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Rosti A, Ammar A, Pignatti M, Molteni G, Franchi A, Cipriani R, Presutti L, Fermi M. SCIP flap in head and neck reconstruction after oncologic ablative surgery: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:1083-1093. [PMID: 37855885 DOI: 10.1007/s00405-023-08287-0] [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: 07/15/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In the surgical treatment of head and neck locally advanced malignancies, microvascular free flaps represent the most valuable solution to reconstruct the tissue defect after resection of the primary neoplasm. In particular, microvascular free flaps allow to restore the functional and aesthetical features of the head and neck compartments. The superficial circumflex iliac perforator (SCIP) flap represents, as an evolution of the groin flap, a valid alternative to the radial fasciocutaneous free (RFFF) flap or the anterolateral thigh (ALT) flap. METHODS This systematic review adhered to the recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) 2009 guidelines. A computerized MEDLINE search was performed using the PubMed service of the U.S. National Library of Medicine ( www.pubmed.org ) and Scopus database ( www.scopus.com ). Two authors screened the articles, then selected and extracted data on malignancies characteristics, reconstructive techniques, outcomes, and complications. RESULTS A total of 25 articles were selected and reviewed among the 39 identified through the search string. Six out of the selected 25 articles were case reports, while the remaining 19 articles were retrospective case series. The whole study population was represented by 174 oncologic patients undergoing ablation of a head and neck tumor and reconstruction with a SCIP flap. The site of reconstruction was the oral cavity in 125 (71.0%) patients, being the tongue the most common subsite in 73 (41.5%) patients, the pharynx in 10 (5.7%) cases, the larynx in 3 (1.7%) and head and neck skin in 36 (20.4%) patients. Only two cases of total flap loss were reported. Partial flap loss or shrinkage requiring minor surgical revisions was observed in 11 patients (6.32%). Primary closure of the donor site was achieved in the whole study population, according to the available data. CONCLUSIONS In head and neck postoncological reconstruction, despite the caliber and the length of the pedicle, SCIP flap offers a pliable and thin skin paddle, allowing single-stage resurfacing, medium to large skin paddle, possibility of composite-fashion harvest and a well-concealed donor site.
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Affiliation(s)
- Alessandro Rosti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
| | - Alessandro Ammar
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Pignatti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gabriele Molteni
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Alberto Franchi
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Riccardo Cipriani
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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Truglio M, Sivori F, Cavallo I, Abril E, Licursi V, Fabrizio G, Cardinali G, Pignatti M, Toma L, Valensise F, Cristaudo A, Pimpinelli F, Di Domenico EG. Modulating the skin mycobiome-bacteriome and treating seborrheic dermatitis with a probiotic-enriched oily suspension. Sci Rep 2024; 14:2722. [PMID: 38302693 PMCID: PMC10834955 DOI: 10.1038/s41598-024-53016-0] [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: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
Seborrheic dermatitis (SD) affects 2-5% of the global population, with imbalances in the skin microbiome implicated in its development. This study assessed the impact of an oily suspension containing Lactobacillus crispatus P17631 and Lacticaseibacillus paracasei I1688 (termed EUTOPLAC) on SD symptoms and the skin mycobiome-bacteriome modulation. 25 SD patients were treated with EUTOPLAC for a week. Symptom severity and skin mycobiome-bacteriome changes were measured at the start of the treatment (T0), after seven days (T8), and three weeks post-treatment (T28). Results indicated symptom improvement post-EUTOPLAC, with notable reductions in the Malassezia genus. Concurrently, bacterial shifts were observed, including a decrease in Staphylococcus and an increase in Lactobacillus and Lacticaseibacillus. Network analysis highlighted post-EUTOPLAC instability in fungal and bacterial interactions, with increased negative correlations between Malassezia and Lactobacillus and Lacticaseibacillus genera. The study suggests EUTOPLAC's potential as a targeted SD treatment, reducing symptoms and modulating the mycobiome-bacteriome composition.
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Affiliation(s)
- Mauro Truglio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Elva Abril
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Valerio Licursi
- Institute of Molecular Biology and Pathology, National Research Council of Italy, 00185, Rome, Italy
| | - Giorgia Fabrizio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
- Department of Biology and Biotechnology C. Darwin, Sapienza University of Rome, 00185, Rome, Italy
| | - Giorgia Cardinali
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | | | - Luigi Toma
- Medical Directorate, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Floriana Valensise
- Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Antonio Cristaudo
- Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy.
| | - Enea Gino Di Domenico
- Department of Biology and Biotechnology C. Darwin, Sapienza University of Rome, 00185, Rome, Italy.
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Rapparini L, Venturi F, Gelati C, Giorgini F, Pignatti M, Placa ML, Scotti B, Veronesi G, Dika E. Reflectance confocal microscopy features of chronic radiodermatitis: A useful tool for presurgical mapping. Skin Res Technol 2024; 30:e13621. [PMID: 38391115 PMCID: PMC10885167 DOI: 10.1111/srt.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Luca Rapparini
- Oncologic Dermatology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Federico Venturi
- Oncologic Dermatology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Chiara Gelati
- Plastic SurgeryIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Federico Giorgini
- Plastic SurgeryIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Marco Pignatti
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
- Plastic SurgeryIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Michelangelo La Placa
- Oncologic Dermatology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Biagio Scotti
- Oncologic Dermatology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Giulia Veronesi
- Oncologic Dermatology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Emi Dika
- Oncologic Dermatology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
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Maniglio M, Maruccia M, Morandi M, Martineau J, Sapino G, Elia R, Pignatti M, di Summa PG. Comparisons of the morbidities of a double gastrocnemius flap and a medial gastrocnemius flap in the orthoplastic reconstruction around the knee. Microsurgery 2024; 44:e31114. [PMID: 37861063 DOI: 10.1002/micr.31114] [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] [Received: 11/27/2022] [Revised: 07/22/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The pedicled gastrocnemius flap is commonly used to treat lower limb defects. Either the medial, lateral, or both heads can be used. When extended soft tissue defects are present, a double gastrocnemius (DG) flap may be used. However, no data of the additional donor site morbidity compared to a medial gastrocnemius (MG) flap are available. The aim of this study was to compare the donor site morbidity of a DG with that of a MG. METHODS Patients with a soft tissue defect around the knee, treated with a gastrocnemius flap between 2018 and 2021 at the University Hospital of Lausanne and Bari, with a minimum follow-up of 12 months, were included. According to the size and the position of the defect, it was decided whether one (10 patients) or two (9 patients) heads of the gastrocnemius were necessary for the coverage. The mean age was 61 years (range 42-82) in DG, and 63 years (range 45-78) in MG. The average defect size was 89.8 cm2 in the DG group and 53.4 cm2 in the MG group. The etiologies were trauma (n = 10), infection (n = 7) and sarcoma (n = 2). A medial approach or a posterior midline approach was used for the harvesting of the gastrocnemius muscle. Once the flap was harvested, it was rotated and transposed anteriorly over the defect, either through a subcutaneous tunnel or by dividing the intervening skin bridge, depending on the soft tissue defect. A split-thickness skin graft was used to close the skin over the remaining exposed muscle flap. The active range of motion of the ankle and knee joints was measured. Muscle strength was assessed with a hand-held dynamometer and by the ability to stand on tiptoe. Physical function was evaluated through the Lower Extremity Functional Scale (LEFS). RESULTS The two groups were homogeneous, with no significant difference in age, sex, and BMI. All flaps survived in both groups. Both groups showed lower values in strength and range of motion of the operated leg, when compared to contralateral side. In plantar flexion, this accounted for a reduction in MG by 3.8 ± 1.0 kg of strength and 8 ± 3° of ROM, and in DG by 4.7 ± 1.7 kg and 16 ± 4°, respectively. For knee flexion, the reduction in MG was 4.4 ± 0.6 kg and 16 ± 7°, while in DG 5.6 ± 1.0 kg and 28 ± 6°. In the MG group, 60% were able to stand on the tiptoe of the operated leg, as opposed to 0% in DG. The average LEFS score in DG was lower by 10.9 points (p < .05). Questions concerning running and jumping had a lower score in DG (p < .01). CONCLUSIONS The harvesting of both gastrocnemii led to significant additional donor site morbidity compared to the harvesting of the medial gastrocnemius alone. However, the additional morbidity did not have an impact on activities of daily living and walking, even though it limited the ability to perform more demanding tasks such as running and jumping. Therefore, based on our study, the choice of a DG flap should be critically assessed in younger, more demanding patients.
