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Fulchignoni C, Cianni L, Matrangolo MR, Cerrone M, Cavola F, Pataia E, Vitiello R, Maccauro G, Farsetti P, Rovere G. A Two-Step Approach to the Surgical Treatment of Soft-Tissue Sarcomas. Curr Oncol 2024; 31:2805-2816. [PMID: 38785494 PMCID: PMC11119024 DOI: 10.3390/curroncol31050213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Nowadays, limb-sparing procedures are the gold standard in the treatment of soft-tissue sarcomas of the limbs. Wide tumor resection with appropriate oncological margins, reconstruction, and stabilization of the involved bone and joint and restoration of the soft tissue lost are essential in order to obtain good clinical and functional outcomes. Tumor excision and soft-tissue reconstruction performed in one-step surgery is chosen by many centers as the preferred approach; however, according to our experience in some selected patients, two-step surgery performed using a dermal regeneration template first and then a margin revision, taking into account the definitive results of the anatomopathological exam conducted over the surgical specimen from the previous surgery, associated with definitive reconstruction surgery over a healthy bed of granulated tissue, showed many potential benefits. Methods: A retrospective observational study was conducted on thirteen patients who underwent a two-step reconstruction procedure using dermal substitution after soft-tissue sarcoma excision. Results: Clinically, the enrolled patients achieved excellent contour and cosmesis of their surgical wounds, with a mean VSS value of 3.07. During the follow-up period, no local recurrences were observed in any patient. Conclusions: Two-step surgery represents the most suitable solution to allow surgical radicality with minimal recurrency and adequate soft-tissue reconstruction, avoiding the possibility of wasting autologous tissue. Our patients generally embraced this approach and the management that followed.
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Affiliation(s)
- Camillo Fulchignoni
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Luigi Cianni
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Maria Rosaria Matrangolo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Mariagrazia Cerrone
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Francesco Cavola
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Elisabetta Pataia
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.F.); (L.C.); (M.R.M.); (F.C.); (E.P.); (R.V.); (G.M.); (G.R.)
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
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Rampazzo S, Ferrari M, Sotgiu MA, Piu G, Solinas MG, Usai N, Bulla A, Serra PL, Grieco F, Montella A, Mazzarello V, Rubino C. Objective Non-Invasive Bio-Parametric Evaluation of Regenerated Skin: A Comparison of Two Acellular Dermal Substitutes. Life (Basel) 2024; 14:121. [PMID: 38255736 PMCID: PMC10817643 DOI: 10.3390/life14010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/04/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Several dermal substitutes are available on the market, but there is no precise indication that helps surgeons choose the proper one. Few studies have tried to compare different xenogeneic bioengineered products, but no objective bio-parametric comparison has been made yet. Fifteen patients who underwent skin reconstruction with Integra® or Pelnac® were retrospectively evaluated. After at least 12 months of follow-up, an objective and quantitative assessment of several skin biophysical properties, such as color, texture, elasticity, hydration, glossiness and trans-epidermal water loss, were measured with non-invasive skin measurement devices. The grafted skin showed a reduction of the superficial hydration level and a tendency to lower values of trans-epidermal water loss with both dermal substitutes. Melanic and hemoglobin pigmentation were higher in comparison to the donor site in both groups, while a melanic pigmentation increase versus the surrounding skin was seen just with Integra®. Finally, the skin was found to be more elastic when reconstructed with Integra®. The skin barrier appeared to be intact in both groups. Hence, these substitutes are valuable means of skin regeneration. Integra® seems to be more advantageous for reconstructing areas that need more skin flexibility.
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Affiliation(s)
- Silvia Rampazzo
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (N.U.); (A.B.); (P.L.S.); (F.G.); (C.R.)
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Marco Ferrari
- Skinlab, Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy; (M.F.); (G.P.); (V.M.)
| | - Maria Alessandra Sotgiu
- Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy; (M.A.S.); (M.G.S.); (A.M.)
| | - Gabriella Piu
- Skinlab, Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy; (M.F.); (G.P.); (V.M.)
| | - Maria Giuliana Solinas
- Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy; (M.A.S.); (M.G.S.); (A.M.)
| | - Noemi Usai
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (N.U.); (A.B.); (P.L.S.); (F.G.); (C.R.)
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Antonio Bulla
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (N.U.); (A.B.); (P.L.S.); (F.G.); (C.R.)
| | - Pietro Luciano Serra
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (N.U.); (A.B.); (P.L.S.); (F.G.); (C.R.)
