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Advanced sarcoma treatment in complex anatomical regions such as the pelvis poses significant surgical challenges. This report details a case involving a 35-year-old man with recurrent osteosarcoma of the left hemipelvis, who underwent a 16 h surgery for hemipelvectomy and reconstruction using a free tibia and fibula fillet leg flap. The procedure, necessitated by an infected, exposed iliac prosthesis, utilized extracorporeal membrane oxygenation (ECMO) for 8 h to maintain flap viability. The flap, incorporating tibia, fibula, and associated musculature was successfully inset and anastomosed to the left common iliac artery and vein, with additional venous anastomosis to the right iliac vein. Despite postoperative challenges such as venous stasis and intestinal ischemia, necessitating further surgical interventions, the patient achieved mobility with a walker at 3 months post-surgery, with stable conditions observed during a 2 years follow-up. ECMO enabled successful preservation and integration of the free fillet leg flap, demonstrating its potential in complex reconstructive surgeries. Specifically, ECMO may extend free flap viability in complex cases, offering new possibilities for challenging oncological and reconstructive surgeries.

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BACKGROUND: Breast image plays an important role in a woman's identity. Breast aesthetics has strong social, emotional, and cultural connotations. OBJECTIVES: We aimed to understand one's breast satisfaction, what is seen as ideal, and the gap between these two facets. We also studied the influence of several factors on these conceptions, including clinical and demographic characteristics, self-esteem, social media use, and pornography. We also studied the motivational factors driving the recourse to surgery. METHODS: An online questionnaire of 64 questions divided into 5 sections was shared on social media to all women over the age of 18. Three versions were available: French, Dutch, and English. The questionnaire was accessible for 45 days (from 12/18/2021 to 01/31/2022). RESULTS: A total of 382 complete responses were analyzed. The average age was 30.6 years; the most frequent breast size was a B cup (29.06%), while the size considered ideal was a C cup (49.48%). Social media and pornography seem to influence the conception of ideal breast; the subgroup that uses them tends to choose a larger breast size as ideal. Smoking and the education level also seem to influence this conception. Furthermore, 26.96% of women would benefit from breast surgery if they did not have to consider the financial aspect. CONCLUSIONS: The ideal breast concept is highly dependent on regional, cultural, and religious factors. It is interesting to note the influence that other less studied factors, such as pornography, smoking habits, and social media, may have. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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Introduction: Augmentation rhinoplasty traditionally represents a serious challenge for plastic surgeons. The association with centrofacial lipofilling is a great approach to achieve harmonious, aesthetic results. The aim of this article is to describe our personal association between Augmentation Rhinoplasty and Centrofacial Lipofilling (ARCL) in non-Caucasian patients. Materials and Methods: In this study, we retrospectively reviewed patients treated with ARCL at our institution between January 2019 and December 2023. We described our personal approach and technique. At a minimum follow-up time of one year, post-operative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry, shape and contour of the nose, and facial harmony and rejuvenation; finally, patients' satisfaction was investigated according to the ROE questionnaire and the modified S-GAIS. Results: A total of 307 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image and facial harmony, as the mean postoperative ROE and S-GAIS score show. None of the grafts extruded or collapsed. Wounds healed without reported major infection. Conclusions: This study has demonstrated that ARCL is a safe approach that contributes to improve functional and aesthetic outcomes, has a high patient satisfaction rate, and limited post-operative complications.

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Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: A comprehensive 20-question survey was designed and distributed using online survey administration software (Google Forms, 2018, Google, Mountain View, CA, USA) from June 2023 to September 2023. The survey aimed to assess the knowledge and utilization of dermatologic diagnostic advancements among plastic surgeons in various European countries. Results: Data were obtained from 29 plastic surgeons across nine European countries, revealing a notable gap between diagnostic technologies and their routine use in surgical practice. The gap for some technologies was both cognitive and applicative; for electrical impedance spectroscopy (EIS) and multispectral imaging, only 6.9% of the sample knew of the technologies and no surgeons in the sample used them. In the case of other technologies, such as high-frequency ultrasound (HFUS), 72.4% of the sample knew about them but only 34.5% used them, highlighting a more significant application problem. Conclusions: Spotlighting this discrepancy provides a valuable foundation for initiating collaborative efforts between units and facilitating knowledge exchange among diverse specialists. This, in turn, contributes to advancing clinical practice by integrating the innovative opportunities presented by ongoing research.

