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Goubier JN, Battiston B, Casanas J, Quick T. Adult traumatic brachial plexus injuries: advances and current updates. J Hand Surg Eur Vol 2024:17531934241229201. [PMID: 38366385 DOI: 10.1177/17531934241229201] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Nerve grafting, tendon transfer and joint fusion are routinely used to improve the upper limb function in patients with brachial plexus palsies. Newer techniques have been developed that provide additional options for reconstruction. Nerve transfer is a tool for restoring upper limb function in total root avulsions where nerve grafting is not possible. In partial brachial plexus injuries, nerve transfers can greatly improve shoulder, elbow, wrist and hand function. Intraoperative electrical stimulation can be used to diagnose precisely which nerve is injured and to choose which nerve fascicles should be transferred. Finally, measuring the postoperative outcome can improve the evaluation of our techniques. The aim of this article was to present the current techniques used to treat patients with brachial plexus injury.
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Affiliation(s)
- Jean-Noel Goubier
- Brachial Plexus and Nerve Surgery Institute, Paris, France
- Hôpital Privé Paul d'Égine, Clinique la Francilienne, Champigny sur Marne, France
- Institut de la Main, Clinique Bizet, Paris, France
| | - Bruno Battiston
- UOD Reconstructive Microsurgery, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Tom Quick
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Centre for Nerve Engineering, University College London, London, UK
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Piccato A, Crosio A, Antonini A, Battiston B, Titolo P, Tos P, Ciclamini D. Single-stage versus two-stage bone flap reconstruction in chronic osteomyelitis: Multicenter outcomes comparison. Microsurgery 2024; 44:e31139. [PMID: 38149353 DOI: 10.1002/micr.31139] [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: 03/07/2023] [Revised: 11/03/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Chronic osteomyelitis is an invalidating disease, and its severity grows according to the infection's particular features. The Cierny-Maiden criteria classify it according to the anatomical aspects (I to IV) and also by physiological class (A host being in good immune condition and B hosts being locally (L) or systemically (S) compromised). The surgical approach to chronic osteomyelitis involves radical debridement and dead space reconstruction. Two-stage management with delayed reconstruction is the most common surgical management, while one-stage treatment with concomitant reconstruction is a more aggressive approach with less available literature. Which method gives the best results is unclear. The purpose of this study is to compare single and two-stage techniques. METHODS The authors carried out a retrospective multicentric cohort study to compare two primary outcomes (bone union and infection healing) in one versus two-stage reconstructions with vascularized bone flaps in 23 cases of limb osteomyelitis (22 patients, 23 extremities). Thirteen subjects (56.5%) sustained a single-stage treatment consisting of a single surgery of radical debridement, concomitant soft tissue coverage, and bone reconstruction. Ten cases (43.5%) sustained a two-stage approach: radical debridement, simultaneous primary soft tissue closure, and antibiotic PMMA spacers implanted in 7 patients. RESULTS No statistical differences were observed between one- and two-stage approaches in bone union rate and infection recurrence risk. Even though bone union seems to be higher and faster in the two-stage than in the one-stage group, and all infection relapses occurred in the one-stage group, data did not statistically confirm these differences. Two of the six cases (33.3%) of bone nonunion occurred in compromised hosts (representing only 17.4% of our sample). The B-hosts bone union rate was 50.0%, while it reached 78.9% in A-hosts, but the difference was not statistically significant (p = .5392). Infection recurrence was higher in B-hosts than in A-hosts (p = .0086) and in Pseudomonas aeruginosa sustained infections (p = .0208), but in the latter case, the treatment strategy did not influence the outcome (p = .4000). CONCLUSIONS Bone union and infection healing rates are comparable between one and two-stage approaches. Pseudomonas aeruginosa infections have a higher risk of infection relapse, with similar effectiveness of one- and two-stage strategies. B-hosts have a higher infection recurrence rate without comparable data between the two approaches. Further studies with a larger sample size are required to confirm our results and define B-hosts' best strategy. LEVEL OF EVIDENCE Level III of evidence, retrospective cohort study investigating the results of treatments.
