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Aim: Venous congestion is a common cause of DIEP flap failure. When identified intraoperatively, an additional venous anastomosis can improve the venous outflow and prevent flap failure. The aim of this study was to assess if the retrograde limb of the internal mammary vein (IMV) could be considered a good recipient vessel to be used when persistent flap congestion is present, and a second venous anastomosis is required. Patients and methods: A retrospective study was conducted in 74 patients who had undergone DIEP flap breast reconstruction. Patients were classified into two groups: SVA (single venous anastomosis) and DVA (dual venous anastomosis). In the SVA group (n = 38), the IMV antegrade limb was used for venous drainage. A single DIEV (Deep Inferior Epigastric Vein) was anastomosed to the superior arm of the IMV. In the DVA group (n = 36), both the antegrade (superior) and retrograde (inferior) stumps of the IMV were used, connecting the larger DIEV to the antegrade IMV and the other DIEV or the SIEV (Superficial Inferior Epigastric Vein) to the IMV retrograde limb. Results: No venous congestion or flap loss was observed when two venous anastomoses were performed using both the IMV antegrade and retrograde limbs (P = 0.3271). In the DVA group, no major complication occurred (P = 0.0453). Operative explorations were significantly reduced in the DVA group (P = 0.0242). Conclusion: These findings suggest that when an additional venous outflow is required, the use of the IMV retrograde limb may help to avoid flap venous congestion. © 2016 Wiley Periodicals, Inc. Microsurgery 36:447–452, 2016.

Background Basal cell carcinoma is the most common non-melanoma skin cancer of the nose. Defects of the nasal ala and tip region are among the most difficult to repair due to their intrinsic characteristics. Objective To present our experience with the extended rotation flap for reconstruction of nasal ala defects and evaluate the outcome using the Patient and Observer Scar Assessment Scale (POSAS). Methods and Materials Twenty-two patients with partial thickness nasal ala defects reconstructed using the extended rotation flap were assessed. Final cosmetic and functional outcomes were evaluated using the POSAS. Results Flaps survived in all the reported cases and no major complication was recorded. Histology showed complete excision of the tumour in all cases. Using the POSAS, the mean overall evaluation for patients was 1.8/10, while the mean overall evaluation for the evaluation panel was 2.2/ 10. Conclusion Although similar flaps have been previously described, the extended rotation flap for nasal ala and tip reconstruction represents a functionally and cosmetically appealing wound closure option, respecting and avoiding any distortion of the alar crease.

Authors present a study about the contraction forces observed in striae distensae fibroblasts (SMF) in a collagen scaffold. Collagen lattices were used to study the mechanical behavior of SDF within the collagen matrix compared to the lattices produced using the healthy skin derived fibroblasts (NSF). A Forcebox device was used to measure the contractile forces. Striae Rubrae fibroblast’s contractile force was by 28% greater than that generated by the NSF and striae albae fibroblasts (P

Background The importance of the clitoris as an organ has been neglected by doctors and anatomists over the centuries. Its central role in female sexuality is widely recognized and respected. Although multiple studies have been conducted on the fundiform ligament of the penis, the literature concerning the suspensory ligament of the clitoris is extremely poor. The possibility to describe its complex structure may help us understand female orgasm and sexuality. Aim Carrying out an anatomical and histological study about the supporting ligaments of the clitoris and in particular the suspensory ligament of the clitoris. Study Design A total of 10 female cadavers were dissected specifically for this study. All the supporting structures of the clitoris were studied, photographed and measured. A histological study of these structures was also carried out. Results The suspensory ligament of the clitoris is a multidimensional structure consisting of three anatomically and histologically distinct components. The superficial layer originates from the anterior abdominal wall, it is the anatomical extension of the fascia superficialis of the abdomen. It mainly consists of loosely organized elastic fibers, fibroblasts and few loosely organized collagen fibers. The intermediate component also originates from the anterior abdominal wall through the extensions of the abdominal aponeurosis that reach the body of the clitoris. It completely encloses the clitoral body and sends lateral extensions to the labia majora. Histologically, this layer mainly consists of well-organized collagen fibers as well as fibroblasts. The deep component is shorter and extends from the pubic symphysis to the knee of the clitoris and also connects the two crus to the pubic symphysis. It almost exclusively consists of very well organized collagen fibers. Conclusion The suspensory ligament of the clitoris is a multidimensional structure that extends from the anterior abdominal wall to the clitoris. Unlike previous descriptions of the ligament supporting the clitoris, we observed that this structure consists of three anatomically and histologically distinct layers. These new anatomical considerations must be taken into account for any surgery affecting the subcutaneous tissues of the pubis and the abdomen as well as for reconstructive surgery of the clitoris and metoidioplasty.

