Fabiana Battaglia

Background: Fingertip injuries frequently involve exposure of bone, tendon, or nail bed and require reconstruction to restore function and appearance. The homodigital adipofascial reverse flap (HDARF) and bilayer dermal substitutes such as Integra are commonly employed, but few comparative studies exist. Methods: A retrospective monocentric study was conducted, including 40 patients treated between 2012 and 2024 for traumatic pulp loss: 20 with HDARF and 20 with dermal substitute plus skin graft. Outcomes were assessed using Semmes-Weinstein monofilament (SWM) test, 2-point discrimination (2PD), Cold Intolerance Symptom Severity, Michigan Hand Outcomes Questionnaire, and return-to-work time. Results: All patients achieved wound healing without major complications. Homodigital adipofascial reverse flap provided superior sensory recovery (85% with normal SWM; mean 2PD < 5 mm), lower incidence of cold intolerance and nail deformities, and shorter return-to-work intervals. Dermal substitutes required longer healing but yielded good aesthetic outcomes and preserved donor sites. Conclusions: Both HDARF and dermal substitutes are safe and effective options for fingertip reconstruction. Homodigital adipofascial reverse flap is preferable for young, active patients requiring rapid functional recovery, whereas dermal substitutes represent a valuable alternative when minimal invasiveness and donor-site preservation are prioritized.

Background: Restoration of sensory feedback has become one of the major goals of modern bidirectional neuroprosthetic rehabilitation, enabling the transition from conventional prosthetic replacement toward bidirectional neuroprosthetic systems capable of restoring physiological sensorimotor communication. This narrative review aims to provide a comprehensive and clinically oriented overview of current neural and related sensorimotor interfaces for upper- and lower-limb prostheses, focusing on their mechanisms of sensory restoration, clinical performance, and translational potential. Methods: A targeted literature search was conducted in PubMed, Scopus, and Web of Science to identify clinical, translational, and landmark studies published between January 2010 and June 30, 2026. Sources were selected according to prespecified relevance criteria consistent with the narrative design of the review. Owing to the heterogeneity of the included technologies, study designs, populations, and outcomes, the evidence was synthesized narratively. Earlier seminal publications were included when relevant to the physiological basis of sensory restoration and the historical evolution of neural interfaces. The selected literature was analyzed thematically according to neural interface technology, sensory restoration strategies, functional outcomes, and clinical translation. Results: Evidence from small pilot studies and experimental evaluations suggests that direct peripheral and central neural interfaces, biological or regenerative interfaces, neuromuscular signal interfaces, non-invasive sensory-feedback systems, and integrated prosthetic platforms may contribute to the restoration or substitution of tactile, proprioceptive, thermal, and multimodal sensory information. Emerging technologies, including regenerative peripheral nerve interfaces, fully implantable wireless systems, biomimetic sensory encoding, adaptive closed-loop control, and artificial intelligence-assisted decoding, may support further clinical translation, although most remain investigational. However, the available evidence remains limited by small patient cohorts, heterogeneous methodologies, and a lack of standardized long-term outcome measures. Conclusions: Neural and related sensorimotor interfaces have shown the feasibility of providing sensory feedback in selected experimental and early clinical settings. Although no single technology currently fulfils all clinical requirements, the integration of complementary biological, neural, and computational approaches appears to represent the most promising pathway toward personalized neuroprosthetic systems with the potential to improve sensorimotor function, although long-term clinical and quality-of-life benefits remain uncertain.

Background: Large segmental bone defects remain a major challenge in reconstructive surgery, particularly in the presence of impaired vascularization. Despite advances in scaffold design and biomaterials, insufficient vascular supply continues to represent the primary limitation in bone tissue engineering, often leading to impaired osteogenesis and graft failure. Objective: This review aims to analyze the role of vascularized flaps as “living bioreactors” in bone tissue engineering, focusing on their capacity to enhance scaffold vascularization, support osteogenesis, and facilitate clinical translation. Methods: A narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science using combinations of the following keywords: “bone tissue engineering”, “vascularized flaps”, “arteriovenous loop”, and “in vivo bioreactor”. Relevant preclinical and clinical studies were selected based on their contribution to vascularization strategies in scaffold-based bone regeneration, with the aim of illustrating the evolution and integration of these approaches. Results: Vascularized flaps provide an established vascular network and a biologically active microenvironment that promote scaffold integration and tissue regeneration. Periosteal flaps demonstrate strong osteogenic potential, whereas muscle and omental flaps primarily act as vascular carriers and adaptable regenerative environments. AV loop-based strategies enable intrinsic axial vascularization, ensuring rapid and homogeneous perfusion of large constructs. Hybrid approaches, including regenerative matching axial vascularization (RMAV), integrate vascularized tissues with advanced biomaterials and show promising translational outcomes. Conclusions: Vascularization-driven strategies represent a paradigm shift in bone tissue engineering, moving from passive scaffold implantation to actively engineered, vascularized constructs. The integration of microsurgical techniques with advanced biomaterials offers significant potential for the development of personalized and clinically applicable bone regeneration strategies.

