Osteonecrosis of the femoral head (ONFH) is a progressive degenerative disease that ultimately requires a total hip replacement. Mesenchymal stromal/stem cells (MSCs), particularly the ones isolated from bone marrow (BM), could be promising tools to restore bone tissue in ONFH. Here, we established a rabbit model to mimic the pathogenic features of human ONFH and to challenge an autologous MSC-based treatment. ON has been originally induced by the synergic combination of surgery and steroid administration. Autologous BM-MSCs were then implanted in the FH, aiming to restore the damaged tissue. Histological analyses confirmed bone formation in the BM-MSC treated rabbit femurs but not in the controls. In addition, the model also allowed investigations on BM-MSCs isolated before (ON-BM-MSCs) and after (ON+BM-MSCs) ON induction to dissect the impact of ON damage on MSC behavior in an affected microenvironment, accounting for those clinical approaches foreseeing MSCs generally isolated from affected patients. BM-MSCs, isolated before and after ON induction, revealed similar growth rates, immunophenotypic profiles, and differentiation abilities regardless of the ON. Our data support the use of ON+BM-MSCs as a promising autologous therapeutic tool to treat ON, paving the way for a more consolidated use into the clinical settings.

Caliber mismatch in microvascular anastomosis can significantly increase procedural difficulty and elevate the risk of thrombosis. A comprehensive literature search in PubMed, Scopus, Web of Science, and Google Scholar was conducted to identify articles addressing surgical techniques for overcoming caliber mismatch in microvascular anastomosis. Various techniques described in the literature were found: modifications of end-to-end anastomosis, the use of end-to-side anastomosis, the application of vessel grafts and the use of vessel couplers. In this review, we critically analyze these techniques and introduce additional technical variations. We discuss the options and express our preferred choice of methods based on specific clinical scenarios: if an alternative vessel (either new or isolated further away) is not found, the severity of the mismatch guides the choice. When less then 1/3 our choice is for vessel dilation and oblique cut of the smaller vessel end (if necessary with the adjunct of a titanium small Ligaclip in an oblique fashion to avoid a cul-de-sac). If caliber mismatch is around or over 1/3, we would prefer an end to side anastomosis.

Treatment of organic fecal incontinence in children, typical of anorectal malformations, is most often conservative; however, when necessary, it can be surgical. Autologous fat grafting, or lipofilling, can be used to improve fecal incontinence. We present our experience with the echo-assisted anal-lipofilling and its effects on fecal incontinence in children and on the quality of life of the entire family. Under general anesthesia, fat tissue was harvested according to the traditional technique, and processed in a closed system Lipogems^® set. Injection of the processed adipose tissue was guided by trans-anal ultrasound assistance. Ultrasound and manometry were also used for follow-up. From November 2018, we performed 12 anal-lipofilling procedures in six male patients (mean age 10.7 years). Five children had a stable improvement in bowel function with Krickenbeck’s scale scores going from soiling grade 3 pre-treatment in 100% of children to grade 1 post-treatment in 75% of them. No major post-operative complications developed. An increase in thickness of the sphincteric apparatus was shown at ultrasound during follow-up. The quality of life of the entire family, evaluated with a questionnaire, improved after the surgical treatment of the children. Anal-lipofilling is a safe and effective procedure to reduce organic fecal incontinence thereby benefiting both the patients and their families.

Androgenetic alopecia (AGA) is a common chronic, hereditary, cutaneous, and androgen-dependent condition. Low self-esteem and negative impact on quality of life are often consequences of AGA. Clinical treatment of AGA using SVF (Stromal Vascular Fraction) has been effective. The hair follicle is affected by various environmental factors and one of the most important factors is the vascularity of the scalp which is itself affected by SVF. In October 2022, we conducted a systematic review to identify all scientific publications discussing hair loss treatment with stromal vascular fraction or adipose stem cells. We selected 140 articles. After a screening process, we kept 9 articles complying with inclusion criteria. No serious adverse events were reported in all studies. Despite a standardized protocol was not found, all studies reported a statistically significant increase in the number (density) of hair after SVF treatment. Two studies found a significant improvement in the pull test. An increase in hair diameter was noticed after treatment. The combination of medical therapy and SVF proved to be advantageous. SVF is nowadays at the center of studies in the field of regenerative medicine due to its potential applications in many branches of medicine and surgery. The initial results are very promising but furthermore, studies are necessary to establish a methodical and systematic research capable of demonstrating its real benefits and the creation of homogenous treatment protocols. (www.actabiomedica.it)

The radial forearm free flap (RFFf) and the antero-lateral thigh flap (ALTf) are considered the “key flaps” for oral cavity reconstruction. Nowadays, the literature lacks of an objective and standardized decision-making algorithm for the flap choice. The aim of this study is to describe a decision-making algorithm concerning the more appropriate flap, RFFf or ALTf, in the reconstruction of intra-oral soft tissues based on the volumetric analysis of the defect with a pre-operative Magnetic Resonance Imaging (MRI), updating our previous surgical experience. We conducted a retrospective observational study including 77 patients who underwent microsurgical reconstruction with RFFf or ALTf after tumor resection of the soft tissues in the oral cavity. During follow-up, patients were evaluated using the UW-QOL questionnaire. Analyzing the scores of the UW-QOL questionnaire based on the size of the tumor on preoperative MRI we found that for tumor volume <50cc and between 50-70cc, the patients reconstructed with RFFf obtained statistically significant better scores compared to the ALTf group, while for tumor volume >70cc, the patients reconstructed with ALTf reported statistically significant better scores. Pre-operative RMI-guided volumetric assessment of oral cancer plays a key role in the planning of adequate soft tissue reconstruction and can objectively help surgeons in the correct choice of the flap (RFFf vs. ALTf) for each case based on preoperative tumor size, suggesting for defects <50cc and between 50 and 70 cc a reconstruction with RFFf, while for defects >70cc a reconstruction with ALTf. (www.actabiomedica.it)

Background/Objectives: Medial thighplasty is a widely performed body contouring procedure, particularly in patients with massive weight loss. Despite advancements in surgical techniques, complications remain a significant concern. The integration of liposuction into thigh lift procedures has shown promise in improving both aesthetic and functional outcomes while reducing risks. This review aims to assess the role of liposuction in medial thighplasty by evaluating its impact on surgical outcomes and complications. Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive search was performed in the MEDLINE/PubMed database using predefined keywords. A total of 52 records were identified, of which 19 studies met the inclusion criteria, encompassing 1113 patients who underwent liposuction-assisted medial thighplasty. Two independent reviewers screened and selected the studies, resolving discrepancies through discussion or consultation with a third reviewer. Data on surgical techniques, complications, and outcomes were extracted and analyzed. Statistical comparisons were performed using the Chi-square test, with significance set at p < 0.05. Results: The incorporation of liposuction significantly reduced the overall complication rate (36.75% vs. 70.68%, p < 0.001). Specific complications, including infections (1.77% vs. 9.02%), hematomas (1.30% vs. 6.77%), and seromas (8.95% vs. 24.81%), were markedly lower in the liposuction group. Conclusions: Liposuction appears to reduce complication rates and improve surgical outcomes in medial thighplasty. Further standardization of techniques and additional research on advanced liposuction technologies are necessary to refine this surgical approach and optimize patient outcomes.