114 - CHEST WALL CONTOURING IN FEMALE-TO-MALE TRANSSEXUALS: OUR EXPERIENCE AND ALGORYTHM

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1 114 - CHEST WALL CONTOURING IN FEMALE-TO-MALE TRANSSEXUALS: OUR EXPERIENCE AND ALGORYTHM VITTORIO RAMELLA (1) - GIOVANNI PAPA (1) - LUIGI TROISI (1) - FEDERICO CESARE NOVATI (1) - ALBERTO FRANCHI (1) - STEFANO BOTTOSSO (1) - ZORAN MARJI ARNEZ (1) AZIENDA OSPEDALI RIUNITI DI TRIESTE, OSPEDALE DI CATTINARA, TRIESTE, ITALIA (1) Chest wall contouring is the first step in sexual reassignment surgery in female-to-male transsexuals, often contextually with hysterectomy with bilateral salpingo-oophorectomy. There are three surgical technique that can be used: subcutaneous mastectomy with semi-circular technique, subcutaneous mastectomy with concentric circular technique and mastectomy with free nipple-areola complex graft. The objective of the study is analysing our experience in this type of surgery and evaluating the key factors for the selection of best technique. We analysed our series of chest wall contouring in order to develop an algorithm for the selection of the appropriate technique. We performed 116 chest wall contouring in 58 female-to-male transsexuals using all three the previous presented techniques. We analysed the patient data, the factors that guide the surgeon in the choice of the technique and the results. We performed 21 mastectomy with semicircular technique, 9 mastectomy with concentric circular technique and 86 mastectomy with free nipple-areola graft. The choice was performed considering many factors. In our experience, the key factors are the breast size, the grade of ptosis and the position and size of the nipple-areola complex. Applying this algorithm, the patient satisfaction was high and the need of a re-intervention was low. Breast size, grade of ptosis and the position and size of the nipple-areola complex are the key factors in choosing the appropriate technique.

2 122 - A SIMPLE AND EFFECTIVE PROTOCOL FOR MICROSURGICAL VASCULAR TRAINING DURING RESIDENCY: A STARWAY TO HEAVEN LONG-LASTING 3 WEEKS! LUIGI ANNACONTINI (1) - MONICA RUCCI (1) - MICHELA CAMPANARO (1) - LUIGI CAGIANO (1) - ROBERTO CECCHINO (1) - DOMENICO PARISI (1) - AURELIO PORTINCASA (1) CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA, AZIENDA OSPEDALIERO UNIVERSITARIA OORR FOGGIA/ UNIVERSITÀ DI FOGGIA, FOGGIA, ITALIA (1) INTRODUCTION: Microsurgery prove how fine and accurate could be reconstructive procedure after oncological demolitions, traumas or in congenital malformations. Thanks to appropriate training, instruments, magnification and suturing material, the microsurgeon can carefully manipulate vessels and nerves. The Authors present their training model in microvascular techniques on laboratory rats. MATERIAL & METHOD: We refer on Residents training in Lab with TT anastomose on femoral artery and femoral vein graft vs femoral artery. It lasts 3 weeks, under a tutor supervision. Basic training foresee 15 Wistar rats for each technique which means 30 TT anastomoses on femoral artery and 15 femoral vein vs femoral artery grafts. A mixture of ketamine and xylazine is used for anesthesia. They used the Carrel technique. Success rate both for TT suture and vein graft pass from 0-20% in the first week to % in the last week. In 3 weeks suturing confidence raise from 120 to 40 min for TT suture and from 180 to 50 min in vein grafting. After this the resident can be involved as assistant in microsurgical procedures. It is not possible to codify how long the Training in Microsurgery should be. A constant working in the Lab represent an imperative starting point. Individual predisposition and motivation represent fundamental elements for the continuing in the study and practice of this branch. A fine technique is the result of years of practice. For Microsurgery: pre-operative planning, dedicated operation theatre, dedicated instruments and an Equipe in harmony are mandatory for success.

