Rossella Elia

Background: This study aimed to evaluate the role of skin flap thickness (SFT), measured by preoperative breast magnetic resonance imaging (MRI), in predicting postoperative complications after nipple-sparing or skin-sparing mastectomy, and to assess its value in guiding reconstructive strategy selection. Methods: We conducted a retrospective single-center study including patients who underwent preoperative breast MRI and nipple-sparing or skin-sparing mastectomy for breast cancer or BRCA1/2 mutations between January 2019 and August 2025. Demographic, clinical, and perioperative data were collected. Patients were stratified into two groups based on mean preoperative SFT: >8 mm (Group A) and p < 0.05). Overall postoperative morbidity was 16.25%. Partial nipple–areola complex necrosis (11.5%) and hematoma (7.7%) occurred significantly more often in Group B compared to Group A (both p < 0.05). Multivariate analysis confirmed preoperative SFT p = 0.012). Conclusion: Preoperative magnetic resonance imaging assessment of skin flap thickness reliably identifies patients at increased risk of postoperative complications. Integrating this parameter into surgical planning may support personalized reconstructive decision-making and improve clinical outcomes.

Background The aim of the paper is to present a single-center experience with two-stage pre-pectoral breast reconstruction using tissue expander entirely covered by acellular dermal matrix (ADM), reporting surgical indications, technique, clinical and histological outcomes. Materials and Methods A prospectively maintained database of consecutive patients who had undergone immediate pre-pectoral expander-based breast reconstruction with ADM over a two years period (2019–2021) was analyzed. The primary clinical outcome measures included patients' subjective assessment of satisfaction and pain. Secondary outcomes were complication rates, the frequency of readmissions and incidence of capsular contracture. All patients underwent ultrasound examination 3 weeks postoperatively and at the end of tissue expansion completion. Histological examination of the periprosthetic tissue was performed during the second stage of the reconstructive procedure. Results A total of 46 patients with a mean age of 46.5 years (range: 24–62) underwent collectively 54 breast reconstructions with a mean follow-up of 22.5 months after definitive implant placement. The time to reach the final volume was on average 47.2 days (range 40–58). Complications occurred in 14 (25.9%) breast reconstructions: 11 (20.4%) seromas, 2 (3.7%) infections, 1 (1.8%) flap necroses, 2(3.7%) expander removals. Overall scores for Satisfaction were all significantly increased after surgery. Histological examination revealed complete ADM integration in the host tissue, with thinner, less sclerotic tissue compared to the submuscular capsular samples. Conclusions Tissue expander-ADM-based breast reconstruction can be safely used in selected cases for two-stage pre-pectoral breast reconstructions and can result in significant pain-relief procedure with optimal aesthetical outcomes. 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 and Objectives: Wound healing is a complex process involving cellular, anatomical, and functional repair, often hindered in chronic wounds associated with diseases like diabetes and vascular disorders. This study investigated the efficacy of conventional and regenerative wound healing approaches in a sheep surgical wound model. Materials and Methods: Six female Bergamasca sheep underwent five full-thickness skin lesions treated with various methods: sterile gauze (control), chlorhexidine, sodium hypochlorite, micronized dermis system application, and dermal matrix. Wound healing progression was monitored over 42 days through wound dimension measurements, exudate analysis, and histopathological evaluations. Results: The results indicated that all wounds healed completely by day 42, with significant reductions in wound size and exudate over time. Notably, Micronized dermis system application and dermal matrix treatments showed a faster evolution in exudate characteristics and improved collagen reorganization compared to other treatments. Histological analysis revealed earlier neovascularization and better reconstitution of hair follicles in these groups. Despite the lack of significant differences in healing time, both regenerative approaches enhanced wound healing phases, contributing to exudate control, angiogenesis promotion, and reduced scar formation. Conclusions: The findings suggest that while micronized dermis system application and dermal matrix do not accelerate acute wound healing compared to conventional methods, they offer potential benefits in managing exudate and improving tissue regeneration, warranting further investigation in chronic wound scenarios.

