Surgical site infection in implant-based breast reconstruction is a complication with variable incidence reported in the literature. Due to potential loss of implant and reconstruction, it can have a strong psychological impact on patients. Background and objectives: This study aimed primarily at analyzing the current status of the surgical site infection (SSI), (type, time of onset, clinical presentation, pathogens and management) in patients who underwent implant-based breast reconstruction at our Breast Unit. Secondarily, we wanted to establish whether introduction of a new, updated evidence-based protocol for infection prevention can reduce SSI in implant-based breast reconstruction. Materials and Methods: A single-center retrospective study was performed primarily to evaluate the incidence and features of SSI after implant-based breast reconstruction from 2007 to 2020. In June 2020, a protocol for prevention of SSI in implant-based breast reconstruction was introduced in clinical practice. Secondarily, a data analysis of all patients who underwent implant-based breast reconstruction in compliance with this protocol was performed after preliminarily assessing its efficacy. Results: 756 women were evaluated after mastectomy and implant-based breast reconstruction for breast cancer. A total of 26 surgical site infections were detected. The annual incidence of SSI decreased over time (range 0–11.76%). Data relating to infections’ features, involved pathogens and implemented treatments were obtained. Since the introduction of the protocol, 22 patients have been evaluated, for a total of 29 implants. No early infections occurred. Conclusions: Surgical site infection rates at our Breast Unit are comparable to those reported in the literature. The SSI rates have shown a decreasing trend over the years. No SSI has occurred since the introduction of the prevention protocol for surgical site infection in June 2020.

Background. Chest-Wall Contouring is generally the first surgical step Trans Men sex reassignment surgery. In case of medium/big size and ptotic breast, free nipple graft technique is the procedure of choice. The position and aspect of neo-nipples are of paramount importance to resemble a male chest. The aim of the present paper was to develop and apply a simple new method of nipple-areola complex free graft. Methods. From January 2018 to December 2020 a novel nipple areola complex (NAC) grafting technique was developed and used when dealing with breast amputation and NAC graft in patients with nipple projection and dimension > 1 cm. The graft was taken from the pigmented skin from the areola leaving a central 5 mm diameter of thoracic/ recipient skin. Results. 15 patients (30 NACs) were treated with the described new NACs graft technique. All patients healed uneventfully and none of them required revision surgery or correction. Discussions. Traditional nipple grafts harvested from the areola are often flat or depressed. Nipple grafts harvested from large and projected female nipples are frequently associated with partial necrosis, graft discoloration and need for revision surgeries or tattoos. In our series, the use of a graft harvested from the pigmented skin of the areola and leaving a central 5 mm diameter of thoracic/recipient skin creates a 3D shadow effect similar to the one of a male nipple. This original and simple procedure can aid surgeons with reproducible nipple reconstructions in free nipple graft mastectomy in case of large nipples.

Background: Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors’ experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients’ quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.

Citation: Bazzacco G, Zelin E, Maronese CA, et al. Rosette-like structure: a main dermoscopic feature in a small trichilemmal cyst.  Dermatol Pract Concept. 2022;12(1):e2022021. DOI: https://doi.org/10.5826/dpc.1201a21 Accepted: May 26, 2021; Published: January 2022 Copyright: ©2022 Bazzacco et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication and approved the final version of the submitted paper. NDM and IZ defined the design and intellectual content of the paper. GB searched for literature, wrote the draft, edited the manuscript and the tables, preparing them for submission. EZ, CAM, and VR reviewed the article with consistent integrations. DS analyzed the histology samples and contributed to image collection. Corresponding author: Enrico Zelin, MD, Dermatology Clinic, Hospital Maggiore, , Trieste, Italy. Email address: enrico.zelin@gmail.com Keywords : trichilemmal cyst, rosette, dermoscopy This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.