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Breast Capsular Contracture (BCC) is one of the adverse complications occurring with greater incidence in breast augmentation surgical procedures. Its formation can be interpreted as the conclusive result of the physiological process known as response to a foreign body. From a biochemical standpoint, the formation of the peri-prosthetic capsule is certainly a multifactorial process: many hypotheses concerning its etiology have been suggested in the literature and a number of related pharmacological protocols have been consequently proposed to clinically treat this pathology with the aim to prevent further complications and avoid future re-interventions. However, the vast majority of these theories seems to be only partially supported by clinical outcomes and thus a shared opinion on this matter is still absent among specialists. Within this framework, by starting from clinical observations which highlighted an unexpected correlation between histo-morphological features of fibrotic capsules and overall size of breast implants, the present study investigates the hypothesis that the biomechanical interaction between prosthesis and host tissue may play a crucial role in the biological processes governing the pathological phenomenon at hand. Therefore, to shed light on the underlying mechanisms which could trigger the breast capsular contracture, both simple analytical solutions, in which elasticity and growth are simultaneously taken into account, and more accurate geometrically faithful Finite Element-based numerical simulations have been exploited. The theoretical findings demonstrate that somehow counter-intuitive radial and hoop stress fields occur at the capsula-implant interface in a way such that their combined action, independently from other possible concurrent factors, results significantly amplified for small-size breast prostheses, localized stress peaks in these cases promoting detaching and rippling phenomena actually observed in BCC clinical complications.

Purpose Lipofilling technique is significantly increasing and the need of a non-invasive method to assess the success of the procedure is becoming mandatory. In particular, US can be considered an alternative method to MRI for evaluation of tissue lipofilling due to the simplicity and easy access of the technique and can be also used for monitoring the efficacy of the surgical procedure. The goal of this study was to demonstrate, the utility of the high-resolution ultrasound technique in the evaluation of autologous adipose tissue lipofilling, used for the correction of post-surgical, post-traumatic and post-burn scars. Materials and methods Twenty-five patients (21 females), aged between 14 and 62 years, underwent surgical correction of scars with ‘‘lipofilling’’ technique. To evaluate the effectiveness of such treatment serial ultrasound examinations were performed at both the region affected from skin dimorphism through the adjacent skin region, using a high frequency transducer. Furthermore, it was assessed the presence of complications ranging from oedema or hematoma to necrosis or adipocyte migration of the graft. Finally, was calculated the average percentage of one-year survival of autologous fat transplant. Results Quantitative evaluations obtained with time series of ultrasound showed that the greatest benefits of autologous adipose tissue lipofilling, are found at the level of the hypodermis, but that also all the other layers of the skin can benefit from this procedure. Conclusion The data acquired demonstrate that the eco color Doppler with high resolution can be considered a valid non-invasive tool for the assessment of morphological and quantitative degree of engraftment of autologous adipose tissue transplanted. Lipofilling is an accurate and effective choice for the correction of congenital or acquired skin disorders for its filler effect and consequent benefit for all tissue layers.

Many congenital ear deformities involve abnormal plical folding, most commonly affecting the helix and the antihelix. Non-hypoplastic auricular deformities can be corrected by appropriate splinting in the early neonatal period without anaesthetic and with minimal cost. At this time, oestrogen activity is increased and the ear cartilage is very malleable. The splinting therapy, devised and popularized in Japan, has not been widely used in Europe. A series of 26 patients having various ear deformities treated by splintage in the early neonate period is presented. Excellent results were achieved in 82% of the splinted ears. In the other 18% results were satisfactory or good. No complications occurred in the series. In conclusion, ear splintage is an effective technique that should be more frequently offered to parents of affected neonates.