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Affiliation(s)
- Mauro Maniglio
- Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Michele Maruccia
- Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionac Area (DIMIPRE-J), University of Bari Aldo Moro, piazza giulio cesare, Bari, Italy
| | - Marco Morandi
- Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Jérôme Martineau
- Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Gianluca Sapino
- Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Rossella Elia
- Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionac Area (DIMIPRE-J), University of Bari Aldo Moro, piazza giulio cesare, Bari, Italy
| | - Marco Pignatti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero Universitaria (AOU), Policlinico di Sant'Orsola di Bologna, Bologna, Italy
| | - Pietro G di Summa
- Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
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Pignatti M, Dolci G, Zamagni E, Pascale R, Piccin O, Ammar A, Zeneli F, Miralles MEL, Mancuso K, Cipriani R, Viale P, Pacini D, Martin-Suàrez S. Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature. Microorganisms 2023; 11:2699. [PMID: 38004712 PMCID: PMC10673517 DOI: 10.3390/microorganisms11112699] [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: 09/27/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Sternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery for severe aortic valve stenosis, followed by sternal wound dehiscence and sternum osteomyelitis due to extended spectrum beta lactamase (ESBL) producing Klebsiella aerogenes. A multiple myeloma diagnosis was also suspected at the positron emission tomography (PET) scan and confirmed with bone marrow biopsy. Multidisciplinary evaluation of the case led to a comprehensive treatment plan. To control the sternal osteomyelitis, total sternectomy was performed followed by immediate reconstruction with a bone (tibia) graft from the tissue bank and fixation with the minimal hardware possible. A microsurgical latissimus dorsi free flap was required to reconstruct the soft tissue defect. After 6 weeks of antibiotic treatment with ertapenem and fosfomycin based on a culture of intraoperative material, no clinical, imaging, or laboratory signs of infection were seen. Multiple myeloma treatment was then started. At 1 year of follow up, no recurrence of infection occurred, and the reconstruction was stable and closed. Multiple myeloma is under chronic treatment with novel agent combination, with an excellent haematological response.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (F.Z.); (M.E.L.M.); (R.C.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (E.Z.); (R.P.); (K.M.); (P.V.); (D.P.)
| | - Giampiero Dolci
- Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elena Zamagni
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (E.Z.); (R.P.); (K.M.); (P.V.); (D.P.)
- Haematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Renato Pascale
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (E.Z.); (R.P.); (K.M.); (P.V.); (D.P.)
- Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ottavio Piccin
- Otorinolaryngology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessandro Ammar
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (F.Z.); (M.E.L.M.); (R.C.)
- Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Flavia Zeneli
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (F.Z.); (M.E.L.M.); (R.C.)
- Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Maria Elisa Lozano Miralles
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (F.Z.); (M.E.L.M.); (R.C.)
- Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Katia Mancuso
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (E.Z.); (R.P.); (K.M.); (P.V.); (D.P.)
- Haematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Riccardo Cipriani
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (F.Z.); (M.E.L.M.); (R.C.)
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (E.Z.); (R.P.); (K.M.); (P.V.); (D.P.)
- Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Davide Pacini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (E.Z.); (R.P.); (K.M.); (P.V.); (D.P.)
- Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Sofia Martin-Suàrez
- Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Sambri A, Fiore M, Rottoli M, Bianchi G, Pignatti M, Bortoli M, Ercolino A, Ancetti S, Perrone AM, De Iaco P, Cipriani R, Brunocilla E, Donati DM, Gargiulo M, Poggioli G, De Paolis M. A Planned Multidisciplinary Surgical Approach to Treat Primary Pelvic Malignancies. Curr Oncol 2023; 30:1106-1115. [PMID: 36661733 PMCID: PMC9857743 DOI: 10.3390/curroncol30010084] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The pelvic anatomy poses great challenges to orthopedic surgeons. Sarcomas are often large in size and typically enclosed in the narrow confines of the pelvis with the close proximity of vital structures. The aim of this study is to report a systematic planned multidisciplinary surgical approach to treat pelvic sarcomas. Seventeen patients affected by bone and soft tissue sarcomas of the pelvis, treated using a planned multidisciplinary surgical approach, combining the expertise of orthopedic oncology and other surgeons (colleagues from urology, vascular surgery, abdominal surgery, gynecology and plastic surgery), were included. Seven patients were treated with hindquarter amputation; 10 patients underwent excision of the tumor. Reconstruction of bone defects was conducted in six patients with a custom-made 3D-printed pelvic prosthesis. Thirteen patients experienced at least one complication. Well-organized multidisciplinary collaborations between each subspecialty are the cornerstone for the management of patients affected by pelvic sarcomas, which should be conducted in specialized centers. A multidisciplinary surgical approach is of paramount importance in order to obtain the best successful surgical results and adequate margins for achieving acceptable outcomes.
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Affiliation(s)
- Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Fiore
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Matteo Rottoli
- General Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Marco Pignatti
- Plastic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marta Bortoli
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Ancetti
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncoloy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Gynecologic Oncoloy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Riccardo Cipriani
- Plastic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Mauro Gargiulo
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gilberto Poggioli
- General Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Pignatti M, Sorbi G, Pinto V, Sorrenti G, Cipriani R. Use of the Spare-Part Strategy to Reconstruct the External Auditory Canal After Subtotal Auriculectomy for Basal Cell Carcinoma. Indian J Otolaryngol Head Neck Surg 2022; 74:5974-5977. [PMID: 36742489 PMCID: PMC9895203 DOI: 10.1007/s12070-021-02654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
After removal of an infiltrative BCC of the auditory meatus, a soft tissue defect of the temporal-mastoid area with bone exposure, needed reconstruction. Several options have been taken into account and a simple yet effective solution has been found following the spare-parts principle. The ear lobe, preserved during cancer removal, was split and used as a thin skin flap. Adequate coverage of the bone exposure and resurfacing of the external auditory canal was obtained with minimal donor site morbidity and a short surgery in a fragile patient with several comorbidities. The spare-parts strategy can provide successful solution to difficult reconstructive cases regardless of the anatomical area.
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Affiliation(s)
- Marco Pignatti
- grid.6292.f0000 0004 1757 1758Plastic Surgery, IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.6292.f0000 0004 1757 1758DIMES-Università di Bologna, Alma Mater Studiorum, Bologna, Italy
| | - Gioia Sorbi
- grid.6292.f0000 0004 1757 1758Plastic Surgery, IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy ,grid.7548.e0000000121697570Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Pinto
- grid.6292.f0000 0004 1757 1758Plastic Surgery, IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Giovanni Sorrenti
- grid.6292.f0000 0004 1757 1758Otolaryngology Head and Neck Surgery, IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Cipriani
- grid.6292.f0000 0004 1757 1758Plastic Surgery, IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Sambri A, Pignatti M, Tedeschi S, Lozano Miralles ME, Giannini C, Fiore M, Filippini M, Cipriani R, Viale P, De Paolis M. Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia. Microorganisms 2022; 10:microorganisms10081640. [PMID: 36014058 PMCID: PMC9414956 DOI: 10.3390/microorganisms10081640] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected (“staged approach”). In five cases, the DT was preserved (“single-stage approach”). A wide debridement was performed, and the cavity was filled with antibiotic-loaded PerOssal beads. All patients had a soft-tissue defect covered by a free vascularized flap (anterolateral thigh perforator flap in eight cases, latissimus dorsi flap in five). At the final follow-up (mean 25 months, range, 13–37), no infection recurrence was observed. In one patient, the persistence of infection was observed, and the patient underwent a repeated debridement. In two cases, a voluminous hematoma was observed. However, none of these complications impacted the final outcome. The successful treatment of FRI depends on proper debridement and obliteration of dead spaces with a flap. Therefore, when dealing with DT FRI, debridement of infected bone and soft tissues must be as radical as required, with no fear of the need for massive reconstructions.
