Pietro Giovanni di Summa

Background: Abdominoperineal resection (APR) may result in significant postoperative defects, with high rates of wound healing complications, especially after radiotherapy. No consensus exists regarding the optimal flap for perineal reconstruction after APR. Methods: This 2-center retrospective study included patients undergoing perineal reconstruction with an oblique rectus abdominis myocutaneous (ORAM) flap or an anterolateral thigh-vastus lateralis (ALT-VL) flap between September 2015 and March 2020. Outcomes of interest were perioperative complications, wound healing time, and length of stay. Results: Twenty-four patients were included (ORAM, n = 10; ALT-VL, n = 14). The mean length of stay and time to complete healing were 26.7 ± 14.31 and 39.3 ± 38.8 days in the ORAM group, compared with 33.14 ± 17.02 and 20.64 ± 8.76 days in the ALT-VL group, respectively ( P = 0.340 and P = 0.167). The groups were also similar for overall (40% versus 28.6%; P = 0.439), major (10% versus 7.1%; P = 0.670), and minor (30% versus 21.4%; P = 0.494) perineal complication rates. Concerning donor-site complications, 3 (30%) patients in the ORAM group developed postoperative bulging, whereas 1 patient in the ALT-VL group experienced postoperative seroma ( P = 0.178). Conclusions: Both ORAM and ALT-VL flaps provided effective and reliable reconstruction of perineal defects after APR, with comparable complication rates. The ALT-VL flap was associated with lower donor-site morbidity, making it a favorable option. ORAM, given the possibility of transabdominal transfer, remains particularly useful when concomitant vaginal wall reconstruction is required.

Experienced burn surgeons correctly assess burn depth in only 60-75% of cases. Various strategies are available to define the degree of burn, ranging from clinical observation (the most common) to biopsy and subsequent histological analysis. Among these, indocyanine green angiography (ICG) is gaining popularity for its potential to improve diagnostic accuracy. This study aims to explore the utility of ICG as a tool for evaluating the extent and severity of burns, thereby enhancing diagnostic accuracy and treatment outcomes in burn care. A systematic review of the literature was conducted using PubMed, Scopus, Embase and the Cochrane Library through February 2025 using the search terms [ICG OR indocyanine green] AND [burn]. Article selection was performed following the PRISMA guidelines. The initial search yielded 201 results, of which 10 articles met inclusion criteria (3 on animal models, 7 on human subjects, involving 122 patients overall). Preclinical studies demonstrated ICG's ability to distinguish between partial- and full-thickness burns with 100% accuracy when compared to histopathology. Clinical studies confirmed improved diagnostic performance over clinical assessment alone. Optimal imaging was reported at five minutes post-injection, with evaluation recommended between days two and three post-injury. Quantitative and qualitative fluorescence analysis enabled discrimination of superficial burns, where dermal vascularization is preserved, from deep burns. This method could reduce waiting times and support early surgical decision-making. A structured clinical algorithm integrating timing, dosing, and interpretation was proposed based on literature. ICG video-angiography has shown to be an effective technique that deserves consideration in the assessment of burn patients. Further studies are needed to increase knowledge and guide its optimal clinical use.

Background: Perforator flaps improved the reconstruction paradigm in the lower extremity, increasing coverage possibilities. This study aims to quantify how added perforators could enhance standard geometrical patterns (compared to random flaps). Methods: A total of 29 cases of lower limb soft tissue reconstruction (STR)—52% trauma, 21% osteomyelitis with skin fistulas, 21% healing disorders with unstable scarring and 6% cancer-related surgery—were performed in our institution between 2012 to 2023 with geometric random (GR) local flaps (34%), geometric perforator-enhanced (GP) flaps (32%) or pure propeller perforator (PP) flaps (34%), were retrospectively analysed. Patients with proximal thigh defects, a follow up of less than 3 months and those who received an axial, muscle or free flap were excluded. Geometric patterns (as length:width ratio (L:W)) were compared among groups, analysing healing outcomes and complications. Results: Leg defects were categorized into 62% distal, 14% middle, 14% proximal third and 10% distal thigh. No significant difference in defect size was detected among groups. Mean flap size was significantly larger for GP (70.5 cm², (p < 0.05)) and PP (74.4 cm², (p < 0.01)) than GR (53.7 cm²). The L:W ratio was significantly higher in GP (L:W 2.2:1, (p < 0.05)) and PP (L:W 2.8:1, (p < 0.01)) than in GR (1.5:1), but no significant difference was found between GP and PP. A reduced complications rate (partial flap loss, infection, healing, revision surgery, etc.) was observed in the GP group, when compared to GR. Conclusions: Flap geometric design can be significantly improved by the inclusion of perforators, maintaining spatial advantages with larger ductility and improved vascular solidity.