High-resolution (17 MHz) color-Doppler ultrasound (US) is used in the evaluation of normal and pathological skin. To analyze retrospectively the sonographic pattern of healthy skin and of some skin lesions using Doppler US and to compare the results with dermoscopy examination and histology to identify specific patterns of ultrasound for differentiating benign from malignant lesions. To select among them the Melanomas to describe their US pattern, the presence and morphology of vascular signal and to compare their thickness at US with the Breslow index. After signing informed consent in accordance with the ethical standards laid down in the Declaration of Helsinki in 1964 and its subsequent amendments, 104 patients with skin lesions were retrospectively studied. Patients were evaluated with clinical dermatological examination and Doppler US, and underwent surgical excision with subsequent histological analysis. Statistical analysis: the difference between variables was analyzed with statistical Chi square test or Fisher’s when appropriate. The strength of the relationship between variables was analyzed with Pearson’s r coefficient. The sensitivity and specificity of US tests were also calculated. Sixty-five malignant lesions and 39 benign lesions were identified at Doppler US. In the 34 melanomas, typical US and vascular patterns were identified depending on the thickness of the lesion and a strong correlation between the latter and Breslow index was confirmed. Doppler US is a valuable diagnostic tool for the study of skin and for pre-excision characterization of skin lesions.

We describe a modification of a skin traction system for progressive skin extension before excision of skin lesions. The traction device consists of Kirschner wires and plastic straps. It results in more homogeneous traction and greater sparing of healthy skin as compared with the earlier silicone bar method. Moreover, the procedure results in lower rates of infection, skin necrosis and breakage of the cutaneous bridges. Histological changes to the treated skin area are similar to those obtained with skin expansion procedures.

Summary Calcifying aponeurotic fibroma is a rare benign soft tissue tumor that primarily occurs on the distal portion of the extremities of children and adolescents. It appears like a firm, painless and slowly growing mass with high local recurrence rates. The lesion has characteristic histological features with areas of proliferative plumps of fibroblasts, chondrocytes and foci of calcification. We present a case of calcifying aponeurotic fibroma of the sub-ungual area of the index finger distal phalanx with bone erosion, surgically treated. A 2 year follow up showed satisfactory functional result and no evidence of recurrence.

A nerve gap is defined as the distance between two ends of a divided nerve. It is caused not just by the nerve tissue lost due to the trauma, or to the following debridement, but also by the actual retraction of the nerve stumps. The retraction is due to the elastic properties of the nerve fibers. Only small nerve gaps, in which minimal tension is required to contrast the elastic properties of the nerve, can be directly repaired (Fig. 1). Any significant tension at the repair site must be managed using other techniques. Peripheral nerve injuries causing gaps larger than 1-2 cm require bridging strategies for repair. Various methods exist to reconstruct nerve lesions with a significant gap: nerve grafts as autologous non-vascularised nerves, vascularised nerve grafts, interposition of venous or arterial segments or interposition of synthetic conduits. Despite the easier availability and execution of these last options, the gold standard, in nerve repair, remains the use of nerve grafts.

Studying ear dimensions in the population of a specific geographic area helps in the planning of both reconstructive and aesthetic operations. We have researched on the anthropometrical measurements of the auricle in a normal Caucasian population of the South of Italy; this paper was presented at the 56" Italian meeting of Plastic, Reconstructive and Aesthetic Surgery Society (SICPRE) in September 2007. We evaluated the mean dimensions of the ear and their relationship with age, sex and height. Other authors have studied the mean dimensions of normal auricles in a North America population [1], while Gualdi-Russo [2], Ferrario et al. [3] and Sforza et al. [4] published on the mean dimensions of the ear in a Caucasian Italian population. In our study, we measured the dimensions of both ears in 740 healthy subjects (380 men, 360 women). We used a direct manual measurement technique based on the establishment of four classical landmarks, two for the length (super-aurale and sub-aurale) and two for the width (pre-aurale and post-aurale) and on the calculation of the distances between them. We also considered independently the lengths of the earlobe and of the cartilaginous part of the ear. We classified the subjects according to gender, height and age; we ended with ten groups for each gender classified by height in \170 cm and [170 cm for males and in \160 cm and [160 cm for females and by age as follows: 15–30 years, 31–45 years, 46–60 years, 61–75 years and [75 years. Results are showed in Tables 1 and 2. We found that both ear length and ear width were larger in men than in women (p \ 0.001) and were larger in taller subjects than in shorter ones (p \ 0.001). We also found that ear length and width increased with age in both genders even in subjects over 75. Recently Alexander et al. [5], in a research conducted with a very accurate measurement method, commented about ear growth. They reported on the age related modification of both ear soft and cartilaginous tissues supporting the theory that the way the ear size increases may be attributable to different facts including the reduced resilience and elasticity of skin with age [6], the reduced tensile strength of connective tissue [7] and the gravitational forces over time [8]. We also want to stress that the ear length increasing along with aging cannot just be attributed to earlobe lengthening; in fact, similarly to Alexander et al., our separate measurements of the length and width of the cartilaginous portion of the ear and of the earlobe length showed that they both grow with age (p \ 0.001 for earlobe, p \ 0.01 for cartilaginous portion) even if the soft tissue portion of the ear suffers much more from the gravitational forces. This is in contrast with the paper by Brucker et al. [1], on a North America population, where they stated that the lobule was the only ear structure that changed significantly with age. In conclusion, we feel that the ear continues to grow with age, even if a more appropriate method of studying the population should include measurements and follow ups of the same subjects during their entire life.

