Use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy: new strategy to reduce complications

Background: Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction. Methods: A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017–2018: enrollment; 2018–2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed. Results: A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications ( p < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade ( p < 0.0001). Conclusions: Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.

Tenosynovial giant cell tumor of the tendon sheat

The review article outlines modern aspects of the nomenclature, etiopathogenesis, diagnosis and treatment of tenosynovial giant cell tumor of the tendon sheath. This is the second most common benign neoplasm of the hand. Non-radical surgical treatment of this disease leads to a large number of recurrence. To avoid tumor recurrence, surgeon must to have the basics of plastic reconstructive surgery, use delicate instruments and optical magnification. In some cases, adjuvant radiation therapy and administration of tyrosine kinase inhibitors may be required.

Application and Experience of Various Reconstructive Procedures in Scalp Defects

Aim: To evaluate the outcome of various reconstructive procedures in scalp defects. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Plastic/Reconstructive Surgery & Burns, LUMHS Jamshoro from 1st January 2018 to 31st December 2020. Methodology: Thirty patients of scalp wounds were admitted through outpatient and casualty departments. The patients were diagnosed by pre-operative workup and on clinical parameters were included. The patients unfit for general anaesthesia, patients having associated skin pathology, patients with history of allergic reactions and patients having any poorly controlled systemic co-morbidity like diabetes and hypertension were excluded. Results: Twenty two (73.33%) were males and 8 (26.66%) were females with mean age of 38.98±8.25 years. Scalp defect was due to trauma in46.66%, electric injury 23.33%, benign lesions 16.66%, malignant tumour 3.33%, Infection 3.33%, haemangioma and pigmented nevus 3.33%. Follow up duration was 42.34±7.83 weeks. Conclusion: Primary closure remained the mainstay of our treatments hence proved that simplest reconstruction should be used whenever possible to provide the most functional and aesthetic scalp reconstruction, with the least amount of complexity. Key Words: Scalp, Reconstructive surgical procedure, Graft, Flap