Background and Objectives: Breast cancer in patients with prior breast augmentation poses unique challenges for detection, diagnosis, and management. Mastectomy rates are increasing, and patients with prior augmentation often have a lower body mass index, making autologous techniques unsuitable. This study aims to assess the best reconstructive option in patients with a history of subglandular or dual-plane breast augmentation. Materials and methods: A prospective analysis was conducted on patients who underwent breast reconstruction after mastectomy. Patients with subglandular or dual-plane breast augmentation were included. Patients were divided into submuscular breast reconstruction (Group 2) or prepectoral breast reconstruction (Group 1) groups. Demographic and surgical data were collected. Results: A total of 47 patients were included, with 23 in Group 1 and 24 in Group 2. Complications occurred in 11 patients (23.4%), with significant differences between groups. The most common complication was seroma formation. Implant loss occurred in 4.3% of cases in Group 1, while no implant loss was observed in Group 2. Patient-reported satisfaction scores were similar between groups at 12 months postoperatively. Conclusions: Subpectoral breast reconstruction with a tissue expander seems a safer and effective technique for patients with prior breast augmentation. It resulted in fewer complications. This approach should be considered as an option for breast reconstruction after mastectomy in this cohort of patients.

Background: Breast reduction, the seventh most performed plastic surgery globally, has witnessed a significant increase in procedures over recent years. Various techniques exist, each with its advantages and complications, emphasizing the critical role of preoperative marking. Although existing literature focuses on different reduction mammaplasty techniques, limited attention is given to surgical preoperative marking. This study introduces a “mosque tower” pattern combined with a superomedial pedicle, aiming to minimize complications and standardize the design based on individualized factors such as patient characteristics and predicted breast reduction weight. Methods: The retrospective case series includes 103 women who underwent reduction mammaplasty between 2017 and 2020. Surgical marking is described, and complications are recorded. The study categorizes breasts into three groups based on key-hole dimensions, correlating them with predicted resection weight. Statistical analysis establishes a rationale formula for selecting key-hole size. Results: A total of 175 breasts were reduced in 103 women with an average follow-up of 29.8 months. The mean resection weight was 883 g per breast (range: 490–2531). A complication rate of 8% was observed, with only 2.8% experiencing wound breakdown, notably lower than reported rates in other studies. Key-hole dimension as a predicting variable was correlated significantly with resection weight. Conclusions: The mosque tower pattern proves to be an effective, safe, and reproducible method for preoperative marking in reduction mammaplasty. The study emphasizes the importance of individualized planning to achieve satisfactory results, particularly for surgeons in their early practice.

Breast cancer in patients with prior breast augmentation poses unique challenges for detection, diagnosis, and management. Mastectomy rates are increasing, and patients with prior augmen-tation often have a lower body mass index, making autologous techniques unsuitable. This study aims to assess the best reconstructive option in patients with a history of subglandular or dual plane breast augmentation. Materials and methods: a prospective analysis was conducted on pa-tients who underwent breast reconstruction after mastectomy. Patients with subglandular or dual plane breast augmentation were included. Patients were divided into submuscular breast recon-struction (group 2) or prepectoral breast reconstruction (group 1) groups. Demographic and sur-gical data were collected. Results: A total of 47 patients were included, with 23 in Group 1 and 24 in the Group 2. Complications occurred in 11 patients (23.4%), with significant differences be-tween groups. The most common complication was seroma formation. Implant loss occurred in 4.3% of cases in the Group 1, while no implant loss was observed in the Group 2. Patient-reported satisfaction scores were similar between groups at 12 months postoperatively. Conclusions: sub-pectoral breast reconstruction with a tissue expander seems a safer and effective technique for pa-tients with prior breast augmentation. It resulted in fewer complications. This approach should be considered as an option for breast reconstruction after mastectomy in this cohort of patients.

