Natural-based and synthetic tissue adhesives have attracted extensive attention in the last two decades for their ability to stabilize uncontrolled bleeding instances. However; these materials present several drawbacks during use that scientists have tried to minimize in order to optimize their usage. This study comprises the development of a novel wound dressing, combining the excellent properties of polylactic acid (PLA) non-woven textile, as substrate, obtained through electrospinning, and a cyanoacrylate-based (CA) tissue adhesive, for rapid hemostatic action. Thus, the fabrication of electrospun PLA membranes at three different PLA concentrations, the design and manufacturing of the support system and the production of surgical patches were carried out. SEM and FT-IR methods were employed for analyzing the morphology as well as the indicative markers for the shelf life evolution of the obtained patches. PLA fibers with well-defined structures and a mean diameter varying between 4.6 and 7.24 μm were obtained with the increase of the concentration of the PLA solutions. In vivo tests on a rat model as well as peeling tests for good patch adhesion on liver fragments harvested from the test animals, with a limit for the strength of the liver tissue of 1.5 N, were carried out. The devices exhibited excellent adhesion to the parenchymal tissue and a long enough shelf life to be used with success in surgical procedures, also facilitating prompt hemostatic action.

Background: Microsurgical skill acquisition and development are complex processes, due to the often complex learning curve, limited training possibilities, and growing restrictions on working hours. Simulation-based training programmes, employing various models, have been proposed. Nevertheless, the extent to which these training programmes are supported by scientific evidence is unclear. The aim of this systematic review is to evaluate the extent and quality of the scientific evidence backing validated microsurgical training programmes. Methods: A systematic literature review was conducted, following a study protocol established a priori and in accordance with the PRISMA guidelines. The databases searched were the Web of Science Core Collection (Web of Knowledge), Medline (Ovid), Embase (Embase.com), and ERIC (Ovid). Studies were included if they described microsurgical training programmes and presented a form of validation of training effectiveness. Data extraction included the number of participants, training duration and frequency, validation type, assessment methods, outcomes, study limitations, and a detailed training regimen. The risk of bias and quality were assessed using the Medical Education Research Study Quality Instrument (MERSQI). Validity was assessed using an established validity framework (content, face, construct, and criterion encompassing both concurrent and predictive validity). The Level of Evidence (LoE) and Recommendation (LoR) were evaluated using the Oxford Centre for Evidence-Based Medicine (OCEBM). Results: A total of 25 studies met the inclusion criteria. Training programmes were classified into one-time intensive courses or longitudinal curricula. Face, content, and construct validity were the most commonly assessed aspects, while predictive validity was the least frequently assessed and not properly evaluated. Training models ranged from low-fidelity (silicone tubes, synthetic vessels) to high-fidelity (live animal models). The Global Rating Scale (GRS), the Structured Assessment of Microsurgery Skills (SAMS), and the Objective Structured Assessment of Technical Skills (OSATS) were the most frequently used objective assessment tools for evaluation methods within the programmes. The risk of bias MERSQI score was 12.96, ranging from 10.5 to 15.5, and LoE and LoR scores were moderated. Across the studies, 96% reported significant improvement in microsurgical skills among participants. However, most studies were limited by small sample sizes, heterogeneity in baseline skills, and a lack of long-term follow-up. Conclusions: While validated microsurgical training programmes improve skill acquisition, challenges remain in terms of standardisation and best cost-effective methods. Future research should prioritise evaluating predictive validity, creating standardised objective assessment tools, and focus on skill maintenance.

Background: Perforator mapping is a mandatory tool for the preoperative planning of a microsurgical free flap, especially in breast reconstruction. Numerous methods for mapping have been described. In this study, we investigate the combined use of Dynamic Infrared Thermography (DIRT) and Colour Doppler Ultrasonography (CDUS) only to see whether it can eliminate the need for Computed Tomography Angiography (CTA). Methods: A prospective study was conducted on 33 patients with deep inferior epigastric perforator (DIEP) flaps for breast reconstruction. DIRT, followed by CDUS and CTA, was performed preoperatively and perforators were confirmed intraoperatively. Results: From 135 hot spots found on DIRT, 123 perforators were confirmed by CDUS (91.11%). A total of 86.66% of the perforator vessels detected on CTA have their correspondent on DIRT, while 95.12% have their correspondent on CDUS. No statistically significant difference (p > 0.05) was found comparing DIRT vs. CTA and CDU vs. CTA. The average DIRT time was 121.54 s and CDUS 232.09 s. The mean sensitivity for DIRT was 95.72% and 93.16% for CDUS. Conclusion: DIRT combined with CDUS can precisely and efficiently identify suitable perforators without the need for CTA in DIEP breast reconstruction.