Background High-intensity focused ultrasound (HIFU) is an advanced technology that has been developed in response to the growing demand for noninvasive face rejuvenation. Objectives The aim of this study was to evaluate the rejuvenation effects, patient satisfaction, and safety of HIFU treatment of the neck in a European population. Methods This was a prospective study of 20 patients. The patients were treated with HIFU, and the outcomes were investigated. The modified FACE-Objective Assessment Scale, developed by our team, and the subjective Investigator Global Improvement Assessment Scale (IGIAS; –1 to 3) were used to judge the results of HIFU. Five blinded evaluators scored the procedure outcomes based on photographs taken before and 6 months after the procedure. Side effects were reported and pain was evaluated on a visual analog scale of 0 to 10. Results Clinical results, such as better definition of the cervicomental angle, were observed in the treated areas. The pretreatment and posttreatment evaluation scores for double chin and skin laxity were evaluated by 4 of 5 evaluators as significantly improved. The IGIAS score was between 1 and 5 in 2 patients, between 6 and 10 in 7 patients, and between 11 and 15 in 11 patients. No patients had a score between –5 and 0. No major complications were reported. The mean pain scores for the D4, M7, and S7 transducer treatments were 5.6 (range, 4.5–6.7), 4.2 (range, 2.5–5.9), and 2.05 (range, 1.05–3.05), respectively. Conclusions HIFU may be considered a satisfactory, simple, reproducible, rapid, and safe procedure for neck rejuvenation. Level of Evidence: 4

The aim of this study is to assess the efficacy and tolerability of carboxytherapy in the cosmetic correction of dark circles. Carboxytherapy is a cosmetic technique based on the subcutaneous injection of carbon dioxide that improves the quality and elasticity of the dermis by increasing the oxygen release to the tissue through an enhancement of the Bohr effect. A prospective clinical trial was conducted on 35 patients requesting the correction of dark cicles. Our protocol was based on weekly treatment sessions and lasted 3 weeks. Each treatment session was based on the bilateral injections of the tear-through defect. Pre- ∖treatment photographs and 6-month post-procedural follow-up photographs were examined and analysed through a face objective assessment scale. All 35 patients were treated. The average scores showed a significant reduction of the skin discoloration without major side effects (p < 0.00001). This study proves that it is possible to carry out multiple injections during the same session to increase the application time of the carbon dioxide and to decrease the number of sessions. These results allowed us to validate a 3-sessions injection protocol to increase the patient compliance.

Introduction: Striae distensae (SD) appear clinically as parallel striae, lying perpendicular to the tension lines of the skin. SD evolve into two clinical phases, an initial inflammatory phase in which they are called “striae rubrae” (SR) and a chronic phase in which they are called striae albae (SA). Fibroblasts seem to play a key role in the pathogenesis of stretch marks. This study was aimed at describing and analyzing stretch marks-derived fibroblasts (SMF), the differences between SR- and SA-derived fibroblasts (SRF, SAF), testing two treatments in vitro (sodium ascorbate and PrP) on SAF. Material and Methods: To characterize the SMF, the expression of alpha smooth muscle actin (alpha SMA) was investigated. Type I collagen expression was measured in SAF, before and after adding different PrP concentrations and sodium ascorbate in the culture medium. Results were processed through statistical analysis models using the Student’s t-test. Results: A significant increase in alpha SMA (P

