The clinical use of platelet-rich plasma (PRP) for a wide variety of application has been reportedly employed most prevalently in problematic wounds, maxillofacial and hemi-facial atrophy, Romberg Syndrome, and diabetic foot ulcers. To our knowledge, PRP has never been described in the enhancement of fat grafting during tissue-engineering application in vivo. The authors describe the preparation of PRP and its use in a series of 43 patients who underwent plastic, reconstructive, and maxillofacial surgery for chronic lower extremity ulcers (n = 18) and multiple facial applications (n = 25). PRP mixed with fat grafting was used in 76% patients affected by multiple facial diseases and in 88.9% patients affected by lower extremity ulcers. PRP injection alone was used in the remaining patients. The authors observed that after a 7.1-week and 9.7-week (average) course of twice-daily wound treatment with PRP suspended on a collagen base, 61.1% and 88.9% of chronic lower extremity ulcers underwent to 100% reepithelization compared with 40% and 60% of controls (n = 10) treated with hyaluronic acid and collagen medication. In patients treated with reconstructing three-dimensional projection of face by fat grafting and PRP, we observed a 70% maintenance of contour restoring and three-dimensional volume after 1 year compared to only 31% of controls (n = 10) treated with fat grafting alone. In vitro, PRP induced a significant increase in the number of adipose-tissue-derived stem cells compared to control cultures. These results documented that PRP accelerates chronic skin ulcer reepithelization and improves maintenance and function of fat graft in patients who underwent plastic reconstructive surgery, possibly by stimulating adipose-tissue-derived stem cell proliferation.

The aim of our study was to analyze the results obtained with the ReCell system for surgical treatment of stable vitiligo. At Department of Plastic and Reconstructive surgery, University of Tor Vergata in Rome, we treated 15 patients with stable vitiligo during a 2-year period. The stability of vitiligo lesions varied between 1 and 4 years. The mean stability was 2.25. The disease activity according to Vitiligo Disease Activity Score (VIDA) was 0 in all cases, which means that all patients had a stability of greater than or equal to 1 year. Three (20%) patients had vitiligo vulgaris, seven (46.6%) segmental vitiligo and five (33.3%) focal vitiligo. Repigmentation was assessed using the Vitiligo Area Scoring Index (VASI). The extent of pigmentation was scored as excellent, good, fair, and poor depending on the percentage of repigmentation in the previously depigmented site. The color of the repigmented area was compared with the adjacent normally pigmented area: excellent color match was present in ten (66.6%) and good in five (33.3%) cases. There was no fair or poor outcome. Repigmentation greater than 75% was recorded in 12 (80%) and 25% to 50% repigmentation in three (20%) of 15 patients treated. ReCell is a feasible, simple and safe technique. The method that uses noncultured autologous epidermal suspension is simpler, less expensive, less time consuming, and does not require sophisticated laboratory facilities as compared with the methods employing cultured melanocytes.

We describe the miniabdominoplasty technique adopted in patients with unfavourable aesthetic defects after Pfannenstiel incisions and give our results from 32 patients. Eligibility criteria were cutaneous ptosis after Pfannenstiel incisions, and skin elastic enough to do the miniabdominoplasty. Exclusion criteria were obese or previously fat subjects in whom the operation was not possible. The technique is based on the combination of a miniabdominoplasty done obliquely up to the fascia, and liposuction. We operated on 32 patients from September 2005 to May 2006. We saw no postoperative bleeding, haematoma, or seroma. Thirty-one patients had a good final result. In one case postoperative asymmetry required secondary remodelling, which was done under local anaesthesia as an outpatient. After six months follow-up we recorded no asymmetry or change in body shape. We use the miniabdominoplasty technique for the correction of cosmetic abnormalities after Pfannenstiel incisions. It is feasible and safe, with a short operating time, and gives good aesthetic results and few postoperative complications. Further studies, with more patients, are now required to validate these results.

Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is an uncommon degenerative and poorly understood condition. It is characterized by a slow and progressive atrophy affecting one side of the face. The incidence and the cause of this alteration are unknown. Pathogenesis of this syndrome is not clear: some authors refer the atrophy of subcutaneous system to the alteration of sympathetic system, whereas others refer it to an alteration of the nervous system referred to the encephalic level or to an interstitial neuritis of the trigeminal nerve. The most common complications that appear in association to this health disorder are as follows: trigeminal neuritis, facial, and epilepsy, the last one being the most frequent complication of the central nervous system. Characteristically, the atrophy progresses slowly for several years, and soon after, it becomes stable. Today, plastic surgery with graft of autogenous fat can be performed after stabilization of the disease. The objective of this work is, through the presentation of a clinical case, suggesting a therapeutic plan formed by 2 sequential treatments: poliglactic acid to obtain skin thickening followed by Coleman technique for reconstructing three-dimensional projection of face contour restoring the superficial density of facial tissues. The results we obtained prove the efficacy of combining these 2 treatments, and the satisfaction of the patient confirms the quality of our results.

In a recent article, Goldman described the singlestage reconstruction of a complete alar loss following basal cell carcinoma surgery. The surgical procedure adopted showed a perfect knowledge of local flaps and, in this context, we would like to complete the scientific debate describing their use in the reconstruction of smaller defects of the alar cartilage such as those present in the congenital agenesis.

The authors present their experience on reconstruction by extraoral bone-anchored implants technique, showing two patients from a total of 13, treated for orbital reconstruction. They were selected from 66 patients treated for reconstruction of orbit, ear and nose using this technique by the staff of the Department of Plastic and Reconstructive Surgery of the University of Tor Vergata, Rome, Italy. They underwent orbital emptying due to cancer pathology. Surgical technique is described in detail; its final purpose being positioning of titanium fixtures on the orbital borders, necessary to anchor the silicone epithesis. The advantages and potential limits of this technique are exposed, exposing the important role of patient's compliance. The importance of preliminary study on the patients is also emphasized and includes clinical evaluation and instrumental examination for surgical planning, completed by a photographic study in the three standard projections.Satisfactory aesthetic results were obtained by the use of this technique and the authors believe it may represent a valid option; complementary to more traditional ones, but is a first choice in patients who cannot endure major surgery or in case of failure of traditional techniques.

Aim. Breast asymmetry is a huge chapter of breast abnormalities. Surgical therapy is the exclusive one. The breast of women can vary in shape, volume and position, thus creating esthetic, social and psychological problems. Methods. We classified breast asymmetry into 6 categories and then we treated them with different surgical techniques: reduction mammaplasty according to Planas; augmentation mammaplasty with prosthesis; grafts or both; ultimately mammaprosthesis (association of mastopessy and prosthesis). We obtained satisfactory esthetic results often with one surgery procedure. Rarely we performed 2 or more procedures of symmetry. We treated 77 patients suffering from breast asymmetry. We excluded in this study the gigantomastic asymmetry (anomaly determined by severe and asymmetric mammary hypertrophy). Results. We found a low number of complications at short and long term. These results are likely due to the ability of the surgeon in the appropriated preoperative evaluation of the patients and of their expectancy and correct surgical techniques. Conclusion. We tried to obtain 3 results: shape and position of the sick breast as same as possible to the contralateral breast and less evident scars located in hidden regions.

Cytokines, and interleukin-6 in particular, are inflammatory peptide mediators that are extensively studied as regulators of bone tissue homeostasis. They seem to be involved in osteoclast activation and bone resorption and probably play a role in osseointegrated implant rejection. In this study we investigate the ability of titanium implants to cause an imbalance in the homeostatic equilibrium of cytokines using the peritoneal cavity of DB-A2 mice as a model. The inflammatory response was evaluated as a messenger ribonucleic acid expression determined by the semiquantitative reverse transcriptase-polymerase chain reaction technique in peritoneal macrophages from titanium-implanted mice. Interleukin-6 release was detected by a specific quantitative enzyme-linked immunosorbent assay. Our results have shown that titanium implants do not significantly stimulate the proinflammatory cytokine system compared to the control group. The enzyme-linked immunosorbent assay test confirms, after a peak in secretion at day 1 compared with basal levels, a clear decrease in interleukin-6 at basal levels on following control at 6 and 9 days after implantation. The study of the interaction between implanted biomaterials and inflammatory mediators seems to be very promising.Perhaps a better understanding of the mechanisms of bone resorption could lead to finding a new clinical solution for patients with osseointegrated implant rejection.