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Di Lorenzo S, Mozzi L, Salmaso F, Silvagni C, Soffientini S, Valenti V, Zagonel V. A multicentre survey on the perception of palliative care among health professionals working in haematology. Support Care Cancer 2024; 32:253. [PMID: 38536470 PMCID: PMC10973048 DOI: 10.1007/s00520-024-08452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with haematologic malignancies have less access to palliative care and are referred later than patients with solid tumours. We developed a survey to investigate this phenomenon, with the intention of analysing palliative care perceptions among health professionals who treat haematology patients and identifying barriers and facilitators to referrals to palliative care services. METHODS This was a multicentre exploratory descriptive web-based survey. A questionnaire was administered to 320 medical and nursing staff members from five Italian haematological units and San Marino's hospital to investigate their perception of palliative care. Quantitative and qualitative analyses were performed. RESULTS A total of 142/320 healthcare professionals completed the survey, achieving a 44% response rate. Most of the respondents supported the integration of haematology and palliative care and were aware of the role of palliative care. Despite this, only half had an in-hospital palliative care team, and only a few had previously attended a specific training course. The majority agreed with palliative care referral when the prognosis was less than 3 months or when the symptoms were incoercible and with blood transfusions even in the last stages of the disease. Many considered the presence of an in-hospital palliative care team or a case manager, as well as structured palliative care training, as fundamental facilitators of palliative care referrals. CONCLUSION These results showed that healthcare professionals in haematology generally hold a favourable attitude and a high interest in integrating palliative care into their patients' care. The low referral rate could depend on clinical, cultural, and organisational issues.
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Affiliation(s)
- Sara Di Lorenzo
- Clinical Hematology and Bone Marrow Transplant and Cellular Therapies Center, Carlo Melzi", Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lisa Mozzi
- Clinical Hematology, Azienda Ospedaliera Ulss 8 Berica, "St. Bortolo" Hospital, Vicenza, Italy
| | - Flavia Salmaso
- Palliative Care Unit, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
| | - Claudia Silvagni
- Continuity of Care Center, Istituto Per La Sicurezza Sociale, Cailungo, Republic of San Marino
| | - Silvia Soffientini
- Integrated Home Care Unit, AULLS 6 Euganea - Terme Colli District, Padua, Italy
| | - Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), "Dino Amadori", Via P. Maroncelli 40, Meldola, FC, 47014, Italy.
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
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Di Lorenzo S, Milia WR, Corradino B, Rinaldi G, Rao M, Cordova A. Radio-Guided Occult Lesion Localization technique for biopsy of non-palpable subcutaneous lesions in suspect metastatic melanoma. Plast Reconstr Surg 2023:00006534-990000000-02123. [PMID: 37734112 DOI: 10.1097/prs.0000000000011071] [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: 09/23/2023]
Affiliation(s)
- Sara Di Lorenzo
- Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy; AOUP Paolo Giaccone, Via del Vespro 129, 90127 Palermo (PA)
| | - Walter R Milia
- Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy; AOUP Paolo Giaccone, Via del Vespro 129, 90127 Palermo (PA)
| | - Bartolo Corradino
- Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy; AOUP Paolo Giaccone, Via del Vespro 129, 90127 Palermo (PA)
| | - Gaetana Rinaldi
- Medical Oncology. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy; AOUP Paolo Giaccone, Via del Vespro 129, 90127 Palermo (PA)
| | - Marco Rao
- Interventional Radiology. University of Palermo, Italy; AOUP Paolo Giaccone, Via del Vespro 129, 90127 Palermo (PA)
| | - Adriana Cordova
- Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy; AOUP Paolo Giaccone, Via del Vespro 129, 90127 Palermo (PA)
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Corradino B, Di Lorenzo S, Cascino AP. Chondro-Cutaneous Autograft for Reconstruction of the Nasal Ala After a Human Bite. Am J Case Rep 2023; 24:e939242. [PMID: 37068053 PMCID: PMC10120602 DOI: 10.12659/ajcr.939242] [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: 03/18/2023]
Abstract
BACKGROUND The nasal ala is a paired structural subunit of the nose that is functionally important in the maintenance of the nasal valve. It consists of 3 anatomically distinct layers: skin, cartilage, and mucosa, all of which need to be restored in reconstructive surgeries to maintain nasal patency. When multiple layers are involved in a defect, the reconstruction requires combining procedures to replace each layer. CASE REPORT We describe a peculiar case of a 58-year-old man with a full-thickness loss of substance of the right nasal ala due to a human bite. The patient came to our hospital after an altercation with another man who bit his nose off. He was initially seen at a smaller regional hospital that did not have a plastic surgery department and was soon after transferred to our facility due to the complexity of the case. To reduce the risk of infection, the patient was treated with a complete course of intravenous antibiotic therapy and the wound was medicated daily with antiseptic solutions. The loss of substance was reconstructed with a composed graft from the auricle concha and the melolabial flap. CONCLUSIONS Defects of the nasal ala are challenging to reconstruct, given its complex 3-dimensional structure. The successful repair of these defects provides aesthetic symmetry and preserves nasal function. A wide variety of reconstructive options have been utilized in many nasal reconstruction cases and have been documented. The combination of a chondro-cutaneous graft from the auricular concha and a melolabial flap graft allowed a good result without local or systemic complications.
