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Segreto F, Carotti S, Marangi GF, Francesconi M, Calia E, Cagli B, Cimmino A, Rossi C, Morini S, Persichetti P. Cathelicidin LL-37 Expression in Human Breast Implant Capsules. Plast Reconstr Surg 2024; 153:1066-1073. [PMID: 37220260 DOI: 10.1097/prs.0000000000010733] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation, and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling, and clinical outcomes. METHODS The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin and eosin, Masson trichrome, immunohistochemistry, and immunofluorescence for LL-37, CD68, α-smooth muscle actin, collagen type I and type III, CD31, and Toll-like receptor-4. RESULTS LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and nine (31%) of the specimens, respectively. In eight cases (27.5%), it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages ( P < 0.001). Moreover, LL-37 expression by macrophages of periexpander capsules negatively correlated with the severity of capsular contracture on definitive implants ( P = 0.04). CONCLUSIONS This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophage modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture. CLINICAL RELEVANCE STATEMENT This is the first study to demonstrate LL37 expression in capsular tissue and to hypothesize its role in contracture and as a prognostic marker for contracture severity. If confirmed, medical strategies or implant coating could be implemented to reduce the risk of contracture for high-risk patients.
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Affiliation(s)
- Francesco Segreto
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Simone Carotti
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | - Maria Francesconi
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Eleonora Calia
- Department of Obstetrics and Gynecology, Campus Bio-Medico of Rome University
| | - Barbara Cagli
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Andrea Cimmino
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Caterina Rossi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Sergio Morini
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Paolo Persichetti
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
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Gratteri M, Marangi GF, Mirra C, Arcari L, Romano FD, Cimmino A, Cogliandro A, Cagli B, Segreto F, Persichetti P. Impact of Incisional Access Site in Primary Breast Augmentation: Evaluation of Patient Satisfaction with SCAR-Q. Aesthetic Plast Surg 2024; 48:1565-1570. [PMID: 37495729 DOI: 10.1007/s00266-023-03502-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. METHODS The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. RESULTS All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. CONCLUSION Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. LEVEL OF EVIDENCE IV Case series study. 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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Affiliation(s)
- Marco Gratteri
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy.
| | - Lucrezia Arcari
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Fara Desiree Romano
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Andrea Cimmino
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
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Marangi GF, Savani L, Gratteri M, Arcari L, Segreto F, Cagli B, Cogliandro A, Vega R, Mirra C, Persichetti P. Main Factors Influencing Patient Satisfaction After Primary Breast Augmentation: A Prospective Study Based on Patient-Reported Outcome Measures. Aesthet Surg J 2024; 44:375-382. [PMID: 38114077 DOI: 10.1093/asj/sjad372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Primary breast augmentation is one of the most sought-after procedures in cosmetic surgery. It is generally related to a high degree of patient satisfaction, but it is not always obvious which factors have greater influence on patient satisfaction. OBJECTIVES The aim of this prospective study was to evaluate how anthropometric, psychological, and social parameters, in association with the main surgical variables, influenced patients' satisfaction with their breasts after surgery. METHODS Patients undergoing primary breast augmentation between October 2018 and February 2022, who completed a 12-month follow-up without complications, were enrolled in the study. For each patient we recorded: BMI, pinch test (upper pole of the breast), surgical access, implant pocket, implant volume, bra size increase, age, smoking habit, civil status, education level, pregnancies, and psychiatric disorders. Each variable was statistically correlated with patient's satisfaction, assessed by BREAST-Q questionnaire preoperatively and 12 months postoperatively. RESULTS Analyzing the data of the 131 patients, we found 3 factors affecting their satisfaction (P<.05); BMI: underweight patients were less satisfied than normal and overweight patients; pinch test: patients with a pinch test >2 cm were more satisfied; volume of the implant and bra size increase: patients with implant volume <300 cc and a less than 2 bra size increase were less satisfied than patients with larger augmentation. CONCLUSIONS BMI, pinch test, implant volume, and extent of volumetric enhancement should be taken into careful consideration by the surgeon during preoperative consultation and surgical planning, because they can be critical to patient satisfaction. LEVEL OF EVIDENCE: 3
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Marangi GF, Mirra C, Gratteri M, Cogliandro A, Salzillo R, Segreto F, Federico G, Romano FD, Rossi C, Persichetti P. Switching from Galenic to Advanced Dressings or Vacuum Assisted Closure Therapy Can Improve Quality of Life of Patients with Chronic Non-Responsive Pressure Skin Ulcers: Preliminary Data with Italian Translation of WOUND-Q. Adv Wound Care (New Rochelle) 2024; 13:131-139. [PMID: 37551983 DOI: 10.1089/wound.2022.0150] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Objective: A few studies have focused on the quality of life (QoL) of patients with chronic non-responsive pressure skin ulcers. The aim of this study was to assess how correct treatment (advanced wound care [AWC] dressings alone or vacuum assisted closure [VAC] therapy alone) changes the QoL of these patients. Approach: One hundred six patients with chronic non-responsive pressure skin ulcers, who had previously used galenic dressings, applied without proper therapeutic indication, were included in this study. We administered the WOUND-Q, at time 0 and after 1 month of appropriate therapy, to assess patient-reported outcome measures. Group 1 consisted of 30 patients treated with advanced dressings, Group 2: 22 patients treated with VAC therapy, and Group 3: 30 patients continuing conventional galenic dressings (Control group). Statistical analysis allowed us to analyze QoL changes over time and to compare WOUND-Q Group 1 and 2 deltas with those of Group 3. The study followed the STROBE statement. Results and Innovation: In all the scales evaluated (Assessment, Drainage, Smell, Life impact, Psychological, Social, Sleep and Dressing), there were significant improvements in mean values for Groups 1 and 2. Kruskal-Wallis tests with Dunn's multiple-comparisons tests and Brown-Forsythe and Welch Analysis of Variance tests demonstrated significant differences between deltas of Group 1 and Group 2 compared with those of Group 3 for most scales analyzed. Conclusions: Administration of the WOUND-Q demonstrated that the application of advanced dressings alone or VAC therapy alone positively affects the QoL of patients with chronic nonresponsive pressure wounds, in comparison with galenic dressings alone. The WOUND-Q has been shown to be a valid tool in studying changes in QoL of these patients.