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Affiliation(s)
- Alice Piccato
- Orthopaedic and Traumatology Department, ASL TO3 Ospedale Civile E. Agnelli Pinerolo, Pinerolo, Italy
| | - Alessandro Crosio
- Hand Surgery and Reconstructive Microsurgery Department, ASST (Azienda Socio Sanitaria Territoriale) Gaetano Pini CTO di Milano, Milano, Italy
| | - Andrea Antonini
- Infectious Diseases and Septic Orthopaedic Department, ASL2 Ospedale di Albenga, Pietra Ligure, Italy
| | - Bruno Battiston
- Hand Surgery Department, A.O.U. Città Della Salute e Della Scienza di Torino, CTO-Orthopaedic and Traumatology II, Torino, Italy
| | - Paolo Titolo
- Hand Surgery Department, A.O.U. Città Della Salute e Della Scienza di Torino, CTO-Orthopaedic and Traumatology II, Torino, Italy
| | - Pierluigi Tos
- Hand Surgery and Reconstructive Microsurgery Department, ASST (Azienda Socio Sanitaria Territoriale) Gaetano Pini CTO di Milano, Milano, Italy
| | - Davide Ciclamini
- Hand Surgery Department, A.O.U. Città Della Salute e Della Scienza di Torino, CTO-Orthopaedic and Traumatology II, Torino, Italy
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Di Summa PG, de Schoulepnikoff C, Guillier D, Cigna E, Jiga LP, Jandali Z, Vezza D, Giacalone F, Ciclamini D, Battiston B, Elia R, Maruccia M. Orthoplastic limb reconstruction using free fibula flap after trauma: Outcomes from a retrospective European multicenter study. Microsurgery 2024; 44:e31054. [PMID: 37170919 DOI: 10.1002/micr.31054] [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: 01/05/2023] [Revised: 03/08/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Free vascularized fibula flap represents the gold standard vascularized bone graft for the management of segmental long bone defects after traumatic injury. The current study represents the largest retrospective multicenter data collection on the use of free fibula flap (FFF) for extremities' orthoplastic reconstruction after trauma aiming to highlight current surgical practice and to set the basis for updating current surgical indications. METHODS The study is designed as a retrospective analysis of prospectively collected data between 2009 and 2021 from six European University hospitals. Patients who underwent fibula flap reconstruction after acute traumatic injury (AF) or as a late reconstruction (LF) after post-traumatic non-union of upper or lower limb were included. Only extra-articular, diaphyseal fracture were included in the study. Surgical data were collected. Time to bone healing and complications were reported as clinical outcomes. RESULTS Sixty-two patients were included in the study (27 in the AF group and 35 in the LF group). The average patients' age at the time of the traumatic event was 45.3 ± 2.9 years in the AF group and 41.1 ± 2.1 years in the LF group. Mean bone defect size was 7.7 ± 0.6 cm for upper limb and 11.2 ± 1.1 cm (p = .32) for lower limb. Bone healing was uneventful in 69% of treated patients, reaching 92% after complementary procedures. Bone healing time was 7.6 ± 1.2 months in the acute group and 9.6 ± 1.5 months in the late group. An overall complication rate of 30.6% was observed, with a higher percentage of late bone complications in the LF group (34%), mostly non-union cases. CONCLUSIONS FFF reconstruction represents a reliable and definitive solution for long bone defects with bone healing reached in 92% cases with a 8.4 months of average bone healing time.
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Affiliation(s)
- Pietro G Di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Camille de Schoulepnikoff
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Guillier
- Department of Plastic and Maxillo-facial Surgery, University Hospital of Dijion, Dijion, France
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and Surgery, Plastic Surgery Unit, University of Pisa, Pisa, 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
| | - Daniele Vezza
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Francesco Giacalone
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Davide Ciclamini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Bruno Battiston
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Rossella Elia
- Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Michele Maruccia
- Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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Isoardo G, Rota E, Ciullo S, Titolo P, Matteoni E, Stura I, Calvo A, Fontana E, Battiston B, Migliaretti G, Ardito RB, Adenzato M. Psychophysiological and Neurophysiological Correlates of Dropping Objects from Hands in Carpal Tunnel Syndrome. Brain Sci 2023; 13:1576. [PMID: 38002536 PMCID: PMC10670400 DOI: 10.3390/brainsci13111576] [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: 09/04/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Dropping objects from hands (DOH) is a common symptom of carpal tunnel syndrome (CTS). We evaluated the clinical, neurophysiological, and psychophysiological features of 120 CTS patients to elucidate the DOH pathophysiology. Forty-nine healthy controls were included. METHODS In the patients, the Boston Carpal Tunnel Questionnaire (BCTQ), the Douleur Neuropathique 4 questions (DN4), and a numeric rating scale for pain (NRS) were evaluated. In patients and controls, we evaluated bilateral median and ulnar motor and sensory nerve conduction studies, cutaneous silent period and cutaneomuscular reflexes (CMR) of the abductor pollicis brevis, cold-detection threshold (CDT) and heat-pain detection threshold (HPT) at the index, little finger, and dorsum of the hand, and vibratory detection threshold at the index and little finger by quantitative sensory testing. RESULTS CTS with DOH had higher BCTQ, DN4 and NRS, lower median sensory action potential, longer CMR duration, lower CDT and higher HPT at all tested sites than controls and CTS without DOH. Predictive features for DOH were abnormal CDT and HPT at the right index and dorsum (OR: 3.88, p: 0.03) or at the little finger (OR: 3.27, p: 0.04) and a DN4 higher than 4 (OR: 2.16, p < 0.0001). CONCLUSIONS Thermal hypoesthesia in median and extra-median innervated territories and neuropathic pain are predictive of DOH in CTS.