Background/Objectives: Nasal reconstruction after non-melanoma skin cancer excision remains challenging due to the need to restore both nasal form and function while ensuring oncologic safety. Beyond surgical success, patient-reported outcomes are increasingly recognized as essential components of postoperative evaluation. The aim of this study was to retrospectively assess oncologic, surgical, and patient-reported outcomes in a real-world cohort of patients undergoing nasal reconstruction following skin cancer excision. Methods: A retrospective cohort study was conducted on 60 patients treated at the University Hospital “G. Martino” (Messina, Italy) between 2019 and 2022. Reconstructive techniques included direct closure, full-thickness skin grafts, local or regional flaps. Oncologic outcomes and postoperative complications were recorded during routine follow-up. Patient-reported outcomes were evaluated using a semi-structured PROM-derived questionnaire adapted from the FACE-Q Skin Cancer Module, NOSE, and SCaFF domains. Internal consistency of the questionnaire was assessed using Cronbach’s alpha. Results: Basal cell carcinoma was the most frequent diagnosis (55%), and the nasal ala, dorsum, and tip were the most commonly involved subunits. Local flaps were performed in 42% of cases. No histologically confirmed recurrences were observed in the flap-reconstructed subgroup during the available follow-up, whereas recurrences were observed in patients managed with non-flap reconstructive approaches. Postoperative complications were uncommon; however, one fatal infectious event occurred in a high-risk patient undergoing complex reconstruction for recurrent disease. The PROM-derived questionnaire demonstrated good internal consistency (Cronbach’s α = 0.82). Functional symptoms were rare, with 93% of patients reporting no snoring or nasal obstruction and 97% reporting no nasal voice alteration. Aesthetic satisfaction was rated as satisfactory or very satisfactory by 63% of patients, and social relationships were not affected in 85%. Patient-perceived recurrence risk (38%) exceeded histologically confirmed recurrence (15%). Conclusions: In this elderly real-world cohort, flap-based nasal reconstruction was associated with generally favorable patient-centered outcomes and low complication rates. The discrepancy between patient-perceived and confirmed recurrence highlights the role of oncologic anxiety. Prospective studies using fully validated PROMs are warranted to support standardized outcome comparison and guide clinical decision-making.

Lingual lipomas are uncommon benign tumors, accounting for < 0.5% of all tongue neoplasms, due to the limited adipose tissue in this region. They are usually asymptomatic and slow growing, which may delay detection. We report the case of a 50‐year‐old man with a 4‐year history of a painless, progressively enlarging submucosal mass on the ventral surface of the tongue. Clinical examination revealed a 3 × 3 cm sessile, yellowish, well‐circumscribed lesion with tense‐elastic consistency. Given its benign appearance, no preoperative imaging was performed. The lesion was surgically excised under local anesthesia, and histopathological analysis confirmed a conventional lipoma composed of mature adipocytes without atypia or lipoblasts. The patient recovered uneventfully and regained full oral function within 2 months. This case emphasizes the importance of including lingual lipomas in the differential diagnosis of tongue masses. It suggests that, in selected cases, clinical assessment alone may be sufficient for diagnosis and treatment planning.

Summary: Reconstruction of the penile shaft represents a complex surgical challenge, especially when both cutaneous and urethral components are involved. Although total phallic reconstruction is well established, partial ventral penile defects lack standardized treatment strategies, particularly in older or multimorbid patients unfit for microsurgical procedures. We present the case of a 78-year-old man with a 2.5 × 3.5 cm full-thickness ventral shaft defect and associated urethral involvement, secondary to Fournier gangrene. A 3.0 × 5.0 cm freestyle propeller flap based on the deep external pudendal artery was designed and harvested. Urethral continuity was restored by suturing a buccal mucosal graft to the internal surface of the flap. The procedure was performed without microsurgical anastomosis, using a minimally invasive approach suitable for high-risk surgical candidates. The postoperative course was uneventful, with spontaneous resolution of minimal venous congestion. At 12-month follow-up, the patient demonstrated complete recovery of normal urinary function, excellent aesthetic results of the penile shaft, and stable flap viability with preserved urethral patency. The deep external pudendal artery–based propeller flap offers a reliable, reproducible, and low-morbidity solution for partial penile shaft reconstruction, combining functional and cosmetic restoration. This technique represents a valuable alternative for patients at high surgical risk who are not candidates for microsurgical phalloplasty. Further anatomical and clinical studies are needed to consolidate its indications.

Background: Scar management remains a significant challenge in plastic and reconstructive surgery, particularly when addressing atrophic, retractile, or fibrotic scars. Autologous fat grafting and hybrid fractional laser therapy have independently shown efficacy in improving scar quality. This study aims to evaluate the synergistic effect of their combination on clinical and functional scar outcomes. Methods: A prospective, comparative study was conducted on patients with cutaneous scars of various etiologies. Participants were treated with either hybrid fractional laser therapy alone (CO₂ and 1570 nm Erbium-glass wavelengths) or a combined protocol of laser plus autologous lipofilling. Clinical outcomes were assessed at baseline and at 30, 60, and 90 days post-treatment using the Vancouver Scar Scale (VSS), patient satisfaction scores, and Visual Analog Scale (VAS) for pain and discomfort. Results: Patients receiving the combined treatment demonstrated significantly greater improvement in scar pigmentation, elasticity, pliability, and thickness compared to those treated with laser alone. Subjective symptoms, including pain and itching, were also more effectively alleviated. The volumetric and regenerative properties of adipose tissue, particularly its content of adipose-derived stem cells (ADSCs) and stromal vascular fraction (SVF), likely contributed to the enhanced outcomes observed. Conclusions: The combination of hybrid fractional laser therapy and autologous lipofilling offers a superior therapeutic strategy for scar remodeling compared to laser monotherapy. This integrated regenerative approach addresses both structural and biological aspects of scar tissue, making it a valuable protocol for personalized and effective scar management. Further randomized trials with larger sample sizes and histological validation are warranted to confirm these preliminary findings and refine therapeutic protocols.