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Affiliation(s)
- Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Marco Gratteri
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Gaetano Federico
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fara Desiree Romano
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Caterina Rossi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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Marangi GF, Gratteri M, Savani L, Porso D, Cimmino A, Arcari L, Romano FD, Segreto F, Mirra C, Persichetti P. Correction of Rectus Abdominis Diastasis: A Prospective Comparative Study Between a New Suturable Polypropylene Mesh Vs Polypropylene Standard Suture Plication. Aesthet Surg J 2024:sjae006. [PMID: 38243919 DOI: 10.1093/asj/sjae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Duramesh is a new suturing concept, combining the principles of meshes with the precision, flexibility and versatility of a suture, suitable also for Abdominal Rectus Diastasis correction. OBJECTIVES This prospective research aimed at comparing this mesh usage versus the polypropylene standard suture plication for Rectus Diastasis repair in terms of safety (infection, seroma, hematoma, surgical wound dehiscence and fistula rates and hospital stay), effectiveness (ARD recurrence evidenced through Ultrasound Sonography, palpability of the muscular suture, surgical time and postoperative pain evaluation) and satisfaction of the patients based on PROMs (BODY-Q). METHODS 65 of the initial 70 patients, undergoing rectus diastasis repair, with a 6 months FU, were randomly divided in two groups: 1 composed of 33 patients treated with Duramesh and 2 of 32 patients treated with standard polypropylene 0 suture plication. Data regarding infection, seroma, hematoma, surgical wound dehiscence and fistula rates, hospital stay, ARD recurrence, palpability of the muscular suture, surgical time, postoperative pain evaluation (VAS) and PROMs (BODY-Q) were analyzed by Prism9. RESULTS No significant differences were reported between the two groups in terms of: infection, seroma, hematoma, surgical wound dehiscence and fistula rates and hospital stay. The mesh usage decreases the time required to perform plication compared with standard polypropylene detached stitches suture. No statistically significant differences were found out regarding VAS and BODY-Q data. CONCLUSIONS Duramesh 0 application for Rectus Diastasis repair is safe and effective without compromising aesthetic improvement, as compared to standard polypropylene 0 plication.
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Affiliation(s)
- Giovanni Francesco Marangi
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Marco Gratteri
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Luca Savani
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Daniela Porso
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Andrea Cimmino
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Lucrezia Arcari
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fara Desiree Romano
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Francesco Segreto
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Carlo Mirra
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Paolo Persichetti
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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Marangi GF, Faiola A, Cimmino AA, Savani L, Mirra C, Gratteri M, Giuffrè MT, Segreto F, Cogliandro A, Persichetti P. Relevance of Self-Consciousness of Appearance on Patient Satisfaction in Primary Rhinoplasty: a 12-Month Follow-up Prospective Study. Aesthetic Plast Surg 2024:10.1007/s00266-023-03803-3. [PMID: 38200126 DOI: 10.1007/s00266-023-03803-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Rhinoplasty procedure has a strong impact on patient quality of life. Plastic surgery patients show a degree of appearance-related distress higher than general population, especially patients undergoing rhinoplasty. Relationship between patient-reported outcome after rhinoplasty and self-consciousness of appearance needs further studies. The aim of this study is to investigate this correlation, considering the surgeon external evaluation as well. MATERIALS AND METHODS A total of 50 consecutive patients underwent primary cosmetofunctional rhinoseptoplasty. Appearance-related distress and surgical outcome were assessed by DAS59 (Derriford Appearance Scale 59) and SCHNOS (Standardised Cosmesis and Health Nasal Outcomes Survey), administered before and after surgery. Follow-up period was 12 months. Third-party clinical outcome was evaluated by three plastic surgeons by a scale ranging from 1 (poor outcome) to 5 (excellent outcome). RESULTS A first division in Group 1 (satisfied) and Group 2 (unsatisfied) was done. DAS59 mean score in Group 1 showed to be statistically lower than Group 2 (p value < 0.05). Spearman's test showed a large strong positive correlation between preoperative and postoperative DAS59 and SCHNOS-C score variations (Delta 0-12 months) (r = 0.7514, p<0.001), as well as between DAS59 and SCHNOS-O (r = 0.5117, p<0.001) and between SCHNOS-C and SCHNOS-O (r = 0.6928, p<0.001). CONCLUSION Rhinoseptoplasty has a significant impact on the patient self-consciousness of appearance, in both negative and positive terms. We emphasize the surgeon's burden, who need to carefully assess and address the patient's expectations during the first evaluation. This distinction is crucial since unrealistic expectations may lead to dissatisfaction even after a properly performed procedure. 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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Affiliation(s)
- Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Angelo Faiola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Andrea Aniello Cimmino
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Luca Savani
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marco Gratteri
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Maria Teresa Giuffrè
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Marianetti TM, Segreto F, Iademarco A, Rossi C, Persichetti P. The use of inter-alar ligaments flap for tip and supra-tip contouring in primary open structural rhinoplasty. Plast Reconstr Surg 2023:00006534-990000000-02134. [PMID: 37749799 DOI: 10.1097/prs.0000000000011094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Precise tip contouring is paramount to achieve pleasant cosmetic results in rhinoplasty. Loss of tip projection or rotation, supra-tip deformities, as well as long-lasting edema, may jeopardize the outcome, thus leading to patient's dissatisfaction or re-intervention. Several approaches were previously reported, sometimes with considerable drawbacks or conclusions mainly supported by experience. The aim of this study is to describe the inter-alar ligaments flap for tip and supra-tip contouring and to comparatively assess its efficacy and safety. METHODS The study included 147 patients who underwent primary structured open rhinoplasty and divided into 2 groups: group 1 underwent harvesting and repositioning of the inter-alar ligaments flap, group 2 underwent conventional tip dissection. Tip edema, supra-tip definition and fullness were blindly scored at 2-, 6- and 12-month post-operative follow-up. Naso-labial angle was measured at 2 and 12 months post-operatively. Univariate analysis and and multivariable regression model were performed. RESULTS Supra-tip definition was significantly higher in group 1 at 2-, 6- and 12-months post-operative follow up (p<0.05, p<0.01 and p<0.01, respectively). Tip edema and supratip fullness were significantly lower in group 1 at each time point (p<0.01). Naso-labial angle, as well as its modification between 2- and 12-months post-intervention, did not differ in the 2 groups. All findings were confirmed when controlled for eventual confounders. CONCLUSIONS The inter-alar ligaments flap proved to be versatile, effective and consistently reliable in reducing tip edema and improving supra-tip definition. It may be tailored to the patient, partially folded to improve tip projection or used to camouflage tip grafts.