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Affiliation(s)
- Andrea Sambri
- Orthopaedics Unit, IRCCS AOU di Bologna, 40138 Bologna, Italy
- Correspondence:
| | - Marco Pignatti
- Plastic Surgery Unit, IRCCS AOU di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Sara Tedeschi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Infectious Disease Unit, IRCCS AOU di Bologna, 40138 Bologna, Italy
| | | | | | - Michele Fiore
- Orthopaedics Unit, IRCCS AOU di Bologna, 40138 Bologna, Italy
| | | | | | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Infectious Disease Unit, IRCCS AOU di Bologna, 40138 Bologna, Italy
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Pinto V, Pignatti M, Contu L, Cipriani R. Defining the Inframammary Fold by Liposuction: An Essential Tool in Aesthetic Shaping of the Reconstructed Breast. Technique and Long-term Results in a Series of Patients. Aesthetic Plast Surg 2022; 46:58-68. [PMID: 34467422 PMCID: PMC8831342 DOI: 10.1007/s00266-021-02543-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/15/2021] [Indexed: 11/05/2022]
Abstract
Background A good inframammary fold (IMF) definition and position is essential to achieve a satisfactory and natural result in breast surgery. This structure can be damaged, especially during mastectomies. Multiple methods are reported in the literature to restore IMF or improve its definition. In this study, we present the results achieved in a series of patients treated with subdermal liposuction. Methods We report on all our patients who underwent IMF liposuction between January 2016 and June 2020. Subdermal liposuction was performed with a blunt 3 mm cannula along the new IMF to promote skin retraction and adherence between skin and fascia. Results were evaluated subjectively by the patients and objectively by 8 individuals not involved with the treatment. Results We performed IMF liposuction in 88 breasts (69 patients), aged 21–74 (mean 52) years for 82 implant-based reconstructions, 2 tuberous breasts, and 4 contralateral breast augmentations. Mean follow-up was 28 months (6–64). Subjective results: the overall result evaluated with the VAS scale reached 86.6/100. All the 22 patients interviewed judged as well defined the new inframammary fold. Objective results: in 83% of cases the definition of the inframammary fold was judged as good or excellent, while symmetry with contralateral IMF, natural appearance, and overall aesthetic outcome were judged as good. Conclusion Based on our long-term satisfactory results, we recommend the technique of subdermal liposuction to improve the definition of IMF in breast reconstruction after mastectomy and other breast procedures. It is effective, easy to perform, minimally invasive, and durable. Level of Evidence IV 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 www.springer.com/00266.
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10
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Pignatti M, Pinto V, Contu L, Cipriani R. Invited Response on: Letter-to-the-Editor: Defining the Inframammary Fold by Liposuction: An Essential Tool in Aesthetic Shaping of the Reconstructed Breast-Technique and Long-Term Results in a Series of Patients. Aesthetic Plast Surg 2021; 46:78-79. [PMID: 34677640 DOI: 10.1007/s00266-021-02622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Pignatti
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), University of Bologna, Bologna, Italy.
| | - Valentina Pinto
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Luca Contu
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Riccardo Cipriani
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
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11
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Pignatti M, D'Arpa S, Roche N, Giorgini FA, Lusetti IL, Lorca-Garcia C, De Santis G, Berenguer B. Surgical treatment of pressure injuries in children: A multicentre experience. Wound Repair Regen 2021; 29:961-972. [PMID: 34473875 PMCID: PMC9293131 DOI: 10.1111/wrr.12964] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/22/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1–17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola di Bologna, Bologna.,DIMES, University of Bologna, Palermo
| | - Salvatore D'Arpa
- Plastic and Reconstructive Surgery, La Maddalena Cancer Center, Palermo, Italy
| | - Nathalie Roche
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Federico A Giorgini
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola di Bologna, Bologna.,Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | - Irene Laura Lusetti
- Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | | | - Giorgio De Santis
- Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | - Beatriz Berenguer
- Pediatric Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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12
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Pignatti M, Spinella A, Cocchiara E, Boscaini G, Lusetti IL, Citriniti G, Lumetti F, Setti G, Dominici M, Salvarani C, De Santis G, Giuggioli D. Invited Response on: Comments on "Autologous Fat Grafting for the Oral and Digital Complications of Systemic Sclerosis: Results of a Prospective Study". Aesthetic Plast Surg 2021; 45:1344-1345. [PMID: 33145615 DOI: 10.1007/s00266-020-02024-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Pignatti
- Plastic Surgery, Policlinico di Sant'Orsola, DIMES, University of Bologna, Bologna, Italy.
| | - Amelia Spinella
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Emanuele Cocchiara
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Giulia Boscaini
- Plastic Surgery, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Irene Laura Lusetti
- Plastic Surgery, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Giorgia Citriniti
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Federica Lumetti
- Rheumatology Unit, University of Modena and Reggio Emilia, Medical School, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Giacomo Setti
- Unit of Dentistry and Oral-Maxillofacial Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Dominici
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Giorgio De Santis
- Plastic Surgery, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
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13
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Coppola PE, Gaibani P, Sartor C, Ambretti S, Lewis RE, Sassi C, Pignatti M, Paolini S, Curti A, Castagnetti F, Ursi M, Cavo M, Stanzani M. Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients. Microorganisms 2020; 8:microorganisms8122055. [PMID: 33371496 PMCID: PMC7767535 DOI: 10.3390/microorganisms8122055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/28/2022] Open
Abstract
The effectiveness of ceftolozane/tazobactam for the treatment of infections in neutropenic patients caused by hypervirulent multidrug-resistant (MDR) Pseudomonas aeruginosa has not been previously reported. We identified seven cases of MDR P. aeruginosa infection in neutropenic patients over a four-month period within the same hematology ward. Four cases were associated with rapid progression despite piperacillin-tazobactam or meropenem therapy, and three patients developed sepsis or extensive skin/soft tissue necrosis. In three of the four cases, patients were empirically switched from meropenem to ceftolozane/avibactam before carbapenem susceptibility test results were available, and all four patients underwent extensive surgical debridement or amputation of affected tissues and survived. Further investigation revealed a common bathroom source of MDR P. aeruginosa clonal subtypes ST175 and ST235 that harbored genes for type III secretion system expression and elaboration of ExoU or ExoS exotoxin. We conclude that ceftolozane/tazobactam plus early source control was critical for control of rapidly progressing skin and soft infection in these neutropenic patients caused by highly virulent ST175 and ST235 clones of MDR P. aeruginosa.
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Affiliation(s)
- Paolo E. Coppola
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Paolo Gaibani
- Microbiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.G.); (S.A.)
| | - Chiara Sartor
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Simone Ambretti
- Microbiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.G.); (S.A.)
| | - Russell E. Lewis
- Infectious Diseases, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy
| | - Claudia Sassi
- Radiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Marco Pignatti
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
- Plastic Surgery, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefania Paolini
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Antonio Curti
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Fausto Castagnetti
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Margherita Ursi
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Michele Cavo
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Marta Stanzani
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Correspondence:
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14
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Dika E, Lambertini M, Misciali C, Fanti PA, Contedini F, Pinto V, Pignatti M, Cipriani F, Corti B, Piraccini BM. Nail-plate dystrophy of the fifth toenail: thinking outside the box. Clin Exp Dermatol 2020; 46:584-587. [PMID: 33231894 DOI: 10.1111/ced.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- E Dika
- Division of Dermatology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - M Lambertini
- Division of Dermatology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - C Misciali
- Division of Dermatology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - P A Fanti
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - F Contedini
- Plastic Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - V Pinto
- Plastic Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M Pignatti
- Plastic Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - F Cipriani
- Plastic Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B Corti
- Pathology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B M Piraccini
- Division of Dermatology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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15
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Pinto V, Antoniazzi E, Contedini F, Pignatti M, Pizzigallo A, Marchetti C, Cipriani R. Microsurgical Reconstruction of the Nose: The Aesthetic Approach to Total Defects. J Reconstr Microsurg 2020; 37:272-281. [PMID: 33202457 DOI: 10.1055/s-0040-1719047] [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: 10/23/2022]
Abstract
BACKGROUND Reconstruction of complex defects involving nose and close facial units represents an aesthetic and functional challenge. Restoring satisfactory nasal shape, combining aesthetic, nasal function and patent airways is mandatory. In this paper, we describe our approach to total nose defects and we report our 20-year experience in microvascular nose reconstruction.Clinical cases are shown to illustrate different surgical techniques and the evolution of our approach. METHODS Nasal reconstruction procedures were performed on 21 patients between 2000 and 2020 using the radial forearm flap (RFF) or anterolateral thigh (ALT) flap. Reported reconstructions included total/subtotal nasal defects, caused by cancer resections. The key point of our approach is the expanded forehead flap for skin coverage. Reconstruction is completed by cartilage grafts to restore nasal framework and to shape nasal tip. Ancillary procedures were needed in some cases to optimize aesthetic outcomes. RESULTS Twenty-one patients completed the multistage nasal reconstruction. The RFF flap was used in 56% of the cases (n = 11), while the ALT flap was used in 44% (n = 10) of our case series. No difference has been detected in the number of reconstructive stages required to achieve the final result comparing RFF and ALT reconstruction (3.3 vs. 3.1 reconstructive steps). Ancillary procedures were performed in 7 patients. CONCLUSION Microvascular tissue transfer plays a key role in full-thickness nasal defects restoration. Comparing the two groups, both the RFF and ALT are effective and reliable options in lining reconstruction, although with different indications. Expanded forehead flap, combined to free cartilage graft, is our gold standard to provide external skin coverage to rebuild the nasal framework. According to our current approach, accurate preoperative planning, supported by modern technologic tools, multistage reconstruction, and ancillary procedures are useful to accomplish satisfactory functional and aesthetic outcomes.
