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Electrochemotherapy (ECT) is one of the newest therapeutic strategies employed as a medical procedure for skin neoplasms' treatment, especially for classic Kaposi's sarcoma (CKS). The aim of this study was to demonstrate ECT clinical response and the local control of CKS disease. The primary endpoint was to value the worth and efficacy of this local therapy in CKS skin lesions' treatment. In total, 19 CKS patients were enrolled, 14 males and 5 females with median age at diagnosis of 72. Complete response (CR) has been gained in 12 patients after first ECT attempt; meanwhile, 3 and 4 out of 19 patients obtained a partial response (PR), so they underwent a second and third ECT treatment, respectively. Clinical response was evaluated during the entire timeframe of the follow-up, which ranged between 3 months and 4 years with a median of 18 months. The control of CKS skin lesions still represents a challenge for surgeons and oncologists. Nevertheless, according to this and other authors' recent experiences, ECT could be considered the gold standard strategy for early-stage patients, but at the same time it could be considered as a valid option in controlling Kaposi's sarcoma locally advanced lesions.

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Electrochemotherapy (ECT) is a local treatment and its use has been standardised for cutaneous nodules of any histological origin. In this study, we use ECT as a neoadjuvant therapy to reduce the size of neoplastic lesions to obtain an ideal cleavage plane where vital or very important vascular and/or nervous structures are separated from the tumour, thus allowing a radical surgical excision, which is otherwise unfeasible. In their retrospective study, the authors identified 41 patients who were treated at our institution with neoadjuvant intent. ECT was performed under general (30 patients, 73%), regional (9 patients, 22%) or local anaesthesia with sedation (2 patients, 5%). At a median time of 2 months (range, 0.3-9) after neoadjuvant ECT, all patients underwent surgical intervention to resect the residual tumour. Median reduction of tumour volume after ECT was 55% (range, 10%-65%). After ECT plus surgery, 25 patients (61%) had complete response (CR), 16 patients (39%) partial response (PR). The percentage of CR in patients with larger lesions (>100 mm) was 27%, in patients with smaller lesions (≤100 mm) was 73% (p = 0.0119). Major side effects after ECT were: bleeding and/or ulceration (54%) and pain (59%) naturally resolved within 1-2 months. Side effects observed after surgery were: necrosis of the flap (N = 3), a case of diastasis of the donor site. Median survival time in CR patients was 53 months (range, 4-108), whereas in PR survival was 23 months (range, 5-126), p = 0.0400. ECT represents a safe and effective therapeutic approach that could be effectively used for neoadjuvant purposes.

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BACKGROUND AND AIM OF THE WORK: Adipose tissue is an organ of energy storage, an endocrine organ, a soft tissue filler and a cosmetically unnecessary tissue discarded by liposuction. Liposuction was designed to correct unaesthetic deposits of subcutaneous fat; it produces satisfactory silhouette contouring when performed by appropriately trained operators using properly selected technologies. However, from lipoaspirate it is possible to obtain autologous fat graft and adipose-derived stem cells (ASCs) for reconstructive surgery and regenerative medicine. Autologous fat transplantation uses include the correction of body contour, malformations and post-surgical outcomes. The regenerative properties of ASCs allow treating damaged tissues such as wounds, burns, scars and radiodermatitis. The aim of this study was to perform a literature review highlighting the crucial role of adipose tissue in plastic and reconstructive surgery, from liposuction to lipofilling and ASCs, exposing the indications, procedures and complications of these surgical techniques. METHODS: Literature review of publications concerning liposuction, lipofilling and adipose-derived stem cells (ASCS). RESULTS: The introduction of liposuction allowed the use of adipose tissue for many clinical uses. The adipose tissue filling properties have been highlighted by the advent of lipofilling. The regenerative properties evidence of autologous fat transplantation encouraged the research on the clinical use of ASCs. CONCLUSIONS: Adipose tissue is not only the main energy storage of our body but also an important source of stem cells that can be used in various fields of regenerative medicine and tissue engineering with encouraging results for the future.

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BACKGROUND: Breast cancer is the most common noncutaneous malignancy among women worldwide. After a breast cancer removal procedure, women are asked to decide about breast reconstruction, mainly to improve their life quality, and they can choose from among many options. Broadly, there are two different types of breast reconstruction procedures: prosthetic implant-based reconstruction and autologous tissue-based reconstruction. METHODS: Implant-breast reconstruction is a minimally invasive procedure compared with autologous breast reconstruction. It is associated with fewer short- and long-term complications. RESULTS: The ideal candidates for implant-based reconstruction are patients with non-redundant soft tissue coverage, who desire a moderate sized non-ptotic breast and have not been previously irradiated. CONCLUSION: The state of the art for implant-breast reconstruction is briefly described in this article.

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The umbilicus is a unique physiologic scar of human life resulting from the healing process of the cut umbilical cord at birth. Its absence leads to an unnatural abdominal appearance, and an abnormally shaped or misplaced umbilicus may draw undue attention to the central abdomen. Loss of the umbilicus can be an embarrassing deformity; this occurs when older techniques of umbilical hernia or incisional hernia repair are employed and after abdominoplasty, urachal cyst repair, omphalocele repair, gastroschisis repair, some tumor excisions, and mobilization of bipedicled or bilateral TRAM/DIEP flaps for breast reconstruction. Umbilicoplasty, in which the umbilicus remains anchored to the deep abdominal fascia but is transposed through a newly-formed aperture in the upper abdominal skin flap, is performed in abdominoplasty either for abdominal flap harvest or purely for aesthetics. On the other hand, umbiliconeoplasty describes the de novo creation of an umbilicus that is absent for either congenital or acquired reasons. The optimal umbilical reconstruction should be reliable, reproducible, aesthetically appropriate, and associated with low morbidity. Ideally, it is also single-staged, except in the case of an infected wound, in which case a delayed primary approach may be prudent. (www.actabiomedica.it).