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Affiliation(s)
- Tito Matteo Marianetti
- Private Practice, Maxillo-Facial Department, Assunzione di Maria Santissima Clinic, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Antonio Iademarco
- Private Practice, Maxillo-Facial Department, Assunzione di Maria Santissima Clinic, Rome, Italy
| | - Caterina Rossi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
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Cagli B, Carotti S, Segreto F, Francesconi M, Marangi GF, Tenna S, Diomedi M, Perrone G, Morini S, Persichetti P. Histologic and Immunohistochemical Evaluation of Human Breast Capsules Formed around Five Different Expander Surfaces. Plast Reconstr Surg 2023; 152:388e-397e. [PMID: 36827480 DOI: 10.1097/prs.0000000000010317] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Polyurethane (PU) coating and implant texturization were designed to reduce the incidence of capsular contracture (CC), even if the link between surface type and CC remains unclear. To date, the etiopathogenetic aspects have not been fully clarified. The aim of this study was to evaluate capsules formed around five different breast expanders. METHODS Thirty patients were divided into randomized groups implanted with five different expanders: smooth, coated with PU foam (poly), with a low-microtextured, high-microtextured, and macrotextured surface (L-micro, H-micro, macro). Specimens of the capsules were removed at implant reconstruction and evaluated for morphology and immunohistochemistry expression of α-smooth muscle actin (α-SMA), collagen type I and III, CD68, CD34, and CD3. Remodeling Combined Index was also evaluated. RESULTS Expression of α-SMA was significantly increased in smooth capsules versus poly, low-microtextured, and high-microtextured groups ( P = 0.007; P = 0.010; P = 0.028), whereas the prevalence of collagen type I in smooth capsules and collagen type III in poly capsules identified a stable versus an unstable tissue. Remodeling Combined Index and α-SMA showed an inverted correlation. CD68 and CD34 cellular expression increased significantly in poly capsules with respect to smooth ( P < 0.001; P < 0.001) and macrotextured groups ( P < 0.001; P < 0.001). CD3 showed no significant difference among the groups. CONCLUSION In this human study, the authors observed that increased tissue remodeling and reduced myofibroblast activation, along with the inflammatory infiltration and neoangiogenesis, especially in the poly and low-microtextured groups, might promote the formation of an unstable and less fibrotic capsule, lowering the risk of CC. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Simone Carotti
- Department of Medicine and Surgery, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | - Maria Francesconi
- Department of Medicine and Surgery, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | | | | | - Giuseppe Perrone
- Research Unit of Pathology, Campus Bio-Medico University of Rome
| | - Sergio Morini
- Department of Medicine and Surgery, Laboratory of Microscopic and Ultrastructural Anatomy
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Marangi GF, Gratteri M, Mirra C, Cogliandro A, Savani L, Ciarrocchi S, Pagano F, Cagli B, Segreto F, Persichetti P. The Correlation Between the Improvement in Patient's Quality of Life and Surgeon's Satisfaction Following Primary Breast Augmentation: A Prospective Study. Aesthet Surg J 2023:7075016. [PMID: 36895187 DOI: 10.1093/asj/sjad052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Patient satisfaction are the primary goal in breast augmentation, but in a few cases patient and surgeon satisfaction are in disagreement. OBJECTIVES The authors try to explain the reasons associated with disparity between patient and surgeons' satisfaction. METHODS Seventy-one patients underwent primary breast augmentation with dual plane technique with inframammary or inferior hemi-periareolar incision were enrolled in this prospective study. Quality of Life using BREAST-Q pre- and post-operative was evaluated. A pre and post photographic analysis was performed by a heterogeneous group of experts whom completed the Validated Breast Aesthetic Scale. Satisfaction with breast score was compared with overall appearance of VBRAS; a difference in score ≥ 1 was considered as discordant judgement. Statistical analysis was performed using SPSS version 18.0, with values of p<0.01 considered statistically significant. RESULTS BREAST-Q analysis, showed a significative improvement of QoL in Psychosocial Well-Being, Sexual Well-being, Physical Well-Being Chest scale and Satisfaction with Breast (p<0.01). Of the 71 pairs, 60 had a concordant judgment between patient and surgeon and 11 discordant. The score expressed by the patients (4.35±0.69) was on average higher than that of the third-party observers (3.88±0.58) with p<0.001. CONCLUSIONS Patient satisfaction is the main goal following the success of a surgical or medical procedure. BREAST-Q and photographic support are 2 important tools in the preoperative visit to understand the patient's real expectations.
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Affiliation(s)
- Giovanni Francesco Marangi
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Marco Gratteri
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Carlo Mirra
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Annalisa Cogliandro
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Luca Savani
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Silvia Ciarrocchi
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Federico Pagano
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Barbara Cagli
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Francesco Segreto
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Paolo Persichetti
- From the Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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Cagli B, Morelli Coppola M, Augelli F, Segreto F, Tenna S, Cogliandro A, Persichetti P. Postmastectomy Radiation Therapy in the Setting of Two-Stage Retropectoral Implant-Based Breast Reconstruction: Should It be Delivered Before or After Implant Exchange? A Retrospective Analysis on 183 Patients. Aesthetic Plast Surg 2022; 46:2643-2654. [PMID: 35854008 DOI: 10.1007/s00266-022-03001-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/19/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Postmastectomy radiation therapy (PMRT) has a primary role in the treatment of locally advanced breast cancer; however, the most appropriate timing of irradiation in immediate tissue expander breast reconstruction (ITEBR) still remains unknown. METHODS A retrospective review was performed on all women undergoing mastectomy and retropectoral ITEBR at Campus Bio-Medico University Hospital in Rome, Italy, between 2010 and 2019. The patients were categorized into three cohorts: patients undergoing PMRT with the tissue expander (TE) in situ, patients with PMRT delivered to the permanent implant (PI), patients who were not administered RT. Complications and failure rates were analysed and compared. Potential predictors of adverse outcomes were analysed. RESULTS Over 10 years, 183 patients underwent retropectoral ITEBR (55 PMRT-TE, 50 PMRT-PI, 78 no-PMRT). The three groups were well matched with respect to patient- and