Our study shows that lymphaticovenular anastomosis improves HRQoL in patients affected by ULL and LLL. Additionally, both a reduction of episodes of lymphangitis and a decrease in the need of conservative therapy were observed in this cohort of patients.

Background: Implant-based breast reconstruction (IBR) is currently the most frequently performed reconstructive technique post mastectomy. Even though submuscular IBR continues to be the most commonly used technique, mastectomy technique optimization, the possibility to check skin viability with indocyanine green angiography, the enhanced propensity of patients undergoing prophylactic mastectomies, and the introduction of acellular dermal matrices (ADMs) have paved the way to the rediscovery of the subcutaneous reconstruction technique. The aim of this article is to update the complication rate of immediate and delayed prepectoral IBR using human ADMs (hADMs). Methods: A literature search, using PubMed, Medline, Cochrane, and Google Scholar database according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, was conducted to evaluate complication rates of prepectoral implant–based reconstructions using hADMs. The following MeSH terms were used: “prepectoral breast reconstruction acellular dermal matrix,” “prepectoral breast reconstruction ADM,” “human ADM breast reconstruction,” and “human acellular dermal matrix breast reconstruction” (period: 2005–2020; the last search took place on April 2, 2020). Results: This meta-analysis includes 1425 patients (2270 breasts) who had undergone immediate or delayed prepectoral IBR using different types of hADMs. The overall complication rate amounted to 19%. The most frequent complication was represented by infection (7.9%), followed by seroma (4.8%), mastectomy flap necrosis (3.4%), and implant loss (2.8%). Conclusions: The overall complication rate was 19%. The most frequent complications were infection, seroma, and mastectomy flap necrosis, while capsular contracture was rare.

Background The superficial circumflex iliac perforator (SCIP) flap has many ideal features, such as fast dissection, possibility to harvest thin, pliable, wide skin island, and concealed donor site scar. In spite of these features, its use was limited because of the wide anatomical variation of the pedicle, which is relatively shorter and has a smaller caliber than other more popular perforator flaps. Several names were given to the branches and perforators in the literature, thus adding confusion to the understanding of its anatomy. Methods We performed a surgical and a radioanatomical study of the SCIP pedicles analyzing high-resolution contrast-enhanced computed tomography (CT) scan of 95 groins, with particular attention to the deep branch (DB) of the superficial circumflex iliac artery (SCIA). Twenty-three of these patients were also studied by detecting the surgical anatomy during SCIP flap harvest. We employed a system of coordinates based on the line between pubic tubercle (PT) and anterior superior iliac spine (ASIS) to describe the position of the perforator of the DB. Results We found a 100% correlation between surgical and radiological findings. The length of the DB from the origin to the point in which its perforator pierced the sartorius fascia ranged from 1.6 to 6.5 cm, mean = 3.62 ± 0.92 cm. The distance between the origin of the DB and the inguinal ligament ranged from 1.1 to 7.5 cm, mean = 2.8 ± 1 cm. The perforator of the DB could be found in 91% of the cases within a box of 4 cm × 3 cm drawn caudally to the line joining the PT with the ASIS. This vessel can show a vertical or horizontal course in the subcutaneous layer. Conclusion Our findings confirm other previous studies and add new information about the position and the course of the perforator of the DB of the SCIA. Important features of the SCIP pedicles can be investigated by the color Doppler ultrasound and CT scan.

The appearance of coronavirus disease 2019 (COVID-19) has provoked a global public health emergency, spreading to more than 150 countries, 1 and Italy has been particularly affected.The COVID-19 pandemic has represented a contemporary "sui generis" challenge for healthy system requiring a sudden reorganization of hospital structures and resettlement of therapeutic algorithms. The directives of the Italian Ministry of Health indicated to postpone all nonurgent surgical procedures and outpatient services, performing only urgent interventions or procedures for oncological pathologies. On March, the American College of Surgeons published guidelines for triage of nonemergent surgical intervention during the coronavirus pandemic, based on the Elective Surgery Acuity Scale (ESAS). 2 The ESAS considers lowrisk cancer as tier 2a (deferrable whenever possible) and other cancers as tier 3 a and so not deferrable. 2 Cancer patients have an elevated risk for acquiring COVID-19 and subsequent complications because of their immunodepression, poor functional status, and frequent hospital visits and admissions. 3 Moreover, Liang et al reported that oncologic patients who underwent surgery in the 30 days before contracting COVID-19 in China developed more frequently a severe form of disease compared to those who did not underwent surgery. 4 Breast carcinoma is the most frequent malignancy among women, and its modern surgical treatment nowadays includes breast reconstruction. Given the rapid evolution of the current situation, very few data of the different breast units about the present attitude toward breast cancer management are available. 5 Breast surgeons seem to agree on the fact that delaying elective surgical procedures may be more appropriate for select cases such as clinical stage I or stage II in which 60-day delays in surgical intervention were not associated with worse oncological outcomes. 6,7 To date, no guidelines on breast reconstructive surgery have been published. The aim of this article is to report our decision-making attitude during COVID-19 emergency in the field of breast reconstruction. In line with government directives, our institution limits elective surgery to oncologic procedures, and the reconstructive time is considered an integrated part of the treatment. All admitted patients undergo a pharyngeal swab at time of hospitalization. Our breast unit delays surgical treatment for low-grade tumors and ductal carcinoma in situ, while other breast cancer patients are offered lumpectomy or mastectomy as needed. Patients are evaluated case by case by a multidisciplinary team composed by breast surgeon, oncologist, radiologist and plastic surgeon to minimize the exposure to COVID-19 without compromising oncological safety and offering the best possible aesthetic outcome. The plastic surgeon purpose should be to achieve a satisfactory aesthetic result by adopting the easiest technique, limiting as much as possible operating times, risk of postoperative complication, duration of hospitalization, and outpatient v...