Cic edizioni internazionali
Il Giornale di Chirurgia

Autologous fat transplantation for secondary breast reconstruction: our experience

Original Article, 117 - 123
doi: 10.11138/gchir/2017.38.3.117
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Abstract
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Background. Autologous fat transplantation is used after breast reconstruction to improve the breast profile. There are a variety of different methods used for fat harvesting, preparation, and reinjection.
This study describes the specific techniques we used in this series of autologous fat transplantations in breast reconstruction patients and reports their outcomes compared with other studies in the literature.
Patients and methods. At the University Hospital of Parma between May 2012 and December 2016, we performed 53 autologous fat transplantations for secondary breast reconstruction patients with
an average age of 49 years (range: 34–65 y). A tumescent fluid (NaCl, epinephrine, and a local anaesthetic) was injected, and the lipoaspirate was harvested using a closed aspiration–injection system connected to
a 50 ml syringe, a 4 mm infiltration cannula, and a -650 mmHg vacuum.
The average amount of lipoaspirate obtained was 100 ml (range: 50–200 ml). Centrifugation of the lipoaspirate (3000 rpm for 3 min) was performed to isolate the adipose tissue (average amount obtained, 80 ml; range: 30–180 ml). Under local anaesthesia, the retrograde injection of thin layers of fat graft in multiple tunnels was performed in the subcutaneous and/or subglandular planes.
Results. Average follow-up was six months. Comparable to other studies, our complication rate was 7.4% (n = 4/53) and included cyst formation at the injection site (n = 1/53) and hematoma at the donor site (n = 3/53). Repeat fat grafting was performed in 28.3% of patients (n = 15/53) due to fat graft resorption.
Conclusions. Autologous fat transplantation is a useful procedure for correcting irregularities in the breast contour in secondary breast reconstruction.

Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy

Original Article, 124 - 129
doi: 10.11138/gchir/2017.38.3.124
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Aim. Postoperative surgical site infections (SSI) are complication of spinal surgery. These complications may lead to a poor outcome with neurological deficits, spinal deformity and chronic pain. The purpose of this study is to explore the statistical value of diagnostic parameters and the proper therapy.
Method. We retrospectively reviewed 550 patients who underwent spinal instrumentation at our department from January 2011 to December 2015. The SSI was present in 16 patients out of 550 operated.
Diagnostic criteria of SSI were the positivity of the surgical wound swab or blood culture, the clinical findings, positivity of laboratory tests and radiological elements. All patients had peri-operative antibiotic prophylaxis. Diagnostic laboratory findings were compared
with a homogeneous control group of 16 patients and analyzed by univariate statistical analysis with Chi-square test for the discrete variables. P<0,05 was considered statistically significant.
Results. Matching the SSI patients with a group of control, fever was not statistically significant for diagnosis as number of leukocytes, neutrophils and lymphocytes. On the contrary values of ESR and CRP were statistically significant with p <0, 01. The hardware was removed only in 3 patients (18%) out of 16 SSI patients.
Conclusion. In this study the statistically significant parameters to diagnose SSI are ESR and CRP values. The leucocytes count, number of lymphocytes and presence of fever integrates the data of ESR and CRP with no statistical significance. Most patients with SSI reach clinical healing with favorable outcome by means of target antibiotic therapy without hardware removal.

Necrotizing fasciitis associated with primary cutaneous B-cell lymphoma. A case report

Clinical practice, 130 - 134
doi: 10.11138/gchir/2017.38.3.130
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Necrotizing fasciitis is a rapidly progressive and life-threatening infection of the deeper skin layers and subcutaneous tissues that moves along the facial planes.
Objectives. We present the rare case of a patient with necrotizing fasciitis associated with high malignancy b-cell lymphoma. Our purpose is to investigate the probable connection between the two pathologies and evaluate the importance of early surgical intervention.
Case report. 51-year old Caucasian woman presented at the E.R. with history of a painful left thigh over a week and fever up to 38,4°C over the last three days. Necrosis of the soft tissues and fascial planes were observed clinically. After the initial treatment and due to the patient’s multiple organ dysfunction (septic shock), she was transferred to the ICU were she was intubated resuscitated with IV fluids and given IV antibiotics. 24 hours after the admission it was decided that the patient should undergo surgery and an extensive debridement of the necrotic area was performed. The antibiogram of the blood culture revealed streptococcus pyogenes and she was administered penicillin while intubated and monitored in the ICU until the seventh postoperative day. On the eighth post-day she was transferred back to the surgical department, hemodynamically normal and stable. She was discharged one month later and she was referred to a plastic surgery center for the final reconstruction surgery.
Conclusions. This case highlights that the high index of suspicion and the early aggressive surgical intervention seems to be very critical to improve survival of the patients with necrotizing fasciitis.

