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Aim: Genital lymphoedema (GL) is a chronic and debilitating disease, which can severely affect the patient’s quality of life with significant socio-economic impact. Nowadays, no gold standard algorithm exists for GL from diagnosis to treatment. This study proposes our therapeutic flowchart based on the three senior consultants’ experience in lymphatic surgery.Methods: A retrospective investigation was conducted on a prospectively maintained database (2018-2022). Inclusion criteria involved all patients who underwent surgical procedures for treating GL in three plastic surgery departments (Lausanne, Bari, and Genova). Outcomes were assessed in terms of oedema reduction, stage regression, and functional reported outcomes.Results: 16 patients with GL were included: 50% underwent debulking surgery, 18.8% microsurgery, and 31.2% debulking + microsurgery. We recorded a significant regression of the GL stage: 62.5% shifted from stage II/III to postoperative stage I. Similarly, we found an infection recurrency resolution in 50%, a scrotal oedema reduction in 62.5%, and a scrotal oedema resolution in 37.5% of the patients treated. While almost half of the patients (53.3%) with associated penile oedema described persistent postoperative penile oedema, only two patients complained of persistent lymphorrhea.Conclusion: According to our clinical experience, preoperative and postoperative physical functional therapy is always recommended. For stages I and IIA, after the failure of the conservative treatment, lymph-venous shunts and lymph node transplantation surgery are proposed at the early time. When GL is already diagnosed at stages IIB and III, the debulking surgery, together with functional procedures, represents our first approach. LESS      Full article

Soft tissue defects of the hand may result from trauma, oncological procedures, or severe infections. Different etiologies have been discussed. In all cases, an accurate clinical examination is mandatory to understand which structures are involved and what must be reconstructed. It can be helpful to simplify the decision-making process to classify these lesions. However, there is no consensus on which classification is best to be used among those described in the literature. This review presents the most common ones, differentiating those classically used to describe tissue loss consequential to a traumatic event from those used to classify soft tissue defects consequent to other events. LESS      Full article

Autologous free tissue transfer is a safe and effective option for breast reconstruction. It is an increasingly utilized technique with well-demonstrated improved patient satisfaction and quality of life. Microvascular thrombosis is a rare but significant complication of microsurgical breast reconstruction, often resulting in flap failure. Proper diagnosis and timely management of this complication are essential to free flap salvage. While microvascular thrombosis poses a threat to flap survival, several methods may be employed to mitigate its more devastating effects. Here, we present a comprehensive review of arterial and venous thrombotic complications in both the intraoperative and postoperative settings. We discuss preoperative risk assessment, methods for flap monitoring, and operative and medical management of thrombotic complications. We present an updated algorithm for the intraoperative management of microvascular thrombosis adapted to reflect the most recent literature and our novel algorithm for the postoperative management of microvascular thrombosis. LESS      Full article

Immediate lymphatic reconstruction (ILR) has become increasingly utilized for the prevention of breast cancer-related lymphedema (BCRL). A growing body of evidence has demonstrated the long-term efficacy of ILR in reducing the rate of BCRL. While certain risk factors for BCRL are well-recognized, such as axillary lymph node dissection, regional lymph node radiation, and elevated body mass index, other potential risk factors such as age and taxane-based chemotherapeutics remain under discussion. Our experience with ILR has highlighted an additional potential risk factor for BCRL. Lymphatic anatomy, specifically compensatory lymphatic channels that bypass the axilla, may play a largely underrecognized role in determining which patients will develop BCRL after ILR. Foundational anatomic knowledge has primarily been based on cadaveric studies that predate the twentieth century. Modern approaches to lymphatic anatomical mapping using indocyanine green lymphography have helped to elucidate baseline lymphatic anatomy and compensatory channels, and certain variations within these channels may act as anatomic risk factors. Therefore, the purpose of this review was to highlight ways in which variations in lymphatic anatomy can inform the application and improve the accessibility of this procedure. As ILR continues to advance and evolve, anatomical mapping of the lymphatic system is valuable to both the patient and lymphatic microsurgeon and is a critical area of future study. LESS      Full article

Breast cancer-related lymphedema (BCRL) is a debilitating disorder affecting an estimated 1 in 5 women and men treated for breast cancer. Fortunately, super microsurgical techniques have advanced in recent years and now provide better options for the treatment of lymphedema, allowing timely surgical intervention that can delay or even prevent lymphatic degeneration. Lymphovenous anastomosis (LVA), a physiologic procedure that restores lymphatic drainage by connecting functioning lymphatic vessels with nearby veins, has been shown to be both minimally invasive and highly effective. The authors describe innovative approaches to LVA that will help optimize outcomes for patients with BCRL. LESS      Full article

Among the many challenges that the hand surgeon has to face in his daily work, nerve defects of the hand represent one of the hardest; unsatisfactory results in their treatment may cause severe limitations for the patient’s social and working life. Many advances have been made over the years in the treatment of such conditions, and at the current state, surgical treatment can achieve satisfactory results. This article aims to review the current concepts in hand innervation and nerve pathophysiology and to describe traditional and novel surgical techniques currently employed to correct these defects. LESS      Full article

