Radial forearm flap (RFF) is one of the most used flaps in reconstructive surgery. Despite its versatility and effectiveness, the donor site is affected by aesthetic and functional issues. In the group of techniques described to improve the donor site morbidity, dermal substitutes offer a valid approach in the wound management. A bilayered bioresorbable dermal substitute (Hyalomatrix) was used to provide the primary coverage of the RFF harvest site followed after 3 weeks by a split-thickness skin graft placement. In this study, 37 patients underwent RFF donor site reconstruction and subjected to a minimum follow-up of 1 year. The dermal substitute was applied on 15 patients, and their outcomes were compared with the data achieved by 22 patients submitted to immediate reconstruction with autologous full-thickness skin graft. Results were documented by digital photographs, the visual analog scale, the Vancouver Scar Scale, and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Data were analyzed and compared through statistical analysis. Total wound coverage was achieved in 4 to 6 weeks, and no tendon impairments were reported in the dermal substitute group. In our experience, the use of the dermal substitute is a valuable mean to minimize RFF donor site morbidity with excellent functional and aesthetic outcomes.

Background: Septal extension grafts allow the precise elongation of the nasal septum to attain facial harmony and optimize aesthetic outcomes. In this context, septal surgery requires meticulous design to address both functional and aesthetic goals. Traditional septoplasty techniques often overlook aesthetic considerations and postoperative nasal structural stability, resulting in unresolved or recurrent deviations, nose tip drooping, and obstruction recurrences. Despite advancements in surgical techniques, achieving simultaneous septal alignment and long-term stability remains a significant challenge. Methods: This study introduces a systematic 4-step technique. The procedure encompasses caudal septum liberation, placement of the septum extension cartilage graft, positioning of an ethmoidal bone graft, and redefinition through an intermediate cartilage. Results: A retrospective analysis of outcomes involving 753 patients was conducted with a minimum follow-up of 6 months. During follow-up visits, 1.73% of cases exhibited residual columellar asymmetry, and 0.66% showed tip asymmetries. The infection rate was 0.40%, with no cases of tip drop identified. The overall satisfaction rating on the Rhinoplasty Outcomes Evaluation questionnaire at 12 months postoperative was 9.3. Conclusions: The technique provides a systematic approach to integrate functional and aesthetic objectives, emphasizing septal stability and alignment while concurrently addressing tip projection and stability. The study provides comprehensive insights into the principles, methodology, and advantages of this rhinoplasty technique. The outcomes underscore the efficacy of the technique, presenting a reliable and long-term stable solution.

Breast augmentation has evolved significantly since its inception in the 1960s, with polyurethane (PU)-coated breast implants emerging as a notable innovation in the 1970s. Despite their potential advantages in reducing capsular contracture, concerns persist among surgeons regarding their safety and technical challenges, particularly in primary augmentation mammoplasty. The aim of this study was to highlight the numerous advantages and safety of PU implants, promoting them as a viable option for primary augmentation mammoplasty. The authors experience documented in the form of a case series was combined with a systematic review that examined the safety and efficacy of PU-coated breast implants for primary augmentation mammoplasty. A case series involving 50 patients who underwent this procedure from January 2023 to January 2024 is reported. Additionally, a comprehensive literature review from 2000 to 2023, using the PubMed, CINAHL, EMBASE, and Scopus databases, along with clinical experience and case reports were conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies indicate a low risk of malignancy associated with PU-coated implants, with no evidence of free 2,4-toluenediamine in the serum samples. A nearly nonexistent occurrence of capsular contracture, along with minimal surgical complexities make it an excellent choice for achieving functional and aesthetic results. PU-coated breast implants demonstrate equivalence to standard textured implants for primary augmentation mammoplasty, with advantages including reduced capsular contracture rates and improved stability. Despite historical skepticism, evidence supports their safety and effectiveness, positioning them as a viable option in breast augmentation surgery. Implementation of appropriate surgical techniques is paramount to optimizing outcomes and ensuring patient satisfaction.

Background Nowadays, implant-based breast reconstruction is a common technique after mastectomy. The widespread use of implant employment is prompting significant concerns regarding the oncological safety of prostheses and the potential impact of surface texture on the recurrence of local breast cancer. This article examines the oncological outcomes associated with postmastectomy breast reconstructions using micro- and macrotexturized implants, focusing on the incidence and relative risk (RR). Materials and Methods A retrospective cohort study was conducted on patients admitted to Multimedica group (IRCCS, San Giovanni Hospital, Milan) and ICH groups (Humanitas Clinical Institute, Milan) between January 2003 and September 2020. Minimum follow-up considered was of 1 year.Patients submitted to either complete or nipple-spearing mastectomy, who underwent breast reconstruction with macrotexturized or microtexturized prosthesis, were included in group A and B, respectively. Results A total of 646 patients met the basic inclusion and exclusion criteria. Group A included 410 (63.5%) patients and group B included 236 (36.5%). Cancer recurrence absolute risk in group A was 5.6 ± 2.2% and in group B was of 2.1 ± 1.8%. RR for breast cancer recurrence in group A compared to group B was of 2.65; confidence interval 95% (1.02; 6.87). Statistical analysis identified a higher local recurrence risk in patients reconstructed with macrotexturized prosthesis (p-value 0.036). Conclusion This study detected a higher risk for local breast cancer recurrence associated to macrotexturized breast implants employment. Further investigations are required to verify these outcomes.

Pre-pectoral (PP) direct-to-implant (DTI) breast reconstruction has gained popularity as a muscle-sparing alternative to subpectoral techniques. Polyurethane-coated implants, with their unique mechanical and biological properties, may further optimize outcomes by reducing capsular contracture and improving implant stability. This systematic review aimed to evaluate the safety, efficacy, and patient-reported outcomes of post-mastectomy PP DTI breast reconstruction using polyurethane-coated implants. A systematic search of PubMed, Embase, Scopus, and Cochrane Library databases was conducted in accordance with PRISMA guidelines. Data on study design, patient and surgical characteristics, complications, aesthetic outcomes, and patient satisfaction were extracted. Risk of bias was assessed using the ROBINS-I tool. Thirteen studies met inclusion criteria, comprising 1717 patients and 2502 breasts reconstructed with polyurethane-coated implants. Mean follow-up across included studies was 12.3 months (range 1-60 months). Mean implant size was 327 cc (range 160-680 cc). Across all studies, implant loss occurred in 1.0% of cases and infection in 0.9%. Capsular contracture with reported Baker grade III-IV cases occurred in 1.0% of cases within ≤12 months of follow-up, increasing to 12.3% in studies with ≥36 months’ follow-up. The most frequent aesthetic drawback was rippling or contour deformity, affecting 183 breasts (7.3%). Patient-reported satisfaction was consistently favorable: 5 studies using the BREAST-Q reported mean scores ranging from 72.6 to 78.3 for Satisfaction with Breasts and 79.9 to 84.6 for Psychosocial Well-Being. Pre-pectoral DTI reconstruction with polyurethane-coated implants is a safe and effective technique, associated with low complication rates and high patient satisfaction. Careful flap selection and adjunctive fat grafting optimize results. Prospective multicenter studies with long-term follow-up are warranted to confirm durability and refine patient selection criteria. Level of Evidence: 3 (Therapeutic):