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Stefura T, Rusinek J, Wątor J, Zagórski A, Zając M, Libondi G, Wysocki WM, Koziej M. Implant vs. autologous tissue-based breast reconstruction: A systematic review and meta-analysis of the studies comparing surgical approaches in 55,455 patients. J Plast Reconstr Aesthet Surg 2023; 77:346-358. [PMID: 36621238 DOI: 10.1016/j.bjps.2022.11.044] [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: 04/13/2022] [Revised: 10/13/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The choice of reconstruction type is of utmost importance in treating breast cancer. There are two major reconstructive pathways in this group of patients: autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR). The aim of this systematic review and meta-analysis was to assess and compare IBR vs. ABR. METHODS A review of studies reporting the differences between the procedures was performed. The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, Scopus, and Web of Science databases were thoroughly searched in September 2021. The data concerning group characteristics, BREAST-Q scores, complication rates, length of stay (LOS), and costs were extracted. The Cochrane risk-of-bias tool was used for randomized studies, while Newcastle-Ottawa Quality Assessment for Cohort Studies was used for other types of research. RESULTS Our meta-analysis included 32 studies (n = 55,455). We observed significantly better outcomes following ABR when it comes to esthetic satisfaction (mean difference [MD] -8.51; 95% confidence interval [CI] -10.70, -6.33; p<0.001) and satisfaction with the entire reconstructive treatment (MD -6.56; 95% CI -9.97, -3.14; p<0.001). Both methods appeared to be comparable in terms of safety, while the complication rates varied insignificantly between the groups (odds ratio [OR] 1.06; 95% CI 0.71, 1.59; p = 0.76). ABR seems to be correlated with significantly higher costs (standard mean difference [SMD] -0.69; 95% CI -1.21, -0.17; p = 0.010). CONCLUSIONS The results obtained from this evidence-based study will improve the understanding of the different clinical pathways that patients can be assigned to. The study emphasized the advantages and disadvantages of both methods.
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Affiliation(s)
| | - Jakub Rusinek
- Jagiellonian University Medical College, Cracow, Poland
| | - Julia Wątor
- Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Maciej Zając
- Jagiellonian University Medical College, Cracow, Poland
| | - Guido Libondi
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Cracow, Poland
| | - Wojciech M Wysocki
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Cracow, Poland; Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Cracow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
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Saour S, Libondi G, Ramakrishnan V. Microsurgical refinements with the use of internal mammary (IM) perforators as recipient vessels in transverse upper gracilis (TUG) autologous breast reconstruction. Gland Surg 2017; 6:375-379. [PMID: 28861378 DOI: 10.21037/gs.2017.05.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/06/2022]
Abstract
BACKGROUND The transverse upper gracilis (TUG) flap is the senior authors' second choice for autologous breast reconstruction when the DIEP flap is not available. It provides durable, pliable tissue with well hidden scars. The main criticism of this flap is the limited volume, donor site complications, short pedicle and vessel mismatch depending on which recipient vessels are used. We described methods of reducing vessel mismatch, complications of venous coupler and refinements to help give a more superior aesthetic outcome. METHODS We describe several maneuvers to help reduce vessel mismatch with the use of the internal mammary (IM) perforator vessels with a modification of the Harashina fish-mouth technique or the use of a vessel bifurcation to increase vessel diameter. We also describe the optimum method of perforator preparation and potential methods to prevent palpable venous couplers. The author's describe their case series of 14 TUG flaps to reconstruct 13 breasts in 12 patients. RESULTS Eight unilateral, 2 partial breast reconstruction, 1 bilateral and 1 bilateral TUG flap for a unilateral reconstruction was carried out. All flaps survived with one partial flap necrosis, one donor site seroma and two cases of palpable/tender venous couplers. The mean reconstructed breast was 320 grams. CONCLUSIONS The TUG flap is a reconstructive challenge, but with correct planning a good aesthetic outcome is possible. The IM perforator is our first choice recipient vessel in TUG breast reconstructions. With meticulous preparation and by overcoming vessel mismatch the use of this recipient vessel is a reliable option.
