Background Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. Methods A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. Results The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ = 0.04) and 0.84 (σ = 0.06) mm, respectively. The mean dissection time to raise the flap was 88 (σ = 7) min. Conclusion This is the first description of a nonliving biological simulation model for training in perforator flap dissection that mimics an ALT flap. As an ex vivo chicken model, it is a cost effective and readily accessible model suitable for repeated practice.

Introduction. The aim of this research was to test, in an animal model, the nerve regeneration technique with a hypoallergenic acellular dermal matrix used to wrap the microsurgical neural suture. Materials and Methods. Two groups of rats received the cut of limb right median nerves. The regeneration technique considers for both groups an end-to-end nerve suture. In the experimental group (A) was used also a wrapping protocol by a conduit of collagen matrix currently used in oral surgery. The animals underwent functional grasping tests (at 1, 3, 5, and 7 months) and a histological and quantitative analysis of distal nerve was performed at the end of experimental time. Result. After seven months, the grasping test reveals functional recovery in each tested animal; this improvement is more evident in Group A. The fibers appear well organized with restored myelin sheaths in both groups. Group A showed a great quantity of connective tissue surrounding the nerve. The quantitative morphology analysis in both groups shows a similar fibers density, fiber diameter, and myelin thickness. The differences between the groups in axon mean diameter are significant. In Group A M/d, D/d, and g-ratio is significantly higher compared to control group. Conclusions. Histological and functional assessments show a functional recovery of the injured nerve in the test groups, stressed by the results of the grasping tests and the meaningful increasing in fiber diameter and higher g-ratio. Moreover, a connective tissue cuff distinguishes the distal portion of the injured nerve. Considering the easy availability and handling of the material used in this study we can conclude that this experimental technique can be considered as a valid alternative to protect nerves in nerve wrap surgery.

Background Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum profundus and course distally along the radial side of the corresponding metacarpophalangeal joints, in front of the deep transverse metacarpal ligament. The first and second lumbrical muscles are typically innervated by the median nerve, and third and fourth by the ulnar nerve. A plethora of lumbrical muscle variants has been described, ranging from muscles’ absence to reduction in their number or presence of accessory slips. The current cadaveric study highlights typical and variable neural supply of lumbrical muscles. Materials Eight (3 right and 5 left) fresh frozen cadaveric hands of 3 males and 5 females of unknown age were dissected. From the palmar wrist crease, the median and ulnar nerve followed distally to their terminal branches. The ulnar nerve deep branch was dissected and lumbrical muscle innervation patterns were noted. Results The frequency of typical innervations of lumbrical muscles is confirmed. The second lumbrical nerve had a double composition from both the median and ulnar nerves, in 12.5% of the hands. The thickest branch (1.38 mm) originated from the ulnar nerve and supplied the third lumbrical muscle, and the thinnest one (0.67 mm) from the ulnar nerve and supplied the fourth lumbrical muscle. In 54.5%, lumbrical nerve bifurcation was identified. Conclusion The complex innervation pattern and the peculiar anatomy of branching to different thirds of the muscle bellies are pointed out. These findings are important in dealing with complex and deep injuries in the palmar region, including transmetacarpal amputations.

Background: The reconstruction of the upper eyelid and the periorbital region is a challenge for the surgeon. The aims of this reconstruction are to guarantee protection to the eyeball, maintain the visual field, and restore the function of the eyelid without damaging other anatomical structures. In this study, the authors describe the use of a propeller myocutaneous flap based on the small vertical branches of marginal, peripheral ed superficial arcade, for the reconstruction of the upper eyelid or periorbital region. Materials and Methods: The authors enrolled 3 patients (Caucasian), between 2018 and 2019, and subjected to reconstructive surgery with the propeller myocutaneous flap of the periorbital region at the Plastic Surgery Unit of the University of Messina. The vascularization of the flap was demonstrated through an anatomical study conducted on cadavers at the dissection laboratories of the University of Bordeaux 2. Results: The authors have shown that the myocutaneous flap represents a valid alternative for loss of substance coverage and reconstruction of the upper eyelid or periorbital region, allowing the achievement of a good aesthetic and functional result. Follow up: Patients were followed up at 3–6–12 months. No complications were reported (flap retraction, periocular region deformity, donor site morbidity). Furthermore, at the last visit, the scars were almost invisible. Conclusions: The use of the propeller myocutaneous flap of the upper eyelid is a valid reconstructive alternative to the standard techniques described so far for the reconstruction of the periorbital region.

Chemical peeling for skin originated in ancient culture: Egypt, Mesopotamia and Africa. Medical knowledge relating to chemical peels is the result of centuries of experience and research. Many substances used in peeling have been described, with a more or less marked action. Objective. In this work we aim to describe the concept of biocomplementation through the use of a needle-free system called 3Phasic System ® . Methods. The 3Phasic System ® consists of a peeling (containing various exfoliating substances) associated with a topical home protocol consisting of topicals and probiotics. This protocol also favors the correction of incorrect eating habits also thanks to the integration with vitamins and probiotics. In this protocol a superficial peeling is used and the indications are: skin resurfacing of the face or body even in dark phototypes, acne vulgaris results, postinflammatory hyperpigmentation, melasma, scars and photodamage. The 3Phasic System ® consists of many agents in reduced concentrations, promoting the efficacy of individual agents and reducing adverse effects. However, familiarity with the properties of peels is very important to avoid negative effects. The possibility of administering 3Phasic System ® on a monthly basis together with the correction of incorrect eating habits, the integration of deficient factors, the administration of probiotics and the application of correct home cosmetics has proven to be effective and safe in patients. The evaluation of the efficacy of the 3Phasic System ® was evaluated through ANTERA 3D ® and VISIA ® in 450 patients in 18 th months. Results. No adverse effects were found in any of the patients. All patients reported positive feedback to the physician in the follow-up session. Evaluation with Antera 3D and Visian highlighted the efficacy of the treatment expressed in percentile points (from +20 to +80). There is no difference in the effectiveness of the 3Phasic System ® between men and women as the results are comparable. Conclusions. The concept introduced with the 3Phasic System ® is one of biostimulation and biocomplementation and not of rejuvenation as the duration of the treatment begins with the first application and continues with topical and oral home treatments, inserting the patient in an aesthetic journey that goes beyond the individual medical treatment.