No abstract

Background. Chest-Wall Contouring is generally the first surgical step Trans Men sex reassignment surgery. In case of medium/big size and ptotic breast, free nipple graft technique is the procedure of choice. The position and aspect of neo-nipples are of paramount importance to resemble a male chest. The aim of the present paper was to develop and apply a simple new method of nipple-areola complex free graft. Methods. From January 2018 to December 2020 a novel nipple areola complex (NAC) grafting technique was developed and used when dealing with breast amputation and NAC graft in patients with nipple projection and dimension > 1 cm. The graft was taken from the pigmented skin from the areola leaving a central 5 mm diameter of thoracic/recipient skin. Results. 15 patients (30 NACs) were treated with the described new NACs graft technique. All patients healed uneventfully and none of them required revision surgery or correction. Discussions. Traditional nipple grafts harvested from the areola are often flat or depressed. Nipple grafts harvested from large and projected female nipples are frequently associated with partial necrosis, graft discoloration and need for revision surgeries or tattoos. In our series, the use of a graft harvested from the pigmented skin of the areola and leaving a central 5 mm diameter of thoracic/recipient skin creates a 3D shadow effect similar to the one of a male nipple. This original and simple procedure can aid surgeons with reproducible nipple reconstructions in free nipple graft mastectomy in case of large nipples.

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.