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Federica Grieco
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (N.U.); (A.B.); (P.L.S.); (F.G.); (C.R.)
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Andrea Montella
- Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy; (M.A.S.); (M.G.S.); (A.M.)
| | - Vittorio Mazzarello
- Skinlab, Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy; (M.F.); (G.P.); (V.M.)
- Department of Biomedical Science, University of Sassari, 07100 Sassari, Italy; (M.A.S.); (M.G.S.); (A.M.)
| | - Corrado Rubino
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy; (N.U.); (A.B.); (P.L.S.); (F.G.); (C.R.)
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Gallagher N, Berger J, Jones HB, Lloyd CJ. Frailty as an indicator of postoperative complications following surgical excision of non-melanoma skin cancer on the head and neck. Ann R Coll Surg Engl 2023; 105:342-347. [PMID: 35950511 PMCID: PMC10066642 DOI: 10.1308/rcsann.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-melanoma skin cancer (NMSC) predominantly affects those aged over 90 years, with 85% of lesions arising on the head and neck, where surgical excision remains the treatment of choice. Frailty is a measure of physiologic age and can be used as a predictor of adverse treatment outcomes. The aim of this study was to determine if the Rockwood Frailty Index is predictive of complications following excision of NMSC. METHODS Data were collected prospectively for patients who underwent an excision of a suspected NMSC from the head or neck across a two-month period. Details of the patient, lesion and procedure were recorded alongside ASA grade and Rockwood's Frailty score. Postoperative complications were recorded four weeks later. RESULTS There was a total of 125 patients: 74 (60%) male, 51 (40%) female; mean age was 78 (±9.8) years. Of the excised sites, 61% were closed primarily, 26% with a full thickness skin graft (FTSG), 13% with a local flap. Frailty ranged from 1 to 7 (median = 4). ASA ranged from 1 to 4 (median = 3). A total of 21 (17%) patients reported postoperative complications. Within this group, the median frailty and ASA grades were 5 and 3. Both frailty and ASA were positively significantly associated with age (p ≤ 0.001). There was no significant difference between the frailty or ASA grades of patients that experienced complications and those who did not. Patients who had a FTSG were significantly more likely to experience complications (p ≤ 0.05). CONCLUSIONS Frailty is not predictive of postoperative complications following excision of NMSC on the head and neck. Postoperative complications are significantly more associated with FTSG.
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Affiliation(s)
| | - J Berger
- Betsi Cadwaladr University Health Board, UK
| | - HB Jones
- Betsi Cadwaladr University Health Board, UK
| | - CJ Lloyd
- Betsi Cadwaladr University Health Board, UK
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Wound Healing after Acellular Dermal Substitute Positioning in Dermato-Oncological Surgery: A Prospective Comparative Study. Life (Basel) 2023; 13:life13020463. [PMID: 36836820 PMCID: PMC9967245 DOI: 10.3390/life13020463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND MatriDerm and Integra are both widely used collagenic acellular dermal matrices (ADMs) in the surgical setting, with similar characteristics in terms of healing time and clinical indication. The aim of the present study is to compare the two ADMs in terms of clinical and histological results in the setting of dermato-oncological surgery. METHODS Ten consecutive patients with medical indications to undergo surgical excision of skin cancers were treated with a 2-step procedure at our Dermatologic Surgery Unit. Immediately after tumor removal, both ADMs were positioned on the wound bed, one adjacent to the other. Closure through split-thickness skin grafting was performed after approximately 3 weeks. Conventional histology, immunostaining and ELISA assay were performed on cutaneous samples at different timepoints. RESULTS No significant differences were detected in terms of either final clinical outcomes or in extracellular matrix content of the neoformed dermis. However, Matriderm was observed to induce scar retraction more frequently. In contrast, Integra was shown to carry higher infectious risk and to be more slowly reabsorbed into the wound bed. Sometimes foreign body-like granulomatous reactions were also observed, especially in Integra samples. CONCLUSIONS Even in the presence of subtle differences between the ADMs, comparable global outcomes were demonstrated after dermato-oncological surgery.