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PURPOSE: Our study aimed to characterize and objectify the prevalence of psychiatric disorders and the use of psychotropic drugs in patients interested in undergoing aesthetic surgery. The psychiatric profile of this population is particularly interesting and is related to self-perception and the general concept of beauty. METHODS: We conducted an observational, retrospective, and bicenter study of 2092 patients seen in plastic surgery departments. Data on general characteristics, pathology, psychiatric history (PH), use of psychotropic drugs, addictions, surgical requests, and surgical complications were recorded and analyzed. RESULTS: Based on our inclusion criteria, we selected 524 patients. The prevalence of psychiatric disorders was 32.25%. The prevalence of depressive disorders (19.27%), anxiety disorders (8.21%), and sleep-wake cycle disorders (7.06%) should be noted. Comparing the population with psychiatric history (PH+) and without psychiatric history (PH-), significant differences were found in patient ethnicity, addictions (tobacco, 37.50% vs 15.00%; drugs, 3.26% vs 0.59%), and comorbidities. In the 66.86% (n = 113) of PH+ patients, the plastic surgeon did not record the presence of psychiatric disorders in the medical record. DISCUSSION: This study offers a broad view of the prevalence and characteristics of psychiatric disorders and the use of psychotropic drugs among patients who want to undergo aesthetic surgery. The prevalence of psychiatric problems in the study population is higher than in the general population (32.25% vs 15.02%). CONCLUSIONS: Our results suggest that plastic surgeons should be properly trained to manage these patients. A multidisciplinary approach involving plastic surgeons, psychiatrists, and psychologists is advocated.

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BACKGROUND: The demand for aesthetic surgery presents a continuously growing trend over the years. The population wishing to undergo this type of surgery presents unique characteristics that are profoundly different in motivational, demographic, and clinical features from patients in other specialties. OBJECTIVES: The aim of our multicenter study is to objectively define the surgical demand and the demographic characteristics of our patients comparing them with general population. We try to better define who are our patients. METHODS: We conducted an observational, multicenter, retrospective study analyzing 3329 consultations involving a total of 2092 patients between January 2019 and June 2019. Based on the inclusion criteria, we selected 524 patients whose demographic characteristics, body mass index, addictions, comorbidities, and aesthetic surgery demand were analyzed. RESULTS: The mean age of our population is 38.58 years (female-to-male ratio, 9:1). The mean body mass index is 27.50 (5.23). A total of 22.90% of the sample have smoking habits, 3.63% have alcohol addiction, 1.53% have drugs addiction, and 53.63% of the population have relevant comorbidities.The 56.68% of the patients have already undergone surgery. The conversion rate of our first consultations to surgery is 49.05%. The most requested operation is abdominoplasty (36.45%), followed by liposuction (22.90%), breast reduction (17.56%), mastopexy (14.79%), and rhinoplasty (7.63%). CONCLUSIONS: This topic is downplayed and seldom studied in the literature; our effort is to make patient profiling crucial and evidence-based in aesthetic surgery.

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Ear reconstructive surgery aims to solve the deformities caused by cancer excision. Despite the numerous surgical procedures described, recreating the complex anatomy of the ear still represents a challenge, particularly for young surgeons. The purpose of this exploratory pilot study is to review our experience with single stage reconstruction of the partial defects of the auricle, and propose an algorithm based on defect size, location, and characteristics. We retrospectively reviewed patients who underwent ear reconstruction after cancer excision at our institution between February 2018 and November 2020. The data collected included patients' demographics, defect characteristics, reconstructive technique used, complications, and outcomes. The patients were evaluated at a minimum follow-up time of 12 months. Forty-six patients were included in the study. The most common cause for ear reconstruction was basal cell carcinoma. The mean area of defect was 4.3 cm2 and the helix was the most frequent location of defect. Two patients experienced post-operative complications. At the one-year follow-up, difference in skin pigmentation was reported in 10 cases, a depressed contour of the ear was found in 4 cases, and moderate ear asymmetry was found in 11 cases. No patient needed a secondary procedure. In conclusion, the proposed reconstructive algorithm represents a reconstructive indication that is simple and characterized by low complication rates and good outcomes for both the patient and the surgeon.

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The coronavirus disease 2019 (COVID-19) pandemic has led to marked changes in surgical training, including that of plastic surgery residents. We performed a survey to gain an insight into the self-reported current and future impact of COVID-19 on plastic surgery residents. METHODS: A 20-point questionnaire was designed by a panel of surgical trainees and trainers, which was filled in by Belgian plastic surgery residents and their international network of peers between 19 and 26 April 2020-week 6 of stringent Belgian lockdown measures. Questions covered the impact of COVID-19 on surgical activity, surgical training, and the future of training. RESULTS: Thirty-five of 38 plastic surgery residents in Belgium filled in the questionnaire, as did 51 of their international peers from 9 other countries. Decreased surgical activity of >75% was reported by 86% of Belgian trainees and by 73% of international colleagues. All consultations were stopped for 26% of Belgian trainees and 37% of international peers. Forty-six percents of Belgian trainees and 27% of international peers were reassigned to different departments. Eighty-five percent of all trainees felt surgical training had suffered, yet 54% of Belgian residents and 39% of international peers felt training should not be prolonged. Anxiety regarding the pandemic was present in 54% of Belgian residents and 69% of international colleagues. CONCLUSIONS: This is the first report, expressing the voice of a representative group of plastic surgery residents, showing a significant impact of COVID-19 on training and activity. A joint effort is needed to provide continued forms of education by virtual education and skills-based learning.