Background Dupuytren's disease decreases quality of life significantly and often requires surgical treatment, nevertheless there is no actual gold standard. The aim of this study was to introduce the use of minimally invasive pull-through technique. Methods From 2016 to 2020, 52 patients suffering from Dupuytren's contracture were treated with the minimally invasive pull-through technique. We evaluated the improvement in range of motion, pain, disability, and quality of life in the long term. Total extension deficit, quick disabilities of the arm, shoulder, and hand (QuickDASH), and EuroQol five dimensions—five levels index were systematically scored before each surgical intervention and reevaluated after 24 months. Results Fourteen patients (26.9%) had already received a previous intervention (percutaneous needle aponeurotomy or collagenase Clostridium histolyticum). The mean preoperative total active extension deficit was 84.0 ± 23.3 degrees (55–130 degrees). Mean follow-up was 36 months. There were no cases of tendon rupture or neurovascular injury. Total active extension deficit at the final follow-up was 3.4 ± 2.3 degrees (0–12 degrees). The mean active range of motion of the MCP and PIP joints were, respectively, 90.5 ± 3.3 degrees (85–96 degrees) and 82.7 ± 2.5 degrees (80–87 degrees). At 24 months after cord excision, a mean 10.7 points improvement in the QuickDASH questionnaire was registered (p < 0.001). Pull-through technique was equally effective both on patients with a primary or a recurrent disease. Eight patients (15.4%) had a recurrence of disease in the metacarpophalangeal joint or proximal interphalangeal joint. Conclusion The pull-through technique is a simple, accessible, and effective technique for the treatment of Dupuytren's contracture. The use of palmar mini-incisions combined with minimal dissection has a low risk of iatrogenic injury to the neurovascular bundles and tendons, and has a low risk of recurrence rate. This study reflects level of evidence IV.

Background: The pedicled gastrocnemius flap is commonly used to treat lower limb defects. Either the medial, lateral, or both heads can be used. When extended soft tissue defects are present, a double gastrocnemius (DG) flap may be used. However, no data of the additional donor site morbidity compared to a medial gastrocnemius (MG) flap are available. The aim of this study was to compare the donor site morbidity of a DG with that of a MG.Methods: Patients with a soft tissue defect around the knee, treated with a gastrocnemius flap between 2018 and 2021 at the University Hospital of Lausanne and Bari, with a minimum follow‐up of 12 months, were included. According to the size and the position of the defect, it was decided whether one (10 patients) or two (9 patients) heads of the gastrocnemius were necessary for the coverage. The mean age was 61 years (range 42–82) in DG, and 63 years (range 45–78) in MG. The average defect size was 89.8 cm² in the DG group and 53.4 cm² in the MG group. The etiologies were trauma (n = 10), infection (n = 7) and sarcoma (n = 2). A medial approach or a posterior midline approach was used for the harvesting of the gastrocnemius muscle. Once the flap was harvested, it was rotated and transposed anteriorly over the defect, either through a subcutaneous tunnel or by dividing the intervening skin bridge, depending on the soft tissue defect. A split‐thickness skin graft was used to close the skin over the remaining exposed muscle flap. The active range of motion of the ankle and knee joints was measured. Muscle strength was assessed with a hand‐held dynamometer and by the ability to stand on tiptoe. Physical function was evaluated through the Lower Extremity Functional Scale (LEFS).Results: The two groups were homogeneous, with no significant difference in age, sex, and BMI. All flaps survived in both groups. Both groups showed lower values in strength and range of motion of the operated leg, when compared to contralateral side. In plantar flexion, this accounted for a reduction in MG by 3.8 ± 1.0 kg of strength and 8 ± 3° of ROM, and in DG by 4.7 ± 1.7 kg and 16 ± 4°, respectively. For knee flexion, the reduction in MG was 4.4 ± 0.6 kg and 16 ± 7°, while in DG 5.6 ± 1.0 kg and 28 ± 6°. In the MG group, 60% were able to stand on the tiptoe of the operated leg, as opposed to 0% in DG. The average LEFS score in DG was lower by 10.9 points (p < .05). Questions concerning running and jumping had a lower score in DG (p < .01).Conclusions: The harvesting of both gastrocnemii led to significant additional donor site morbidity compared to the harvesting of the medial gastrocnemius alone. However, the additional morbidity did not have an impact on activities of daily living and walking, even though it limited the ability to perform more demanding tasks such as running and jumping. Therefore, based on our study, the choice of a DG flap should be critically assessed in younger, more demanding patients.