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Affiliation(s)
- Valentina Pinto
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisa Antoniazzi
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Contedini
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Pignatti
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, University of Bologna, Italy
| | - Angelo Pizzigallo
- Oral and Maxillofacial Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIBINEM, University of Bologna, Italy
| | - Riccardo Cipriani
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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16
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Pignatti M, Pinto V, Giorgini FA, Lozano Miralles ME, Cannamela G, D'Arpa S, Cipriani R, De Santis G. Meta-analysis of the effects of venous super-drainage in deep inferior epigastric artery perforator flaps for breast reconstruction. Microsurgery 2020; 41:186-195. [PMID: 33170970 DOI: 10.1002/micr.30682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/18/2020] [Accepted: 10/30/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Venous congestion is the most common vascular complication of the deep inferior epigastric artery perforator (DIEP) flaps. Adding a second venous drainage by anastomosing a flap vein and a recipient vein (super-drainage) is considered the solution of choice. Evidence to support this procedure, had not yet been confirmed by an analysis of the literature. We aimed to provide this evidence. MATERIALS AND METHODS We searched the literature (MedLine, Scopus, EMBASE, Cochrane Library, and Google Scholar), for studies discussing venous congestion and venous super-drainage in DIEP flap for breast reconstruction. Thirteen of the 35 articles compared results between one or two venous anastomoses. Meta-analysis was performed following PRISMA guidelines. Pooled risk ratio (RRs) for congestion, fat necrosis, partial necrosis, and total necrosis with corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model with the Mantel-Haenszel method. The need to return to surgery (95% CI) was estimated with a random effect model using the DerSimonian and Liard method. RESULTS We showed a statistically significant advantage of super-drainage to reduce the venous congestion of the flap (RR: 0.12, 95% CI: 0.04-0.34, p-value <.001), partial flap necrosis (RR: 0.50, 95% CI: 0.30-0.84, p-value .008), total flap necrosis (RR: 0.31, 95% CI: 0.11-0.85, p-value .023), and the need to take the patient back to surgery for perfusion-related complications (RR: 0.45, 95% CI: 0.21-0.99, p value .048). CONCLUSIONS Performing a second venous anastomosis between the SIEV and a recipient vein (venous superdrainage) reduces venous congestion and related complications in DIEP flaps for breast reconstruction.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.,DIMES, University of Bologn, Bologna, Italy
| | - Valentina Pinto
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Federico A Giorgini
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.,Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Elisa Lozano Miralles
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.,Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore D'Arpa
- Plastic and Reconstructive Surgery, La Maddalena Cancer Center, Palermo, Italy
| | - Riccardo Cipriani
- Plastic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Giorgio De Santis
- Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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17
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Hallock GG, Pignatti M. Propeller Flaps. Semin Plast Surg 2020; 34:130. [PMID: 33041679 DOI: 10.1055/s-0040-1714085] [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: 10/23/2022]
Affiliation(s)
- Geoffrey G Hallock
- Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
| | - Marco Pignatti
- Plastic and Reconstructive Surgery, Bologna University Hospital, Bologna, Italy
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Pignatti M, Spinella A, Cocchiara E, Boscaini G, Lusetti IL, Citriniti G, Lumetti F, Setti G, Dominici M, Salvarani C, De Santis G, Giuggioli D. Autologous Fat Grafting for the Oral and Digital Complications of Systemic Sclerosis: Results of a Prospective Study. Aesthetic Plast Surg 2020; 44:1820-1832. [PMID: 32632623 DOI: 10.1007/s00266-020-01848-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Systemic sclerosis is a connective tissue disease. Skin involvement of the mouth and hand may compromise function and quality of life. Autologous fat grafting has been described as a specific treatment of these clinical features. We report the results of our prospective study designed to treat and prevent skin complications in systemic sclerosis. MATERIALS AND METHODS We treated 25 patients with mouth and/or hand involvement (microstomia, xerostomia, skin sclerosis, Raynaud's phenomenon and long-lasting digital ulcers) with autologous fat grafting, according to the Coleman's technique, around the mouth and/or at the base of each finger. The surgical procedures were repeated in each patient every 6 months for a total of two or three times. Clinical data were collected before the first surgery and again 6 months after each surgical procedure. Pain, skin thickness, saliva production and disability were assessed with validated tests. RESULTS Overall we performed 63 autologous fat grafting sessions (either on the mouth, on the hands or on both anatomical areas). Results at 6 moths after the last session included improvement of xerostomia evaluated with a sialogram, reduction of the skin tension around the mouth and, in the hands, reduction of the Raynaud phenomenon as well as skin thickness. Pain was reduced while the perception of disability improved. Digital ulcers healed completely in 8/9 patients. CONCLUSIONS Our results confirm the efficacy and safety of autologous fat grafting for the treatment of skin complications and digital ulcers due to systemic sclerosis. In addition, the patients' subjective well-being improved. Level of evidence V 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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Pignatti M, Hallock GG. Introduction to "Propeller Flaps". Semin Plast Surg 2020; 34:131-132. [PMID: 33041680 DOI: 10.1055/s-0040-1715156] [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] [Indexed: 10/23/2022]
Abstract
The editors of this issue of Seminars in Plastic Surgery dedicated to propeller flaps met in 2009 at the "1st Tokyo Meeting on Perforator and Propeller Flaps." On that occasion, as part of the advisory panel of the meeting, they contributed to the definition and classification of these flaps. Since then, several evolutions and new applications of propeller flaps appeared in the literature. In 2019, the editors met again in Bologna, Italy, where they decided to collect the experiences from prominent authors in propeller flap surgery and provide them to the readers in this monographic dedicated publication.
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Affiliation(s)
- Marco Pignatti
- Chirurgia Plastica e Ricostruttiva, Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italia
| | - Geoffrey G Hallock
- Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
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Pignatti M, Pinto V, Giorgini FA, Lozano Miralles ME, D'Arpa S, Cipriani R, De Santis G. Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature. J Reconstr Microsurg 2020; 37:216-226. [PMID: 32871602 DOI: 10.1055/s-0040-1716349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV. METHODS We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV. RESULTS Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis. CONCLUSION Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, Policlinico di Sant'Orsola-DIMES, University of Bologna, Italy
| | | | - Federico A Giorgini
- Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy.,Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Elisa Lozano Miralles
- Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy.,Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore D'Arpa
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | | | - Giorgio De Santis
- Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
Propeller flaps are local flaps based either on a subcutaneous pedicle, a single perforator, or vessels entering the flap in such a way so as to allow the flap to rotate on their axis. Depending on the kind of pedicle and the anatomical area, the preoperative investigation and the harvesting techniques may vary. An adequate knowledge of skin and subcutaneous tissue perfusion in the different areas of the body is very important to plan a propeller flap to be successful. The surgeon should begin by finding the most suitable perforators in the area surrounding the defect using available technology. The position, size, and shape of the flap are planned about this point. For perforator-pedicled propeller flaps, the procedure starts with an exploration from the margins of the defect or through a dedicated incision to visualize any perforators in the surroundings. The most suitable perforator is selected and isolated, the skin island is replanned, and the flap is harvested and rotated into the defect. The variations in surgical technique for other types of propellers and in specific anatomical areas are also described. Compared with free flaps, propeller flaps have the advantage of a simpler, shorter operation, without the need for a recipient vessel for microanastomosis. Yet, from a technical point of view, an adequate experience in dissecting perforators and the use of magnifying glasses are almost always required.