Lymphedema of the eyelids is a very annoying condition which causes functional and aesthetic problems. Appearance of the eyelids can condition the individual's self-image, and some pathological alteration of this anatomical area can often have psychological and social consequences. Eyelid lymphedema can recur even after entirely satisfactory surgical treatment. We present a case of early stage bilateral lymphedema of the lower eyelid, in a renal transplant patient, treated by an early approach.

An infant with typical popliteal pterygium syndrome had intraoral fibrous bands binding the maxillary and mandibular alveolar ridges. This resulted in dramatically restricted mouth opening. These bands were divided surgically with endoscopic assistance.

Background Cutaneous melanoma (CM) is the most lethal form of skin malignancy, which registers a constant increase in incidence worldwide. The identification of molecular alteration(s) involved in its biological aggressiveness represents a major challenge for researchers, considering that existing therapies are ineffective to treat metastasizing cases. The epigenetic control of chromatin dynamics during DNA synthesis, replication, and repair is fundamental for the orderly progression of cell proliferation. The Chromatin Assembly Factor 1 (CAF-1) complex acts as a major regulator of this process; its intermediate (p60) subunit has been recently proposed as a novel proliferation and prognostic marker for several tumors. We aimed to establish if the evaluation of the expression of CAF-1/p60 in primary CM may help define the prevision of outcome of patients. Methods Immunohistochemistry with anti-CAF-1/p60 was performed on paraffin-embedded tissue sections of 130 cases of primary CM retrieved from the archive files of the Department of Biomorphological and Functional Sciences, Section of Pathology, University "Federico II" of Naples, Italy. Results were compared with histopathological and follow-up data of patients. Results CAF-1/p60 was expressed in all CM. A significant statistical association between the overexpression of the protein and the occurrence of skin, node and/or distant metastases (P < 0.05) emerged, independently from histopathological prognostic factors. Conclusions CAF-1/p60 looks promising as a new prognostic marker for CM and sheds new light on the molecular events associated with photocancerogenesis and melanoma biology. The screening for CAF-1/p60 might contribute to the molecular sub-classification of CM, with improved translational outcomes.

Background The posterior auricular flap alone has always been popular because of its prompt availability, its rich vascularity, and the ease of closing the donor-site defect primarily. Methods Fifty-seven patients with partial ear defects covered with posterior auricular flaps during the period between 2002 and 2007 were reviewed. In the authors' series, posterior auricular flaps were harvested based on a simple random vascularization and tailored to reach almost any defect of the ear by a simplified and standardized approach. Results The authors propose a simple nomenclature after grouping the flaps according to skin paddle type, pedicle type, pedicle base, flap transfer method, and flap movement; they present a standardized algorithm with which to choose the flap design for a given defect from this group. Conclusions The authors contribute three new flap designs to enhance the versatility of the posterior auricular flap. These are the superiorly and inferiorly based twisted island flaps and the posterior auricular propeller flap.