treatment-related factors (p > 0.05), with the exception of neoadjuvant chemotherapy and irradiation. The mean follow-up was, respectively, 4.58, 7 and 5.75 years. Radiotherapy either to the TE or to the PI was independently associated with failure and conversion to autologous procedures (p < 0.0001). Failure rate was significantly higher when TE was irradiated (p = 0.03). PMRT was associated with severe capsular contracture development (p < 0.00001), the odds being higher when irradiation was delivered after implant exchange (p = 0.04). Increased BMI was significantly associated with failure. CONCLUSIONS When PMRT is delivered to the TE, the risk of failure is higher (OR 2.77); when the PI is irradiated, reconstruction will more likely be affected by severe capsular contracture (OR 2.7). However, considering that the overall risk of severe capsular contracture correlated to PMRT is higher than failure, we believe that irradiation should be delivered to the TE. Performing a proper capsuloplasty at the time of implant exchange, indeed, allows to correct the deformities related to radiation-induced capsular contracture. Patients with unfavourable outcomes after TE placement and RT, instead, can be directly switched to autologous reconstruction. 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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Affiliation(s)
- Barbara Cagli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Marco Morelli Coppola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Federica Augelli
- Department of Plastic Surgery and Burn Unit, Niguarda Hospital, Milan, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
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11
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Marangi GF, Segreto F, Alessandri-Bonetti M, Coscarella G, Panasiti V, Vaienti L, Persichetti P. Basal cell carcinoma arising within port-wine stain. Int J Dermatol 2021; 61:e269-e270. [PMID: 34628637 DOI: 10.1111/ijd.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni Francesco Marangi
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Francesco Segreto
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, IRCSS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giulia Coscarella
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Vincenzo Panasiti
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, IRCSS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Paolo Persichetti
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
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Olaifa K, Nikodinovic-Runic J, Glišić B, Boschetto F, Marin E, Segreto F, Marsili E. Electroanalysis of Candida albicans biofilms: A suitable real-time tool for antifungal testing. Electrochim Acta 2021. [DOI: 10.1016/j.electacta.2021.138757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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13
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Conforti C, Agozzino M, Emendato G, Fai A, Fichera F, Marangi GF, Neagu N, Pellacani G, Persichetti P, Segreto F, Zalaudek I, Dianzani C. Acne and diet: a review. Int J Dermatol 2021; 61:930-934. [PMID: 34423427 DOI: 10.1111/ijd.15862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/12/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
Acne is one of the most frequent dermatological afflictions especially for people in their first 30 years of age. Several studies have shown that nutrition is one of the key factors involved in acne pathogenesis. Data show that a high glycemic index diet may be a trigger in acne pathogenesis, while patients with a low glycemic index diet have fewer acne lesions. Milk and chocolate are also involved in the exacerbation of acne. However, foods rich in omega-3 fatty acids suppress the production of inflammatory cytokines with therapeutic effect. Additionally, docosapentaenoic acid and γ-linolenic acid have demonstrated improved acne lesions. The aim of this review was to summarize current knowledge on the association between acne and diet with special attention to the most frequently discussed factors involved in its pathogenesis: milk, chocolate, omega-3 fatty acids, hyperglycemia, hyperinsulinism, and IGF-1.
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Affiliation(s)
| | | | - Giovanni Emendato
- Department of Plastic, Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, Italy
| | - Annatonia Fai
- Department of Plastic, Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, Italy
| | - Federica Fichera
- Department of Plastic, Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, Italy
| | - Giovanni F Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Nicoleta Neagu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
| | - Caterina Dianzani
- Department of Plastic, Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, Italy
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14
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Neagu N, Conforti C, Agozzino M, Marangi GF, Morariu SH, Pellacani G, Persichetti P, Piccolo D, Segreto F, Zalaudek I, Dianzani C. Melasma treatment: a systematic review. J DERMATOL TREAT 2021; 33:1816-1837. [PMID: 33849384 DOI: 10.1080/09546634.2021.1914313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Melasma is a common chronic refractory disorder of pigmentation affecting people with darker skin types. Overall prevalence varies between 8.8% and 40%, depending on the ethnicity of the population and the geographical area. Therapeutic management of melasma is challenging, with high recurrence rates which significant impacts on the quality of life. No single treatment is universally efficacious. Systemic treatments with tranexamic acid and polypodium leucotmatous had promising results, although the former was related to systemic side effects. Microneedling and peeling were also efficacious, although their superiority to topical hydroquinone, the gold standard in melasma treatment, remains to be established. Similarly, laser and light devices have been beneficial. However, recurrence rates remain high in all treatment groups. Combination therapies, either in double or triple combinations yielded the best results when compared to single terapies. Treatment choice should be made after Wood's lamp examination, as well as dermatoscopic evaluation, in order to select the best treatment option, targeted at each melasma subtype.
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Affiliation(s)
- Nicoleta Neagu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | | | | | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Francesco Segreto
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Conforti C, Vezzoni R, Giuffrida R, Fai A, Fadda S, Marangi GF, Persichetti P, Piccolo D, Segreto F, Zalaudek I, Dianzani C. An overview on the role of CO 2 laser in general dermatology. Dermatol Ther 2021; 34:e14692. [PMID: 33351990 DOI: 10.1111/dth.14692] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022]
Abstract
Among different laser types, the carbon dioxide (CO2 ) laser remains one of the most used by dermatologists. Its usefulness has been demonstrated both for therapeutic and cosmetic purposes. This review aims to provide an overview of the applications of CO2 laser in dermatology, focusing on the treatment of infective, neoplastic, and antiaesthetic lesions.