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Affiliation(s)
- Marco Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Italy
| | - Valentina Pinto
- Department of Plastic Surgery, Policlinico di Sant'Orsola - Bologna, Italy
| | - Ann-Charlott Docherty Skogh
- Department of Surgery, Breast Cancer Center, South General Hospital, Stockholm, Sweden and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Federico Armando Giorgini
- Department of Plastic Surgery, Policlinico di Sant'Orsola - Bologna, Italy
- Department of Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Cipriani
- Department of Plastic Surgery, Policlinico di Sant'Orsola - Bologna, Italy
| | - Giorgio De Santis
- Department of Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Geoffrey G. Hallock
- Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
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22
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Pignatti M, Ogawa R, Mateev M, Georgescu AV, Balakrishnan G, Ono S, Cubison T, Pinto V, D'Arpa S, Koshima I, Hyakusoku H, Hallock GG. Our Definition of Propeller Flaps and Their Classification. Semin Plast Surg 2020; 34:139-144. [PMID: 33041682 PMCID: PMC7542214 DOI: 10.1055/s-0040-1715158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/16/2022]
Abstract
The term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90 degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isolated perforator, and the terms propeller and perforator flap were used together. Thereafter, the surgical technique of propeller flaps evolved and new applications developed. With the "Tokyo consensus," we proposed a definition and a classification schema for propeller flaps. A propeller flap was defined as an "island flap that reaches the recipient site through an axial rotation." The classification included the SPP (SPP) flap, the perforator pedicled propeller (PPP) flap, and the supercharged PPP (SCP) flap. A recent update added a new category, the axial pedicled propeller (APP) flap. Here we propose our updated and comprehensive classification of propeller flaps, taking into account the previous classification and subsequent publications. Based on their vascular pedicle, we consider the following five types of propellers: (1) SPP flap, 2.PPP flap, its subtype (2a) SCP flap, (3) APP flap, (4) muscle propeller flap, and (5) chimeric propeller flap. The variables that can be taken into account in the classification are as follows: type of nourishing pedicle, degrees of skin island rotation, position of the nourishing pedicle, artery of origin of the pedicle, and flap shape.
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Affiliation(s)
- Marco Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Bologna, Italy
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Musa Mateev
- Department of Plastic Surgery, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Alexandru V. Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, Clinical Hospital of Rehabilitation, University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Govindasamy Balakrishnan
- Plastic, Hand & Microvascular Surgery, Right Hospitals, Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
| | - Shimpei Ono
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Tania Cubison
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Valentina Pinto
- Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Bologna, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences (DICHIORONS), University of Palermo, Palermo, Italy
| | - Isao Koshima
- International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiko Hyakusoku
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Geoffrey G. Hallock
- Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
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23
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Abstract
Propeller perforator flaps (PPFs) have long been proven as valid reconstructive tools for a wide range of soft tissue defects in different body regions. During the last decade, despite their numerous advantages, many authors have thoroughly analyzed outcomes of these flaps, sometimes discouraging their use mainly because of a high failure rate. Accurate patient selection, adequate preoperative planning, and an appropriate dissection technique seem to potentially improve outcomes. Our study provides a review of the relevant literature related to PPF complications and of our experience, describing reasons for failure, measures for preventing them, and approaches for a prompt evaluation and management of complications.
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Affiliation(s)
- Marta Cajozzo
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Lucian P. Jiga
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Zaher Jandali
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Mismil Muradov
- Department of Plastic Surgery, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan
| | - Marco Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola, DIMES, Bologna University, Bologna, Italy
| | - Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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Pignatti M, Sapino G, Alicandri-Ciufelli M, Canzano F, Presutti L, De Santis G. Treatment of Recurrent Tracheocutaneous Fistulas in the Irradiated Neck with a Two Layers-Two Flaps Combined Technique. Indian J Plast Surg 2020; 53:423-426. [PMID: 33402777 PMCID: PMC7775241 DOI: 10.1055/s-0040-1714769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap.
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Affiliation(s)
- M Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola, DIMES, University of Bologna, Bologna, Italy
| | - G Sapino
- Department of Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - M Alicandri-Ciufelli
- Department of Otolaryngology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - F Canzano
- Department of Otolaryngology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - L Presutti
- Department of Otolaryngology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - G De Santis
- Department of Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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25
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Pignatti M, Pinto V, Miralles MEL, Giorgini FA, Cannamela G, Cipriani R. How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northern Italy. J Plast Reconstr Aesthet Surg 2020; 73:1348-1356. [PMID: 32499187 PMCID: PMC7255253 DOI: 10.1016/j.bjps.2020.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/09/2020] [Indexed: 11/17/2022]
Abstract
The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon's evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.
| | | | - Maria Elisa Lozano Miralles
- Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy; Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
| | - Federico A Giorgini
- Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy; Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
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26
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Condorelli AG, Ferrari B, Francomano M, Rocco B, Sighinolfi MC, Giacomelli L, Pignatti M, Magnoni C. Buschke-Lowenstein tumor: Use of dermal matrix for reconstruction of genital area. Dermatol Ther 2020; 33:e13874. [PMID: 32558104 DOI: 10.1111/dth.13874] [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] [Received: 04/26/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Alessandra Grazia Condorelli
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Ferrari
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Mariangela Francomano
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy and Polistudium SRL, Milan, Italy
| | - Marco Pignatti
- Plastic Surgery, Policlinico di Sant'Orsola, DIMES, University of Bologna, Bologna, Italy
| | - Cristina Magnoni
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Cortesi L, Baldassarri B, Ferretti S, Razzaboni E, Bella M, Bucchi L, Canuti D, De Iaco P, De Santis G, Falcini F, Galli V, Godino L, Leoni M, Perrone AM, Pignatti M, Saguatti G, Santini D, Sassoli de'Bianchi P, Sebastiani F, Taffurelli M, Tazzioli G, Turchetti D, Zamagni C, Naldoni C. A regional population-based hereditary breast cancer screening tool in Italy: First 5-year results. Cancer Med 2020; 9:2579-2589. [PMID: 32045136 PMCID: PMC7131858 DOI: 10.1002/cam4.2824] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022] Open
Abstract
Background Up to 10% of individuals with breast cancer (BC) belong to families with hereditary syndromes. The aim of this study was to develop an instrument to identify individuals/families at high‐hereditary risk for BC and offer dedicated surveillance programs according to different risks. Methods The instrument consisted of a primary questionnaire collecting history of BC and ovarian cancer (OC). This questionnaire was applied to women enrolled in the Emilia‐Romagna Breast Cancer Screening Program. General practitioners (GPs) and specialists could propose the same questionnaire too. Women with a score of ≥ 2, were invited to complete an oncogenetic counseling. According to the Tyrer‐Cuzick evaluation, women considered at high risk were invited to involve the most representative alive individual of the family affected with BC/OC for BRCA1/2 genetic testing. Results Since January 2012 and December 2016, 660 040 women were evaluated by the regional screening program, of which 22 289 (3.5%) were invited to the Spoke evaluation, but only 5615 accepted (25.2%). Totally, also considering women sent by GPs and specialists, 11 667 were assessed and 5554 were sent to the Hub evaluation. Finally, 2342 (42.8%) women fulfilled the criteria for genetic testing, and 544 (23.2%) resulted BRCA1/2 mutation carriers. Conclusions To our knowledge, this is the first regional population‐based multistep model that is aimed to identify individuals with BRCA1/2 mutations and to offer an intensive surveillance program for hereditary‐high risk women. This tool is feasible and effective, even if more efforts must be performed to increase the acceptance of multiple assessments by the study population.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Haematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Bruna Baldassarri
- Department of Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Stefano Ferretti
- Department of Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Elisabetta Razzaboni
- Department of Oncology and Haematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Mariangela Bella
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Debora Canuti
- Cancer Screening Unit, Local Health Agency of Romagna, Rimini, Italy
| | - Pierandrea De Iaco
- Unit of Oncologic Gynecology, Department of Obstetrics and Gynecology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Giorgio De Santis
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.,Azienda Usl della Romagna, Forlì, Italy
| | - Vania Galli
- AUSL Modena, Mammography Screening Centre, Modena, Italy
| | - Lea Godino
- Department of Medical and Surgical Sciences, University of Bologna, Hospital of Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Maurizio Leoni
- Oncology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Anna Myriam Perrone
- Unit of Oncologic Gynecology, Department of Obstetrics and Gynecology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Marco Pignatti
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianni Saguatti
- Senology Unit, Bellaria Carlo Alberto Pizzardi Hospital, Bologna, Italy
| | - Donatella Santini
- Sant'Orsola-Malpighi Polyclinic, University of Bologna, Hospital of Bologna, Bologna, Italy
| | | | - Federica Sebastiani
- Department of Oncology and Haematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Mario Taffurelli
- Department of the Health of Woman, Child and Urological Diseases, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Giovanni Tazzioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniela Turchetti