Dear Editor, We read with interest the communication on ‘A simple and practical method for axillary osmidrosis resection’ by Liu X, Mao T, Lei Z, Fan D appeared on JPRAS 2009.1 We found the description of the technique very useful with the support of intra-operative pictures. The use of artery clips to evert the skin flaps can be easily reproduced. However it is surprising that the Authors did not consider and mention in the References a paper by Mr N Breach appeared in the Annals of the Royal College of Surgeons of England in the late 70ies,2 when he was Senior Registrar at the Plastic Surgery Department of the Queen Victoria Hospital, East Grinstead, UK. Since then this latter procedure for surgical treatment of axillary hyperhidrosis has been widely adopted, [3], [4] and [5] especially in the Western world and in the UK where is known as the ‘Breach’ procedure. The main difference with the technique described in the paper by Liu X et al. consists in the number of incisions that has now been minimized.

Less severe congenital auricular anomalies can be corrected by appropriate splinting in the early neonatal period without anaesthetic and with minimal cost. We present a series of 46 patients affected by various ear deformities (non cryptotia, non Stahl's ear, non prominent ear) that we treated by splintage during the early neonatal period. These deformational auricular anomalies were classified according to the limitation to the external ear architecture development: vertically, horizontally and focally deformed ears. This new classification guided us in splint shaping and positioning. Excellent or satisfactory results were achieved in 98% of the splinted ears. Ear splintage is an effective technique for treatment of neonates with deformational auricular anomalies.

Digital nerve injuries are common; injuries of the common digital nerves are less frequent than those involving the proper digital nerves. Traditional techniques used to reconstruct peripheral nerves are: direct suture, autologous nerve grafts, autologous vein grafts, vascularised nerve graft and alloplastic nerve grafts. Autologous nerve grafts remain the most common conduits for segmental defects. Difficulties can arise when attempting to repair complex nerve gaps, particularly when joining the proximal stump of the common digital nerve with two distal stumps of proper digital nerves as in lesions involving the web space. We present below a case of such a lesion. We describe the use of the lateral antebrachial cutaneous nerve (LABCN) as donor nerve, by exploiting its natural branchings.

The upper eyelid has long been considered a good source of skin graft, but it is infrequently used as a unipedicled flap, based either medially or laterally, to reconstruct the skin of the lower eyelid. Here we describe a procedure in which we use the upper eyelid skin and underlying orbicularis muscle as a myocutaneous flap to reconstruct the lower eyelid and periorbital region.

The family of the of adenosine diphosphate-ribose) polymerase (PARP) proteins is directly involved in genomic stability, DNA repair, and apoptosis by DNA damage. In this study, we evaluated the role of PARP-1 in melanoma and its prognostic importance. We studied by immunohistochemistry and Western blot analysis PARP-I expression in a selected series of 80 primary melanoma of the head and neck region. The results were correlated with tumor thickness and patient's outcome. A follow-up of at least 3 years was available. Fifteen cases of benign melanocytic nevi were used as controls. Normal melanocytes showed only scattered, focal nuclear positivity and were considered as negative for PARP-1 expression by immunohistochemistry (score, 0). Thirty cases of melanoma (37.5%) showed nuclear expression of PARP-1 in both radial and vertical growth phases. Western blot analysis showed the presence of a high signal for full-length PARP-1 only in the cases with high immunohistochemical (nuclear) expression of protein (score, ++/+++) in both radial and vertical growth phase. A significant correlation was present between PARP-1 expression in vertical growth phase and the thickness of tumor lesion (P = .014); all but one tumor measuring less than 0.75 mm showed no or low PARP-1 expression. No correlation was found between PARP-1 expression in radial growth phase and tumor thickness (P = .38, data not shown). These data suggest that PARP-1 overexpression is a potential novel molecular marker of aggressive cutaneous malignant melanoma and a direct correlation between PARP-1-mediated inhibition of the apoptosis and biologic behavior of cutaneous malignant melanoma. (C) 2005 Elsevier Inc. All rights reserved.