Background: Predicting the viability of the skin flaps after mastectomy is of high importance and significance in immediate breast reconstruction. Numerous methods have been used and are readily available. This review aims to describe and compare the current preferred perfusion assessment tools. Methods: Four major scientific databases—Web of Science, PubMed, Embase, and Scopus—were consulted to retrieve reviews, meta-analyses, clinical trials, experimental studies, and case reports focused on skin flap perfusion assessment following mastectomy. English-language articles published within the last 10 years were included. The most recent search was conducted on 31 July 2024. Results: A summary focused on the relevant information of all included studies was drafted, and the results of the studies have been synthetized and compared. A total of 58 studies have been included in this review. Conclusion: Indocyanine green angiography (ICG-A) is the preferred and most-used method of evaluating perfusion, especially in high-risk patients, while new technologies show promising results and might be of great interest in the future. Perfusion assessment tools complement and should not replace clinical evaluation.

Background and Objectives: The technique of complete mesocolic excision (CME) for colonic cancer is being advocated to improve the local control of the disease and increase the long-term survival. However, even with an open approach, CME is a complex technique and has not yet been adopted as standard care. Laparoscopy has been proven to bring significant advantages to colorectal surgery but performing a laparoscopic CME (Lap-CME) for colonic cancer is even more technically demanding than CME in open surgery. The purpose of this study is to evaluate whether Lap-CME can be offered as a standard procedure for patients with colonic cancer and to compare the results with those obtained after a conventional, open technique. Materials and methods: This study included 100 consecutive patients with colonic cancer, who were operated on by the same surgical team using a standardized medial-to-lateral open or laparoscopic complete mesocolic excision technique. The perioperative data was prospectively recorded in a database and retrospectively analyzed with the aim of identifying the proportion of patients that received Lap-CME, to evaluate the success rate of the procedure and to identify whether there are differences in the oncological quality of CME between the laparoscopic and open surgery groups. Results: Most of the patients enrolled in this study were in the advanced stages of the disease, with the incidence of pT3 tumors being 67% and the mean tumor size averaging 4.5 cm. Laparoscopic CME was performed in 39% of cases overall, with 41.4% being right colectomies, 42.5% being left colectomies and 16.1% being transverse colectomies. All of the parameters relevant to the oncological quality of resection, namely total lymph node count, resection margins, or the completeness of resection, were similar between the open and laparoscopic groups both when analyzed for the entire cohort or when analyzed for specific subgroups according to the tumor location (right, transverse, or left colon) or stage of the disease (pT3 or stage III). Conclusions: Laparoscopic complete mesocolic excision for colonic cancer can be offered as a standard procedure by experienced surgical teams in carefully selected patients and provides oncological results similar to those obtained with open surgery.

Background: Traumatic injuries cause millions of deaths annually, with intra-abdominal hemorrhage as a leading cause. Achieving hemostasis remains challenging. This study evaluates the hemostatic properties of a novel biocompatible cyanoacrylate–polylactic acid patch. Methods: Thirty-six male Wistar rats were randomized into three groups (control, study, and TachoSil^®) and underwent a standardized liver resection. The hemostasis times were recorded, and blood samples were drawn to assess hemoglobin, hematocrit, and cytokine levels (IL-6 and TNF-α) using validated assays. Results: In the study group, a median time to hemostasis of 94 s was recorded, compared with 256 s for electrocautery (p < 0.001) and 120 s for TachoSil^® (p = 0.010). Hemoglobin levels significantly decreased postoperatively in all groups, with the TachoSil^® group showing the lowest median value (from 15.4 g/dL to 11.9 g/dL, p = 0.006). Furthermore, only the TachoSil^® group exhibited a marked inflammatory response with a significant rise in IL-6 (from 15.6 to 26.8 pg/mL, p = 0.04) and TNF-α (from 9.8 to 28.6 pg/mL, p = 0.01). Conclusions: The results demonstrated that the novel cyanoacrylate–polylactic acid patch achieved rapid hemostasis and was associated with reduced inflammatory responses compared with both electrocautery and TachoSil^®. These findings suggest that this hybrid material may offer a safer and more effective hemostatic alternative.