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Rampazzo S, Spissu N, Pinna M, Sini GAM, Trignano E, Nonnis R, Sanna C, Rodio M, Tettamanzi M, Rubino C. One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm. J Clin Med 2023; 12:jcm12031170. [PMID: 36769816 PMCID: PMC9917996 DOI: 10.3390/jcm12031170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Immediate implant-based breast reconstruction in patients with large and ptotic breasts may be challenging due to skin redundancy. The use of a reduction mammoplasty pattern for the mastectomy skin excision has proven to be a reliable option for these patients as it allows for a better shape, projection, and symmetrization. This approach has been described in the literature for both one- and two-stage reconstruction with either sub- or pre-pectoral reconstruction with an acellular dermal matrix (ADM) or non-biological mesh. One-stage immediate breast reconstructions have a positive significant impact on patients' psychosocial well-being and quality of life. The purpose of this paper is to describe an institutional algorithm that allows one to perform one-stage implant-based breast reconstructions in patients with large and ptotic breasts.
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Affiliation(s)
- Silvia Rampazzo
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Noemi Spissu
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Michela Pinna
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Germana A. M. Sini
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Emilio Trignano
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Rita Nonnis
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Claudia Sanna
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
- Correspondence:
| | - Manuela Rodio
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Matilde Tettamanzi
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Clinical Evaluation of the Efficacy and Tolerability of Rigenase ® and Polyhexanide (Fitostimoline ® Plus) vs. Hyaluronic Acid and Silver Sulfadiazine (Connettivina ® Bio Plus) for the Treatment of Acute Skin Wounds: A Randomized Trial. J Clin Med 2022; 11:jcm11092518. [PMID: 35566643 PMCID: PMC9105357 DOI: 10.3390/jcm11092518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Compare the efficacy and tolerability of Connettivina® Bio Plus (Group A) gauze and cream, and Fitostimoline® Plus (Group B) gauze and cream for the treatment of acute superficial skin lesions. Design: Single-center, parallel, randomized trial. A block randomization method was used. Setting: University of Salerno—AOU San Giovanni di Dio e Ruggi d’Aragona. Participants: Sixty patients were enrolled. All patients fulfilled the study requirements. Intervention: One application of the study drugs every 24 h, and a six-week observation period. Main outcome measures: Efficacy and tolerability of the study drugs. Results: In total, 60 patients (Group A, n = 30; Group B, n = 30) were randomized; mean age was 58.5 ± 15.8 years. All patients were included in the outcome analysis. Total wound healing was achieved in 17 patients undergoing treatment with Connettivina® Bio Plus and 28 patients undergoing treatment with Fitostimoline® Plus. The greater effectiveness of the latter was significant (p = 0.00104). In Group B, a significantly greater degree of effectiveness was observed in reducing the fibrin in the wound bed (p = 0.04746). Complications or unexpected events were not observed. Conclusions: Both Connettivina® Bio Plus and Fitostimoline® Plus are secure and effective for treating acute superficial skin lesions. Fitostimoline® Plus was more effective than Connettivina® Bio Plus in wound healing of acute superficial skin lesions, especially if fibrin had been observed in the wound bed.
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Lo Torto F, Frattaroli JM, Kaciulyte J, Mori FLR, Troisi L, Ciudad P, Manrique OJ, Marcasciano M, Pajardi GE, Casella D, Cigna E, Ribuffo D. The Keystone Flap: A Multi-centric Experience in Elderly Patients Treatment. J Plast Reconstr Aesthet Surg 2021; 75:226-239. [PMID: 34642063 DOI: 10.1016/j.bjps.2021.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 12/19/2022]
Abstract
Soft tissue reconstruction in elderly patients must be rapid and reliable. The keystone island flap (KF) offers an effective solution, with low complication rates and quick recovery. This multi-centric study aims to show authors' experience with KFs in treating soft tissue defects of trunk and limbs. Patients with soft tissue defects suitable for KF reconstruction were recruited from March 2019 to December 2019. Active inflammation and previous surgeries in the same region were considered exclusion criteria. Complications that occurred during follow-up were recorded, and their incidence pattern was assessed with the Fisher test. Seventy-two patients with mean age of 76.2 years old were selected. They presented lesions in torso (46; 63.9%) or in upper (4; 5.6%) or lower (22; 30.6%) limb regions. Fifteen (20.8%) wounds were non-oncologic lesions, and the others were oncologic lesions, mostly non-melanoma skin cancers. KF type I was carried out in 42 (58.3%) cases, KF type II-A in 13 (18%) cases, double opposed type III KF in 16 (22.2%) patients, and 1 (1.4%) case required partial flap's undermining (IV KF). Mean post-operative recovery period was 4.3 days (range, 1-9 days). Post-surgical complications occurred in 15 (20.8%) cases, 7 (9.7%) of them were considered major complications. No statistically significant difference in complications' incidence, nor among different surgical sites nor among KF types, was registered. Reconstructive surgeons have to adapt their work to elderly patients. The KF allows rapid operative times, low morbidity rates, and short post-operative recovery time, thus appearing as a feasible solution.