Contexte et objectif: La préservation de la qualité de vie après un traitement anticancéreux est un défi majeur pour les survivantes du cancer du sein. Environ 42 à 70 % des patients qui reçoivent une thérapie systémique pour le cancer du sein, y compris une thérapie endocrinienne, développeront une atrophie vulvo-vaginale (AVV). Pour ces patientes, les traitements à base de gel couramment proposés pour les applications topiques sont restrictifs. Récemment, des approches thérapeutiques innovantes et non hormonales, telles que la thérapie laser, ont fait leur apparition. L'objectif de cette étude de faisabilité est d’étudier la sécurité et l'efficacité de la thérapie au laser CO2 chez les femmes ayant des antécédents de cancer du sein. Matériel et méthodes: Cette étude monocentrique prospective a porté sur 20 patientes atteintes d'AVV qui ont été traitées à l'hôpital universitaire Henri Mondor entre 2017 et 2018. Nous avons inclus des patientes ayant un indice de santé vaginale (IHV) < 15 et une contre-indication à l'administration d'hormones en raison d'antécédents de cancer du sein. Deux séances de laser au dioxyde de carbone ont été utilisées. Le traitement a été administré selon les paramètres suivants : programme « vaginal Tight », FinePulse (pulse largeur de 0,9 ms) et densité énergétique de 11,5 J/cm2 qui permet de couvrir 70 % de la zone vaginale ciblée à traiter. Toutes les patientes ont eu leur visite de suivi à un (M1), trois (M3) et six (M6) mois après le premier traitement pour évaluer l'efficacité du traitement sur l'atrophie vulvo-vaginale. Le score d'indice de santé vaginale et le score de détresse sexuelle féminine (FSD) ont été utilisés pour évaluer l'efficacité du traitement et son impact sur la qualité de vie sexuelle. Un score ≥ 11 a été associé à un dysfonctionnement sexuel. Les scores d'indice de santé vaginale et FSD ont été évalués avant traitement et mois1 M1, M3 et M6 du suivi. Résultats: L’âge moyen des patientes était de 56,1 ± 8,8 ans (min–max, 27–69 ans). Dix-sept des 20 patientes avaient déjà été ménopausées (âge moyen de la ménopause, 51,25 ± 1,5 ans). Au moment de l'inclusion, les scores moyens du score d'indice de santé vaginale et du FSD étaient respectivement de 10,58 ± 1,71 et 21,36 ± 15,10. Quatorze patientes sur 20 (70 %) avaient un score de détresse sexuelle féminine ≥ 11 au départ. À M1, le score d'indice de santé vaginale moyen a augmenté de manière significative pour atteindre 13,42 ± 2,3 (p = 0,03), ce qui représente une amélioration de 21 % par rapport au niveau de référence. Une amélioration persistante et significative du score d'indice de santé vaginale a été observée à M6, le score passant à 16,75 ± 4,23 après le traitement (p < 0,0001), ce qui représente une amélioration de 34 % par rapport au score moyen de départ. La moyenne su score FSD à M1 était de 19,83 ± 13,57, ce qui représente une diminution de 7 % par rapport aux scores de base (p < 0,01). À M3, le score de détresse sexuelle féminine a diminué de manière significative pour atteindre 13,88 ± 15,58, ce qui représente une amélioration de 35 % (p = 0,006). Il a augmenté à 10,35 ± 14,7 à M6, ce qui représente une amélioration de 52 % (p = 0,001). À M3, 35 % des patients avaient un score de détresse sexuelle féminine > 11, et à M6, seuls 15 % avaient un score de détresse sexuelle féminine > 11. Aucun effet secondaire n'a été signalé lors du suivi. Conclusion: Cette étude de faisabilité pilote a montré que le traitement par laser au dioxyde de carbone semble être une méthode efficace et sûre pour améliorer la trophicité et diminuer la sécheresse de la muqueuse vaginale chez les femmes atteintes d'atrophie vulvo-vaginale qui s'est développée après un traitement systémique du cancer du sein.

La reconstruction vaginale immédiate est généralement réalisée à la suite d'une exentération pelvienne pour cancer du col de l'utérus, en cas de récidive (après radiothérapie) ou de fistules radiques sévères. Le prélèvement des lambeaux sur des vaisseaux perforants, tels que le lambeau perforant basé sur le pédicule épigastrique inférieur (DIEP), permet d'obtenir des tissus viables pour la reconstruction vaginale et est associé à une réduction de la morbidité du site donneur. Ce rapport décrit la technique chirurgicale, qui est l'une des procédures de choix pour la reconstruction vaginale. Il s'agit d'une technique fiable et avantageuse, en particulier chez les femmes pour qui il ne restait plus que l'option de l'exentération en cas d’échec de l'irradiation.

Background and Objective: Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non-invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD. Study Design/Materials and Methods: This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm 2 , frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 μm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported. Results: Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported. Conclusion: Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. 51:230–238, 2019. © 2018 Wiley Periodicals, Inc.