- Department of Medical and Surgical Sciences, University of Bologna, Hospital of Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Claudio Zamagni
- Department of Hematology and Oncology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Carlo Naldoni
- Department of Health and Welfare, Emilia-Romagna Region, Bologna, Italy
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Pignatti M, Feletti A, Sapino G, Marotti F, Pavesi G, De Santis G. Myelomeningocele Repair Combining a Double Cryopreserved Amniotic Membrane Homograft and the Keystone Flap in a 3-Year-Old Child: A Case Report. Pediatr Neurosurg 2020; 55:106-112. [PMID: 32454485 DOI: 10.1159/000507715] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Early repair in patients affected by myelomeningocele (MMC) is of paramount importance in order to prevent infection, minimize neural tissue damage, and reduce mortality. Treatment must include duraplasty and possibly an adequate soft tissue coverage. Delayed surgery in MMC patients can be more tedious due to the less clear borders between the placode and the skin. Moreover, the risks of wound infection and breakdown increase significantly. CASE PRESENTATION We present the unusual case of a large MMC in a 3-year-old patient treated by combining the recently described cryopreserved amniotic membrane (AM) as homograft for dural reconstruction and a bilateral Keystone flap for soft tissue reconstruction. DISCUSSION Thanks to its anti-inflammatory and elastic proprieties, the AM can play an important role in preventing adhesion between the reconstructed layers, thus reducing the risk of spinal cord tethering. The Keystone flap, at the same time, allows the wound tension to be distributed widely over the flap margins and not only along the midline, which overlies the duraplasty, enhancing the scar quality and lowering the risk of cerebrospinal fluid recurrence and wound dehiscence, with no donor site morbidity.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, University Hospital "Policlinico di Sant'Orsola", DIMES, University of Bologna, Bologna, Italy,
| | - Alberto Feletti
- Neurosurgery Unit, Department of Neurosciences, Modena University Hospital, Modena, Italy
| | - Gianluca Sapino
- Plastic Surgery Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adult, Modena University Hospital, Modena, Italy
| | - Francesca Marotti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adult, Modena University Hospital, Modena, Italy
| | - Giacomo Pavesi
- Neurosurgery Unit, Department of Neurosciences, Modena University Hospital, Modena, Italy
| | - Giorgio De Santis
- Plastic Surgery Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adult, Modena University Hospital, Modena, Italy
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D'Arpa S, Pignatti M, Vieni S, Muradov M, Blondeel P, Cordova A. The Thin bilateral and bipedicled DIEAP flap for axillary reconstruction in hidradenitis suppurativa. HANDCHIR MIKROCHIR P 2019; 51:469-476. [PMID: 31307106 DOI: 10.1055/a-0881-9646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Reconstruction after resection of advanced stage hidradenitis suppurativa is currently performed with pedicled perforator flaps, that allow functional reconstruction and preservation of shoulder function. Skin availability is limited by the possibility of closing the donor site primarily. Bilateral cases need to be treated in two stages, since the operation is carried out in the lateral decubitus. In this manuscript the application of bilateral and bipedicled DIEAP flaps to bilateral and extensive cases is presented. PATIENTS AND METHODS Between October 2008 and October 2018, 39 patients were treated for axillary hidradenitis suppurativa. Of these, 11 patients had bilateral reconstruction with bilateral DIEAP flaps (22 flaps) and one patient had unilateral reconstruction with a bipedicled DIEAP flap. 23 flaps were used. Twelve flaps were raised above Scarpa's fascia, 6 flaps werethinned after dissection. Three flaps were not thinned in the first stage. Average flap size was 14 × 17cm for the bilateral flaps, while the bipedicled flap was 15 × 32cm. RESULTS Average operative time was 324 minutes. No flap necrosis was observed. Two patients had wound dehiscences in the axilla and one in the abdomen, all treated conservatively. One patient had a pyoderma gangrenosum at both surgical sites that healed after cortisone therapy. No revisions were needed for the flaps that were thinned during the primary operation. The three patients whose flaps where not thinned needed liposuction after three months for thinning. There was one disease recurrence, unilateral and treated surgically. Mean follow up was 64 months. CONCLUSIONS Axillary reconstruction with the DIEAP flap allows reconstruction of large and bilateral defect in a single operation closing the donor site primarily. If the flap is thinned during the operation, no thinning seems to be needed postoperatively. Otherwise the flap shall be thinned by liposuction three months after the initial procedure. We believe that the benefits of this technique outweigh the added complexity of a microsurgical procedure when bilateral resections are needed, the defects are too wide to close the donor site of a pedicled flap primarily and the lower abdomen is free of disease.
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Affiliation(s)
- Salvatore D'Arpa
- Gent University Hospital, Department of Plastic and Reconstructive Surgery, Gent, Belgium Università degli Studi di Palermo, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Plastic and Reconstructive Surgery, Palermo, Italy
| | - Marco Pignatti
- Azienda Ospedaliera Universitaria Policlinico di Modena, Chirurgia Plastica, Modena, Italy
| | - Salvatore Vieni
- Università degli Studi di Palermo, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Plastic and Reconstructive Surgery, Palermo, Italy
| | - Mismil Muradov
- Syzganov National Scientific Center of Surgery, Plastic Surgery, Almaty, Kazakhstan
| | - Phillip Blondeel
- Gent University Hospital, Department of Plastic and Reconstructive Surgery, Gent, Belgium
| | - Adriana Cordova
- Università degli Studi di Palermo, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Plastic and Reconstructive Surgery, Palermo, Italy
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Toia F, D'Arpa S, Pignatti M, Noel W, Cordova A. Axial propeller flaps: A proposal for update of the "Tokyo consensus on propeller flaps". J Plast Reconstr Aesthet Surg 2017; 70:857-860. [PMID: 28285010 DOI: 10.1016/j.bjps.2017.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, Via del Vespro, 129, Palermo, Italy
| | - Salvatore D'Arpa
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Department of Plastic and Reconstructive Surgery, Gent University Hospital, De Pintelaan 185, Gent, Belgium.
| | - Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy
| | - Warren Noel
- Department of Plastic and Reconstructive Surgery, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, Paris, France
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, Via del Vespro, 129, Palermo, Italy
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Pignatti M, Zanella S, Borgna-Pignatti C. Can the surgical tourniquet be used in patients with sickle cell disease or trait? A review of the literature. Expert Rev Hematol 2016; 10:175-182. [DOI: 10.1080/17474086.2017.1273765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Modena University Hospital, Modena, Italy
| | - Sara Zanella
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
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Lundgren TK, Pignatti M, Halle M, Boscaini G, Skogh ACD, Luigi C, De Santis G. Composite orbital reconstruction using the vascularized segmentalized osteo-fascio-cutaneous fibula flap. J Plast Reconstr Aesthet Surg 2015; 69:255-61. [PMID: 26687794 DOI: 10.1016/j.bjps.2015.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/15/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022]
Abstract
Reconstruction of composite orbital defects must address the orbit and an exposed skull base and/or maxillary region. The orbit should not only be covered but also reshaped to accommodate the orbital contents or an epithesis when warranted. This study presents a rationale for a near-anatomical reconstruction of the orbit, together with adjacent dead space obliteration, using the segmentalized osteo-fascia-cutaneous fibula flap. Before the flap transfer, a cutting template for the fibula is made according to the measures and requirements of the facial defect. The segmentalized bone is then osteosynthesized to the facial skeleton and revascularized. Thus, an orbital depth is created by the bony fibula, whereas the fascio-cutaneous part of the flap may be used for lining the orbit and obliteration of the skull base or the maxillary region, or resurface the palate and/or the nasal cavity.
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Affiliation(s)
- T Kalle Lundgren
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Martin Halle
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Giulia Boscaini
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Ann-Charlotte Docherty Skogh
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Chiarini Luigi
- Department of Cranio-Maxillofacial Surgery, Modena University Hospital, Policlinico di Modena, Italy
| | - Giorgio De Santis
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.
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Pignatti M, Spaggiari A, Sala P, Loschi P, Fiumana E, Faggioli R. Laser treatment of angiofibromas in tuberous sclerosis. Minerva Pediatr 2014; 66:585-586. [PMID: 25336102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tuberous sclerosis complex is an autosomal dominant disorder that can cause nonmalignant hamartomas in any organ. Angiofibromas are the most disturbing marker of the disease because they are conspicuously present on the face. We report the case of a 15-year-old girl affected by tuberous sclerosis, whose facial angiofibromas were satisfactorily treated by a green light vascular laser (532 nm).
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Affiliation(s)
- M Pignatti
- Department of Plastic and Reconstructive Surgery Policlinico di Modena, University of Modena & Reggio Emilia, Italy -
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Pignatti M, Loschi P, Pedrazzi P, Marietta M. Mondor's disease after implant-based breast reconstruction. Report of three cases and review of the literature. J Plast Reconstr Aesthet Surg 2014; 67:e275-7. [PMID: 24939830 DOI: 10.1016/j.bjps.2014.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 03/17/2014] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena I - 41124, Italy
| | - Pietro Loschi
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena I - 41124, Italy.
| | - Paola Pedrazzi
- Haemostasis and Thrombosis Center, Department of Haematology and Oncology, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena I - 41124, Italy
| | - Marco Marietta
- Haemostasis and Thrombosis Center, Department of Haematology and Oncology, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena I - 41124, Italy
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Cortesi L, Razzaboni E, Toss A, De Matteis E, Marchi I, Medici V, Tazzioli G, Andreotti A, De Santis G, Pignatti M, Federico M. A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive Italian women. Ann Oncol 2013; 25:57-63. [PMID: 24276029 DOI: 10.1093/annonc/mdt422] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 01/06/2023] Open
Abstract
BACKGROUND Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. PATIENTS AND METHODS This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. RESULTS In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. CONCLUSIONS Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization.