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Affiliation(s)
- Samer Saour
- Department of Plastic and Reconstructive Surgery, St. Andrews Centre of Burns and Plastics, Broomfield Hospital, Chelmsford CM1 7ET, UK
| | - Guido Libondi
- Department of Plastic and Reconstructive Surgery, St. Andrews Centre of Burns and Plastics, Broomfield Hospital, Chelmsford CM1 7ET, UK
| | - Venkat Ramakrishnan
- Department of Plastic and Reconstructive Surgery, St. Andrews Centre of Burns and Plastics, Broomfield Hospital, Chelmsford CM1 7ET, UK
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Raposio E, Libondi G, Bertozzi N, Grignaffini E, Grieco MP. Effects of Topic Simvastatin for the Treatment of Chronic Vascular Cutaneous Ulcers: A Pilot Study. J Am Coll Clin Wound Spec 2016; 7:13-18. [PMID: 28053863 DOI: 10.1016/j.jccw.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/27/2022] Open
Abstract
Recent research suggests that statins might be useful in the process of wound healing, playing a positive immune-modulatory role, improving microvascular function and reducing oxidative stress. The aim of this pilot study was to evaluate the efficacy of topic application of Simvastatin-based cream in the treatment of chronic vascular cutaneous ulcers, comparing this type of treatment to a collagen-based dressing, proven to be effective for ulcer treatment. A total of 20 ulcers were studied in 2 Groups of randomly-chosen patients for a period of one month. In the first Group a 0.5% Simvastatin-based cream was topically administered, while the second Group (control) was treated with an absorbable type I bovine collagen-based medication. Each week, wound healing progress was observed in both Groups, and the ulcers photographed. Wound healing rate was calculated by considering the absolute change in area and by the formula "healing ratio (%) = [(Area0 - Areat4)/Area0] × 100," both sets of data being related to the days comprised in the study in order to calculate healing rate per day. Statistical analysis was performed by Student t test. Study endpoint equaling the time-course changes of ulcer areas. At the end of the study, when considering absolute change in area, the experimental Group appeared to heal better and faster than the control Group although differences between the Groups were not statistically significant. Conversely, rates of wound healing in the experimental and control Groups were 46.88% and 64% respectively, revealing statistically significant differences. (P < 0.05). In conclusion, topic application of a simvastatin-based cream proved to be well- tolerated but not effective in the management of vascular leg ulcers in a 4 week-period.
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Affiliation(s)
- Edoardo Raposio
- Department of Surgical Sciences, Plastic Surgeon Division, University of Parma, Parma, Italy; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Guido Libondi
- Department of Surgical Sciences, Plastic Surgeon Division, University of Parma, Parma, Italy; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Nicolò Bertozzi
- Department of Surgical Sciences, Plastic Surgeon Division, University of Parma, Parma, Italy; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Eugenio Grignaffini
- Department of Surgical Sciences, Plastic Surgeon Division, University of Parma, Parma, Italy; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele P Grieco
- Department of Surgical Sciences, Plastic Surgeon Division, University of Parma, Parma, Italy; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Libondi G, Solinas M, Martella EM, Cattelani L. Nipple sparing mastectomy with immediate silicone implant reconstruction for malignant phyllodes tumor in a 19-year-old girl. Eur Rev Med Pharmacol Sci 2015; 19:4498-4500. [PMID: 26698244] [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 Due to the rarity of MPT, the clinical records in the literature, collected along decades, lack to address a modern approach to breast reconstruction after mastectomy. CASE PRESENTATION We report a case of a teen-aged female diagnosed to have a malignant phyllodes in her right breast. DISCUSSION The surgical treatment of choice, taking in account the relation between the volume of the mass and the breast dimension, was considered to be a mastectomy. As the disease didn't involve the skin envelope a nipple-areolar-sparing gland removal allowed an immediate prosthetic reconstruction with a contralateral augmentation for symmetrization, so obtaining a satisfactory aesthetic outcome. CONCLUSIONS At our knowledge we present for the first time this surgical approach that, in selected patients, can reach the oncologic radicality and an adequate cosmetic result too.
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Affiliation(s)
- G Libondi
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Department of Surgical Sciences, Parma University Hospital, Parma, Italy.