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Affiliation(s)
- Claudio Conforti
- Dermatology and Venereology Department, University of Trieste, Ospedale Maggiore di Trieste, Trieste, Italy
| | - Roberta Vezzoni
- Dermatology and Venereology Department, University of Trieste, Ospedale Maggiore di Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Annatonia Fai
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Sara Fadda
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Giovanni Francesco Marangi
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | | | - Francesco Segreto
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Iris Zalaudek
- Dermatology and Venereology Department, University of Trieste, Ospedale Maggiore di Trieste, Trieste, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
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Conforti C, Dianzani C, Agozzino M, Giuffrida R, Marangi GF, di Meo N, Morariu SH, Persichetti P, Segreto F, Zalaudek I, Neagu N. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. Biology (Basel) 2020; 9:E449. [PMID: 33291502 PMCID: PMC7762103 DOI: 10.3390/biology9120449] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/07/2023]
Abstract
There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Caterina Dianzani
- Dermatology Section, Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy;
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy;
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Silviu-Horia Morariu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Nicoleta Neagu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
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17
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Marangi GF, Segreto F, Morelli Coppola M, Arcari L, Gratteri M, Persichetti P. Management of chronic seromas: A novel surgical approach with the use of vacuum assisted closure therapy. Int Wound J 2020; 17:1153-1158. [PMID: 32716145 DOI: 10.1111/iwj.13447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022] Open
Abstract
Postoperative seroma is a common complication of many surgical procedures in which anatomical dead space has been created. A particular case of lesion in which seroma occurs is the Morel-Lavallée lesion (MLL), which is an uncommon closed soft-tissue degloving injury that develops after high-energy trauma or crush injury where shearing forces separate the subcutaneous tissue from the underlying fascia. The diagnostic evaluation begins with an adequate history and physical examination, followed by instrumental research with ultrasonography, computed tomography, and magnetic resonance imaging. Postoperative seromas and MLLs share a similar pathology and natural evolution as both injuries, once chronic, develop a pseudobursa; thus, the authors think that the same treatment algorithm may be suitable for both the lesions. Several strategies for the treatment of post-surgical and post-traumatic seromas have been described in the literature, ranging from conservative measures for acute and small injuries to surgical management and sclerotherapy for chronic and large ones. Despite some seromas resolving with conventional management, lesion recurrence is a matter of concern. The authors present their experience in the treatment of both post-surgical and post-traumatic chronic seromas not responsive to conservative treatments by surgical drainage of the seroma, capsulectomy, and application of vacuum-assisted closure therapy to allow granulation tissue formation, dead spaces obliteration, and wound healing. Primary wound closure with closed suction drain placement and an elastic compression bandaging are finally performed. From 2014 to 2019, a total of 15 patients (9 females and 6 males) were treated for recurrent chronic seromas with the proposed surgical approach. Five cases were MLLs, while 10 cases were postoperative seromas. The patients were between 33 and 79 years old, and they were followed up at 4 weeks and 3 and 6 months after surgery. All 15 patients with chronic seromas not responsive to conservative treatment showed a complete resolution of the lesions with the proposed treatment approach with no evidence of lesion recurrence, proving its effectiveness.
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Affiliation(s)
- Giovanni F Marangi
- Division of Plastic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Francesco Segreto
- Division of Plastic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | | | - Lucrezia Arcari
- Division of Plastic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Marco Gratteri
- Division of Plastic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Paolo Persichetti
- Division of Plastic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
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Segreto F, Carotti S, Marangi GF, Francesconi M, Scaramuzzino L, Gratteri M, Caldaria E, Morini S, Persichetti P. The use of acellular porcine dermis, hyaluronic acid and polynucleotides in the treatment of cutaneous ulcers: Single blind randomised clinical trial. Int Wound J 2020; 17:1702-1708. [PMID: 32710584 DOI: 10.1111/iwj.13454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022] Open
Abstract
Reconstruction of chronic ulcers is often hampered by lack of local tissues and poor general conditions. Conservative approaches with debridement and advanced medications, such as polyurethane foam, stand as mainstays. However, the healing process is often slow, thus increasing the risk for infection or other complications. In such cases, porcine dermis (PD) and polynucleotides-added hyaluronic acid (PAHA) were previously reported to accelerate healing. The aim of the study was to compare the efficacy of PD, PAHA and polyurethane foam in chronic ulcers. Thirty patients were randomly divided into 3 groups: group 1 was treated with advanced medications, group 2 with PD, group 3 with PAHA. Standardised photographs and biopsies were taken before treatment and at 30-day follow-up. Photographs were processed to calculate the wound area. Specimens were stained with Haematoxylin/Eosin, Masson trichrome, and immunohistochemically for CD34, alpha-Smooth Muscle Actin (α-SMA), Collagen types I and III, Ki67. The re-epithelialized area was larger in patients treated with PD and PAHA compared with those treated with polyurethane foam (P < .05 and P < .01, respectively). Specimens from patients treated with PD and PAHA showed a higher number of myofibroblasts (α-SMA+, P < .01), neo-angiogenesis (CD34+, P < .01), proliferating dermal cells (Ki67+, P < .01), proliferating keratinocytes (Ki67+, P < .01) and collagen type 1 deposition (P < .05). No difference was found between PD and PAHA. PD and PAHA proved to be more effective than polyurethane foam in the treatment of chronic ulcers. These approaches are a versatile and reliable option to address such cases.
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Affiliation(s)
- Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Simone Carotti
- Laboratory of Microscopical and Ultrastructural Anatomy, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Maria Francesconi
- Laboratory of Microscopical and Ultrastructural Anatomy, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Luca Scaramuzzino
- Department of General and Emergency Surgery, "Federico II" University, Naples, Italy
| | - Marco Gratteri
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Erika Caldaria
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Sergio Morini
- Laboratory of Microscopical and Ultrastructural Anatomy, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
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Brunetti B, Barone M, Tenna S, Salzillo R, Segreto F, Persichetti P. Pedicled perforator‐based flaps: Risk factor analysis, outcomes evaluation and decisional algorithm based on 130 consecutive reconstructions. Microsurgery 2020; 40:545-552. [DOI: 10.1002/micr.30590] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/29/2020] [Accepted: 03/27/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Beniamino Brunetti
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of Rome Rome Italy
| | - Mauro Barone
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of Rome Rome Italy
| | - Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of Rome Rome Italy
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of Rome Rome Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of Rome Rome Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of Rome Rome Italy
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Segreto F, Marangi GF, Signoretti M, Cazzato V, Giorgino R, Alessandri-Bonetti M, Persichetti P. The Use of Botulinum Toxin in Flap Surgery: A Review of the Literature. Surg Innov 2019; 26:478-484. [PMID: 30734634 DOI: 10.1177/1553350619828902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Botulinum neurotoxin-A and botulinum neurotoxin-B have been shown to play a potential role in improving flap survival in animal models. The aim of this study is to review indications as well as to study injection timing, technique, and doses of botulinum neurotoxin-A and botulinum neurotoxin-B in animal models. Seventeen articles describe a total of 266 animals that underwent botulinum toxin injections before or during flap harvesting or vascular anastomosis procedure. All the studies demonstrated a beneficial effect of botulinum toxin administration in flap surgery or vascular anastomosis. Botulinum neurotoxin-A injection was shown to be a reliable approach in reducing vascular complications rate and increasing survival of flaps in animal models. The main conclusions drawn from the study include the following: perivascular injections targeting each vascular pedicle are preferred in cases of free flaps or axial flaps; subdermal injections are favorable in cases of random pattern skin flaps; and injections should be performed 7 days before flap elevation.