Summary As older people increasingly care for their body image and remain active longer, the demand for reduction mammaplasty is increasing in this population. Only a few studies of reduction mammaplasty have specifically focussed on the outcomes in elderly women. We developed a new breast reduction technique: the Liposuction-Assisted Four Pedicle-Based Breast Reduction (LAFPBR) that is especially indicated for elderly patients. The aim of this paper was to describe the LAFPBR technique and to determine whether it could be considered a safer option for elderly patients compared to the superomedial pedicle (SMP) technique. A retrospective study included sixty-two women aged 60 years and over who underwent bilateral breast reduction mammaplasty. Thirty-one patients underwent LAFPBR and 31 patients were operated using the SMP technique. Complications and patient satisfaction in both groups were analysed. Patient satisfaction was measured using a validated questionnaire: the client satisfaction questionnaire 8 (CSQ-8). The LAFPBR technique required less operating time, and avoided significant blood loss. Six minor complications were observed in SMP patients. No LAFPBR women developed a procedure-related complication. Patient satisfaction was high with a mean score of 29.65 in LAFPBR patients and 28.68 in SMP patients. The LAFPBR is an easy procedure that appears safer than SMP and results in a high satisfaction rate in elderly women.

Background: Hyaluronic acid (HA) injections involve a risk of vascular complications. Transillumination (TL) is a noninvasive technique that appears to allow preliminary detection of superficial vascular structures of the face to avoid intravascular HA injection. The purpose of our study was to test the efficacy of TL in terms of its sensitivity to locate vessels in the areas undergoing treatment and to reduce post-injection vascular complications. Material and Methods: We conducted a prospective study enrolling 72 patients who consulted for HA injections to treat facial wrinkles. We used TL on one side of the face to obtain a vascular mapping of the face. The area undergoing testing was randomized for the TL technique. The primary study endpoint was sensitivity for identifying subcutaneous veins and the differences in complication rates between the side of the face where TL was used to guide the injection and the side of the face where no vascular exploration method was used. Results: TL sensitivity for locating the superficial temporal vein was 100%, 91% for the supratrochlear, supraorbital and infraorbital veins, and 95% for the dorsal nasal veins (p < 0.01). The complication rate was higher on the side of the face where no vascular exploration method was used (22.2% vs 2.7%; p = 0.010046). Conclusions: Our preliminary findings validate our hypothesis concerning the advantage of using TL to identify superficial veins before performing injections. This method is simple and affordable, and the learning curve is small. Level of Evidence IV: 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.

Background The availability of more accurate techniques used for transgender surgery, has resulted in an increased number of patients requesting facial feminization surgery (FFS). The aim of this study was to present authors male-to-female transsexual patients FFS pre-operative planning using photo-editing software, computer-aided design (CAD), modelling and three-dimensional (3D) printing. Material and Methods Twenty-five patients underwent FFS between November 2015 and May 2018. They were retrospectively included in this study, and their records analyzed. Facial patients 3D models were printed and used for an accurate pre-operative planning, and shown to the patients. To assess patient satisfaction the pre, six months and one year post-operative scores obtained using Satisfaction With Life Scale (SWLS) and Subjective Happiness Scale (SHS) were compared. The scores following a normal distribution obtained by each patient were compared using a paired T test. Results The 3D model preparation mean time was 145±13.2 minutes. A total of 114 surgical procedures were carried out. The mean operative time was 420±23 minutes. Patients experienced no postoperative complication. All patients were very satisfied after surgery with a significant difference between pre and post-operative scores (p=0.002; p=0.03). Conclusion With use of 3D modelling, surgeons are getting closer and closer to a custom made surgery era especially required for complex procedures as FFS. We suggest using 3D technology for a more accurate pre-operative planning.

Most patients who undergo cosmetic rejuvenation treatment hope to appear younger and healthier. Although a number of scales have been put forward to assess facial aging, to date none has focused on predicting patients' age. The purpose of our study was to validate a more complete version of the face - Objective assessment scale previously developed by the authors. Since patients with a photo-damaged skin can look older than others we created a new sub-scale: the facial photo-aging scale, in order to provide a more comprehensive method for the overall assessment of facial aging. The Rasch model was used as part of the validation process. We assigned a score to each patient based on the scales we have developed. The correlation between a patient's actual age and the obtained scores was analyzed; we also analyzed the inter-rater reliability and test-retest reliability. All the scales exceeded criteria for acceptability, reliability and validity. The facial aging scale we have developed may prove to be a valuable tool to assess patients before and after facial rejuvenation treatment or surgery, as well as for clinical research in the field of facial skin regeneration.

