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Borsetti M, Gangemi EN, Germano S, Clemente A, Devalle L, Cerato C, Merlino G. Inveterated Facial Palsy Correction with Endoscopically Assisted Multiple Muscle Transposition and Lifts: The EMTL Procedure. Indian J Plast Surg 2020; 53:344-348. [PMID: 33402763 PMCID: PMC7775192 DOI: 10.1055/s-0040-1721877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction
The aim of the present analysis was to study the safety and efficacy associated with reanimation in facial nerve palsy by the endoscopically assisted multiple muscle transposition and lifts (EMTL).
Patients and Methods
The study sample included all patients who had undergone a facial reanimation by EMTL procedure from September 2015 to May 2019. The patients were analyzed retrospectively, with more than 1 year of follow-up, and were evaluated in terms of functional-aesthetic results and postoperative complications. The outcome was evaluated with the Sunnybrook scale.
Results
Fourteen patients were included in the present study. They were all inveterate palsies with minimum 4 years from the initial injury. The preoperative Sunnybrook score ranged from 0 to 5 and the postoperative ranged from 30 to 65. Spontaneous smile achievement was obtained in 10 patients and only mild restoration in one patient. The scar and static correction were satisfactory in all patients. Eye protection was improved in all cases with some form of active blinking in six cases.
Conclusion
This study showed that facial palsy correction with EMTL procedure offers a promising alternative treatment for patients with facial palsy not suitable for microsurgical muscle transposition.
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Affiliation(s)
- Marco Borsetti
- Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
| | - Ezio Nicola Gangemi
- Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
| | - Silvia Germano
- Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
| | - Alessandra Clemente
- Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
| | - Luca Devalle
- Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
| | - Claudia Cerato
- Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
| | - Giorgio Merlino
- Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
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Gangemi EN, Devalle L, Merlino G, Germano S, Clemente A, Cerato C, Borsetti M. Bone regeneration after pedicled periosteal dorsal metacarpal flap. Reconstructive technique. Ann Ital Chir 2020; 91:534-537. [PMID: 33295303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The dorsal metacarpal artery (DMCA) flap is considered as one of the working horses to cover exposed extensor tendon or bone of dorsal digits. The periosteal composite DMCA reverse flap (pcDMCAr flap) is described as a fast and safe solution to manage this kind of trauma. A 35-year-old male had a trauma to his left hand from a circular saw. The resultant injury was localized to the proximal middle finger with a dorsal bone loss. A vascularized composite flap, including 3th metacarpal periosteum, was elected as the most appropriate option. Postoperative follow-up at 6 months confirmed bony regeneration. There are no documented cases to the best of our knowledge demonstrating the use of pcDMCAr flap to treat fractures with bone loss in the proximal digits. This report suggests that technique may be employed as regenerative bone flap in reconstructive surgery for proximal fingers trauma with bone loss and open fracture. KEY WORDS: Bone regeneration, Dorsal metacarpal flap, Periosteum.
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Bergamin F, Gangemi EN, Cerato C, Clemente A, Borsetti M, Suriani A, Taraglio S. An unusual case of neurothekeoma of the arm in an adult. J Orthop Traumatol 2015; 17:287-90. [PMID: 26577935 PMCID: PMC4999369 DOI: 10.1007/s10195-015-0386-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 10/17/2015] [Indexed: 12/20/2022] Open
Abstract
Neurothekeomas are uncommon benign neoplasms with a peripheral nerve sheath origin. This tumor usually involves dermis and is described as a small, solitary, slow growing and reddish to flesh-colored nodule or papule. Neurothekeoma preferentially affects the central aspect of the face, the arms or shoulders of women in the second and third decades of life. This is the first case report of neurothekeoma involving the wrist developing from synovial tissue and with uncertain clinical behavior in an adult female. The tumor was completely excised under brachial plexus block. Histopathologically, the examination of the microscopic slides revealed the presence of a 20-mm diameter, well-circumscribed and multilobulated tumor composed of abundant myxoid stroma with cellular elements; with immunohistochemistry there was positivity to vimentin but S100-protein, epithelial membrane antigen, cytokeratin AE1-3, CD99 and CD34 were all negative. This pattern suggested a myxoid tumor form of neurothekeoma, mixed subtype. The patient had an atypical local recurrence and was re-operated after 3 months. After 12 months there was no evidence of clinical recurrences confirmed by magnetic resonance evaluation. Basically, our case report adds an important element in the correct clinical management of neurotecheomas: faced with a histological diagnosis with an unusual localization and mixed or hypercellular type, clinicians must consider the possibility of an early local recurrence, suggesting a close clinical and radiological follow-up.