Epidural abscess imitating recurrent pilonidal sinus: a case report

Clinical practice, 135 - 138
doi: 10.11138/gchir/2017.38.3.135
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Pilonidal sinus or pilonidal cyst is a common benign disease, affecting mostly young working men. We present the first case of an epidural abscess imitating pilonidal sinus. A 33-year old male, suffering from previously undiagnosed and untreated diabetes mellitus (DM), presented to our emergency department (ER), one month after open surgical treatment of pilonidal sinus, due to weakness and fever. After re-operation of the pilonidal cyst and due to post-operative pus production and continuation of fever a computer tomogr aphy (CT )scan was performed revealing an epidural abscess extending from the thoracic vertebrae 12 (T-12) to the sacrococcygeal area. At that point he underwent
new surgery for drainage of the epidural abscess. The patient received intravenous antimicrobial treatment and was discharged on the 23rd postoperative day without signs or symptoms of infection. At follow up for a whole year no signs of recurrence have been observed.

Primitive squamous cell carcinoma of the breast (SCCB): case report of an uncommon variant of metaplastic carcinoma

Clinical practice, 139 - 142
doi: 10.11138/gchir/2017.38.3.139
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Introduction. Metaplastic carcinoma of the breast includes a heterogeneous group of neoplasms characterized by admixture of adenocarcinoma with area of squamous, chondroid and osseous differentiation.
If the tumor shows pure squamous differentiation, it is designated as squamous carcinoma. SCCB accounts for less than 1% of all invasive breast carcinoma. It can present as cystic lesions and simulate a breast abscess.
Case report. A 75-year old woman was visited at our General Surgery Unit for a palpable lump, about 5 cm in size, at the lower inner quadrant of right breast. Mammography revealed 3cm oval opacity with micro calcifications and US appearance as isoechogenic lump with lesion solid-cystic appearance; cytology deposes for cystic inflammatory lesion(C2) to be monitored. A subsequent ultrasound check one year later confirmed an increase of volume, so micro histology sampling was made with suspect malignancy(B4). After biopsy, the patient underwent excision of cyst. Final histological examination showed SCCB with diffuse positivity for Cytokeratin 34beta-E12 and p63; negative reactions to ER and PR; monoclonal antibody Ki67 > 40%; HER2/neu with score 2+ and FISH examination negative. Subsequently, the patient underwent radical Madden mastectomy which confirmed the histological diagnosis and the negativity of the lymph nodes.
Discussion. In literature, prognosis and therapy are still discussed; SCCB has shown very little responsiveness to common chemotherapy.
Conclusion. A quadrantectomy or a radical mastectomy with lymph node dissection must be considered the best treatment for this rare neoplasia.

Polythelia in a 13-year old girl

Clinical practice, 143 - 146
doi: 10.11138/gchir/2017.38.3.143
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We present a rare case of a 13-year old girl with a bilateral polythelia.
We would like to draw attention to this particular mammary malformation.

Primary intestinal choriocarcinoma in a patient with long-standing Crohn’s disease

Clinical practice, 147 - 148
doi: 10.11138/gchir/2017.38.3.147
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Extra-gonadal choriocarcinoma is an extremely rare highly malignant neoplasm with a poor prognosis. In the gastrointestinal tract it usually arises in stomach, esophagous, bowel intestine and colon. Only few cases are pure and not associated with a classic adenocarcinoma.
The correlation of Crohn’s disease with choriocarcinoma is not reported.
We describe a case of 47-year old man with primary choriocarcinoma of the colon in a previously documented Crohn’s disease.

Medico legal aspects on neuromonitoring in thyroid surgery: informed consent on malpractice claims

Methods, Techniques, Drugs, 149 - 154
doi: 10.11138/gchir/2017.38.3.149
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Aim. The purpose of this paper is to provide a forensic profile framework of neuromonitoring in thyroid surgery, regarding the information given to the patient and its classification as part of professional liability in the event of recurrent injury.
Method. Evaluation and reflections on the required behaviour of the surgeon on providing details on the operation before the informed consent is given and to outline the possible legal implications regarding professional liability as a result of recurrent injury. In particular, if it is an obligation to inform the patient about using this method and if it is possible for the surgeon to freely choose whether to employ this method, which is still burdened by a certain percentage of error and for that reason it cannot be defined a "standard of care".
Results. To recognize neuromonitoring the role of standard of care in surgery of the thyroid means attribute a role of method able to avoid the surgeon to cause iatrogenic damage to the laryngeal nerve. For the foregoing reasons that is not true, determining false positives and false negatives, and this can be a double edged sword for the surgeon.
Conclusions. Although the progress in the field of thyroid surgery made in the last decade, currently there is no scientific reassuring evidence to completely avoid the possibility of producing an iatrogenic lesion of the laryngeal nerve. Information given to the patient prior to surgery should respect the requirements of completeness, freedom and honesty in order to allow the patient to self-determination.

