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Morphostructural changes in transferred fasciocutaneous free flaps: a preliminary clinical and immunohistochemical report
No full textSummary Many local factors, yet to be investigated, can promote changes in tissue transferred
by microsurgical technique into the recipient site. Several studies have attempted to
assess the nature of modifications that occur in the vascular network of such a flap after transfer.
Although these investigations have interesting conclusions, the majority of them were
based only on indirect evaluations. The aim of this study was to detect, by histological and statistical
analysis, the morphostructural changes that occurred in fasciocutaneous free flaps
transferred to the cephalic region or to the lower limb. Patients were enrolled in this study
only when neither local inflammatory reactions nor systemic diseases were observed at the
time of biopsy. Six patients consented to undergo biopsy at both the donor and the recipient
area of a previously transferred fasciocutaneous free flap. Three flaps were used for facial reconstruction,
and three others for lower limb reconstruction. Standard staining and immunohistochemical
investigations were performed. The sections were also analysed by specific
software. Statistical analysis of the data was performed using the student’s t-test and Fisher’s
test. In five out of six transferred flaps (83%), there was increased microvascularity compared
to the donor area. It was correlated to the neoangiogenesis in the dermal layer of the flaps. In
five recipient sites there were more new vessels. In particular, a higher score of angiogenesis
was observed both in the cheek (one flap) and in the non weight-bearing area of the foot (two
flaps) (P < 0.001). Some differences in microvascularity between the donor and the recipient
site in the same flap were related to the specific recipient site. This represents the first demonstration
of adaptation of fasciocutaneous free flaps to the recipient area, as well as to their
new function, at both the macroscopic and microscopic level.
a 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons
Long-term follow-up in the treatment of keloids by combined surgical excision and immediate postoperative adjuvant irradiation
No full textAprospective study on the result of surgical excision
and adjuvant irradiation for therapy-resistant keloids
was conducted by van de Kar et al. (Plast. Reconstr.
Surg. 119: 2248, 2007). This approach to keloids follows
the International Clinical Recommendations on
Scar Management based on retrospective studies that
do not define recurrence. Moreover, the significant
variations in methodology of most of the studies is
well highlighted; many of them, being retrospective,
refer to a treatment that is not standardized, and
inclusion/exclusion criteria were set afterward (subjecting
the study to bias), making it difficult to compare
results. What is really clear is that there is still
no consensus on the optimal treatment of keloids.
After a mean follow-up of 19 months, van de Kar et
al. had a cure rate of 28 percent, compared with the
78 percent average of previous studies. They ascribed
their low rate to the “long” follow-up and the strict
inclusion criteria of their study
Il trattamento del melanoma cutaneo: valore diagnostico e prognostico del linfonodo sentinella.
No full text
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