Background: Perineural fibrotic adhesions are among the major complications of

Scalp reconstruction is a daily challenge for plastic surgeons. The authors propose their algorithm for reconstructive surgery after ablative surgery. They considered not only the size defect but also the anatomical defect and the clinical condition of the patient to achieve the best choice for reconstruction. During the two-year period, a total of 86 procedures were performed on 78 patients. We used five different techniques for reconstruction, including primary closure, graft, local or free flap, and a dermal regeneration template. No statistical difference of complication was observed in the different groups. We consider our algorithm a useful improvement in the management of the defect at the vertex.

Obturator hernia of the ureter is uncommon. Computed tomography of a 77-year-old woman with sudden-onset lower left abdominal pain and urinary symptoms showed an obturator hernia with ureteral entrapment. Obturator hernia is a diagnostic challenge because the hernial mass is very insidious. It should be suspected in emaciated, multiparous, elderly women presenting with unexplained pain in the groin, hip, thigh or knee. High levels of clinical suspicion of high-risk patients and recourse to investigation by computed tomography are important, as delay in diagnosis and treatment is associated with increased morbidity and mortality.

When a tumor local recurrence occurs a possible approach can be a mastectomy with simultaneous breast reconstruction with autologous tissue. The area involved by tangential radiation portals includes also the internal mammary artery and veins, considered by the most part of plastic surgeons to be the best recipient vessels for a free flap in breast reconstruction. Internal mammary vessels receives low but not necessary insignificant doses during whole breast irradiation; arteries and veins are traditionally considered quietly resistant to the irradiation but limited data on the flux in mammary vessels after radiotherapy are available. The goal of our study (37 patients from September 2011 to February 2012) was to evaluate modifications in vascular parameters of the flux at ultrasonography in the internal mammary chain after adjuvant radiotherapy that could influence the choice of the autologous surgical technique (free or pedicled flap) and the choice of the recipient vessels in breast reconstruction. Based on the results of our study, we would recommend avoiding an irradiated recipient site when no irradiated recipient vessels are available; a preoperative ultrasound evaluation is recommended in patients underwent whole breast irradiation.