Background: The Dermo Ablation Surgery (DAS) Medical® (Technolux, Italy) device is a plasma blade which induces a plasma voltaic arc causing a retraction in the epidermis and superficial dermis. Objective: The aim of our study is to prove the efficacy and safety of the DAS Medical® device in dermatochalasis size reduction. Methods: Our prospective study included 25 adult patients presenting with upper eyelid dermatochalasis undergoing a two-session treatment protocol with the DAS Medical® device (with a month treatment-free interval). The primary end point was the reduction in the size of the dermatochalasis. The secondary end points were patient satisfaction, and a blinded assessment of the outcomes was carried out by 15 plastic surgery specialists on post-procedural pictures. Results: The mean reduction in the size of the dermatochalasis was estimated at 2.47 mm on a 6-month follow-up (13.5 mm at T0 vs. 11.03 mm at 6 months, p = 0.0002) and 1.97 mm on a 12-month follow-up ((13.5 mm at T0 vs. 11.53 mm at 12 months, p = 0.0055). Eighty per cent of the patients and 78% of the assessing clinicians were globally satisfied with the results on a 12-month follow-up. The mean visual analogue pain score reported during the treatment was 4.5/10; MEOPA® was used in 23% of cases. No irreversible post-procedural sequelae (complications) were observed. Conclusion: Voltaic plasma arc treatment with DAS Medical® is an effective technique for non-invasive blepharoplasty on moderate dermatochalasis patients not suffering from palpebral lipoptosis and is very well tolerated. It can be usefully and successfully associated with surgery. Level of Evidence IV: 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.

Objective: Approximately 50% to 70% of breast cancer survivors are affected by one or more symptoms of vulvovaginal atrophy (VVA). For those who cannot take hormone therapy, autologous platelet-rich plasma combined with hyaluronic acid (A-PRP-HA) may provide a new alternative therapy for the treatment of VVA in postmenopausal women with history of breast cancer. Methods: We enrolled 20 postmenopausal breast cancers survivors with VVA and a score of 15 showed a successful treatment outcome. The FSD score decreased significantly during the study, from a baseline score of 36.35-2.53 pretreatment to 30.15-2.47 6 months after treatment, representing improvement of 17% (P

Determining which facelift procedures yield the most long-term rejuvenating effects and stability over time is an important question in cosmetic surgery: does radical and invasive surgery produce the most long-lasting results? The experience of our team suggests that using a combination of various techniques (liposuction, lipectomy, myotomies, suspensions, tissular induction techniques) appears to be essential to achieve satisfactory, lasting results. In this paper, we describe the lower facelift and neck rejuvenation combined method. To assess the outcomes of this technique, we conducted a prospective study of 44 patients treated at our hospital by the same surgeon between 2012 and 2015. For assessment purposes, we used the FACE-Objective Assessment Scale developed by our team. The scores obtained by three blinded graders before surgery and 12 months after surgery were compared using a paired t-test. A p value < 0.05 was considered significant. The results were satisfactory, with improvement in the appearance of treated areas. A significant difference between the pre- and postoperative scores was observed (p < 0.00001). The lower face and neck rejuvenation combined method addresses the factors that contribute to the appearance of ageing in the lower third of the face and neck. In our study, this method resulted in positive, lasting outcomes, with few complications.

Background All the labia minora reduction techniques fail to treat the other component of the abnormally increased labia minora to majora ratio: the labia majora atrophy. The purpose of this study is to describe a technique of female genitalia beautification, which combines labia majora augmentation and conservative labia minora reduction. Methods The hypertrophied labia minora were first treated by a conservative inferior wedge excision with a superior flap. The conservative excision was done to obtain labia minora that would still protrude beyond the labia majora because it will be masked by the augmentation of the labia majora. Labia majora augmentation was done by autologous fat transplantation. The newly augmented labia majora completely masked the conservatively reduced labia minora. Results Twenty-one patients underwent surgery for labia majora augmentation and labia minora reduction. One patient (4.7%) had a small separation of the labial edge postoperatively that resolved with no additional interventions. There was no flap necrosis or infections. No patient reported pain or sexual dysfunction. Seventeen patients (81%) were satisfied or very satisfied with their results. Conclusions Labia majora augmentation combined with a conservative labia minora reduction is an appealing procedure because it enhances the global aspect of the female genitalia while reducing the labioplasty complications.