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Affiliation(s)
- Bartolo Corradino
- Department of Surgical, Oncological, and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Sara Di Lorenzo
- Department of Surgical, Oncological, and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Andrea Pio Cascino
- Department of Surgical, Oncological, and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
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Errichiello S, Di Lorenzo S, Visintini C, Venturini M, Mazzega Fabbro C, Petean M, Comuzzi C, Cerne D. [Haemopoietic stem cells transplantation: a narrative review]. Assist Inferm Ric 2023; 42:36-50. [PMID: 37283138 DOI: 10.1702/4023.39985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
. Haemopoietic stem cells transpantation: a narrative review. Haematopoietic stem cell transplantation (HSCT) is an effective treatment for many haematological malignancies and its employment is growing thanks to the increased possibility of finding suitable donors and the discovery of therapies to treat major complications. The fourth contribution on emergencies in the oncology setting proposes a narrative literature review to describe the transplant pathway, the types of HSCT, the conditioning regimen, the stem cells reinfusion, the aplasia phase, the major complications and the follow-up. The review included secondary studies published from 2020 to 2022, on adult transplanted patients and written in English; 30 studies were included. In addition, 28 primary studies describing key issues and 11 textbooks were added. Both autologous and allogeneic HSCT expose patients to infectious or drug therapy-related complications, such as mucositis and bleedings. The allogeneic HSCT is at higher risk of major complications such as the graft-versus-host disease and the venous-occlusive disease. The update proposed is accompanied by two cases with multiple choice questions, in patients who underwent autologous stem cells hematopoietic transplantation: case 1 (published in this issue of the AIR journal) on septic shock and case 2 (which will be published in the next issue of the AIR journal) on a massive hemothorax.
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Affiliation(s)
- Sara Errichiello
- Centro Trapianti e Terapie Cellulari Carlo Melzi, SOC Clinica Ematologica, Presidio Ospedaliero Universitario S. Maria della Misericordia, Udine, Azienda Sanitaria Universitaria Friuli Centrale
| | - Sara Di Lorenzo
- Centro Trapianti e Terapie Cellulari Carlo Melzi, SOC Clinica Ematologica, Presidio Ospedaliero Universitario S. Maria della Misericordia, Udine, Azienda Sanitaria Universitaria Friuli Centrale
| | - Chiara Visintini
- Centro Trapianti e Terapie Cellulari Carlo Melzi, SOC Clinica Ematologica, Presidio Ospedaliero Universitario S. Maria della Misericordia, Udine, Azienda Sanitaria Universitaria Friuli Centrale
| | - Margherita Venturini
- Corso di Laurea in Infermieristica, Dipartimento di Area Medica, Università degli Studi di Udine
| | - Cristina Mazzega Fabbro
- Corso di Laurea in Infermieristica, Dipartimento di Area Medica, Università degli Studi di Udine
| | - Marco Petean
- Servizio Infermieristico Domiciliare, Distretto di Tarcento, Udine, Azienda Sanitaria Universitaria Friuli Centrale
| | - Chiara Comuzzi
- Centro Trapianti e Terapie Cellulari Carlo Melzi, SOC Clinica Ematologica, Presidio Ospedaliero Universitario S. Maria della Misericordia, Udine, Azienda Sanitaria Universitaria Friuli Centrale
| | - Diana Cerne
- Centro Trapianti e Terapie Cellulari Carlo Melzi, SOC Clinica Ematologica, Presidio Ospedaliero Universitario S. Maria della Misericordia, Udine, Azienda Sanitaria Universitaria Friuli Centrale
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Di Lorenzo S, Errichiello S, Cerne D, Venturini M, Visintini C. [Indications for CAR-T cell therapy and management of the complications: an update]. Assist Inferm Ric 2022; 41:195-211. [PMID: 37283174 DOI: 10.1702/3974.39540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
