Background The incidence rates of melanoma have risen to worrying levels over the last decade. Delayed diagnosis, due to faults on the detection stage, indicates the necessity of new aiding diagnosis techniques. Since metabolic activity is highly connected to neoplasia formation, a detection technique that focuses its results on vascular responses, as Infrared thermal (IRT), seems to be a viable option. Materials and methods Static and dynamic (cooling) thermal images of melanoma and melanocytic nevi lesions were collected and analysed to retrieve thermal parameters characteristic of this skin lesion types. The steady‐state and dynamic variables were tested separately with different machine learning classifiers to verify whether the distinction of melanoma and nevi lesions was achievable. Results The differentiation of both types of skin tumours was doable, achieving an accuracy of 84.2% and a sensitivity of 91.3% with the implementation of a learner based on support vector machines and an input vector composed by static variables. Conclusion The use of IRT for skin tumour classification is achievable, but some improvement is needed to raise the metrics of sensitivity and specificity. For future work, it is recommended the study of dynamic parameters for the classification of other types of skin neoplasia.

Background Many strategies have been developed to lower the high complications rate associated with a full abdominoplasty. The dissection technique may have a role to achieve this goal. Objectives The present study compares two different dissection techniques to perform a full abdominoplasty with Scarpa fascia preservation: avulsion technique and electrodissection. Methods A retrospective observational cohort study was performed in two health institutions from January 2005 to January 2019. A total of 251 patients were involved: 122 patients submitted to abdominoplasty using the avulsion technique (Group A) and 129 with diathermocoagulation (coagulation mode) (Group B). The latter was further divided into group B1(57 patients with device settings according to surgeon’s preferences) and B2(72 patients with a specific regulation aiming at minimal tissue damage). Several variables were analyzed: population characteristics, time of hospital stay, time to drain removal, total and daily drain output, emergency department visits, readmission, reoperation, local and systemic complications. Results There were no statistically significant differences between the general characteristics of both groups, except for previous abdominal surgery. The diathermocoagulation group had a significantly lower length of hospital stay and time to drain removal. Moreover, these advantages were maximized when electrocautery was done with a specific low voltage setting as significant differences were found. The other outcomes were identical. Conclusions Limiting the extension of electrodissection with the avulsion technique didn´t present any advantage. Using diathermocoagulation (coagulation mode) during a full abdominoplasty with Scarpa fascia preservation, especially when it’s aimed at minimal tissue damage, reduces patients’ time with drains.

Background: Scarpa fascia preservation during abdominoplasty has been shown to reduce complications associated with the traditional technique. As an extension of a previously published randomized controlled trial, this study aims to clarify whether preservation of Scarpa fascia during abdominoplasty has an influence on scar quality or sensibility recovery. Methods: This was a single-center clinical trial, involving 160 patients randomly assigned to one of two surgical procedures: classic full abdominoplasty (group A) and abdominoplasty with preservation of Scarpa fascia (group B). Patients were later convoked to assess scar quality and abdominal cutaneous sensibility. Scar quality was evaluated through the Patient and Observer Scar Assessment Scale. Cutaneous sensibility was measured on the upper and lower abdomen, using light touch, Semmes-Weinstein testing (5.07/10-g monofilament), and a 25-gauge needle. Results: A total of 99 patients (group A, 54 patients; group B, 45 patients) responded to contact, with a mean follow-up time of 44 months. Concerning scar quality, Patient and Observer Scar Assessment Scale scores were similar between groups. On the upper abdomen, there was a statistically significant difference between groups on cutaneous sensibility, on the examination with the Semmes-Weinstein 5.07/10-g monofilament (group A, 79.6 percent; group B, 93.3 percent; p = 0.046) and pain (group A, 90.7 percent; group B, 100 percent; p = 0.044). No statistically significant differences were found between groups on the lower abdomen. A considerable proportion of patients (two-thirds) still presented sensibility alterations in the subumbilical area 3½ years after abdominoplasty. Conclusion: Scarpa fascia preservation during abdominoplasty does not influence scar quality, but it improves sensibility recovery in the supraumbilical area. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

When an auricular defect is caused by high-energy trauma that causes damage to the surrounding tissues, the patient may be not a candidate for reconstruction with local flaps and free tissue transfer may be necessary. Here we present a case of total auricular reconstruction in a 27 year-old man who had total loss of the left ear and traumatized temporal skin and fascia. A radial forearm flap prelaminated by a porous polyethylene implant was employed. A "printed" ear made of silicone, based on the patient's CT-scan of the contralateral ear, was used for intraoperative molding of the future reconstruction. Prolonged prelamination time and surgical delay (three months) were performed to reduce edema, distortion and loss of definition of the framework after revascularization. After subsequent integration and neovascularization of the added tissue, the prelaminated flap was transferred. Flap reinnervation was also performed by direct coaption of the great auricular nerve to the lateral antebrachial cutaneous nerve. The flap fully survived and there were no complications in the early postoperative period. Between 3 and 6 months, the patient returned to normal ranges in terms of warmth and cold, and recovered the discriminative facial sensibility. After one year the auricular reconstruction was intact and satisfactory aesthetic results were achieved. This method may offer a satisfactory solution for a difficult problem and may be considered for acquired total ear defects.