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Affiliation(s)
| | | | | | - Vito Cazzato
- 1 "Campus Bio-Medico di Roma" University, Rome, Italy
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Morelli Coppola M, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol 2018; 11:387-396. [PMID: 30087573 PMCID: PMC6063260 DOI: 10.2147/ccid.s133672] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Keloids are pathological scars presenting as nodular lesions that extend beyond the area of injury. They do not spontaneously regress, often continuing to grow over time. The abnormal wound-healing process underlying keloid formation results from the lack of control mechanisms self-regulating cell proliferation and tissue repair. Keloids may lead to cosmetic disfigurement and functional impairment and affect the quality of life. Although several treatments were reported in the literature, no universally effective therapy was found to date. The most common approach is intralesional corticosteroid injection alone or in combination with other treatment modalities. Triamcinolone acetonide (TAC) is the most commonly used intralesional corticosteroid. The aim of this article was to review the use of TAC, alone or in combination, in the treatment of keloid scars. The response to corticosteroid injection alone is variable with 50-100% regression and a recurrence rate of 33% and 50% after 1 and 5 years, respectively. Compared to verapamil, TAC showed a faster and more effective response even though with a higher complication rate. TAC combined with verapamil was proved to be effective with statistically significant overall improvements of scars over time and long-term stable results. TAC and 5-fluorouracil (5-FU) intralesional injections were found to achieve comparable outcomes when administered alone, although 5-FU was more frequently associated with side effects. Conversely, the combination of 5-FU and TAC was more effective and showed fewer undesirable effects compared to TAC or 5-FU alone. Several kinds of laser treatments were reported to address keloids; however, laser therapy alone was burdened with a high recurrence rate. Better results were described by combining CO2, pulsed-dye or Nd: YAG lasers with TAC intralesional injections. Further options such as needle-less intraepidermal drug delivery are being explored, but more studies are needed to establish safety, feasibility and effectiveness of this approach.
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Affiliation(s)
- Marco Morelli Coppola
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico" University of Rome, Rome, Italy,
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico" University of Rome, Rome, Italy,
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico" University of Rome, Rome, Italy,
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico" University of Rome, Rome, Italy,
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Segreto F, Marangi GF, Delle Femmine PF, Greco F, Persichetti P. Foreign Body Reaction Mimicking Sarcoma. Plast Reconstr Surg Glob Open 2018; 5:e1612. [PMID: 29632787 PMCID: PMC5889436 DOI: 10.1097/gox.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/22/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022]
Abstract
Foreign body reaction can sometimes mimic the features of sarcoma. A 42-year-old patient was referred to our department for a rapidly growing subcutaneous mass in the posteromedial aspect of the lower leg. Ultrasonography and magnetic resonance imaging were highly suggestive for soft tissue sarcoma. The patient underwent surgical resection. The histho-pathologic diagnosis found that the supposed sarcoma was an inflammatory pseudo-tumor, also referred to as "gossypiboms". Surgeons must be aware that, in some cases, the imaging cannot reliably distinguish between sarcoma and foreign body reaction.
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Affiliation(s)
- Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy; and Unit of Diagnostic Imaging, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy; and Unit of Diagnostic Imaging, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Pietro Francesco Delle Femmine
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy; and Unit of Diagnostic Imaging, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Federico Greco
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy; and Unit of Diagnostic Imaging, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy; and Unit of Diagnostic Imaging, "Campus Bio-Medico di Roma" University, Rome, Italy
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Segreto F, Carotti S, Marangi GF, Tosi D, Zingariello M, Pendolino AL, Sancillo L, Morini S, Persichetti P. The role of angiogenesis, inflammation and estrogen receptors in breast implant capsules development and remodeling. J Plast Reconstr Aesthet Surg 2017; 71:637-643. [PMID: 29277501 DOI: 10.1016/j.bjps.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 10/27/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant placement. The multiple factors unbalancing the physiological response to the foreign body have not been fully elucidated. The aim of this study was to investigate the role of neo-angiogenesis, inflammation and estrogen receptors in peri-prosthetic tissue development and remodeling. METHODS The study enrolled 31 women who underwent expander substitution with definitive implant. Specimens were stained with hematoxylin/eosin, Masson trichrome, immunohistochemistry and immunofluorescence for alpha-smooth muscle actin, estrogen receptor-α (ER-α), estrogen receptor-β (ER-β), Collagen type I and III, CD31 (as a marker of neo-angiogenesis) and vascular endothelial growth factor (VEGF). Inflammatory infiltration was quantified and analyzed. Transmission electron microscopy was performed for ultrastructural evaluation. RESULTS Myofibroblasts, mainly localized in the middle layer of capsular tissue, expressed VEGF, ER-α and ER-β. ER-β expression positively correlated with Collagen type I deposition (p= 0.025). Neo-angiogenesis was predominant in the middle layer. CD31 expression positively correlated with Collagen type I expression (p=0.009) and inflammatory infiltration grade (p= 0.004). The degree of inflammatory infiltration negatively correlated with the time from implantation (p = 0.022). DISCUSSION The middle layer is key in the development and remodeling of capsular tissue. Myofibroblasts produce VEGF, that induces neo-angiogenesis. New vessels formation is also correlated to the inflammatory response. Collagen deposition is associated with ER-β expression and neo-angiogenesis. These findings may prelude to targeted pharmacologic therapies able to control such interactions, thus hampering the self-sustaining loop promoting the progression of physiologic fibrosis toward pathologic contracture.