. Indications for CAR-T cell therapy and management of the complications: an update. INTRODUCTION The engineering of T lymphocytes with the chimeric antigen receptor (CAR-T) opened a new pattern for the treatment of malignant neoplasms and it was pivotal for the treatment of some haematological malignancies. AIM To describe the therapy with CAR-T, the mechanism, the management process, the role of the multidisciplinary team and highlight the main complications and management, follow-up, the impact on quality of life and the role of nurse. METHOD A literature review was conducted. Secondary studies published between 1 January and 17 October 2022, in English and Italian language, on adult population undergoing CAR-T, were included. Of the 335 articles, 64 were, finally, included. RESULTS New CAR-T products have been tested for the treatment of acute myeloid leukaemia, multiple myeloma and some kind of solid tumours. The two main toxicities are the cytokine release syndrome and the neurotoxicity. Alternative drugs have been tested for minor adverse effects. The multidisciplinary team and the nurse are fundamental, both in the clinical care and in the organization; an emphasis was put on the correct patients' information. Quality of life after CAR-T treatment is still poorly investigated. CONCLUSIONS The knowledge on CAR-T is in continuous and rapid growth and several questions are still without answer, requiring a continuous update of the transplant centres.
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Di Lorenzo S, Visintini C. [Cytokine release syndrome in a patients treated with CAR-T cells therapy: a case report]. Assist Inferm Ric 2022; 41:212-221. [PMID: 37283175 DOI: 10.1702/3974.39541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This is the third contribution of a series of updates on oncological emergencies. The updates are published in the form of a case, with multiple-choice questions to assess knowledge, a brief discussion of the answer, and reference literature, to further explore. This case, which involves the management of a B-cell non-Hodgkin lymphoma, is accompanied by a more extensive update on CAR-T cell treatment.
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Toia F, Cajozzo M, Rosatti F, Di Lorenzo S, Rinaldi G, Mazzucco W, Cordova A. Effectiveness of clinical and instrumental follow-up for cutaneous melanoma. Surg Oncol 2022; 44:101821. [PMID: 35947885 DOI: 10.1016/j.suronc.2022.101821] [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: 03/24/2022] [Revised: 07/05/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Follow-up guidelines for melanoma greatly differ in the methods of screening for recurrence, and timing and duration of the follow up, with many areas of controversy and a lack of general consensus. The aims of this study are to present our protocol and case series for follow up and to summarize and discuss current literature on melanoma follow-up guidelines/recommendations in different countries. METHODS We retrospectively reviewed 539 patients operated for melanoma between 2004 and 2013 at the same Institution. Data on the diagnostic role of the different clinical and instrumental detection methods were adjusted for sex, age at diagnosis, staging and evaluated by Fisher's exact test and multivariate analysis. Recommendations from the literature were summarized and discussed. RESULTS Local recurrences and second melanoma were always identified through physical examination, irrespectively of melanoma staging. Regional metastases were most often identified through physical examination and ultrasound, being more frequent in stage II and III, while distant metastases were most often identified through CT scans. Surveillance follow-up schedules vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Similarities and controversies in the different follow-up protocols are presented and discussed. CONCLUSION Our clinical series showed that physical examination is very powerful in identifying local recurrences and second melanomas. Physical examination and ultrasound are equally powerful in identifying regional metastases, and alternating them over time could allow to reduce the number of follow-up visits. CT scans, differently from chest x-ray, showed a high power in identifying distant metastases. Surveillance follow-up schedules in the literature vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Standard protocols are desirable for a better evaluation of results.
