Background Wide axillary reconstruction after hidradenitis suppurativa (HS) excision still represents a great challenge. Thoracodorsal artery perforator flap is one of the most reliable local reconstructive techniques. Although its anatomy and harvesting technique have been well described, specific reconstructive criteria still lack. The aim of this study was to help surgeons in planning axillary reconstruction on flaps based on the thoracodorsal artery. Methods Twelve patients affected by HS at Hurley stage III underwent wide “en block” excision and immediate reconstruction with 15 local thoracodorsal artery perforator flaps and 2 muscle-sparing latissimus dorsi flaps. A thorough chart review has been performed with preoperative and postoperative photographic documentations. Early and late complications have been analyzed. Results A total of 15 perforator flaps on thoracodorsal artery and 2 muscle-sparing latissimus dorsi flaps have been raised. The early complication rate was 29%, whereas the late complication rate was 35%. Except for one, all patients declared they were satisfied or highly satisfied from both aesthetic and functional points of view. Analyzing specific aspects, we have described several important details to consider for the reconstruction of the axilla. Through a retrospective analysis, we have classified HS axillary patients into 4 categories to better plan surgical reconstruction. Conclusions Axillary reconstruction is still a plastic surgery challenge. Peculiar surgical details should be considered when approaching this area. This new classification may help young surgeons during the reconstructive phase.

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Therapeutic, III.

No abstract

Background Perforator flaps surgery barely damages underlying muscle function, but only clinical qualitative evidences exist about muscle preservation after surgical dissection. We have employed for the first time electromyography and nerve conduction studies in evaluating the latissimus dorsi electrical muscle function after thoraco-dorsal artery perforator flap dissection in a retrospective cohort study. Methods We included ten consecutive patients requiring axillary reconstruction with thoraco-dorsal artery perforator flap, from June 2017 to June 2018. All patients were suffering from hidradenitis suppurativa. Electromyography (EMG) and nerve conduction study (NCS) were conducted on each patient, both before and after the operation. Differences between pre-and postoperative amplitude and latency values were calculated. Results Postoperative signal amplitude and latency means did not differ significantly from the preoperative one. Operative time and area of excision did not correlate with changes of electrical function. Conclusions This is the first quantitative analysis performed for the evaluation of muscle electrical activity after perforator flap surgery. Perforator pedicle intra-muscular dissection does not cause any injury to the muscle fibers. TDAP flap confirms to be a safe procedure for latissimus dorsi muscle function. Level of evidence: Level III, therapeutic study.

No abstract

Loco-regional flaps have been widely used for the reconstruction of digital injuries without requiring microvascular anastomosis, however, they result in scarring and compromised functional outcomes. This study demonstrates our experience utilizing the innervated radial artery superficial palmar branch (RASPB) perforator free flap for complex digital injury reconstruction. From May 2007 to March 2014, the innervated RASPB perforator free flap was used to reconstruct 79 distal complex hand and digital soft tissue defects of which 14 were used to re-vascularise the distal digit in a flow-through fashion. All free flaps were innervated by the palmar cutaneous branch of the median nerve. All 79 free flaps survived and all 14 digits re-vascularized successfully. One flow-through free flap developed distal skin necrosis which healed uneventfully without further procedure. The average follow-up was 21.5 months. Measurement of two-point discrimination ranged from 7 to 13 mm. All patients were satisfied with the aesthetic results. The innervated RASPB perforator free flap is a feasible and effective option for the reconstruction of complex digital defects and the flow-through concept, when utilized in cases with compromised vascularity, provides reliable re-vascularization. Level III, therapeutic study.

Acupuncture originated in ancient China but is used around the world to treat a variety of diseases. Research has not provided conclusive evidence proving the existence of meridians, or the lines along which acupuncture needles are inserted. Currently, some members of the scientific community recognize the existence of acupuncture points but not of the meridians. Thus, when acupuncture is accepted, it is regarded as a suitable treatment for some symptoms and diseases, but its effectiveness is ascribed directly or indirectly to the nervous system. Gross anatomy is the discipline upon which scientific biomedicine is based, and the author uses juxtaposition to compare the shapes of the 12 main meridians with the anatomical shapes of their related organs; this comparison has revealed similarities that are worthy of consideration. This article discusses similarities between the shape of the Large Intestine and Kidney acupuncture meridians and the anatomy and embryology of the colon and urogenital tract in humans and other animals. Verification of these and other morphological similarities by human and comparative anatomists, geneticists, and biologists would support the hypothesis that meridians are involved in embryonic morphogenesis, extrauterine development, and the conservation of health. Such a possibility should increase scientific interest in the biophysical existence of meridians and prompt research that applies this new perspective to novel experimental projects.