Background Facial burn outcomes are often difficult to treat. Residual scars represent a problem for aesthetic and functional concerns as well as for patient's social and psychological life. Autologous fat graft can be used in the treatment of burn outcomes, providing a sensitive improvement in the quality of the burned areas. The aim of our report is the discussion of the value of lipofilling and fractional CO2 laser in optimizing aesthetic and functional results of burn sequelae. Methods We treated twenty four patients with post burns scars who underwent to autologous fat graft followed by CO2 fractional laser treatment. Results At one year follow up all the patients noted an improvement of their clinical condition, with a better texture, softness, color and elasticity of the skin. Conclusions Lipofilling combined to CO2 laser can complete and improve the results of the standard surgical approach used in burned patients.

Background Electrochemotherapy (ECT) is a novel modality for the treatment of skin nodules and cutaneous or subcutaneous tumors that allows delivery of low and non-permeant drug into cells. The aim of this prospective single-center study was to evaluate ECT efficacy in the local treatment of Classic Kaposi's sarcoma (CKS) skin localization stage I-II sec. Brambilla et al. Methods Nineteen consecutive patients affected by classic KS were included in this study. All patients underwent blood sampling and concurrent incisional biopsy for histological diagnosis and Kaposi's sarcoma related herpes virus 8 (HHV-8) molecular analysis. ECT treatment of KS cutaneous lesions were performed according to the European Standard Operating Procedures of Electrochemotherapy (ESOPE). The primary endpoint of the study was the evaluation of ECT efficacy in the treatment of KS skin nodules and the assessment of HHV-8 viral load in the peripheral blood following the ECT therapy. Results Complete response (CR) was observed in 14 (73.6%) patients after first ECT session, while 3 (15.7%) and 2 (10.5%) out of 19 patients received a second and a third ECT treatment, respectively. Clinical response dragged out the whole follow-up period that ranged between 6 and 31 months with a median of 16 months. Conclusions Clinical management of CKS skin localizations still represents a challenging task for surgeons and oncologists. Therefore, according to this and other author's recent experiences, ECT is claimed to become the "new standard of care" as first line treatment strategy for stage I-II CKS patients. © 2013 Elsevier Ltd. All rights reserved.

Introduction: Anatomical variability of anterolateral thigh flap (ALT) perforators has been reported. The aim of this study is to assess if the use of intraoperative indocyanine green angiography (iICGA) can help surgeons to choose the ALT flap best perforator to be preserved. Patients and methods: A retrospective study was conducted in 28 patients with open tibial fracture, following a road traffic crash, who had undergone ALT flap. Patients were classified into two groups: ICGA group (iICGA was used to select the more reliable perforator) and control group. The mean tissue loss size of the ICGA group (n = 13, 11 men and 2 women, mean age: 52 ± 6 years) was of 16.6 cm × 12.2 cm. The mean defect size of the control group (n = 15, 14 men and 1 women, mean age: 50 ± 5.52 years) was of 15.3 cm × 11.1 cm. Statistical analysis was performed to analyze and compare the results. Results: ICGA allowed preserving only the most functional perforator, that provided the best ALT flap perfusion in 10 out of the 13 cases (77%). ICGA allowed a significant operative time reduction (160 ± 23 vs. 202 ± 48 minutes; P

The goal of adding platelet-rich plasma (PRP) to autologous fat graft is to increase the survival rate of the graft. After their activation, platelets release some important growth factors. As a result, PRP may increase the proliferation and differentiation of Adipose-derived stem cells (ASCs) into adipocytes, improve fat graft vascularisation, and may block the apoptosis of grafted adipocytes. The other benefit expected from the addition of PRP to fat graft is the improvement of cutaneous trophicity above the grafted areas. An exhaustive review of the literature retrieved 11 clinical studies on humans and 7 on animals. A statistically significant increase of the survival rate of fat grafts has been found in 9 comparative studies. Our synthesis allowed us to set up the following protocol: addition of 20% of PRP activated with calcium hydrochloride to fat grafts. It may enhance the results of autologous facial fat graft in regenerative and aesthetic facial surgery.