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Affiliation(s)
- Federica Bergamin
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy.
| | - Ezio Nicola Gangemi
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Claudia Cerato
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Alessandra Clemente
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Marco Borsetti
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Adolfo Suriani
- Department of Laboratory Diagnostics, Division of Pathology, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Stefano Taraglio
- Department of Laboratory Diagnostics, Division of Pathology, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
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Berchialla P, Gangemi EN, Foltran F, Haxhiaj A, Buja A, Lazzarato F, Stella M, Gregori D. Predicting severity of pathological scarring due to burn injuries: a clinical decision making tool using Bayesian networks. Int Wound J 2012; 11:246-52. [PMID: 22958613 DOI: 10.1111/j.1742-481x.2012.01080.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
It is important for clinicians to understand which are the clinical signs, the patient characteristics and the procedures that are related with the occurrence of hypertrophic burn scars in order to carry out a possible prognostic assessment. Providing clinicians with an easy-to- use tool for predicting the risk of pathological scars. A total of 703 patients with 2440 anatomical burn sites who were admitted to the Department of Plastic and Reconstructive Surgery, Burn Center of the Traumatological Hospital in Torino between January 1994 and May 2006 were included in the analysis. A Bayesian network (BN) model was implemented. The probability of developing a hypertrophic scar was evaluated on a number of scenarios. The error rate of the BN model was assessed internally and it was equal to 24·83%. While classical statistical method as logistic models can infer only which variables are related to the final outcome, the BN approach displays a set of relationships between the final outcome (scar type) and the explanatory covariates (patient's age and gender, burn surface area, full-thickness burn surface area, burn anatomical area and wound-healing time; burn treatment options such as advanced dressings, type of surgical approach, number of surgical procedures, type of skin graft, excision and coverage timing). A web-based interface to handle the BN model was developed on the website www.pubchild.org (burns header). Clinicians who registered at the website could submit their data in order to get from the BN model the predicted probability of observing a pathological scar type.
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Affiliation(s)
- Paola Berchialla
- Department of Public Health and Microbiology, University of Torino, Torino, ItalyDepartment of Plastic and Reconstructive Surgery, Burn Center, Trauma Center, Torino, ItalyUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, ItalyProchild ONLUS, Trieste, ItalyUnit of Cancer Epidemiology, CPO Piemonte, University of Torino, Torino, Italy
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Mariano F, Bergamo D, Gangemi EN, Hollo' Z, Stella M, Triolo G. Citrate anticoagulation for continuous renal replacement therapy in critically ill patients: success and limits. Int J Nephrol 2011; 2011:748320. [PMID: 21603110 PMCID: PMC3097066 DOI: 10.4061/2011/748320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 01/20/2011] [Indexed: 11/20/2022] Open
Abstract
Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the "continuous" systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.
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Affiliation(s)
- Filippo Mariano
- Department of Medicine Area, Nephrology and Dialysis Unit, CTO Hospital, Via G. Zuretti 29, Turin, Italy
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Chiummariello S, Monarca C, Rizzo MI, Ruggiero M, Gangemi EN, Scuderi N, Alfano C. ["Step technique" in the treatment of the loss of substance of the lower lip]. G Chir 2010; 31:549-551. [PMID: 21232202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The most frequent pathology of the lower lip is the neoplastic pathology and squamous cell carcinoma is the most clinically diagnosed. Wide excision is the correct surgical approach but it may cause severe morpho-functional and aesthetic damages. At the Plastic and Reconstructive Department of Policlinico Umberto I, " Sapienza" University of Rome, from 2005 to 2008 36 patients were treated, 19 only by surgical excision (Group I) and 17 by Johanson's technique (Group II). Follow-up was at 6 and 12 months to evaluate the morpho-functional outcome, the asymmetry and the healing. Moreover a questionnaire of 9 items was proposed to patients to evaluate functional and aesthetic results. Data showed that Johansons' s flap achieves the same results of the complete surgical excision but with better morpho-functional and aesthetic outcomes, greater satisfaction and same staying in hospital for patients.
