Patients presenting with chronic wounds in venous insufficiency often represent a challenge, like other conditions, like lymphatic impairment, may complicate the wound healing process. The purpose of this report is to highlight how the treatment of lymphatic impairment may be beneficial in patients affected by chronic ulcers with concomitant venous insufficiency. We present the case of a 78-year-old woman affected by chronic venous insufficiency (CVI) with long-lasting ulcers secondary to sclerosing agents treatment for varicose veins. The patient's condition was refractory to both conservative and surgical treatment. Since the patient also presented with severe lymphorrhea, with a significant amount of daily secretion, ICG-lymphography was performed subcutaneously, to visualize the pathway of lymphatic drainage and leakage. It also allowed marking on the skin the exact location of lymphatic vessels distally to the wound area. Hence, two lymphatico-venous anastomoses were performed between the two major collecting lymphatic vessels and two subcutaneous veins of adequate size. The postoperative course was uneventful and the procedure allowed for immediate resolution of lymphatic leakage and complete wound healing within 2 weeks with no recurrence in the follow-up time of 1.5 years. Based on the outcomes of this case, it is possible to consider the use of CVI treatment and lymphedema surgery as a combined approach to complicated cases of long-standing venous ulcers with lymphorrhea.

The nose represents the most common site for the presentation of cutaneous cancer, especially in sun-exposed areas: ala, dorsum, and tip. Even the smallest loss of substance can create aesthetic and psychosocial concerns for patients; therefore, surgeons who perform nasal reconstruction should be strictly confident with the pertinent surgical anatomy in order to tailor the procedure to the patient’s condition and needs. Radical tumor excision and satisfactory aesthetic and functional results are primary targets. Restoring the original shape is the goal of any reconstruction: appropriate reshaping of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures are paramount features. Multiple options exist to re-establish functional and aesthetic integrity after surgical oncology; nevertheless, the management of nasal defects can be often challenging, and the gold standard is yet to be found. The current goal is to highlight some of the more common techniques used to reconstruct cutaneous defects of the nose with a specific focus on decision making based on the aesthetic subunit and defect size. The authors attempt to share common pitfalls and offer practical suggestions that they have found helpful in their clinical experience.

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Patients presenting large chest wall defects often represent a challenge, the more when other conditions, like osteomyelitis, may complicate the wound healing process. We present a case of long-lasting cutaneous fistulas of the chest wall caused by ribs and sternum osteomyelitis, refractory to both conservative and surgical treatment. Both lateral intercostal perforator flap and internal mammary perforator flap were performed in the same surgery for chest wall coverage after accurate debridement. The procedure allowed for resolution of osteomyelitis and wound healing with no recurrence. The purpose of this report is to highlight how, in apparently untreatable cutaneous fistulas caused by ribs and sternum osteomyelitis, an accurate debridement and coverage with perforators propeller flaps may be successful.

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W e had the great pleasure of reading the interesting article entitled "Seasonal Impact on Surgical-Site Infections in Body Contouring Surgery: A Retrospective Cohort Study of 602 Patients over a Period of 6 Years" by Duscher et al. 1 Body contouring surgery has increased a lot in recent years, because of the increase in bariatric surgery. Unfortunately, there are many complications that occur in body contouring surgery. We would like to congratulate the authors for the research that relate an increased rate of surgical-site infection, which is one of the most frequent complications during the summer season after body contouring surgery. Body contouring operations, as the authors have clearly highlighted, are elective procedures; very careful preoperative planning would be required to reduce the risks and complications that may occur as a result of the surgery itself. Furthermore, in our experience, and as reported in the literature, smokers and those with a high body mass index and comorbid conditions such as diabetes are more at risk of postoperative complications. 2 In our experience, postoperative infections after body contouring surgery are severe complications, in both winter and summer months. Even in our cases, we found an increase in the rate of infections and wound

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