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Affiliation(s)
- Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Simone Carotti
- Center for Integrated Biomedical Research (CIR), Laboratory of Microscopic and Ultrastructural Anatomy, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
| | - Daniele Tosi
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Maria Zingariello
- Center for Integrated Biomedical Research (CIR), Laboratory of Microscopic and Ultrastructural Anatomy, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Alfonso Luca Pendolino
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Laura Sancillo
- Medicine and Aging Sciences, University G. D'Annunzio of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Sergio Morini
- Center for Integrated Biomedical Research (CIR), Laboratory of Microscopic and Ultrastructural Anatomy, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
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Aveta A, Brunetti B, Tenna S, Segreto F, Persichetti P. Superficial temporal artery perforator flap: Anatomic study of number and reliability of distal branches of the superficial temporal artery and clinical applications in three cases. Microsurgery 2017; 37:924-929. [PMID: 29034512 DOI: 10.1002/micr.30237] [Citation(s) in RCA: 6] [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: 08/10/2016] [Revised: 08/01/2017] [Accepted: 08/25/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited information is available about the anatomical feasibility and clinical applications of flaps based on distal divisions of the superficial temporal artery (STA). The aim of this study was to investigate the anatomy of the STA, focusing on the number and reliability of distal branches and to show representative cases for the use of such flaps for zygomatic, parieto-frontal and occipital reconstructions. METHODS Fifty volunteers were examined bilaterally by Doppler to investigate the presence and variability of the distal divisions of STA branches. Dissection was performed on 14 temporal regions of 7 fresh cadavers. Three cases of reconstruction following skin cancer in the zygomatic (7 × 5 cm defect), parieto-frontal (4 × 4 cm defect) and occipital areas (4 × 2 cm defect) are presented. All the flaps were pedicled and based on a single vessel. RESULTS In all the 50 volunteers, the parietal branch split into 2 ± 0 branches (anterior and posterior), bilaterally, while an average of 2.84 ± 0.46 and 2.82 ± 0.48 branches originated from the frontal vessel on the right and left side, respectively. 2 ± 0 parietal and 3 ± 0 frontal (superior, central, and inferior) cutaneous perforator branches were identified in all cadaveric specimens. Flaps (4 × 10 cm, 5 × 7 cm, and 2 × 5 cm, respectively, width × length) healed uneventfully providing stable coverage. CONCLUSIONS STA distal perforator branches proved to be anatomically constant in both the cadaveric and clinical settings. Although a larger series of cases is needed, island flaps based on such vessels may represent a versatile surgical option, allowing a wide range of reconstructions in the different facial subunits.
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Affiliation(s)
- Achille Aveta
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Beniamino Brunetti
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Stefania Tenna
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Francesco Segreto
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
| | - Paolo Persichetti
- Unit of Plastic Surgery and Dermatology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
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Segreto F, Tosi D, Marangi GF, Pendolino AL, Santoro S, Gigliofiorito P, Persichetti P. Iloprost administration in acrodermatitis of Hallopeau complicated by acquired toes syndactyly: a case report and review of the literature. Eur Rev Med Pharmacol Sci 2015; 19:2945-2948. [PMID: 26367710] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Acrodermatitis Continua of Hallopeau (ACH) is a variant of pustular psoriasis often very difficult to treat. Secondary syndactyly, also called "pseudosyndactyly", is rare and can be a complication of burns, dystrophic epidermolysis bullosa or trauma. If left untreated, joint complications and definitive functional impairments may occur. CASE REPORT We report a case of a 74-year-old man with acrodermatitis continua of Hallopeau involving the toes and complicated by syndactyly. ACH regression following Iloprost administration was also observed. DISCUSSION Published studies are mainly limited to case reports only, due to the rarity of the disease. Therefore, there are no clear-cut therapeutic management guidelines available for this chronic and sometimes debilitating disease. ACH is often recalcitrant to the available therapies. Topical and systemic treatments have been described in literature with no long-lasting results. CONCLUSIONS To our knowledge, this is the first report of foot syndactyly associated to ACH. In our patient, ACH symptoms regressed with Iloprost administration: this finding has never been previously described in literature. If confirmed by other clinical experiences, Iloprost could be a further therapeutic option in ACH.
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Affiliation(s)
- F Segreto
- Plastic and Reconstructive Surgery Unit, Università Campus Bio-Medico di Roma, Rome, Italy.
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Brunetti B, Tenna S, Aveta A, Poccia I, Segreto F, Cerbone V, Persichetti P. Posterior trunk reconstruction with the dorsal intercostal artery perforator based flap: Clinical experience on 20 consecutive oncological cases. Microsurgery 2015; 36:546-551. [DOI: 10.1002/micr.22408] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Beniamino Brunetti
- Department of Plastic, Reconstructive and Aesthetic Surgery; “Campus Bio-Medico Di Roma” University; Rome Italy
| | - Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic Surgery; “Campus Bio-Medico Di Roma” University; Rome Italy
| | - Achille Aveta
- Department of Plastic, Reconstructive and Aesthetic Surgery; “Campus Bio-Medico Di Roma” University; Rome Italy
| | - Igor Poccia
- Department of Plastic, Reconstructive and Aesthetic Surgery; “Campus Bio-Medico Di Roma” University; Rome Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery; “Campus Bio-Medico Di Roma” University; Rome Italy
| | - Vincenzo Cerbone
- Department of Plastic, Reconstructive and Aesthetic Surgery; “Campus Bio-Medico Di Roma” University; Rome Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery; “Campus Bio-Medico Di Roma” University; Rome Italy
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Persichetti P, Segreto F, Pendolino AL, Del Buono R, Marangi GF. Breast implant capsule flaps and grafts: a review of the literature. Aesthetic Plast Surg 2014; 38:540-8. [PMID: 24764105 DOI: 10.1007/s00266-014-0308-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/18/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND A breast implant capsule forms as a physiological response to the foreign material. Over the past decades, authors started to consider the breast implant capsule as a new source of tissue, thus describing several capsular flaps and grafts. The aim of this article is to provide an overview of the applications and indications for the use of capsular tissue flaps and grafts in reconstructive and aesthetic surgery. METHODS A review of the literature on breast implant capsule grafts and flaps was conducted. The reported surgical techniques were described and compared for indications and complications. The studies were evaluated and compared for number of patients and follow-up. RESULTS The search yielded a total of 21 citations. Patient population was reported in 11 studies for capsular flaps and 2 articles for capsular grafts. Between 1997 and 2012, a total of 74 patients underwent surgery with the use of capsular tissue. Among these, 60 patients had a capsular flap (81 %) and 14 (19 %) had a capsular graft. Complications were experienced in 5 patients (6.7 %). CONCLUSIONS Capsular flaps and grafts are indicated mainly to address breast implant-related problems. The breast implant capsule represents a versatile and reliable source of tissue for both aesthetic and reconstructive surgery. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
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Affiliation(s)
- Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, 00128, Rome, Italy
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Brunetti B, Tenna S, Aveta A, Poccia I, Segreto F, Persichetti P. Soft-tissue coverage of the elbow. Plast Reconstr Surg 2014; 133:435e-437e. [PMID: 24572902 DOI: 10.1097/01.prs.0000438447.78400.a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Beniamino Brunetti
- Department of Plastic, Reconstructive, and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
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Persichetti P, Segreto F, Carotti S, Marangi GF, Tosi D, Morini S. Oestrogen receptor-alpha and -beta expression in breast implant capsules: experimental findings and clinical correlates. J Plast Reconstr Aesthet Surg 2013; 67:308-15. [PMID: 24389289 DOI: 10.1016/j.bjps.2013.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 09/27/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
Abstract
Myofibroblasts provide a force to decrease the surface area of breast implant capsules as the collagen matrix matures. 17-β-Oestradiol promotes myofibroblast differentiation and contraction. The aim of the study was to investigate the expression of oestrogen receptors α and β in capsular tissue. The study enrolled 70 women (80 capsules) who underwent expander or implant removal, following breast reconstruction. Specimens were stained with haematoxylin/eosin, Masson trichrome and immunohistochemistry and immunofluorescence stainings for alpha-smooth muscle actin (α-SMA), oestrogen receptor-alpha (ER-α) and oestrogen receptor-beta (ER-β). The relationship between anti-oestrogenic therapy and capsular severity was evaluated. A retrospective analysis of 233 cases of breast reconstruction was conducted. Myofibroblasts expressed ER-α, ER-β or both. In the whole sample, α-SMA score positively correlated with ER-α (p = 0.022) and ER-β expression (p < 0.004). ER-β expression negatively correlated with capsular thickness (p < 0.019). In capsules surrounding expanders α-SMA and ER-α, expressions negatively correlated with time from implantation (p = 0.002 and p = 0.016, respectively). The incidence of grade III-IV contracture was higher in patients who did not have anti-oestrogenic therapy (p < 0.036); retrospective analysis of 233 cases confirmed this finding (p < 0.0001). This study demonstrates the expression of oestrogen receptors in myofibroblasts of capsular tissue. A lower contracture severity was found in patients who underwent anti-oestrogenic therapy.