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Affiliation(s)
- Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Marta Cajozzo
- Plastic and Maxillofacial Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fernando Rosatti
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy.
| | - Sara Di Lorenzo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Gaetana Rinaldi
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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Di Lorenzo S, Corradino B, Panzarella V. Non-Hodgkin B-cell lymphoma involving the palate. Lancet Oncol 2018; 19:e275. [PMID: 29726392 DOI: 10.1016/s1470-2045(17)30606-x] [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: 05/22/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Sara Di Lorenzo
- Plastic Surgery Unit, Department of Surgery, Oncology, and Stomatology, University of Palermo, Sicily, Italy.
| | - Bartolo Corradino
- Plastic Surgery Unit, Department of Surgery, Oncology, and Stomatology, University of Palermo, Sicily, Italy
| | - Vera Panzarella
- Oral Medicine Unit, Department of Surgery, Oncology, and Stomatology, University of Palermo, Sicily, Italy
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Di Lorenzo S, Zabbia G, Corradino B, Tripoli M, Pirrello R, Cordova A. A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap. Am J Case Rep 2017; 18:1284-1288. [PMID: 29199268 PMCID: PMC5726147 DOI: 10.12659/ajcr.905671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 01/01/2023]
Abstract
Patient: Female, 82 Final Diagnosis: Giant basal cell carcinoma Symptoms: Anemia Medication: — Clinical Procedure: — Specialty: Plastic Surgery
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Affiliation(s)
- Sara Di Lorenzo
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Giovanni Zabbia
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Bartolo Corradino
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Massimiliano Tripoli
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Roberto Pirrello
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
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Di Lorenzo S, Corradino B. U-stitches in microvascular anastomosis in an animal model. Microsurgery 2017; 38:126-127. [PMID: 29064121 DOI: 10.1002/micr.30258] [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: 05/13/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Sara Di Lorenzo
- Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche. Sez Chirurgia Plastica, Università di Palermo, Palermo, Italy
| | - Bartolo Corradino
- Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche. Sez Chirurgia Plastica, Università di Palermo, Palermo, Italy
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Di Lorenzo S, Fanale D, Corradino B, Caló V, Rinaldi G, Bazan V, Giordano A, Cordova A, Russo A. Absence of germline CDKN2A mutation in Sicilian patients with familial malignant melanoma: Could it be a population-specific genetic signature? Cancer Biol Ther 2016; 17:83-90. [PMID: 26650572 DOI: 10.1080/15384047.2015.1108494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/14/2022] Open
Abstract
Germline CDKN2A mutations have been described in 25% to 40% of melanoma families from several countries. Sicilian population is genetically different from the people of Europe and Northern Italy because of its historical background, therefore familial melanoma could be due to genes different from high-penetrance CDKN2A gene. Four hundred patients with cutaneous melanoma were observed in a 6-years period at the Plastic Surgery Unit of the University of Palermo. Forty-eight patients have met the criteria of the Italian Society of Human Genetics (SIGU) for the diagnosis of familial melanoma and were screened for CDKN2A and CDK4 mutations. Mutation testing revealed that none of the families carried mutations in CDK4 and only one patient harboured the rare CDKN2A p.R87W mutation. Unlike other studies, we have not found high mutation rate of CDKN2A in patients affected by familial melanoma or multiple melanoma. This difference could be attributed to different factors, including the genetic heterogeneity of the Sicilian population. It is likely that, as in the Australian people, the inheritance of familial melanoma in this island of the Mediterranean Sea is due to intermediate/low-penetrance susceptibility genes, which, together with environmental factors (as latitude and sun exposure), could determine the occurrence of melanoma.
