Background: Fournier’s gangrene (FG) is a very aggressive necrotizing fasciitis involving subcutaneous fat and skin of scrotal and perineal regions. Vacuum-assisted closure (VAC) is a well-known method used to treat complex wounds. The authors for the first time enhance a multimodal strategy to treat the FG using VAC, reducing the number of surgical debridements, allowing a one-step surgical reconstruction with locoregional fasciocutaneous flap. Methods: Six patients with the diagnosis of FG were reviewed retrospectively at our institution. All patients were affected by very extensive FG. The FG Severity Index (FGSI) was used to evaluate the prognosis of the case at admission. Following the acute phase (24–48 h), VAC was used to achieve wound cleaning and prepare the area to a single-stage reconstruction with superomedial thigh flap. Hyperbaric oxygen therapy was also used before final reconstruction. Results: The average FGSI was 10.5, ranging from 8 to 12. All patients survived and were completely healed at the mean follow-up time of 9 months (range 3–30 months). Conclusions: VAC therapy is effective to clean and prepare the wounds, cutting off the fasciitis process and reducing the hospital stay and patient discomfort. Multidisciplinary treatment is mandatory during this devastating infection.

procedure, and she was elderly and obese which are risk factors for wound hematomas.Large core devices are unnecessary when smaller gauge needle core biopsy can achieve the diagnosis, at lower cost and morbidity. This case was amenable to 14G core biopsy, which is highly sensitive in most cases, and complications may have been avoided. The lesion type and patient risk factors should be considered and the biopsy procedure tailored to the individual case.A 37-year-old woman presented at our institute with a recent history of right breast cancer treated with radical mastectomy and failed reconstruction. The patient had a mammary history of bilateral breast augmentation in 2001.In May 2006, she underwent modified radical mastectomy with immediate breast reconstruction with Latissimus Dorsi flap plus silicon gel-filled prosthesis and contralateral breast augmentation. Ten days later, the right prosthesis from the reconstructed breast was removed due to an infection that did not respond to cephalosporin. The decision was made not to delay chemotherapy (CT).The patient was a candidate to adjuvant CT with a regimen of AC ·4 cycles (adriamicin + cyclophosphamide) followed by CMF ·3 cycles (cyclophosphamide + methotrexate+ 5-fluorouracil), associated with ovarian suppression with luteinizing-hormone releasing hormone analog. At the end of the therapy, she underwent a breast and axillary radiotherapy (50 Gy).Eight months later, she underwent a right breast reconstruction. Preoperative evaluation was normal and blood examinations were all normal. She was an athletic and nonsmoker woman with no comorbidities.She underwent a right breast reconstruction with a monopedicle transverse rectus abdominus myocutaneous (TRAM) flap plus prosthesis and a contralateral breast prosthesis exchange (Fig. 1). Surgery lasted

The developed microsurgical chamber provides a highly vascular, isolated tool for in vivo tissue engineering.

The ultimate goal in the treatment of facial palsy is the restoration of voluntary and spontaneous movement to the paralyzed side of the face, symmetrical to the normal side. We report our experience treating 40 patients with established facial palsy over a 4-year period. All patients underwent either temporalis transfer or free latissimus dorsi transfer as a single stage to improve lower facial symmetry. We believe that both techniques reliably achieve an increase of movement in facial reanimation after oncological, traumatic, or congenital facial palsy.

Despite evidence of significant atrophy, the muscle still underwent morphological changes during contraction that were comparable to those on the normal control side.