The procedure used to repair upper lip defects depends on various factors: size and location of the defect, the conditions of neighbouring tissues, and the aetiology of the deformity. A single-stage procedure rarely gives a satisfactory cosmetic outcome in patients who have also lost the philtrum or a philtral crease. Here, we describe a single-step procedure for the reconstruction of the upper lip and philtrum that resulted in a good aesthetic appearance.

Congenital cleft earlobe is a rare auricular malformation. Various techniques have been reported for the correction of this deformity. Few papers deal with surgical techniques to correct the triple lobe sub-type cleft. This anomaly presents more technical difficulties in the three-dimensional rearrangement than other sub-types. We describe the technique used to correct a triple lobe deformity in a 5-year-old boy. The postoperative result was satisfactory at one year follow-up.

Cauliflower ear is a serious deformity of the auricle induced by single or repeated injury to the external ear. Few papers deal with surgical techniques for correcting this deformity. We describe the use of ipsilateral excess cartilage to restore the helical rim.

A skin graft may fail to adhere to the recipient site because of fluid collecting between the graft and the area being treated. We have devised a simple procedure, consisting of a vacuum-sealed dressing, to fix skin grafts on the lower limbs. A fully portable, battery-operated aspirator continuously draws secretions through a vacuum-sealed dressing, preventing accumulation of fluid underneath the graft. Patients are not confined to bed, thus reducing nursing time. The procedure was applied successfully in seven out of nine patients treated for ulcers of the lower limbs.

Sir:Simple wedge resection is widely used for reconstruction of full-thickness helical rim defects smaller than 1.0 to 1.5 cm.1 For reconstruction of defects up to 2.5 cm, crescentic or star excisions can be used. However, these techniques can frequently cause skin contraction and ear cupping.For de

Monofilament synthetic absorbable suture materials offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual bio-absorption. An investigation was conducted on 72 rats to compare three types of monofilament absorbable suture material (Polydioxanone, Poliglecaprone 25, Glycomer 631), with respect to their clinical characteristics, tissue inflammatory reaction and suture absorption times. The results identified different qualities for each suture: Poliglecaprone 25 and Glycomer 631 suture materials were found to be less reactive than Polydioxanone in rat skin. However, because of their extremely low tissue reaction values, all three materials were deemed particularly suitable for use as intracuticular sutures. Absorption times in rat skin were less than 3 months for Poliglecaprone 25, between 3 and 6 months for Glycomer 631 and 6 months for Polydioxanone. The differences in suture characteristics which were detected in our study can help in the surgical selection of the most appropriate suture material.

Chickenpox is a very common childhood illness, with a low rate of complications among hospitalized children. A rare case of acute necrotizing fasciitis occurring as a complication of chickenpox in a seven year old white boy is reported. This severe complication is a potentially lethal bacterial infection of subcutaneous tissues and fascia, with possible necrosis of underlying muscle. Confused terminology and rarity of the disease can lead to a wrong or delayed diagnosis. This case is presented to remind surgeons of the devastating potential of necrotizing fasciitis in children and to emphasize the necessity of a prompt and aggressive therapeutic approach.

We have treated three patients in the last 5 years for scrotal calcinosis; age range, 19–42. The technique we used was very similar to that described by Demirdover et al. consisting in excision of the affected scrotal tissue and direct closure [1, 5]. We have found it useful to pre-plan the extensive scrotal skin excision (Fig. 1) with a W plasty design (Fig. 2) to interrupt the final scar (Fig. 3). Our three patients healed uneventfully. In case of a recurrence, which we did not have, we would probably advise defect reconstruction with skin grafts.