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Affiliation(s)
- Sara Di Lorenzo
- a Department of Surgical , Oncological and Oral Sciences, Section of Plastic Surgery, University of Palermo , 90127 Palermo , Italy
| | - Daniele Fanale
- b Department of Surgical , Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo , 90127 Palermo , Italy
| | - Bartolo Corradino
- a Department of Surgical , Oncological and Oral Sciences, Section of Plastic Surgery, University of Palermo , 90127 Palermo , Italy
| | - Valentina Caló
- b Department of Surgical , Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo , 90127 Palermo , Italy
| | - Gaetana Rinaldi
- b Department of Surgical , Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo , 90127 Palermo , Italy
| | - Viviana Bazan
- b Department of Surgical , Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo , 90127 Palermo , Italy
| | - Antonio Giordano
- c Sbarro Institute for Cancer Research and Molecular Medicine, Temple University , Philadelphia , PA 19122 , USA
| | - Adriana Cordova
- a Department of Surgical , Oncological and Oral Sciences, Section of Plastic Surgery, University of Palermo , 90127 Palermo , Italy
| | - Antonio Russo
- b Department of Surgical , Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo , 90127 Palermo , Italy
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Corradino B, Di Lorenzo S, Hubova M, Cordova A. Propeller flap for treatment of a poststernotomy sternal fistula: a case report. J Plast Reconstr Aesthet Surg 2014; 67:e266-9. [PMID: 25213714 DOI: 10.1016/j.bjps.2014.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/18/2014] [Accepted: 07/26/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED The treatment of post-operative deep sternal wound infections is a real challenge for surgeons. Conservative treatment with debridement and vacuum-assisted closure (VAC) therapy is not always successful. In the most severe and chronic cases, a surgical debridement and reconstruction of the defect is mandatory. In this report, the authors present a case of a 61-year-old female patient with a chronic cutaneous fistula in the sternal region following a median sternotomy after coronary artery bypass. The patient had already undergone treatment with antibiotics, drainage of an abscess and local debridement, but the infection continued to relapse periodically. The authors decided to treat the fistula with debridement and reconstruction with a local freestyle propeller flap mobilised from the right parasternal region. RESULTS The fistula healed without any complications. There has been no relapse, and the aesthetic result is satisfactory. The scar at the donor site is acceptable with a minimum alteration to the mammary region. CONCLUSIONS Sternal fistulas after medial sternotomy are difficult to treat. The treatment method of debridement followed, in certain cases, by VAC therapy is quite controversial. A surgical procedure is sometimes necessary to speed healing. Mobilisation of a freestyle propeller flap represents a less invasive surgical approach to the treatment of sternal fistulas in cases of conservative treatment failure.
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Affiliation(s)
- Bartolo Corradino
- Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Via del Vespro 129, Palermo 90127, Italy
| | - Sara Di Lorenzo
- Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Via del Vespro 129, Palermo 90127, Italy
| | - Martina Hubova
- Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Via del Vespro 129, Palermo 90127, Italy.
| | - Adriana Cordova
- Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Via del Vespro 129, Palermo 90127, Italy
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Cordova A, D'Arpa S, Di Lorenzo S, Toia F, Campisi G, Moschella F. Prophylactic chimera anterolateral thigh/vastus lateralis flap: preventing complications in high-risk head and neck reconstruction. J Oral Maxillofac Surg 2013; 72:1013-22. [PMID: 24534160 DOI: 10.1016/j.joms.2013.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE In high-risk head and neck cases treated with tumor resection and associated radical neck dissection, orocutaneous fistulas and wound breakdowns in the neck are relatively frequent and can have serious consequences, such as carotid blowout syndrome (CBS), the need for salvage reoperations, and prolonged recovery time. The authors present the application of a prophylactic chimeric anterolateral thigh (ALT) and vastus lateralis (VL) flap to prevent complications. MATERIALS AND METHODS A retrospective review was performed of a historical group (96 patients) of patients with head and neck cancer treated with tumor resection, radical neck dissection, and microsurgical reconstruction of the tumor site only and a prospective cohort (21 patients) in which a chimeric ALT-VL flap was used to simultaneously reconstruct the tumor site and sternocleidomastoid muscle to fill dead space and protect the carotid artery. RESULTS The rate of complications was higher in the historical group: CBS occurred in 4.1% and orocutaneous fistulas in 11.5% of patients; 5.2% of patients required major salvage surgery for a wound complication. In the cohort group, no CBS or orocutaneous fistula occurred and no major salvage surgical procedure was needed. CONCLUSIONS Prophylactic ALT-VL flaps in high-risk head and neck cancers provide adequate and long-lasting soft tissue coverage for the carotid artery, with minimal additional morbidity, and could be beneficial in preventing serious and life-threatening wound complications and the need for reoperation.