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Affiliation(s)
- Federico Lo Torto
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy.
| | - Jacopo M Frattaroli
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Juste Kaciulyte
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Francesco L R Mori
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
| | - Luigi Troisi
- University Department of Hand Surgery and Rehabilitation - San Giuseppe Hospital - IRCCS MultiMedica Group, Milano, Italy
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, United States
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, "Breast Unit" Integrata di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Giorgio E Pajardi
- University Department of Hand Surgery and Rehabilitation - San Giuseppe Hospital - IRCCS MultiMedica Group, Milano, Italy
| | - Donato Casella
- Azienda Ospedaliera Universitaria Senese, UOC Chirurgia Oncologica della Mammella, Siena, Italy
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Diego Ribuffo
- Sapienza University of Rome, Policlinico Umberto I, Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Roma, Italy
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Di Giuli R, Dicorato P, Kaciulyte J, Marinari N, Conversi F, Mazzocchi M. Donor Site Wound Healing in Radial Forearm Flap: A Comparative Study Between Dermal Substitute and Split-Thickness Skin Graft Versus Full-Thickness Skin Graft Primary Coverage. Ann Plast Surg 2021; 86:655-660. [PMID: 33661229 DOI: 10.1097/sap.0000000000002777] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Radial forearm flap (RFF) is one of the most used flaps in reconstructive surgery. Despite its versatility and effectiveness, the donor site is affected by aesthetic and functional issues. In the group of techniques described to improve the donor site morbidity, dermal substitutes offer a valid approach in the wound management. A bilayered bioresorbable dermal substitute (Hyalomatrix) was used to provide the primary coverage of the RFF harvest site followed after 3 weeks by a split-thickness skin graft placement. In this study, 37 patients underwent RFF donor site reconstruction and subjected to a minimum follow-up of 1 year. The dermal substitute was applied on 15 patients, and their outcomes were compared with the data achieved by 22 patients submitted to immediate reconstruction with autologous full-thickness skin graft. Results were documented by digital photographs, the visual analog scale, the Vancouver Scar Scale, and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Data were analyzed and compared through statistical analysis. Total wound coverage was achieved in 4 to 6 weeks, and no tendon impairments were reported in the dermal substitute group. In our experience, the use of the dermal substitute is a valuable mean to minimize RFF donor site morbidity with excellent functional and aesthetic outcomes.
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Affiliation(s)
- Riccardo Di Giuli
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Paolo Dicorato
- Unit of Plastic and Reconstructive Surgery, Department of Surgery "P.Valdoni," Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | | | - Niccolò Marinari
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Francesco Conversi
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Marco Mazzocchi
- From the Unit of Plastic and Reconstructive Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
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Moon KC, Chung HY, Han SK, Jeong SH, Dhong ES. Tissue-engineered dermis grafts using stromal vascular fraction cells on the nose: A retrospective case-control study. J Plast Reconstr Aesthet Surg 2019; 73:965-974. [PMID: 31902623 DOI: 10.1016/j.bjps.2019.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/29/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND In a previous study, our group demonstrated that cultured autologous fibroblast-seeded artificial dermis was superior to artificial dermis for covering defects after surgical excision of basal cell carcinoma (BCC) in terms of scar quality. However, utilizing cultured cells for clinical purposes requires Food and Drug Administration-approved facilities and techniques and a lengthy culture period. The purpose of this retrospective study was to compare the effects of tissue-engineered dermis containing stromal vascular fraction (SVF) cells with artificial dermis on scar quality after surgical excision of BCC on the nose. METHODS Between April 2010 and February 2018, patients who were treated with tissue-engineered or artificial dermis grafts and those with a follow-up period of greater than a year were included in this study. The Patient and Observer Scar Assessment Scales (POSAS) were compared between two groups according to the location of the graft, which was classified based on nasal subunits: the upper two-thirds zone; the lower one-third zone, except for the ala; and the alar zone. RESULTS A tissue-engineered dermis composed of SVF cells and an artificial dermis were applied to 30 and 47 patients, respectively. In upper two-thirds and lower one-third zones, except for the ala, no statistically significant differences were found in any parameters. In the alar zone, statistically significant differences were detected in 10 of 21 POSAS parameters. CONCLUSION To cover nasal defects, the tissue-engineered dermis graft may be superior to the artificial dermis graft regarding scar quality at the ala. However, there were no significant differences in other zones.