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Affiliation(s)
- Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Simone Carotti
- Center for Integrated Biomedical Research (CIR), Laboratory of Microscopic and Ultrastructural Anatomy, Campus Bio-Medico of Rome University, Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy.
| | - Daniele Tosi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Sergio Morini
- Center for Integrated Biomedical Research (CIR), Laboratory of Microscopic and Ultrastructural Anatomy, Campus Bio-Medico of Rome University, Rome, Italy
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Segreto F, Carotti S, Marangi GF, Tosi D, Morini S, Persichetti P. Abstract 153. Plast Reconstr Surg 2013. [DOI: 10.1097/01.prs.0000430095.40416.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Persichetti P, Aveta A, Segreto F. Combined Use of Acellular Dermal Matrix and Supraclavicular Artery Island Flap for Oropharyngeal Reconstruction. Plast Reconstr Surg 2013; 131:641e-642e. [DOI: 10.1097/prs.0b013e31828277d0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Persichetti P, Toto V, Signoretti M, Del B, Brunetti B, Segreto F, Lazzeri D, Marangi GF. The correction of nasal septal deviations in rhinoplasty. ACTA ACUST UNITED AC 2013. [DOI: 10.13172/2052-7837-1-2-517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Brunetti B, Tenna S, Segreto F, Del Buono R, Persichetti P. Lateral arm reconstruction with posterior radial collateral artery perforator based flap. J Plast Reconstr Aesthet Surg 2013; 66:875-6. [PMID: 23375832 DOI: 10.1016/j.bjps.2013.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
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Brunetti B, Tenna S, Aveta A, Segreto F, Persichetti P. Angular artery perforator flap for reconstruction of nasal sidewall and medial canthal defects. Plast Reconstr Surg 2012; 130:627e-628e. [PMID: 23018736 DOI: 10.1097/prs.0b013e318262f6ac] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Beniamino Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy
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Persichetti P, Toto V, Segreto F, Tosi D, Campa S, Marangi GF. The "inverted V" technique for rib cartilage L-shaped struts in rhinoplasty. Arch Facial Plast Surg 2012; 14:466-467. [PMID: 23165907 DOI: 10.1001/jamafacial.2013.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Affiliation(s)
- Beniamino Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Tonini G, Intagliata S, Cagli B, Segreto F, Perrone G, Onetti Muda A, Santini D, Persichetti P. Recurrent Scrotal Hemangiomas During Treatment With Sunitinib. J Clin Oncol 2010; 28:e737-8. [DOI: 10.1200/jco.2010.30.4865] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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38
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Carotti S, Guarino MPL, Cicala M, Perrone G, Alloni R, Segreto F, Rabitti C, Morini S. Effect of ursodeoxycholic acid on inflammatory infiltrate in gallbladder muscle of cholesterol gallstone patients. Neurogastroenterol Motil 2010; 22:866-73, e232. [PMID: 20426797 DOI: 10.1111/j.1365-2982.2010.01510.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reduced gallbladder (GB) contractility and chronic inflammatory changes in the mucosa have been reported in patients with cholesterol gallstones (GS). Ursodeoxycholic acid (UDCA) restores GB contractility and antagonises liver macrophage activation. In the colon, hydrophobic bile acid, not hydrophilic UDCA, induces mast cell degranulation. We studied the presence of monocyte/macrophage infiltrate, cyclooxygenase (COX)-2, inducible nitric oxide synthase (iNOS) expression, the number of total and degranulated mast cells in the GB muscle layer of cholesterol GS patients, and the effect of UDCA administration. METHODS Gallbladder tissue was obtained from cholesterol GS patients, either treated or untreated with UDCA (10 mg kg(-1) day(-1)) for 30 days prior to surgery. Gallbladders removed for neoplastic diseases, not involving GB, were evaluated for control purposes. The presence of monocytes/macrophages (CD68 positive), granulocytes, and mast cells, and the COX-2 and iNOS expression, was determined immunohistochemically. KEY RESULTS The number of CD68, granulocytes, mast cells, COX-2 and iNOS positive cells was significantly higher in the muscle layer of GS patients than in controls. Compared to untreated patients, those treated with UDCA showed significantly lower levels of CD68, COX-2 positive cells and degranulated mast cells and a lesser number of iNOS positive cells and granulocytes. CONCLUSIONS & INFERENCES An inflammatory monocyte/macrophage, mast cell and granulocyte infiltrate is present in the GB muscle layer of GS patients. Ursodeoxycholic acid decreases macrophages, degranulated mast cells and COX-2 expression. These results suggest that monocytes/macrophages and degranulating mast cells contribute to muscle cell dysfunction in cholesterol GS patients and support the anti-inflammatory effect of UDCA.
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Affiliation(s)
- S Carotti
- Department of Biomedical Research (CIR), University Campus Bio-Medico, Rome, Italy
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