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Thyroid microcarcinoma (TMC) it's a rare type of differentiated thyroid cancer, which according to the World Health Organization measures 10 mm or less. Accounting 7-16 % of all thyroid carcinomas, it occurs at any age, more frequently in men, with a female to male ratio of 1:3. More frequently histotype is the papillary subset, PTCM. Aim of this study is to retrospectively evaluate the patients diagnosed with TMC in terms of their clinical and histopathological features. In our institution we collected 23 cases of TMC sampled on 338 plongeant being operated. All the tumors, in our study, were found incidentally during the treatment of benign thyroid diseases. All the sample were analyzed and prepared using the same frozen section technique. Surgical pathology identified 11 papillary microcarcinomas, 10 follicular microcarinomas, 1 oncocytary microcarcinomas and in 1 patient was found only a focal tireocitary transformation. TMC's prognosis and treatment is still a subject of controversy We propose our approch consisting in total thyroidectomy (less than 5 gr residual thyroid tissue), being considered the low rate of post-operative complications, and recurrences: all patients are disease-free at the median follow-up of 78 months (range 96 to 30 months). We have considered either the less malignancy habit of this neoplasia either its well prognosis.

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INTRODUCTION: Factor VII deficiency is a rare cause of haemorrhagic syndrome. The Authors describe a case of a 46 years old patient with congenital factor VII deficiency that successfully underwent breast surgery after treatment with Novoseven® before the procedure. MATERIALS AND METHODS: The AA used the schedule reported below to value the levels of PT and aPTT in the patient. Blood Collection: Venous blood from patient and control was collected in glass tubes for routine serum preparation and into plastic tubes (0.129 M sodium citrate, Becton-Dickinson Vacutainer Systems) in a ratio of blood to anticoagulant of 9:1. Platelet Poor Plasma (PPP) was obtained by centrifugation at 4.000 x g for 15 minutes at room temperature. The plasma was recentrifuged for another 10 min at 12000 g to fully eliminate platelet concentration. A normal control plasma pool was prepared by mixing equal volumes of platelet-free plasma obtained from at least 50 normal volunteers. Prothrombin time (PT) was measured with Recombiplastin (IL, Milano Italy). Activated partial thromboplastin times (APTT) was measured with APTT-SP (IL, Milano Italy). They were performed on the coagulation analyzer ACL 1000 (IL, Milano Italy). RESULTS: The results were interpreted from the ratio of the patient times to the normal control times (Table I). CONCLUSION: The infusion of Novoseven solved the clotting problems enabling the surgical procedure, without risks for the patient.

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INTRODUCTION: Factor VII deficiency is a rare cause of haemorrhagic syndrome. The Authors describe a case of a 46 years old patient with congenital factor VII deficiency that successfully underwent breast surgery after treatment with Novoseven® before the procedure. MATERIALS AND METHODS: The AA used the schedule reported below to value the levels of PT and aPTT in the patient. Blood Collection: Venous blood from patient and control was collected in glass tubes for routine serum preparation and into plastic tubes (0.129 M sodium citrate, Becton-Dickinson Vacutainer Systems) in a ratio of blood to anticoagulant of 9:1. Platelet Poor Plasma (PPP) was obtained by centrifugation at 4.000 x g for 15 minutes at room temperature. The plasma was recentrifuged for another 10 min at 12000 g to fully eliminate platelet concentration. A normal control plasma pool was prepared by mixing equal volumes of platelet-free plasma obtained from at least 50 normal volunteers. Prothrombin time (PT) was measured with Recombiplastin (IL, Milano Italy). Activated partial thromboplastin times (APTT) was measured with APTT-SP (IL, Milano Italy). They were performed on the coagulation analyzer ACL 1000 (IL, Milano Italy). RESULTS: The results were interpreted from the ratio of the patient times to the normal control times (Table I). CONCLUSION: The infusion of Novoseven solved the clotting problems enabling the surgical procedure, without risks for the patient. KEY WORDS: Breast cancer, Factor VII deficiency, Major surgery, Recombinant fVIIa.

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