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Affiliation(s)
- Kyung-Chul Moon
- Department of Plastic Surgery, Korea University College of Medicine, 148 Guro-Dong, Guro-Ku, 152-703 Seoul, Republic of Korea
| | - Ha-Yoon Chung
- Department of Plastic Surgery, Korea University College of Medicine, 148 Guro-Dong, Guro-Ku, 152-703 Seoul, Republic of Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, 148 Guro-Dong, Guro-Ku, 152-703 Seoul, Republic of Korea.
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University College of Medicine, 148 Guro-Dong, Guro-Ku, 152-703 Seoul, Republic of Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University College of Medicine, 148 Guro-Dong, Guro-Ku, 152-703 Seoul, Republic of Korea
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Maruccia M, Marannino P, Elia R, Ribatti D, Tamma R, Nacchiero E, Manrique O, Giudice G. Treatment of finger degloving injury with acellular dermal matrices: Functional and aesthetic results. J Plast Reconstr Aesthet Surg 2019; 72:1509-1517. [DOI: 10.1016/j.bjps.2019.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
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The New Trend of Pre-pectoral Breast Reconstruction: An Objective Evaluation of the Quality of Online Information for Patients Undergoing Breast Reconstruction. Aesthetic Plast Surg 2019; 43:593-599. [PMID: 30710175 DOI: 10.1007/s00266-019-01311-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/13/2019] [Indexed: 01/09/2023]
Abstract
The Web has increasingly become the major source of information about health care, and patients who need to undergo breast reconstruction often use the internet to acquire an initial knowledge on the subject. We would like to present our study that investigates the quality of published information on pre-pectoral breast reconstruction. We searched the term "Pre-pectoral breast reconstruction" on Google® and Yahoo®. Forty-two web sites were selected and underwent qualitative and quantitative assessment using the expanded EQIP tool. The analysis of document contents showed a critical lack of information about qualitative risks and side-effects descriptions, treatment of potential complications, alert signs for the patient and precautions that the patient may take. Health professionals should inform patients about the potential difficulties of identifying reliable informational web sites about pre-pectoral breast reconstruction. The quality of available information should be improved, especially the important topics included in the content data section of the modified EQIP tool.Level of Evidence IV 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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Marcasciano M, Mazzocchi M, Kaciulyte J, Spissu N, Casella D, Ribuffo D, Dessy LA. Skin cancers and dermal substitutes: Is it safe? Review of the literature and presentation of a 2-stage surgical protocol for the treatment of non-melanoma skin cancers of the head in fragile patients. Int Wound J 2018; 15:756-768. [PMID: 29863792 DOI: 10.1111/iwj.12924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 11/29/2022] Open
Abstract
Non-melanoma skin cancers (NMSC) represent the most common skin tumours of the head region. We describe the use of dermal substitute in a 2-stage surgery protocol for selected fragile patients to remove NMSC of the head region. A review of the literature focusing on dermal substitutes' safety after skin tumours excision is provided. A total of 45 fragile patients with NMSC in the head region were selected and scheduled for the 2-stage surgical protocol. The first stage consisted of traditional surgical excision and immediate coverage with Hyalomatrix (Fidia Advanced Biopolymers, Abano Terme, Italy). After histology confirmed diagnosis and clearance of the margins, full-thickness skin autografts were performed. All of the patients reached complete tumour excision and wound healing. No local recurrences were registered during 24 months follow up. The 2-stage surgical therapeutic-diagnostic-reconstructive approach represents a less stressful and oncologically safe surgical protocol in selected fragile patients. When patients cannot tolerate invasive and long surgical procedures, general anaesthesia, and long hospitalisation, skin grafting following temporary skin substitute coverage can achieve oncological clearance and provide good functional and aesthetic results. The use of dermal substitutes represents a valid alternative surgical option in cases of ASA III, fragile patients non-eligible for complex reconstructive surgery. To our knowledge, this is the first paper reviewing literature focusing on dermal substitutes' applications and safety after skin tumour excision.
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Affiliation(s)
- Marco Marcasciano
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Marco Mazzocchi
- Unit of Plastic and Reconstructive Surgery, Department of Surgery, Ospedale Santa Maria Della Misericordia, Perugia (PG), Italy
| | - Juste Kaciulyte
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Noemi Spissu
- UOC di Chirurgia Generale, Ospedale San Francesco, di Nuoro, Italy
| | - Donato Casella
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Diego Ribuffo
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
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