maintained the same shape observed on PLLA films. This different behavior suggests that the biomaterial-interaction is stem cell specific., Competing Interests: The authors declare no conflict of interest.

The major challenge for stem cell translation regenerative medicine is the regeneration of damaged tissues by creating biological substitutes capable of recapitulating the missing function in the recipient host. Therefore, the current paradigm of tissue engineering strategies is the combination of a selected stem cell type, based on their capability to differentiate toward committed cell lineages, and a biomaterial, that, due to own characteristics (e.g., chemical, electric, mechanical property, nano-topography, and nanostructured molecular components), could serve as active scaffold to generate a bio-hybrid tissue/organ. Thus, effort has been made on the generation of in vitro tissue engineering modeling. Here, we present an in vitro model where human adipose stem cells isolated from lipoaspirate adipose tissue and breast adipose tissue, cultured on polymeric INTEGRA ® Meshed Bilayer Wound Matrix (selected based on conventional clinical applications) are evaluated for their potential application for reconstructive surgery toward bone and adipose tissue. We demonstrated that human adipose stem cells isolated from lipoaspirate and breast tissue have similar stemness properties and are suitable for tissue engineering applications. Finally, the overall results highlighted lipoaspirate adipose tissue as a good source for the generation of adult adipose stem cells.

Background: We present a rare case involving severe hypertrophy of the labia majora. This 39-year-old married woman developed a clinically noticeable bilateral lipodystrophy of her labia majora following the administration of chronic antiretroviral therapy. Different combination drug regimens that included drugs like Crixivan(®), Epivir(®), and Zerit(®) were administered to the patient from 1998 to 2005. The patient is currently on a single drug regimen of Atripla(®) with the disease under control and no other comorbidities. The severity of the pubic protuberance created an appearance resembling male genitalia, even when covered by underwear. This anatomical abnormality obviously impaired her social life and forced her to avoid wearing tight pants, swimming garments, and tight clothes in general. She also avoided any sexual activity., Methods: Her pubic hair was shaved. Crural creases and vulvar mucosa were marked in order not to be violated. The estimated amount of skin and fat to be removed was marked. Intraoperative tailor-tacking suturing was used to mark the extent of the resection of the labia majora. Sutures were left in place to verify the accurate tension of the remaining skin. The procedure was performed with the patient under general anesthesia. Labial skin resection was performed by sharp dissection. Electrocautery was then used to excise the lobulated fat accumulation. Two layers of 3/0 Vicryl(®) sutures were used in the lax subcutaneous tissue. 4/0 Vicryl(®) rapide was used on the skin to approximate wound edges. Suction drains were left in place for 48 h to reduce the dead space and to manage postoperative bleeding. The patient was instructed to keep ice and compression pads on the area for the first 24 h and to keep the area clean. This was followed by the application of antibiotic ointment two times a day on the wounds to avoid blood crust formation and to keep the skin soft., Results: Stitches were removed on POD 14 after an overall uneventful postoperative course. The sensitivity of the labia majora's interior aspect was preserved, even initially. With the legs slightly open, the labia majora just covered the entrance to the vagina. The clitoris and labia minora became visible again, restoring a normal anatomical appearance. Moderate edema was observed for 4 weeks after surgery., Conclusion: The surgical technique used provided an excellent result according to the patient, who regained her self-confidence and started having a normal sexual life again., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The authors present their experience in the study of blood supply of flaps. The machine used to study both pre and postoperatively the myocutaneous flap is the echo-color Doppler, a brand new device which has recently been used in investigating the morphology and the blood supply. The use of such method has provided us with the following information: detailed ultrasound structure of the skin, subcutaneous and muscular tissues of the examined flap; localization of vessels within the flap; size of the vessel in its whole length; quality and speed of both the arterial and venous flow. Such information is very important for the surgeon to plan in detail the reconstruction by knowing the blood supply of myocutaneous flap.

The aim of this paper is to evaluate the role of Doppler and echo color-Doppler in the microsurgical treatment of varicocele. Since December 1993, 87 consecutive patients underwent microsurgical treatment of varicocele. The study demonstrates that Doppler and Color-flow-Duplex scanning provide an accurate, non-invasive method to identify the position of accessory spermatic veins, evaluating at the same time the flow characteristics of the microsurgical anastomosis.

Forty patients were examined with colour Doppler to study the vascularization of rectus abdominis myocutaneous flaps before operations. The accuracy of this non-invasive ultrasound technique allowed us to describe the characteristics of the blood flow, including volume and velocity, diameter of vessels and their transverse section area within the epigastric arteries which supply the superior and inferior vascular pedicles of the flap. Vessels are drawn on the skin surface so that the flap can be more precisely and rapidly dissected. We are now using colour Doppler to assess variations in the diameter of vessels and in other variables of blood flow within the vascular pedicle of the transferred flap. These evaluations before and after operation are a great help to the reconstructive surgeon in the choice of operation and will lead to an appreciable reduction in postoperative morbidity.

At the Plastic and Reconstructive Surgery Department of the University of Perugia, 104 patients have been examined by color flow duplex scanning in order to study latissimus dorsi vascular supply before and after surgical procedures. This noninvasive ultrasound technique provides a precise and accurate measurement of blood flow velocity (15 cm/s) and volume (27 ml/min) within the thoracodorsal artery, which represents the vascular pedicle of the flap, and it allows us to detect the exact location of the perforating branches with their cutaneous distribution. This preoperative evaluation, pointing out vascular pathologies that contraindicate use of the latissimus dorsi flap, can be considered a great help for the reconstructive surgeon in the choice of the most suitable operation, and it can surely lead to a significant decrease in postoperative graft failure rates.

The paper reports the A. experience of 1460 cases of verrucae treated with cryosurgery. A hyperdry nitrogen monoxide method was used which enables a temperature of approximately -80 degrees C to be obtained. The large number of cases treated allowed the A. to present a statistical picture which was highly significant with regard to the mean number of applications, mean freezing time and, lastly, the mean healing time for different types of verrucae. The study confirms that cryosurgery is the elective treatment for this type of pathology.

The authors report their personal experience of the treatment of condylomas in both male and female patients using cryosurgery. The temperature of -80 degrees C which can be obtained using hyperdry nitrogen monoxide equipment allow radical treatment to be performed without pain in an outpatient setting without general or loco-regional anesthesia. The characteristics of this treatment allow patients to be regularly monitored, thus eliminating all signs of recidivation of those lesions which were too small to be seen at the start of treatment. The patient is considered cured after an interval of approximately 30-40 days after the disappearance of all condylomas.

The paper reports the Author's experience of the use of the muscle-skin flap of the upper rectum homolateral to the abdomen in the reconstruction of defects of the anterior thoracic wall following cancer surgery or radionecrosis, and compares it to that using other flaps (lower T.R.A.M., Latissimus dorsi, etc.). The well known anatomy of the flap, which is fed by the upper epigastric artery, also requires a precise surgical technique to isolate the muscular fibres without damaging vascularisation, a fundamental requisite for the vitality of the flap itself. Equally important for the vitality of the operation is a detailed study of the skin above the flap in patients treated with radiotherapy. The common and specific (epigastric hernia) complications of this operation are also examined, together with the precautions used by the Authors to prevent their occurrence.

A chance case of aneurysm of the brachiocephalic trunk suggested a review of the literature on this rare pathology. Stress is laid on the possible asymptomaticity of the lesion and on its frequent chance observation in chest X-rays; the diagnostic procedure, at times particularly complex, may not lead to decisive results but the possibility of aneurysm of the brachiocephalic trunk must be borne in mind in any case so as to avoid gross diagnostic and therapeutic errors.