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De Francesco F, Tirino V, Desiderio V, Ferraro G, D'Andrea F, Giuliano M, Libondi G, Pirozzi G, De Rosa A, Papaccio G. Human CD34/CD90 ASCs are capable of growing as sphere clusters, producing high levels of VEGF and forming capillaries. PLoS One 2009; 4:e6537. [PMID: 19657392 PMCID: PMC2717331 DOI: 10.1371/journal.pone.0006537] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 07/08/2009] [Indexed: 12/21/2022] Open
Abstract
Background Human adult adipose tissue is an abundant source of mesenchymal stem cells (MSCs). Moreover, it is an easily accessible site producing a considerable amount of stem cells. Methodology/Principal Findings In this study, we have selected and characterized stem cells within the stromal vascular fraction (SVF) of human adult adipose tissue with the aim of understanding their differentiation capabilities and performance. We have found, within the SVF, different cell populations expressing MSC markers – including CD34, CD90, CD29, CD44, CD105, and CD117 – and endothelial-progenitor-cell markers – including CD34, CD90, CD44, and CD54. Interestingly, CD34+/CD90+ cells formed sphere clusters, when placed in non-adherent growth conditions. Moreover, they showed a high proliferative capability, a telomerase activity that was significantly higher than that found in differentiated cells, and contained a fraction of cells displaying the phenotype of a side population. When cultured in adipogenic medium, CD34+/CD90+ quickly differentiated into adipocytes. In addition, they differentiated into endothelial cells (CD31+/VEGF+/Flk-1+) and, when placed in methylcellulose, were capable of forming capillary-like structures producing a high level of VEGF, as substantiated with ELISA tests. Conclusions/Significance Our results demonstrate, for the first time, that CD34+/CD90+ cells of human adipose tissue are capable of forming sphere clusters, when grown in free-floating conditions, and differentiate in endothelial cells that form capillary-like structures in methylcellulose. These cells might be suitable for tissue reconstruction in regenerative medicine, especially when patients need treatments for vascular disease.
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Affiliation(s)
- Francesco De Francesco
- Dipartimento di Medicina Sperimentale, Sezione di Istologia ed Embriologia, Tissue Engineering and Regenerative Medicine (TERM) Laboratory, Seconda Università di Napoli, Napoli, Italy
- Dipartimento di Scienze Ortopediche, Traumatologiche, Riabilitative e Plastico-Ricostruttive, Seconda Università di Napoli, Napoli, Italy
| | - Virginia Tirino
- Dipartimento di Medicina Sperimentale, Sezione di Istologia ed Embriologia, Tissue Engineering and Regenerative Medicine (TERM) Laboratory, Seconda Università di Napoli, Napoli, Italy
| | - Vincenzo Desiderio
- Dipartimento di Medicina Sperimentale, Sezione di Istologia ed Embriologia, Tissue Engineering and Regenerative Medicine (TERM) Laboratory, Seconda Università di Napoli, Napoli, Italy
| | - Giuseppe Ferraro
- Dipartimento di Scienze Ortopediche, Traumatologiche, Riabilitative e Plastico-Ricostruttive, Seconda Università di Napoli, Napoli, Italy
| | - Francesco D'Andrea
- Dipartimento di Scienze Ortopediche, Traumatologiche, Riabilitative e Plastico-Ricostruttive, Seconda Università di Napoli, Napoli, Italy
| | - Mariateresa Giuliano
- Dipartimento di Medicina Sperimentale, Sezione di Biotecnologie, Seconda Università di Napoli, Napoli, Italy
| | - Guido Libondi
- Dipartimento di Medicina Sperimentale, Sezione di Istologia ed Embriologia, Tissue Engineering and Regenerative Medicine (TERM) Laboratory, Seconda Università di Napoli, Napoli, Italy
- Dipartimento di Scienze Ortopediche, Traumatologiche, Riabilitative e Plastico-Ricostruttive, Seconda Università di Napoli, Napoli, Italy
| | - Giuseppe Pirozzi
- UOC Biologia cellulare e Bioterapia, Istituto Nazionale Tumori “G. Pascale”, Napoli, Italy
| | - Alfredo De Rosa
- Dipartimento di Scienze Odontostomatologiche, Ortodontiche e Chirurgiche, Seconda Università di Napoli, Napoli, Italy
| | - Gianpaolo Papaccio
- Dipartimento di Medicina Sperimentale, Sezione di Istologia ed Embriologia, Tissue Engineering and Regenerative Medicine (TERM) Laboratory, Seconda Università di Napoli, Napoli, Italy
- * E-mail:
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