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Affiliation(s)
- L Cortesi
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
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Pignatti M, Gerunda GE, Rompianesi G, De Ruvo N, Di Benedetto F, Codeluppi M, Bonucchi D, Pacchioni L, Loschi P, Malaventura C, De Santis G. Treatment of wounds colonized by multidrug resistant organisms in immune-compromised patients: a retrospective case series. Patient Saf Surg 2013; 7:28. [PMID: 24139428 PMCID: PMC3847491 DOI: 10.1186/1754-9493-7-28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/26/2013] [Indexed: 11/26/2022] Open
Abstract
Background Immune-compromised patients incur a high risk of surgical wound dehiscence and colonization by multidrug resistant organisms. Common treatment has been debridement and spontaneous secondary healing. We report on the results obtained in nine such patients whose wounds were treated by debridement, negative pressure dressing and direct closure. Methods All immune-compromised patients referred to our Institution between March 1, 2010 and November 30, 2011 for dehiscent abdominal wounds growing multidrug resistant organisms were treated by serial wound debridements and negative pressure dressing. They were primarily closed, despite positive microbiological cultures, when clinical appearance was satisfactory. As a comparison, records from patients treated between March 1, 2008 and February 28, 2010 who, according to our Institution’s policy at that time, had been left to heal by secondary intention, were retrieved and examined. Results Nine patients were treated by direct wound closure, five had been treated previously by secondary intention healing. Overall, ten patients had received liver transplant, 1 kidney transplant, 1 was HIV infected, 1 suffered from multi-organ failure, 1 was undergoing hemodialysis. Wound dehiscence involved skin and subcutaneous layers in all patients, in two the muscular layer was also involved. Mean healing time was significantly shorter in patients treated more recently by primary intention in comparison with historical patients (28 vs 81 days). The only complication observed was a small superficial abscess that developed around a non-absorbable stitch 10 months after closure in a patient treated by primary closure. Conclusions According to our results, fast healing can be safely obtained by closure of a clinically healthy wound, despite growth of multidrug resistant organisms, even in immune-compromised patients.
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Affiliation(s)
- Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Policlinico of Modena,University of Modena and Reggio Emilia, Via del Pozzo 71, Modena I - 41124, Italy.
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Pignatti M, Iwuagwu FC, Browne TF. Late partial failure of a free ALT flap. J Plast Reconstr Aesthet Surg 2012; 65:e124-7. [DOI: 10.1016/j.bjps.2011.11.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 11/26/2011] [Indexed: 11/26/2022]
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Pignatti M, Pedone A, Baccarani A, Guaraldi G, Orlando G, Lombardi M, De Santis G. High-density hyaluronic acid for the treatment of HIV-related facial lipoatrophy. Aesthetic Plast Surg 2012; 36:180-5. [PMID: 21717261 DOI: 10.1007/s00266-011-9771-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 03/29/2011] [Accepted: 06/02/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial lipoatrophy is a stigmatizing hallmark of HIV. The injection of facial fillers has an essential role in the treatment of this condition. The objective of our study was to verify the safety and efficacy of a new formulation of high-density hyaluronic acid for the injectable treatment of HIV-related facial lipoatrophy. METHODS We treated with high-density hyaluronic acid injections HIV patients affected by moderate to severe facial lipoatrophy and evaluated them at last follow-up, at a minimum of 36 weeks. Physician-related outcomes included pre-and post-treatment ultrasound measurement of the soft-tissue thickness of the cheeks and qualitative assessment of aesthetic results by means of the Global Aesthetic Improvement Scale using pre- and post-treatment photos of the patients. Patient satisfaction outcomes were evaluated with the VAS-face scale and Freiburg test. RESULTS Fifty-four patients were studied. The median number of treatment sessions was 3 and the median length of treatment was 5.5 months. The thickness of the soft tissues of the cheek increased significantly from 9.45 to 13.12 mm (p<0.0001). On the basis of the Global Aesthetic Improvement Scale, 87.5% of the patients were judged as "much improved" or "improved." Patient satisfaction at 1 year from the end of treatment was proven (VAS-face: 77.9; Freiburg questionnaire: 93.6% of patients were satisfied or very satisfied). Complications were limited to mild redness and swelling in the early postoperative period. CONCLUSION Long-term improvement of facial contour and excellent patient satisfaction, in the absence of severe side effects, were obtained by the injection of high-density hyaluronic acid (STYLAGE® XL) in HIV patients with facial lipoatrophy.
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Affiliation(s)
- Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
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Grisendi G, Bussolari R, Veronesi E, Piccinno S, Burns JS, De Santis G, Loschi P, Pignatti M, Di Benedetto F, Ballarin R, Di Gregorio C, Guarneri V, Piccinini L, Horwitz EM, Paolucci P, Conte P, Dominici M. Understanding tumor-stroma interplays for targeted therapies by armed mesenchymal stromal progenitors: the Mesenkillers. Am J Cancer Res 2011; 1:787-805. [PMID: 22016827 PMCID: PMC3195936] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 05/17/2011] [Indexed: 05/31/2023] Open
Abstract
A tumor represents a complex structure containing malignant cells strictly coupled with a large variety of surrounding cells constituting the tumor stroma (TS). In recent years, the importance of TS for cancer initiation, development, local invasion and metastases has become increasingly clear allowing the identification of TS as one of the possible ways to indirectly target tumors. Inside the heterogeneous stromal cell population, tumor associated fibroblasts (TAF) play a crucial role providing both functional and supportive environments. During both tumor and stroma development, several findings suggest that TAF could be recruited from different sources such as locally derived host fibroblasts, via epithelial/endothelial mesenchymal transitions or from circulating pools of fibroblasts deriving form mesenchymal progenitors, namely mesenchymal stem/stromal cells (MSC). These insights prompted scientists to identify multimodal approaches to target TS by biomolecules, monoclonal antibodies, and more recently via cell based strategies. These latter strategies appear extremely promising, although still associated with debated and unclear findings. This review discusses crosstalk between cancers and their stroma, dissecting specific tumor types, such as sarcoma, pancreatic and breast carcinoma, where stroma plays distinct paradigmatic roles. The recognition of these distinct stromal functions may help in planning effective and safer approaches aimed either to eradicate or to substitute TS by novel compounds and/or MSC having specific killing activities.
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Affiliation(s)
- Giulia Grisendi
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
| | - Rita Bussolari
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
| | - Elena Veronesi
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
| | - Serena Piccinno
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
- Unit of Paediatric Oncology, Haematology and Marrow Transplantation, Department of Mother and ChildModena
| | - Jorge S Burns
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
| | | | - Pietro Loschi
- Unit of Plastic Surgery, Department of Head & Neck SurgeryModena
| | - Marco Pignatti
- Unit of Plastic Surgery, Department of Head & Neck SurgeryModena
| | - Fabrizio Di Benedetto
- Unit of Hepato-Pancreato-Biliary and Transplant Surgery, Department of General SurgeryModena
| | - Roberto Ballarin
- Unit of Hepato-Pancreato-Biliary and Transplant Surgery, Department of General SurgeryModena
| | - Carmela Di Gregorio
- Section of Pathology, Department of Pathologic Anatomy and Forensic MedicineModena
| | - Valentina Guarneri
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
| | - Lino Piccinini
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
| | - Edwin M Horwitz
- Division of Oncology/Blood and Marrow Transplantation, The Children's Hospital of Philadelphia and The University of Pennsylvania School of MedicinePhiladelphia, Pennsylvania, USA
| | - Paolo Paolucci
- Unit of Paediatric Oncology, Haematology and Marrow Transplantation, Department of Mother and ChildModena
| | - PierFranco Conte
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology, Hematology and Respiratory Diseases, University-Hospital of Modena and Reggio EmiliaModena, Italy
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Pignatti M, Iwuagwu FC, Harrison AP, Cerio R. Desmoplastic trichoepithelioma confused with cutaneous squamous cell carcinoma in childhood. J Plast Reconstr Aesthet Surg 2010; 64:e92-4. [PMID: 21130056 DOI: 10.1016/j.bjps.2010.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/09/2010] [Indexed: 11/26/2022]
Abstract
Squamous cell carcinoma of the skin is very rare in childhood, especially without predisposing factors or underlying diseases. We report the case of a desmoplastic trichoepithelioma misdiagnosed as cutaneous squamous cell carcinoma in a 12 years old boy Only accurate multiple reviews of the histological samples and repeated questioning of the mother could finally clarify the diagnostic dilemma. Desmoplastic trichoepithelioma is a quite uncommon benign adnexal tumor with a reported incidence, in adults, of 1 in 5000 skin biopsies. It usually affects the face of middle-aged women, but it has been reported at any age. The treatment of desmoplastic thricoepithelioma includes curettage and electrodesiccation or surgical removal. Recurrence or appearance of new lesions is rare. The diagnosis of squamous cell carcinoma in a child without predisposing factors should be accepted with great caution and only after expert histological review.