3 123 - MODIFIED ABBÈ FLAP FOR LIP RECONSTRUCTION MICHELA CAMPANARO (1) - JUAN MANUEL MARQUEZ CAŃADA (2) - LUIGI ANNACONTINI (1) - MONICA RUCCI (1) - LUIGI CAGIANO (1) - DOMENICO PARISI (1) - AURELIO PORTINCASA (1) CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA, AZIENDA OSPEDALIERO UNIVERSITARIA OORR FOGGIA/ UNIVERSITÀ DI FOGGIA, FOGGIA, ITALIA (1) - HOSPITAL CLINICO, HOSPITAL CLINICO, VALENCIA, SPAGNA (2) Lips reconstruction is one of the hardest procedures in the head and neck reconstruction. The first goal is to achieving a complete restoration of its function, such as oral competence, muscle function, sensation and oral gape. We dived the defects of the upper lip in three kinds, according of the amount of tissue to restore: only vermilion, vermilion plus cutaneous defect, or previous two plus mucosa defect. When all these tissues are involved, the classical ABBE flap and its modifications already published, led to good functional restoration, without an adequate aesthetic result. Murray improved the aesthetic result of this technique with the use of skin grafts in combination with columella advancement flaps and vermilion rotation. We present a modification of the ABBE-Standler flap for upper lip reconstruction including a superior mucosa-vermilion bilateral prolongation and an inferior bilateral prolongation of the skin. Our goal is to increase de volume and projection of the upper lip. The technique includes two stages. The first one for the elevation and insetting of the flap, the second one for cutting the pedicle and the final insetting. With a period of 3 weeks between them. Postoperative follow up included daily visits during the first week, and each week until one month 3 weeks after the second surgery, the upper lip is projected with a noticeable increase of the volume. There were no complications. Preserved sensibility. The patient is able to smile, kiss and flow with an optimal mouth opening. Moreover the patient reports an improvement of his self-esteem, and has started to increase his social life. We present a double extended abbe flap Laying H flap that solves the restoration of lip defects, projection and white lip length, providing improved results in the upper lip reconstruction both in aesthetic and functional restoration.

4 129 - COMPLEX THORACO-ABDOMINAL RECONSTRUCTIONS GIANPAOLO FAINI (1) U.C. CHIRURGIA PLASTICA E RICOSTRUTTIVA, AZIENDA OSPEDALIERA SPEDALI CIVILI DI BRESCIA, BRESCIA, ITALIA (1) The Author presents three clinical cases in which the use of microsurgery has been considered mandatory in order to obtain a complete resolution. Between July 2014 and March 2015, 3 patients have undergone microsurgical reconstruction for coverage of loss of substance respectively in the thoracic region (subclavian artery prosthesis exposure), thoracic region (resection of clavicular osteosarcoma) and thoraco-abdominal region (resection of myosarcoma). The recipient vessels have been in 2 cases the internal mammary vessels and in one case the deep inferior epigastric artery. The flap used were 2 vertical rectus abdomis miocutaneous flap and 1 muscular latissimus dorsi flap. The post-operative period has been uneventful for all the three patients with complete survival of the flaps. In all the three cases a stable coverage has been achieved. In some particular cases it is not possible to obtain a stable and valid reconstruction and coverage of the thoracic and abdominal regions with the sole use of local flaps, neither with the use of perforator propeller flaps, due to the extent of the defect or for the impossibility to use loco regional options. In these circumstances the use of microsurgical technique allows to obtain a valid and stable coverage with long term results and relative morbidity.

5 130 - USE OF PEDICLED AND MICROSURGICAL PERFORATOR FLAPS FOR RECONSTRUCTION OF VARIOUS ANATOMICAL REGIONS: A SINGLE-SURGEON OPERATIVE CASES ANALYSIS GIANPAOLO FAINI (1) - ALESSANDRA SCAINI (1) - PAOLO PANDOLFI (1) U.C. CHIRURGIA PLASTICA E RICOSTRUTTIVA, AZIENDA OSPEDALIERA SPEDALI CIVILI DI BRESCIA, BRESCIA, ITALIA (1) The Author presents his clinical and surgical experience regarding the use of pedicled and microsurgical perforator flaps, analyzing success and failure rate, and complications. This case series has also been compared with the available Literature. From March 2011 to May (87,5%) pedicled and 8 (12,5%) microsurgical perforator flaps have been raised. This case series is single-surgeon and corresponds to the totality of the perforator flaps performed in our Division. The only inclusion criteria considered has been the use of a perforator flap. The etiology of the clinical cases varied from traumatic, oncologic, actinic damage and loss of substance secondary to pressure sores. This cases series includes the reconstruction of all anatomical areas of the body This series presents a 90,6% of complete success rate with the achievement of a stable and valid reconstruction. The failure rate is of 9,4% with the complete loss of 6 flaps. 13 of 64 flaps (20,3%) presented complications, treated conservatively in 4 cases. Among all the results, that will be discussed in the presentation, it is of a certain importance the decrease of overall failure rate of this surgery, ranging from 20% of in 2011 to 4% in Our case series matches the results of the other surgical case series presented in International Literature. It is also possible to infere a progressive temporal decrease of complications and failure rate, for both pedicle and microsurgical flaps, due to the learning curve of the single operator.