BREAST RECONSTRUCTION

Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy. Among these TRAM flap and latissimus dorsi flap techniques. The nipple and the darker area around the nipple (areola) can also be added. To restore completely the breast it may be necessary more than just one surgery. The preparation steps are fundamental to decide the strategy to adopt and achieve the best result. It may be also necessary to proceed on the other breast to achieve the right symmetry.

SKIN CANCER SURGERY

Basal cell carcinoma, squamous cell carcinoma and melanoma are the most common skin neoplasias. They affect especially people from light skin and to any kind of skin highly exposed to sun. The way they appear may vary, from reddish patch of dry skin that won’t heal, flesh-colored (or pink, red, or brown) pearl-shaped lump, hard (scaly or crusty) reddish bump, patch, or pearl-shaped growth, open sore that itches and bleeds, to a mole on the skin that is growing, changing shape, or changing color in case of melanoma. Histological examination of the area will determine which is the better surgical procedure to adopt. Some intensive and most complex forms, can be used the Mohs technique, when it is highly recommended to combine microscopic examination of all excised tissues occurs during the surgery to fast achieve the most efficient result.

MELANOMA

The incidence of Melanoma is increasing: it represents the 5% of all cancer among male population (the 5th relatively) and the 4% among the female population (the 7th relatively). The risk of Melanoma is correlated with the exposition to UVA (especially the use of tanning lamps), weaknesses and characteristics of phenotype, number of malign and atypical nevus, skin color, family history and DNA heritage.

PATOLOGY
The most important fact refers to the thickness of primitive cancer and according the latest staging AJCC 2009, the number of mitosis per squared millimeters. Ulceration itself may represents a prognostic factor of primal Melanoma whereas the serum degrees of LDH, regardless the position of metastasis, means an advanced status of the disease. Almost 50% of melanomas presents the mutation of BRAF’ kinesis involved in the MAPK activation. The BRAF mutations most frequents are born by the EXON 15.

CLINICAL FEATURES
The melanoma usually presents itself as skin pigmented wound with irregular borders and varied pigmentation. Skin wounds which modify overtime in dimensions, shape, color, or the appearance of ulcerated or bleeding wounds may be symptoms of melanoma. At the beginning melanomas may appear similar to benign nevus, fundamental is the dermoscopy examination.

DIFFERENTIAL DIAGNOSYS/STAGING
Each suspected wound must be completely removed and carefully examined. For the definition of primitive cancer is important to determine the tumor thickness and the number of mitosis per sq.mm, as well the presence of ulcerations. The current classification AJCC includes those three factors, the number of lymph-nodes affected and the degrees of implication (micro or macro).

SURGETICAL THERAPY
Surgery is the main treatment option for most melanomas, and usually cures early stage melanomas. The standard method of doing this is by surgical excision (cutting it out). The width of the excision depends on the characteristics of primitive cancer. The margins are determined according the thickness of the primitive. For those patients which presents thickness of the wounds 0.76 is always recommended to proceed to a deeper research of the LS. For patients with visible regional adenopathies or positive sentinel lymph-node is necessary a complete nodal dissection when technically feasible. Surgery is extremely urgent for patients at the IV stage.

POST BARIATRIC SURGERY

PBS (Post Bariatric Surgery) are those procedures intended to solve blemishes cause by bariatric surgery and heavy weight loss. The surgery also known as lipoplasty aims to reshape body’s structure to improve aspect and patient self-esteem, and avoid the risk of painful chafing, rashes and infections caused by overhanging skin. Different areas may be treated as face, neck, chest, abdomen, back, hips, buttocks, arms, thighs, legs, calves. Ideal patients for PBS surgery are those which have reached and maintain for at least 6 – 12 months an ideal weight. Together we will discuss about the best strategy to follow, explaining and focusing on the advantages and disadvantaged that each therapy involved, so identifying the right procedures according starting conditions and patient’ wishes.
The surgeries involved may be:

Arm Lift: right for you if the underside of your upper arms are sagging or appear loose and full due to excess skin and fat.
Breast Lift (Mastopexy): raises the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour.
Breast Reduction: indicated for women when occur an extraordinary development of breast, breast hypertrophy or gigantomstia
Gynecomastia: the surgical correction of over-developed or enlarged breasts in men.
Back Lift: when occur excess skin which involved the scapolary, lumbar and sacral region.
Upper Body Lift: is the procedure which threat all together the defects that involved arms, breast and upper region of the back.
Tummy Tuck (Abdominoplasty): removes excess fat and skin and, in most cases, restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.
Circumferential Abdominoplasty: is more extensive than a standard tummy tuck and the procedure involved all the waist line, through which had been removed excess skin and fat and tightens the muscles, including thighs and buttocks, and a new navel may be created.
Thigh Lift: reshapes the thighs by reducing excess skin resulting in smoother skin and better-proportioned contours of the thighs and lower body.
Spiral Thigh Lift: improves the thigh laxity of the front, back, inner and outer thigh. This procedure combines the incisions of an inner thigh lift with that of a lower body lift, to lift the buttocks, to restore an hour-glass waist, and to tighten the lower back and abdomen.
Circumferential Thigh Lift: is a technique which addresses the skin redundancy at the anteromedial, lateral, and posterior thigh.
Belt Lipectomy (Lower Body Lift): a surgical procedure that reshapes the patient’s abdomen, hips, thighs, and buttocks. The lower body lift extends the tummy tuck incision completely around the lower torso. This allows re-suspension of the lateral and anterior thighs along with the traditional tummy tuck improvements.
Liposuction: usually performed with the others procedure in order to increase the laxity of soft tissue, to obtain: a wider and easy resection of the skin; reduction of adipose tissue and prevent risk of fat-necrosis; a resection in compliance of the deep lymphatic system; opportunity to care some lipo- dystrophies in certain areas; optimized the final results of other procedures to reshape the body. In some particular cases, for patients which present exceed adipose tissue, good quality of the skin and slight laxity, liposuction is a viable technique for reshape body profile, without the use of more invasive surgery. Often patients prefer to improve tummy, followed by upper body, breast, arms and thigh. In certain conditions, when not disease are associated, is possible to threat different areas in the same session.

DIABETIC FOOT

In most of the patient, especially aged people, diabetes may cause the so called diabetic neuropathy, that consists into an alteration of feet sensitiveness, which combined with arteriopathy of lower arts may evolved into a neuroischaemic foot. Risks of ulcers, deep injures, contamination and over bacterial infections are very high and may required, if not adequately treated, invalidating interventions till the amputation. Is really important to have a clear view of this situation in order to proceed with precision, fast and extreme care.

HANDS AND ARTS SURGERY

These procedures aim to treat diseases that cause pain and impair the strength, function and flexibility of your wrist, fingers and arts. Specifically we treat: Carpal tunnel syndrome; Rheumatoid arthritis; Dupuytren’s contracture; Trigger finger; De Quervain tenosynovitis; Rhizarthrosis; Hands’ Angiodysplasias; Cellbow; Valgus Toe.

OSTEOMELITYS

Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs. The incidence of this disease in today society is growing constantly and represents a serious and significant question. Our activity embraces three main areas: the clinic picture of the situation, the therapy, and the rehabilitation.

HAIR TRANSPLANTATION

Also known as hair restoration and hair replacement surgery, consists in the transplantation via microscope of hair follicles from one area of the body to the area that is lacking. The donor site is usually on the head. In the same session is possible to install 700 – 1000 implants. Areas usually treated are the front, parietal, sides and summit.