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Affiliation(s)
- Marco Pignatti
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex CM1 7ET, United Kingdom.
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Pignatti M, Pasqualini M, Governa M, Bruti M, Rigotti G. Propeller flaps for leg reconstruction. J Plast Reconstr Aesthet Surg 2008; 61:777-83. [DOI: 10.1016/j.bjps.2007.10.077] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 10/06/2007] [Accepted: 10/25/2007] [Indexed: 11/15/2022]
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Abstract
The distal lateral arm flap (DLAF) was used to reconstruct six extensive defects of the digits: 2 degloving injuries of the thumb and 4 major skin losses of the fingers. Two adjacent fingers were involved in 1 patient. Flap size ranged from 3 x 7 cm to 9 x 14 cm. Four flaps were reinnervated using the posterior cutaneous nerve of the forearm. All flaps survived, though 1 showed marginal necrosis. Average follow-up was 53.4 months. Thumb opposition scored 5 according to Kapandji; finger ROM averaged 50.75%; pinch strength 72.5%. Protective sensation with touch localization was restored. Patient satisfaction for resurfaced digits averaged 8.9 on a 10-points visual analogic scale. All donor sites resulted in a painless scar with good patient satisfaction. The DLAF offers a thin, pliable skin ideal for digit reconstruction, with low rate of donor site morbidity and can be considered when toe-to-hand flap transfer is not advisable or refused by the patient.
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Affiliation(s)
- Andrea Atzei
- Hand Surgery Unit, Policlinico G.B. Rossi, Azienda Ospedaliera-Universitaria, Piazzale L.A. Scuro 10, 37100 Verona, Italy.
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Pignatti M, Hansson HA, Gewalli F. Calvarial bone healing under spring distension at continuous forces. Ann Plast Surg 2006; 57:561-8. [PMID: 17060740 DOI: 10.1097/01.sap.0000229019.29857.14] [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: 11/26/2022]
Abstract
The aim of the present study was to evaluate in young animals the dynamics of calvarial bone healing when exposing a bone defect to continuous forces for up to 13 weeks. Six-week-old rabbits after a sagittal suture strip craniectomy were randomized for either of the following protocols: (1) no spring was applied (n = 7); (2) a titanium-molybdenum alloy (TMA) lower-force spring was inserted across the craniectomy gap (n = 9); (3) a stainless steel (SS) higher-force spring was applied (n = 8), or (4) sham operation (n = 8). Results showed that the surgically created calvarial bone gap was after 3 weeks kept widened both when a spring of lower force (TMA) and when a spring exerting a higher force (SS) was applied. At 6 weeks, none of the rabbits of the spring-exposed (2 and 3) groups had any bone bridging the gap, while bone bridging was visible in animals of the 2 groups (1 and 4) lacking springs. Strikingly enough, in both spring-treated groups, the surgically created defect was still after 13 weeks incompletely bridged by bone, interposed by connective tissue, most evidently in those exposed to higher forces (SS). In contrast, a normal sagittal suture enclosed by lamellar bone was seen in both the sham and the strip groups. We conclude that exposing a surgically created calvarial bone defect to continuous mechanical forces delayed the bridging of the bone defect by at least 13 weeks, even if the force exerted by either spring was very low. In any case, when a higher force (SS group) was applied, the bone reunion was efficiently prevented. No side effects were recognized.
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Affiliation(s)
- Marco Pignatti
- Second Division of Plastic Surgery, Ospedale Civile Maggiore, Verona, Italy
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Atzei A, Pignatti M, Maria Baldrighi C, Maranzano M, Cugola L. Long-term results of replantation of the proximal forearm following avulsion amputation. Microsurgery 2005; 25:293-8. [PMID: 15934117 DOI: 10.1002/micr.20131] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 11/07/2022]
Abstract
This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of successful replantation of an avulsed proximal forearm and its acceptance on the part of patients. After a minimum follow-up of 3 years (average, 4.7 years), muscular and sensory recovery was evaluated with the Medical Research Council scale, and global function according to the demerit score system of Chen (China Med 5:392-397, 1967). Subjective evaluation and patient satisfaction were investigated by means of a questionnaire. One patient was classified as grade 2, 4 patients as grade 3, and 5 patients as grade 4 according to Chen (China Med 5:392-397, 1967). However, in spite of the poor objective results, patient satisfaction was obtained in 90% of cases, and the replanted extremity was considered of help for common activities of daily living. In conclusion, replantation of an avulsed proximal forearm should be considered only in patients who are strongly motivated to maintain body integrity, and who are aware of the expected functional limitations.
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Affiliation(s)
- Andrea Atzei
- Hand Surgery Unit, Azienda Ospedaliera Universitaria di Verona, Policlinico G.B. Rossi, Verona, Italy
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Pignatti M, Benati D, Cavadas PC. Effect of the two-wall-stitch mistake upon patency of rat femoral vein anastomosis: Preliminary observations. Microsurgery 2004; 24:339-44. [PMID: 15274195 DOI: 10.1002/micr.20026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/11/2022]
Abstract
Anastomotic patency is believed to be the most important factor in microvascular surgery. The two-wall stitch is a technical error commonly considered to cause thrombosis of the anastomosis, especially on the venous side. In order to demonstrate the real effect on vein patency of the two-wall stitch, the authors performed a standardized mistake after correct microanastomosis on the femoral vein of 15 rats, with one stitch passing through the whole thickness of the two walls of the vein. Traditional correct anastomoses on the contralateral side were used as controls. Patency was assessed at 5, 20, and 60 min and at 24 h by the milking test, and by direct section of the vessel at 24 h. The results showed no statistically significant difference between the two techniques. Histological examination confirmed the clinical judgment about the vessel's patency, and ultrastructural microscopy evidenced only mild signs of endothelial activation. In conclusion, this study indicates that the occasional two-wall stitch does not necessarily increase the risk of venous occlusion in anastomoses of the rat femoral vein.
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Affiliation(s)
- Marco Pignatti
- II Division of Plastic Surgery, Ospedale Civile Maggiore and University of Verona, Verona, Italy
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Tiberio R, Marconi A, Fila C, Fumelli C, Pignatti M, Krajewski S, Giannetti A, Reed JC, Pincelli C. Keratinocytes enriched for stem cells are protected from anoikis via an integrin signaling pathway in a Bcl-2 dependent manner. FEBS Lett 2002; 524:139-44. [PMID: 12135756 DOI: 10.1016/s0014-5793(02)03040-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [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: 01/05/2023]
Abstract
Because inhibition of integrin signaling induces apoptosis, we investigated whether keratinocytes expressing beta1 and alpha6beta4 integrins (enriched for stem cells) are protected from cell death. Keratinocytes rapidly adhering to type IV collagen expressed highest levels of beta1 and alpha6beta4 and of the anti-apoptotic stem cell marker p63. Apoptotic cells were significantly higher in slowly adhering than in rapidly adhering keratinocytes. Anti-beta1 integrin caused a significant increase in apoptotic cells, while it decreased Bcl-2 levels in stem keratinocytes. Bax and Bad proteins were higher in slowly adhering than in rapidly adhering cells. By contrast, Bcl-2, Bcl-x and Mcl-1 proteins were highest in rapidly adhering keratinocytes and nearly absent in slowly adhering cells. After addition of anti-beta1 integrin, the apoptotic rate was significantly higher in HaCaT cells not expressing Bcl-2 than in controls. These results indicate that keratinocytes enriched for stem cells are protected from apoptosis via beta1 integrin, in a Bcl-2 dependent manner.
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Affiliation(s)
- Rossana Tiberio
- Department of Internal Medicine, Section of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy
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