III CONGRESSO NAZIONALE S.I.C.U.T. DI PRIMAVERA
La Chirurgia d’Urgenza e del Trauma Italiana nei contesti di maxiemergenza

congresses, academies, societies, 156
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Vol. XXXVIII (No. 3) 2017 May - June

  1. A neurological disease on the face of an ancient Roman sculpture
    Baggieri G., Galieti L.
    doi: 10.11138/gchir/2017.38.3.115
  2. Autologous fat transplantation for secondary breast reconstruction: our experience
    Simonacci F., Grieco M.P., Bertozzi N., Raposio E.
    doi: 10.11138/gchir/2017.38.3.117
  3. Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy
    Dobran M., Marini A., Gladi M., Nasi D., Colasanti R., Benigni R., Mancini F., Iacoangeli M., Scerrati M.
    doi: 10.11138/gchir/2017.38.3.124
  4. Necrotizing fasciitis associated with primary cutaneous B-cell lymphoma. A case report
    Spiridakis K.G., Intzepogazoglou D.S., Flamourakis M.E., Sfakianakis E.E., Daskalaki A.V., Vakonaki E.K.., Rahmanis E., Kostakis G.E., Christodoulakis M.S.
    doi: 10.11138/gchir/2017.38.3.130
  5. Epidural abscess imitating recurrent pilonidal sinus: a case report
    Koutserimpas C., Nikitakis N., Skarpas A., Lada M., Papachristou E., Velimezis G.
    doi: 10.11138/gchir/2017.38.3.135
  6. Primitive squamous cell carcinoma of the breast (SCCB): case report of an uncommon variant of metaplastic carcinoma
    Punzo C., Fortarezza F., De Ruvo V., Minafra M., Laforgia R., Casamassima G., Pezzuto F., Punzi A., Caporusso C., Angelelli G., Palasciano N.
    doi: 10.11138/gchir/2017.38.3.139
  7. Polythelia in a 13-year old girl
    Halleland H.H., Balling E., Tei T., Arcieri S., Mertz H., Mele M.
    doi: 10.11138/gchir/2017.38.3.143
  8. Primary intestinal choriocarcinoma in a patient with long-standing Crohn’s disease
    Pezzuto F., Fortarezza F., Falcone V., Quintiliani C., Piscitelli D.
    doi: 10.11138/gchir/2017.38.3.147
  9. Medico legal aspects on neuromonitoring in thyroid surgery: informed consent on malpractice claims
    Demontis R., Pittau M.R., Maturo A., Petruzzo P., Calò G.
    doi: 10.11138/gchir/2017.38.3.149
  10. ATLAS OF ANATOMY, Latin nomenclature (3rd edition)
    Di Matteo G.
  11. III CONGRESSO NAZIONALE S.I.C.U.T. DI PRIMAVERA La Chirurgia d’Urgenza e del Trauma Italiana nei contesti di maxiemergenza
    Di Matteo G.
Last Viewed articles: la lista degli ultimi x visitati.
  1. III CONGRESSO NAZIONALE S.I.C.U.T. DI PRIMAVERA
    La Chirurgia d’Urgenza e del Trauma Italiana nei contesti di maxiemergenza

    Di Matteo G.
  2. ATLAS OF ANATOMY, Latin nomenclature (3rd edition)
    Di Matteo G.
  3. Medico legal aspects on neuromonitoring in thyroid surgery: informed consent on malpractice claims
    Demontis R., Pittau M.R., Maturo A., Petruzzo P., Calò G.
    doi: 10.11138/gchir/2017.38.3.149
  4. Primary intestinal choriocarcinoma in a patient with long-standing Crohn’s disease
    Pezzuto F., Fortarezza F., Falcone V., Quintiliani C., Piscitelli D.
    doi: 10.11138/gchir/2017.38.3.147
  5. Polythelia in a 13-year old girl
    Halleland H.H., Balling E., Tei T., Arcieri S., Mertz H., Mele M.
    doi: 10.11138/gchir/2017.38.3.143
  6. Primitive squamous cell carcinoma of the breast (SCCB): case report of an uncommon variant of metaplastic carcinoma
    Punzo C., Fortarezza F., De Ruvo V., Minafra M., Laforgia R., Casamassima G., Pezzuto F., Punzi A., Caporusso C., Angelelli G., Palasciano N.
    doi: 10.11138/gchir/2017.38.3.139
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