Background: Chest-wall contouring surgery (chest-wall reconstructive surgery) is often the first surgical procedure in female-to-male (FtM) gender reassignment surgery (GRS). The main goal of this procedure is to create an aesthetically pleasing male-like chest contour. No universally accepted algorithm exists for detection of the appropriate surgical technique. Also, there is no tool for objective evaluation of the quality of life and satisfaction of these patients after the operation. Methods: This study involves a single-center clinical trial assessing the patients who underwent subcutaneous mastectomy in FtM GRS between 2003 and 2019. The selection of patients was based on the new “simplified” algorithm consisting of 2 different surgical techniques: the semicircular and the double-incision with free nipple grafting. The selection was based on 3 criteria: breasts size, breast ptosis, and skin elasticity. The outcomes and complication rates were collected and analyzed. The patients’ satisfaction and Quality of Life was assessed with a 5-point Likert scale questionnaire, specifically conceived for FtM patients. The aesthetic evaluation was performed using a 5-point Likert scale dealing with the 5 items featuring as the main goals of GRS. Results: 184 mastectomies were performed in 92 FtM GRS patients. The overall reoperation rate was 11.9%. The patient survey revealed both a high satisfaction rate and a good aesthetic result (4.4/5). Conclusions: The proposed algorithm facilitates the selection of the most suitable technique for top surgery. The patient satisfaction rate evaluated by the proposed Health-Related Quality of Life questionnaire confirmed the outcomes of the use of the algorithm. Further studies to validate the proposed evaluating tools are needed.

Background. Pressure ulcer is a major burden in surgical patients, increasing the length of hospital stay and the healing process, possibly leading to infectious complications and higher health care costs. In current literature there is no consensus on which element is mainly responsible for the onset of these lesions neither the role of surgery has been clarified. Methods. We collected a case series of consecutive admitted patients to Cattinara Hospital Neurosurgery Department in Trieste from March 2019 to June 2019. All the patients were assessed for surgery related pressure ulcer (SRPU) risk using the Pressure Score Risk Assessment Scale modified by Scotts. Epidemiologic data of all patients were recorded and the incidence of surgical related pressure ulcer calculated. The sample consisted of 124 patients with an average hospitalization length of 12.45 days; 71.8% of the enrolled patients were elective surgery patients, 5.5% emergency surgery and 22.6% urgency surgery. Comorbidity data were collected for each patient and surgical related time procedures noted.Results. The calculated incidence rate of surgery related pressure ulcer in a single center perioperative neurosurgical setting was 4.8%; the average surgery duration time was 213 minutes (mean ± 81 standard deviation, SD) whilst four out of six of these patients were admitted to intensive care unit due to unstable clinical conditions (average ICU stay time: 2.83 days; mean ± 4.99 standard deviation, SD). Time to SRPU onset was 6.83 days (mean ± 3.66 standard deviation, SD). The main site of SRPU onset was sacrum (66% of patients with developed SRPU). Discussion. This study evaluates single-center incidence of SRPU in neurosurgical perioperative setting with specifically SRPU management trained healthcare providers; deeper and systematic understanding of SRPU epidemiology in other local hospital wards and multi-centered comparison are needed.