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Gangemi EN, Carnino R, Stella M. Videocapillaroscopy in postburn scars: in vivo analysis of the microcirculation. Burns 2010; 36:799-805. [PMID: 20381256 DOI: 10.1016/j.burns.2010.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 12/23/2009] [Accepted: 02/04/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the study was the evaluation in vivo of the differences between the microcirculatory characteristics of the postburn scar and the healthy skin. METHODS Twelve patients with postburn scars were included in the study, evaluating fifteen scar areas and twelve healthy skin areas by means of contact optical probe videocapillaroscopy. The examined areas for each patient were the right and the left upper limb. Capillary density, length and diameter, together with capillary distribution pattern (punctiform, reticular, directional) and the presence of microhaemorrhages and neoangiogenesis were studied. RESULTS The results were obtained by two different researchers using the capillaroscope's software. Capillary loop diameter and length, capillary distribution pattern and presence of neoangiogenesis were found to be significantly increased in postburn scars compared with controls. There were also significant differences between hypertrophic tissue in the active phase and the one in the remission phase for capillary diameter and presence of neoangiogenesis. CONCLUSION Videocapillaroscopy showed "in vivo" a change in local microcirculation architecture using a microscope. Patients with hypertrophic burn scars showed a variety of microcirculatory changes, often clustered in a characteristic pattern of abnormally oriented, dilated capillaries and neoangiogenetic phenomena. This methodology is highly likely to be of value in the assessment and prognostication of burn outcome.
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Affiliation(s)
- Ezio Nicola Gangemi
- Department of Plastic and Reconstructive Surgery, Burn Center, Traumatological Hospital, Turin, Italy.
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Bollero D, Stella M, Gangemi EN, Spaziante L, Nuzzo J, Sigaudo G, Enrichens F. Purpura fulminans in meningococcal septicaemia in an adult: a case report. Ann Burns Fire Disasters 2010; 23:43-47. [PMID: 21991197 PMCID: PMC3188232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Indexed: 05/31/2023]
Abstract
Purpura fulminans is a rare and severe complication of meningococcal septicaemia. It presents as a petechial rash spreading rapidly in extent and depth, evolving into full-thickness skin necrosis. The condition is extremely uncommon in the adult population. We report the case of a 28-yr-old man with extensive meningococcal-related skin necrosis. The initial diagnosis was made and first treatment given in the emergency department of a local hospital, from where after 12 days he was transferred to our hospital. Our approach was based on the continuation of intensive treatment and on staged aggressive debridement. Temporary alloplastic skin grafts were used to prepare the wound bed and the wounds were closed with autologous skin grafts. The patient survived but subsequently, owing to chronic skin ulceration and scar instability, he underwent late bilateral below-the-knee amputation.The patient returned to normal deambulation with an orthopaedic prosthesis 18 months after the onset of meningococcal septicaemia.
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Affiliation(s)
- D Bollero
- Department of Plastic and Reconstructive Surgery, Burns Centre, Traumatological Hospital, Turin, Italy
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Abstract
Burn wounds give rise to the largest scars we can find in human pathology, influencing patients' quality of life. Despite the improved knowledge on pathophysiology, efficacy of the various treatments remains unsatisfactory. In this short review recent literature is examined with a focus on recent data on postburn pathological scars epidemiology and risk factors, which underline the high prevalence and the long evolution, pointing to identify this illness as a systemic inflammatory one, more frequent in women and in those of younger age, regulated by local factors relevant in wound healing.