Collagen-based supplements have become a keystone in the management of the ageing process, with proven ability to repair skin damage, bestowing a youthful and healthy appearance sought in the pursuit of beauty. Collagen is an essential scaffold protein that gives smoothness and elasticity to skin, but its production declines with age. Finding ways to tackle this problem is now strongly promoted as an effective way to transform skin and hair, repairing age-related deterioration. A growing number of scientific studies show exciting evidence that it is possible to rejuvenate ageing or damaged skin, improve function of worn joints, and support personal wellbeing and vitality. In recent times, research on the mechanisms which impact the production of collagen in skin and the ideal organization into functional fibres which give skin its characteristic elasticity and firmness has provided new insights into how this bio-scaffold can support cells, tissues and organs. The factors which influence collagen production over a lifetime (e.g., puberty, pregnancy, menopause, andropause), intrinsic factors (e.g., genetics, age, ethnicity) and extrinsic factors (e.g., UV-radiation, pollution, smoking) and the potential for new technologies, ingredients and devices to restore collagen and matrix components to their optimal condition are improving the ability to deliver anti-aging strategies with unprecedented results. This paper will review skin collagen production, structure and function throughout the lifestages, emphasizing its relationship with health, appearance and beauty. LESS      Full article

Periodontal tissue engineering involves a multi-disciplinary approach towards the regeneration of periodontal ligament, cementum and alveolar bone surrounding teeth, whereas bone regeneration specifically applies to ridge reconstruction in preparation for future implant placement, sinus floor augmentation and regeneration of peri-implant osseous defects. Successful periodontal regeneration is based on verifiable cementogenesis on the root surface, oblique insertion of periodontal ligament fibers and formation of new and vital supporting bone. Ultimately, regenerated periodontal and peri-implant support must be able to interface with surrounding host tissues in an integrated manner, withstand biomechanical forces resulting from mastication, and restore normal function and structure. Current regenerative approaches utilized in everyday clinical practice are mainly guided tissue/bone regeneration-based. Although these approaches have shown positive outcomes for small and medium-sized defects, predictability of clinical outcomes is heavily dependent on the defect morphology and clinical case selection. In many cases, it is still challenging to achieve predictable regenerative outcomes utilizing current approaches. Periodontal tissue engineering and bone regeneration (PTEBR) aims to improve the state of patient care by promoting reconstitution of damaged and lost tissues through the use of growth factors and signaling molecules, scaffolds, cells and gene therapy. The present narrative review discusses key advancements in PTEBR including current and future trends in preclinical and clinical research, as well as the potential for clinical translatability. LESS      Full article

Neck aesthetics are a vital and indispensable component of cervicofacial beauty. Cosmetic deformities may be due to congenital or acquired etiologies and successful management depends on accurately diagnosing the underlying anatomical problems and applying the appropriate surgical and non-surgical procedures to achieve the desired result. For clinical evaluation and treatment, neck anatomy may be conceptualized into three layers wherein the superficial layer consists of the skin and subcutaneous fat, the intermediate layer of platysma muscle and interplatysmal fat, and the deep layer of subplatysmal fat, digastric muscles, submandibular glands, and skeletal support structures. The goal of this article is to review neck aesthetics, cosmetic deformities, and indications for different treatment techniques by way of a systematic layered approach. LESS      Full article

Aim: The reason why non-calibrated hair variables poorly estimate scalp hair coverage during hair growth studies was studied.Methods: Hair productivity integrates density, diameter and daily hair growth rate. Cross-sectional studies have established hair productivity in female and male patients (480 vs. 90 controls) with self-evaluation of hair loss, phototrichogram (CE-PTG-EC) and scalp coverage scoring, (SCS). Tracking productivity of individual hair follicular units from longitudinal studies challenged the application of our methods during drug trials.Results: Hair loss means decreased productivity and increased “time to complete coverage”. The hair mass index (HMI) linearly connects productivity with clinical perception of coverage, i.e., SCS. The ensuing HMI abacus translates independently of gender, age, pattern or severity and unravelled unequal intervals between categories of the Ludwig and Hamilton classifications. With one severity grade shift, time to complete coverage varied from 21-51 days, i.e., no equality. During longitudinal studies, SCS detected improved productivity, reflecting clinically relevant responses, but remained stable in the absence of significant productivity variations. Follicular unit labelling and individual hair growth tracing showed that reversal of miniaturised hair follicles does not play a major role during drug-induced hair regrowth. The latter reflects re-activation of resting-dormant terminal hair follicles. The recovered productivity would not be possible once hair follicles enter the phase of structural-functional irreversible miniaturisation.Conclusion: Besides pattern identification, density of nanohair and HMI appear as innovative diagnostic approaches. Abrupt transformation (within one cycle) of terminal hair follicles into miniaturised ones and its reversal as the effect of active FDA-approved drugs remain highly improbable. LESS      Full article