Background: Upper blepharoplasty for dermatochalasis is a common oculoplastic procedure worldwide, but postoperative suture removal can be uncomfortable or impractical for some patients. Aims and Objectives: This study aimed to compare outcomes between absorbable and non-absorbable sutures used for upper eyelid blepharoplasty closure and to assess differences in complication rates. Materials and Methods: We analyzed data from consecutive upper eyelid blepharoplasty procedures performed over a 3 year period. Patients were categorized based on the type of suture used for skin closure, with exclusion criteria including any prior eyelid or orbital surgery. Postoperative complications, outcomes, and aesthetic satisfaction scores (1–10) were compared between the two suture groups. Results: The study included 149 patients: 69 with absorbable sutures and 80 with non-absorbable polypropylene sutures. Demographic variables were similar between groups. Operative time, estimated blood loss, return to work and follow-up duration were comparable. No significant differences in complication rates were observed (2.9% vs. 2.5%, p   = 1.000), though a slight trend toward reoperation was noted in the absorbable suture group (8.7% vs. 6.2%, p  = 0.570). Patient and surgeon satisfaction scores were similar. Conclusion: Our findings suggest that absorbable sutures are a viable and safe alternative to non-absorbable sutures for upper eyelid blepharoplasty, with no significant differences in postoperative outcomes or overall satisfaction. Level of Evidence III: 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/Objectives: Surgical site infection (SSI) rates following breast surgical procedures range from 0.8% to 26%. Both prophylactic antibiotics and antimicrobial-coated sutures have been shown to play an important role in reducing these complications. This study aimed to evaluate the impact of antibiotic prophylaxis in mastectomy procedures using triclosan-coated sutures. Methods: This study included 300 consecutive patients who underwent mastectomy for breast cancer over a two-year period, during which triclosan-coated Vicryl Plus sutures were used. Patients were divided into two groups based on the use of antibiotic prophylaxis. The prophylaxis group received 1.5 g cefuroxime intravenously at anesthesia induction (600 mg clindamycin in case of allergy), while the control group received no antibiotics. Endpoints of interest included differences in SSI and specific wound-healing complications at follow-up. Results: There was no significant difference in the overall SSI rates between the two groups: 23.2% in the prophylaxis group vs. 18.8% in the control group [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.69–1.13; vs. OR: 1.16; 95% CI 0.85–1.58; p = 0.343]. No adverse drug reactions were observed. Staphylococcus aureus was the most isolated microorganism in both groups. Multivariate analysis identified prolonged operative time and hematoma formation as significant predictors of postoperative infection. Conclusions: Antibiotic prophylaxis did not reduce the rate of SSI following mastectomy for breast cancer when triclosan-coated sutures were used. Further high-quality, independent studies are warranted, particularly in breast surgery context.

Male genital lymphedema (MGL) is a debilitating condition that may require surgical intervention. Lymphaticovenous anastomosis (LVA) can be ineffective in primary and advanced cases because of lymphatic disruption, whereas vascularized lymph node transfer (VLNT) can overcome this limitation by promoting neolymphangiogenesis but traditionally carries some risk of donor site complications. Gastroepiploic vascularized lymph node transfer (GEVLNT) has recently emerged as an effective treatment option for upper and lower limb lymphedema, with negligible complications. However, its role in genital lymphedema remains unexplored. This is the first short series reporting the use of GEVLNT in MGL. Three male patients (44, 61, and 52 years old) with GL underwent GEVLNT. The first patient had idiopathic disease, which relapsed after previous treatment with LVA; the other two had secondary lymphedema due to cancer treatment and hydrocele surgery, respectively. In all patients, the right gastroepiploic lymphosome was harvested laparoscopically, with flap sizes of 14 × 5 cm, 15 × 4 cm, and 12 × 4 cm, respectively. The recipient vessels were the deep inferior epigastric artery and vein in the first case, and the superficial external pudendal vessels in the other two. Post‐operative courses were uneventful for all patients, with no complications reported. Follow‐up periods were 36, 23, and 12 months, respectively. In all cases, GEVLNT resulted in significant clinical improvements and reductions in genital lymphedema severity (GLS) scores (7–1, 9–4, and 8–4). Our preliminary experience suggests that GEVLNT could be a viable and effective option for treating male genital lymphedema with minimal donor site morbidity and stable results over time. However, further research with larger patient cohorts, comparative studies, and long‐term follow‐up is needed to fully establish its efficacy.

Background/Objectives: Significant weight loss, whether through bariatric surgery or medication-assisted approaches, presents unique challenges for body contouring procedures. A thorough preoperative evaluation is essential to optimize outcomes and minimize risks. Methods: A comprehensive literature search was conducted across various databases to identify studies on assessment, nutritional optimization, thromboembolic risk, and surgical planning for post-weight-loss patients, with a particular focus on those undergoing medication-assisted weight loss using Glucagon-like peptide-1 (GLP-1) agonists. Results: A detailed review of medical history, comorbidities, weight loss trajectory, and nutritional status is essential. Common conditions such as diabetes, hypertension, and sleep apnea often improve after weight loss but require ongoing management. Nutritional deficiencies, particularly in vitamins and minerals, necessitate dietary counseling and supplementation. Patients who have undergone significant weight loss are at increased risk of thromboembolic events, particularly after body contouring procedures. Surgical planning should be patient-centered, setting realistic expectations and employing a strategic, staged approach when necessary to optimize outcomes. GLP-1 agonists users require special consideration due to their distinct metabolic and physiological profiles. Conclusions: Optimizing preoperative assessment, nutrition, and thromboprophylaxis is critical for safe and effective body contouring in post-weight-loss patients. With the increasing prevalence of medication-assisted weight loss, surgical strategies must adapt to address the distinct anatomical and physiological features of these patients.