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Nipple inversion is a particular condition characterized by shorter galactophorous ducts, periductal fibrosis, and lack of soft tissue under the nipple base. It can be congenital or acquired, and it affects about 10% of the female population. Many operative techniques have been described seeking to correct this deformity, but a unique landmark strategy does not exist yet. Although acceptable results have been reported, every surgical technique has its drawbacks. We describe our 5 years' experience in correcting inverted nipples by using a simple personal approach. Between January 2004 and January 2009, we treated 52 patients presenting with nipple inversion using 2 V-Y dermoglandular flaps performed in the dermoglandular portion of the nipple. This method is effective in the correction of moderate and severe inverted nipple deformities. Follow-up period ranged from 1 to 6 years. Results showed recurrence in 1 case and postoperative complications in 3 patients. The authors have found this to be an ideal procedure for correcting inverted nipple; the use of an easy to perform V-Y flap ensures nipple protrusion and support, lactation, and minimal scars.

In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgical field may be a problem for both the patient and the surgeon. However, the relevant literature is mostly based on complications related to application of tattoos or methods used to remove them. To date, few reports have focused on the importance of preserving a tattoo during a surgical procedure, and no organized studies could be found. The aim of this paper is to provide an overview of the range of solutions that surgeons can use to preserve tattoos during surgery. A PubMed database search was done to assess other surgeons' experience. The terms "tattoo" in combination with "incision", "surgery", "surgical", or "operative" were used as key words. Following a review of the literature, photographs of patients presenting with a tattoo in the last 5 years at University Campus Bio-Medico of Rome were identified in order to determine the frequency of patients presenting with tattoos in our department. The patients were classified according to sex, age, type of surgery, number of tattoos, and tattoo location. Specific requests to preserve tattoos were recorded. Finally, an algorithm of treatment according to tattoo dimension and location is proposed. Knowledge of all the strategies available for saving tattoos is important for plastic and cosmetic surgeons. If a tattooed area needs to be operated on, surgeons should attempt, when possible, to avoid altering the tattoo in order to maximize the final cosmetic result.

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BackgroundLesions of the distal phalanges of the fingers frequently involve the nail bed. There are few therapeutic options for nail‐bed reconstruction and they often lead to painful scars and onychodystrophy. We present our experience with the distal adipofascial laterodigital reverse flap.MethodsFifteen patients (average age 46.33 years, range 28–73) with tumors or traumatic injuries (crush injuries, nail avulsion, and partial fingertip amputations) of the nail bed, underwent digital reconstruction through the distal adipofascial laterodigital reverse flap from June 2018 to August 2019. The size of the fingertip defect covered with the flap was ranged between 1.1 × 1.1 and 1.6 × 1.2 cm (average size 1.4 × 1.2 cm). The flap was harvested enrolling subcutaneous tissue from the lateral aspect of the middle and distal phalanx from the less damaged side.ResultsThe average size of the harvested flaps was 1.3 × 1.2 cm (range 1.1 × 1.0 to 1.4 × 1.1 cm). All adipofascial flaps survived entirely and the nail bed healed in all patients, with an average healing time of 21 days and a subsequent regrowth of the nail. The follow up ranged from 6 to 12 months, with a mean of 7 months.ConclusionsThe distal reverse adipofascial flap provides a very versatile and reliable coverage of the distal finger and its nail bed. It is a rapid and reproducible surgical procedure with poor morbidity for the donor site.Level of EvidenceIV.