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Affiliation(s)
- Adriana Cordova
- Full Professor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Salvatore D'Arpa
- Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Sara Di Lorenzo
- Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesca Toia
- Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppina Campisi
- Full Professor, Section of Oral Medicine "V. Margiotta", Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Moschella
- Full Professor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
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Lorenzo SD, Trapassi A, Corradino B, Cordova A. Histology of the Oral Mucosa in Patients With BRONJ at III Stage: A Microscopic Study Proves the Unsuitability of Local Mucosal Flaps. J Clin Med Res 2013; 5:22-5. [PMID: 23390472 PMCID: PMC3564564 DOI: 10.4021/jocmr1253e] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/11/2022] Open
Abstract
Background Bisphosphonate Osteonecrosis of the Jaw (BRONJ) is a newly recognized condition reported in patients treated with aminobisphosphonates (BF). BRONJ is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates who has not had radiotherapy to the jaw. Treatment protocols have been outlined, but trials and outcomes of treatment and long-term follow-up data are not yet available. In 2004 an expert panel outlined recommendations for the management of bisphosphonate-associated osteonecrosis of the jaws. Through the histological study of the oral mucosa over the bone necrosis and around the osteonecrosis area in 8 patients affected by BRONJ at III stage, the authors highlight the inappropriateness of the local mucosal flaps to cover the losses of substance of the jaw, BF-related. Methods Mucosa tissue was taken from 8 patients, affected by BRONJ, III stage. The samples taken from the mucosa around and over the osteonecrosis area were fixed with formalin and an ematossilina-eosin dichromatic coloring was carried out. Results The samples of mucosa showed pathognomonic signs of cell suffering that prove that in these patients using local mucosa flaps is inappropriate. Conclusions The authors suggest that only a well vascularized flap as free flap must be used to cover the osteonecrosis area in patients with BRONJ stage III. Because of the structural instability of the mucosa in patients suffering of osteonecrosis Bf related the local flaps are prone to ulceration and to relapse.
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Affiliation(s)
- Sara Di Lorenzo
- Dipartimento Di Discipline Chirurgiche Ed Oncologiche, Sezione Chirurgia Plastica , Universita Di Palermo, Italy
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Di Lorenzo S, Corradino B, Toia F, Cordova A. A rare case of malignant transformation of endometrioma: a case report. Eur J Plast Surg 2011. [DOI: 10.1007/s00238-010-0489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Di Lorenzo S, Corradino B. Detection of flap venous and arterial occlusion using interstitial glucose monitoring in a rodent model. Plast Reconstr Surg 2011; 127:1396. [PMID: 21364454 DOI: 10.1097/prs.0b013e318206317d] [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] [Indexed: 11/25/2022]
Affiliation(s)
- Sara Di Lorenzo
- Dipartimento di Discipline Chirurgiche ed Oncologiche, Sezione di Chirurgia Plastica, Università di Palermo, Palermo, Italy
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Abstract
CONCLUSIONS Infiltration of botulinum toxin in the major salivary glands allows a temporary reduction of salivation that begins 8 days afterwards and returns to normal within 2 months. The inhibition of salivary secretion, carried out before the oral cavity reconstructive surgery, could allow a reduction of the incidence of oro-cutaneous fistulas and local complications. OBJECTIVES Saliva stagnation is a risk factor for patients who have to undergo reconstructive microsurgery of the oral cavity, because of fistula formation and local complications in the oral cavity. The authors suggest infiltration of botulinum toxin in the major salivary glands to reduce salivation temporarily during the healing stage. PATIENTS AND METHODS During the preoperative stage, 20 patients with oral cavity carcinoma who were candidates for microsurgical reconstruction underwent sialoscintigraphy and a quantitative measurement of the salivary secretion. Injection of botulinum toxin was carried out in the salivary glands 4 days before surgery. The saliva quantitative measurement was repeated 3 and 8 days after infiltration, sialoscintigraphy after 15 days. RESULTS In all cases, the saliva quantitative measurement revealed a reduction of 50% and 70% of the salivary secretion after 72 h and 8 days, respectively. A lower rate of local complications was observed.