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BACKGROUND AND AIM: The aim of breast reduction is to reduce excessive breast volume, ensuring an adequate vascular supply and sensitivity of the nipple-areola complex, as well as to produce an aesthetically pleasing final shape. The authors report on their experience with medial-pedicle-based breast reduction combined with both vertical and inverted-T skin resection patterns for different types of breast hypertrophy. METHODS: From January 2012 to June 2015, 27 female patients (mean age: 49 years) underwent reduction mammoplasty with the medial pedicle technique. The choices of medial pedicle base widths were: 6 cm for low-grade mammary hypertrophy (350-500 gr per breast), 6-8 cm for medium-grade hypertrophy (500-1000 gr per breast), or 8-10 cm for severe mammary hypertrophy (>1000 gr per breast). The authors chose the model of vertical skin resection for low-grade breast hypertrophy. The vertical model was used for medium-grade breast hypertrophy, and Wise skin resection was chosen on a case-by-case basis; only the Wise model was applied to severe breast hypertrophy.  Results: The mean weight of breast excised was 540 g on the left (range, 207 to 1160 g) and 564.8 g on the right (range, 215 to 1150 g). The complications were minor and self-limiting. All patients reported relief of neck pain, back pain, and bra strap indentations after 6 months of follow-up. CONCLUSIONS: Breast reduction surgery must address both functional and aesthetic issue by restoring an aesthetically pleasing shape to ptotic or hypertrophic breasts, repositioning the NAC in a physiological position. Various breast reduction techniques have been attempted to combine the safety of the pedicle with aesthetic and functional results. Surgeons should tailor the best technique to each patient. We found that medial-pedicle-based reduction mammoplasty is effective and reliable because it can be applied to a wide range of breast hypertrophy, with reproducible breast weight reduction and results that are aesthetically satisfactory for both patients and surgeons.

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INTRODUCTION: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, with an excellent prognosis after surgical removal. However, nodal metastasis are present in about 5% of cases and the death rate is about 2%. PRESENTATION OF CASE: The aim of this study is to report our experience about the surgical treatment of cSCC at the Cutaneous, Regenerative, Mininvasive and Plastic Surgery Unit, University of Parma, Italy, between January 2014 and February 2016. We statistically analyzed the group of patients regarding the average age, gender, localization and size of the lesions. The surgical margins of the excisions are studied and we report the results obtained after a follow up of 3 to 25 months. DISCUSSION: Between January 2014 and February 2016 in our Cutaneous, Regenerative, Mininvasive and Plastic Surgery Unit, we removed 36 squamous cell carcinomas, including 11 cSCCs in situ. The average annual incidence of squamous cell carcinoma in northeast of Italy is about 28,9  cases per 100,000 individuals.The number of cSCCs that we removed is lower than the Italian average. In our opinion, this is due to an increase in the early diagnosis of precancerous lesions and their medical or surgical treatment. This reduces the incidence of squamous cell carcinomas developing from precancerous lesions. CONCLUSION: The excision of cutaneous squamous cell carcinoma should be undertaken with a safety margin of at least 0.9 mm to minimize recurrence and metastasis.

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One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of "the ideal breast size", although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article.

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OBJECTIVE: To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. PATIENTS AND METHODS: Literature review of publications concerning autologous fat grafting. RESULTS: Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The "wet" method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. CONCLUSIONS: Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.

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Worldwide, hard-to-heal lower limb wounds are estimated to affect 1.5-3% of the adult population with a treatment-related annual cost of $10 billion. Thus, chronic skin ulcers of the lower limb are a matter of economic and public concern. Over the years, multiple medical and surgical approaches have been proposed but they are still inadequate, and no effective therapy yet exists. Regenerative medicine and stem cell-based therapies hold great promise for wound healing. Recently, many plastic surgeons have studied the potential clinical application of adipose-derived stem cells (ASCs), which are a readily available adult stem cell population that can undergo multilineage differentiation and secrete growth factors that can enhance wound-healing processes by promoting angiogenesis, and hence increase local blood supply. ASCs have been widely studied in vitro and in vivo in animal models. However, there are few randomized clinical trials on humans, and these are still ongoing or recruiting patients. Moreover, there is no consensus on a common isolation protocol that is clinically feasible and which would ensure reproducible results. The authors aim to provide readers with an overview of the biological properties of ASCs as well as their clinical application, to help better understanding of present and future strategies for the treatment of hard-to-heal wounds by means of stem cell-based therapies.

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INTRODUCTION: The use of autologous fat transplantation to correct volume and contour defects, scars, and asymmetry after breast cancer surgery has increased over the past 20 years. Many developments and refinements in this technique have taken place in recent years, and several studies of the safety of lipofilling in the breast have been published. PRESENTATION OF CASE: We performed a literature review of this technique, highlighting the crucial role of lipofilling in breast cancer reconstruction. DISCUSSION: The efficacy of the fat graft transplantation depends on the experience and the technique used by the surgeon. The ASCs (adipose-derived stem cells) contained in the fat graft has proven to be crucial for breast reconstruction by mean the regeneration of tissue, through the chemotactic, paracrine, and immunomodulatory activities and their in situ differentiation. CONCLUSION: The role of lipofilling for breast reconstruction could be more significant with the application of the findings of experimental research on tissue engineering and ASCs.