A Peculiar Case of Large and "Unresectable" Primary Localized Cutaneous Nodular Amyloidosis of the Ankle

Nodular cutaneous amyloidosis represents the rarest variant of primary localized cutaneous amyloidosis. The proposed management ranges from topical or systemic agents to surgical treatment. Complete surgical excision is advisable due to its potential progression to systemic amyloidosis due to dermis and subcutaneous tissue infiltration. However, in particular locations, the risk of functional complications is high, so an alternative treatment option should be considered. We report a case of a large primary nodular cutaneous amyloidosis of the leg involving the joint capsule which was successfully treated by incomplete surgical removal, without recurrences at 7-year follow-up.

Use of porcine acellular dermal matrix to repair lung Hernia after minithoracotomy: A case report with 6-Year follow-up

Lung hernia following minimally invasive cardiac surgery is rare with few reported cases in the literature. Surgical repair is debated, and several methods have been described including a variety of synthetic and biological materials. We report a case of a 36-year-old woman who developed lung hernia and a strong retraction of the pectoralis major muscle after minithoracotomy that was performed for mitral valve surgery. The herniated lung was reduced and the chest wall defect was repaired with a non-cross linked acellular dermal matrix (ADM) anchored to the thoracic wall. At a 6-year follow-up, she was asymptomatic and without recurrence of the hernia. Our experience suggests that ADMs are a safe and reliable surgical technique for lung hernia repair due to their biological and mechanical properties, even in those secondary hernias to minithoracotomy where a complete muscle coverage of the matrix could not be provided.

Associated use of silicone-vitamin E gauzes and α-tocopherol acetate oil in healing of skin graft donor sites

Split-thickness skin graft is one of the most used procedures in plastic surgery. This procedure involves numerous painful dressings at the donor site. α-Tocopherol acetate has anti-oxidative and anti-inflammatory properties and it can reduce the local bacterial growth, thereby promoting wound healing. We designed a prospective study to evaluate the effects of two different kinds of dressings at skin graft donor sites. A total of 30 patients were subjected to daily dressings with α-tocopherol acetate oil and traditional moist gauzes (group 1). Another 30 patients were subjected to dressings every 4 days with α-tocopherol acetate oil and silicone-vitamin E gauzes (group 2). Healing time, infection rate, patient's pain perception and costs were evaluated in both the groups. No statistically significant difference was found in terms of healing time. The infection rate was slightly different in the two groups. Significant reduction of pain perception was detected in group 2. In the same group, significant reduction in the total cost of the treatment was also observed. α-Tocopherol acetate oil and silicone-vitamin E gauzes may represent a safe, simple, painless and inexpensive method for improving skin graft donor site healing.

Easy and cheap way to prepare skin extenders

Skin extender is a very useful method to repair wounds when oedema and skin retraction make a direct suture impossible. We have developed a new, simple and cheap way to prepare skin extenders based only on elastic vessel loops and metal clips stapler commonly used for skin suture and available in any operating room. This simple method can be performed both in the operating room and at the patient bedside, even under local anaesthesia, causes no bleeding and appears to be inexpensive and rapidly usable and should be made readily available in any hospital.

Evaluation about Antimicrobical Activity of Silver in Orthoshield Safe-T-Tie® Ligatures Used in Orthodontic Patients

Purpose: to value efficacy of anti microbic propriety of silver ligatures Orthoshield Safe-T-Tie® on periodontal tissues in orthodontic patients. Materials and methods: 50 orthodontic patients between 11 and 20 years old with permanent teeth were selected in this study. We evaluated periodontal health of maxillary and mandibular lateral incisors and canines at TO before the substitution of elastomeric ligatures with Orthoshield Safe-T-Tie® ligatures and at T1 (one month after substitution of ligatures). We used PI (Periodontal Index), GI (Gingival Index) and PRC-real-time to analyze periodontal health. Results: there was an improvement of gingival inflammation and a reduction of periodontal pathogens. Conclusions: Orthoshield Safe-T-Tie® ligatures improve periodontal health in orthodontic patients.

Laser Biostimulation and Self Ligating Appliances in Orthodontics: Periodontal Remodeling

24 patients are selected and 30 teeth in vestibular mucosae, without keratinized gingiva. No active periodontal disease (no BOP and gingival recessions). No BOP and CAL loss at the start of the orthodontic treatment. Every patient was treated with self ligating appliances (Time2/Time3, American Orthodontics). In every orthodontic session (each 30 days as average) the patient was treated with Nd: Yag laser biostimulation, for 90 seconds, with 320 micron fiber section, on utilizing the Biostimulating machine paremeters. No termical effects were produced by lasers applications. At the moment of debonding, 30 teeth involved in the research were evaluated in terms of quality and quantity of attached gingiva. BOP and CAL loss were also investigated. Every tooth considerated, at the end of orthodontic treatment showed a attached gingiva around the crown: the average of keratinized gingiva at the end of the study was 2,7 mm and the mean increasing at each month was 0,45 mm. The combination between self ligating appliances and laser's biostimulation could improve the differentiation of periodontal ligaments stem cells in fibroblasts, able to promote attached gingiva around the crown of the teeth erupted in oral vestibular mucosae.

Skin expansion versus free forearm flap in forehead reconstruction

The authors present their experience in surgical reconstruction of the forehead cosmetic unit, either with tissue expansion or free tissue transfer. Some of the cases underwent a full reconstruction of the entire cosmetic forehead unit en bloc performed by means of free forearm flap such as in postoncological exeresis and in post-traumatic reconstruction. The other method of choice was tissue expansion. The authors expanded the forehead unit for a giant naevus treatment in a child, and used a bilateral expansion of the forehead for tumour clearance of the middle third of the forehead. Results and problems related to the two techniques are presented and discussed.