bleomycin-A5 injection for head and neck lymphangioma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:139e44. 17. Shou BQ, Shou WD, Yang Z, et al. Intralesional injection of pingyangmycin for treatment of venous-venular malformation in the maxillofacial regions of children: report of 306 cases. Shanghai Kou Qiang Yi Xue 2006;15:136e9. 18. Roggiani M, Stoehr JA, Leonard BA, et al. Analysis of toxicity of streptococcal pyrogenic exotoxin A mutants. Infect Immun 1997;65:2868e75. 19. Kullendorff CM. Efficacy of bleomycin treatment for symptomatic hemangiomas in children. Pediatr Surg Int 1997;12:526e8. 20. Tai KW, Lii CK, Chou MY, et al. Relationship between intracellular glutathione level and the mode of cell death induced by pingyangmycin. Oral Oncol 2003;39:13e8. 21. Puig S, Casati B, Staudenherz A, et al. Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 2005;53:35e45. 22. Green D. Mechanism of action of sclerotherapy. Semin Dermatol 1993;12:88e97.

A ribonuclease from the hepatopancreas of Octopus vulgaris has been purified 900-fold. The purified enzyme shows one band upon electrophoresis in polyacrylamide gels and is homogenous with respect to size as shown by analytical ultracentrifugation. The molecular weight of the enzyme is approximately 34,000 and its sedimentation coefficient s20,w is 3.2. The enzyme activity has an optimum at pH 5.5 and is inhibited by Zn2+, Cu2+, Fe2+, PMB, and iodoacetate. The purified enzyme has neither deoxyribonuclease nor phosphomonoesterase activity; it exhibits endonuclease activity and specifically cleaves phosphodiester bonds next to purine bases, preferentially adenine, with the formation of oligonucleotides terminating in 3′-purine nucleotides, via cyclic phosphate intermediates.

Aims and Background Sentinel lymph node (SLN) detection is currently employed in patients with malignant melanoma (MM) to spare them unnecessary lymph node dissection. Methods and Study Design We investigated 241 patients (130 men and 111 women, median age, 50 years (range, 14-92)) with MM (192 before and 51 after surgical biopsy); two of them had more than one melanoma lesion. In each patient approx. 10 MBq of 99mTc Nanocoll in 0.1 mL (Nycomed Amersham Sorin; particle size range, 3-80 nm) was injected intradermally around the MM lesion or surgical scar. Dynamic acquisition was performed for 20 minutes (20 frames/min) and the study was concluded within four hours of injection. Using an external radioactive marker, the skin over the SLN was marked with China ink. Results 294 SLNs were scintigraphically identified: 117 in the inguinal region, 147 in the axillae, four in the submandibular region, three in the laterocervical region and 23 at other sites. In two patients no drainage was detected. In 43 patients more than one sentinel node was identified. In 13 patients with lesions located in the trunk the tracer drained towards multiple lymph node stations or unexpected lymph nodes (nine cases). Histology and immunohistochemistry diagnosed MM in 25 SLNs; 19 were positive for metastasis with hematoxylin-eosin staining, five with Hmb45 and one with CD68 immunostaining. All 25 detected lymphatic basins were excised. In nine of these basins there was metastatic involvement of at least one other lymph node besides the SLN. During follow-up, which ranged from six to 86 months, metastatic disease was found in only one patient with a histologically negative SLN six months after surgery. Conclusions This study confirms the utility of scintigraphic SLN detection in patients with MM. In most of the cases the procedure led the surgeon to evaluate the drainage area, which is unpredictable for lesions in the trunk and may be difficult to delineate using only patent blue dye. Furthermore, in approximately 10% of cases we observed dual drainage from individual lesions, mainly those located on the trunk. We will proceed to compare the results obtained during follow-up with those of an investigational group of patients with melanoma who were not subjected to lymphoscintigraphy for SLN detection in order to obtain well-founded information on the prognostic value of this technique.

β-METHYLASPARTATE (β-MA) was identified1 as a product of glutamate metabolism in cell-free extracts of Clostridium tetanomorphum. β-MA is a strong antimeta-bolite toward aspartate: it is an inhibitor of pyrimidine biosynthesis from aspartate2 and of urea synthesis from citrulline + aspartate3. In addition, β-MA seems to have certain interesting metabolic activities: it participates in transamination reactions in rat and rabbit liver and brain4 and in Escherichia coli5, and it may also be a precursor in the de novo synthesis of thimine6.