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Affiliation(s)
- Bartolo Corradino
- Dipartimento di Discipline Chirurgiche ed Oncologiche, Cattedra di Chirurgia Plastica, Università di Palermo, Parlermo, Italy.
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Corradino B, Di Lorenzo S, Mossuto C, Costa RP, Moschella F. Botulinum toxin in preparation of oral cavity for microsurgical reconstruction. Acta Otolaryngol 2009. [DOI: 10.1080/00016480902968094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Di Lorenzo S, Cordova A. Simultaneous endoscope-assisted contralateral breast augmentation with implants in patients undergoing postmastectomy breast reconstruction with abdominal flaps. Plast Reconstr Surg 2007; 120:1083-1084. [PMID: 17805142 DOI: 10.1097/01.prs.0000278199.05232.3d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sara Di Lorenzo
- Departments of Surgery and Oncology, Section of Plastic and Reconstructive Surgery, University of Studies of Palermo, Palermo, Italy
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Abstract
BACKGROUND We present our experience in the reconstruction of full-thickness losses of the substance of the nose using a forehead flap and a composite graft (taken from the anterior surface of the concha and adequately shaped) as both support and endonasal lining. This technique has never been described for the reconstruction of large full-thickness losses of the substance of the nose. The donor site of the composite graft in the concha is repaired by a Masson retroauricular flap. METHODS This technique was used on 14 patients (age range, 52-92 years) after full-thickness excision of tumors of the distal third of the nose. Follow-up was from 1 to 4 years. All the composite grafts were revascularized. RESULTS The results obtained were stable over time, and rhinoscopy, carried out 6 months after the operation, confirmed a homogeneous aspect and a perfect integration of the graft in the residual mucosa. CONCLUSIONS The use of a composite graft for internal lining and a forehead flap for external skin allowed is to obtain good results with minimal retraction. This technique is simple, fast and almost free of side effects.
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Affiliation(s)
- Adriana Cordova
- Dipartimento di Discipline Chirurgiche ed Oncologiche, Sezione di Chirurgia Plastica, University of Palermo, Palermo, Italy.
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Caraglia M, Abbruzzese A, Leardi A, Pepe S, Budillon A, Baldassare G, Selleri C, Lorenzo SD, Fabbrocini A, Giuberti G, Vitale G, Lupoli G, Bianco AR, Tagliaferri P. Interferon-alpha induces apoptosis in human KB cells through a stress-dependent mitogen activated protein kinase pathway that is antagonized by epidermal growth factor. Cell Death Differ 1999; 6:773-80. [PMID: 10467351 DOI: 10.1038/sj.cdd.4400550] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [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: 11/09/2022] Open
Abstract
We have demonstrated that interferon-alpha2-recombinant (IFNalpha) at growth inhibitory concentrations enhances the expression and signalling activity of the epidermal growth factor receptor (EGF-R) in human epidermoid carcinoma KB cells. Here we report that KB cells exposed to IFNalpha underwent apoptotic cell death and this effect was antagonized by EGF. We have also found that IFNalpha enhanced the expression of heat shock proteins (HSP) HSP-70, HSP-90 and HSP-27 and activated the NH2-terminal Jun kinase-1 (JNK-1) and p38 mitogen activated protein kinase, the target enzymes of a stress-dependent intracellular transduction pathway. Moreover, the overexpression of the wild-type JNK-1, obtained through plasmid transfection of KB cells, induced apoptosis which was potentiated by the exposure of wild-type JNK-1 (JNK-1wt)-transfected cells to IFNalpha. All these effects were neutralized by the addition of EGF to parental and JNK-1wt-transfected KB cells exposed to IFNalpha. In conclusion, EGF has a protective effect on KB cells from apoptosis while antagonizing a stress response elicited by IFNalpha and targeted on the stress pathway terminal kinases.
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Affiliation(s)
- M Caraglia
- Dipartimento di Biochimica e Biofisica 'F. Cedrangolo', Il Università di Napoli, Italy
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