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Affiliation(s)
- Maurizio Stella
- Department of Reconstructive Plastic Surgery, Burn Center
and Skin Bank, Trauma Center, Turin, Italy,
| | - Carlotta Castagnoli
- Department of Reconstructive Plastic Surgery, Burn Center
and Skin Bank, Trauma Center, Turin, Italy
| | - Ezio Nicola Gangemi
- Department of Reconstructive Plastic Surgery, Burn Center
and Skin Bank, Trauma Center, Turin, Italy
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Gangemi EN, Gregori D, Berchialla P, Zingarelli E, Cairo M, Bollero D, Ganem J, Capocelli R, Cuccuru F, Cassano P, Risso D, Stella M. Epidemiology and risk factors for pathologic scarring after burn wounds. ACTA ACUST UNITED AC 2008; 10:93-102. [PMID: 18347236 DOI: 10.1001/archfaci.10.2.93] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe the clinical characteristics of postburn scars and determine the independent risk factors specific to these patients. While burns may generate widespread and disfiguring scars and have a dramatic influence on patient quality of life, the prevalence of postburn pathologic scarring is not well documented, and the impact of certain risk factors is poorly understood. METHODS A retrospective analysis was conducted of the clinical records of 703 patients (2440 anatomic burn sites) treated at the Turin Burn Outpatient Clinic between January 1994 and May 15, 2006. Prevalence and evolution time of postburn pathologic scarring were analyzed with univariate and multivariate risk factor analysis by sex, age, burn surface and full-thickness area, cause of the burn, wound healing time, type of burn treatment, number of surgical procedures, type of surgery, type of skin graft, and excision and graft timing. RESULTS Pathologic scarring was diagnosed in 540 patients (77%): 310 had hypertrophic scars (44%); 34, contractures (5%); and 196, hypertrophic-contracted scars (28%). The hypertrophic induction was assessed at a median of 23 days after reepithelialization and lasted 15 months (median). A nomogram, based on the multivariate regression model, showed that female sex, young age, burn sites on the neck and/or upper limbs, multiple surgical procedures, and meshed skin grafts were independent risk factors for postburn pathologic scarring (Dxy 0.30). CONCLUSION The identification of the principal risk factors for postburn pathologic scarring not only would be a valuable aid in early risk stratification but also might help in assessing outcomes adjusted for patient risk.
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Affiliation(s)
- Ezio Nicola Gangemi
- Department of Plastic and Reconstructive Surgery, Burn Center, Traumatological Center, Via Zuretti 29, 10126 Turin, Italy.
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Gangemi EN, Garino F, Berchialla P, Martinese M, Arecco F, Orlandi F, Stella M. Low triiodothyronine serum levels as a predictor of poor prognosis in burn patients. Burns 2008; 34:817-24. [PMID: 18242870 DOI: 10.1016/j.burns.2007.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 10/23/2007] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Euthyroid sick syndrome is a common finding in critically ill patients with nonthyroidal illness, characterized by low serum levels of free triiodothyronine (fT3) with a peculiar increase in reverse T3 (rT3) and normal-to-low free thyroxine (fT4) as well as thyroid-stimulating hormone (TSH) levels. This condition has been proposed as a prognostic factor of worse outcome in critically ill patients, while no conclusive data are available in burns. METHODS Since thyroid function testing is contained in our baseline laboratory tests at admission, we retrospectively evaluated fT3, fT4 and TSH in 295 consecutive burn patients admitted to the Burn Center of Turin from January 2002 to December 2006, comparing hormone levels in survivors and non-survivors. RESULTS fT3 and TSH levels were significantly lower (p<or=0.0002) in non-survivors compared to survivors, while no significant difference between the two populations was found in fT4 concentrations. Excluding from the study 20 patients who received dopamine administration for more than 21h, serum fT3 levels fell further still (p=0.0003). In addition, fT3 concentrations showed a significant correlation with burn severity expressed by the Roi score (Spearman's correlation coefficient -0.37 with p<0.00001). CONCLUSION Low fT3 levels are associated with poor outcome in burn patients. Hence, fT3 measurement could be proposed as a strong and cost-effective tool of poor prognosis.
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Affiliation(s)
- Ezio Nicola Gangemi
- Department of Plastic and Reconstructive Surgery-Burn Center, Traumatological Hospital, Turin, Italy
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