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Affiliation(s)
- Gianluca Isoardo
- Department of Neurosciences & Mental Health, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy;
| | - Eugenia Rota
- Neurology Unit, San Giacomo Hospital, Novi Ligure, ASL Alessandria, 15121 Alessandria, Italy;
| | - Stefano Ciullo
- Department of Psychology, University of Turin, 10124 Turin, Italy; (S.C.); (E.F.); (R.B.A.)
| | - Paolo Titolo
- UOD Reconstructive Microsurgery, Department of Orthopedics & Traumatology, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy; (P.T.); (B.B.)
| | - Enrico Matteoni
- ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, 10126 Turin, Italy; (E.M.); (I.S.); (A.C.)
| | - Ilaria Stura
- ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, 10126 Turin, Italy; (E.M.); (I.S.); (A.C.)
| | - Andrea Calvo
- ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, 10126 Turin, Italy; (E.M.); (I.S.); (A.C.)
- 1st Neurology Unit, Department of Neurosciences & Mental Health, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy
| | - Elena Fontana
- Department of Psychology, University of Turin, 10124 Turin, Italy; (S.C.); (E.F.); (R.B.A.)
| | - Bruno Battiston
- UOD Reconstructive Microsurgery, Department of Orthopedics & Traumatology, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy; (P.T.); (B.B.)
| | - Giuseppe Migliaretti
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy;
| | - Rita B. Ardito
- Department of Psychology, University of Turin, 10124 Turin, Italy; (S.C.); (E.F.); (R.B.A.)
| | - Mauro Adenzato
- Department of Psychology, University of Turin, 10124 Turin, Italy; (S.C.); (E.F.); (R.B.A.)
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Guzzini M, Ciclamini D, Arioli L, Titolo P, Carrozzo A, Latini F, Battiston B, Ferretti A. Correlation between Risk Factors and Healing Times in Long Bone Nonunions Treated with Corticoperiosteal Flap from the Medial Femoral Condyle. J Reconstr Microsurg 2023; 39:502-507. [PMID: 36577498 DOI: 10.1055/a-2004-2364] [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: 12/29/2022]
Abstract
BACKGROUND The rate of fracture nonunion varies depending on the anatomical site. Numerous procedures have been proposed to treat recalcitrant nonunions. The vascularized medial femoral condyle corticoperiosteal free flap (MFCCFF) is increasingly used in nonunions with small bone loss.The percentage of success of the MFCCFF is high but the factors involved in delayed bone healing or failure of this technique or the contraindications are not described in the literature.This multicentric study aims to identify and report the different factors involved in determining the time of bone healing in the treatment of atrophic nonunion of long bones with the vascularized medial MFCCFF. METHODS All patients who underwent vascularized medial MFCCFF from January 2011 to December 2020 for the treatment of recalcitrant atrophic nonunions of long bones. Patients were reviewed at 2 and 6 weeks, and 3, 6, and 12 months postoperatively and evaluated by physical and radiographic examinations and patient-reported outcome measures. RESULTS The final study population comprised 59 patients with a mean follow-up of 26.2 ± 7.6 months, a rate of bone healing of 94.9% with a mean radiographic bone healing time of 4.1 ± 1.3 months, and low morbidity of the donor site. Diabetes mellitus, a body mass index (BMI) ≥30 kg/m2, and ≥2 previous surgeries on the fracture site were factors predicting timing for bone healing at the multivariate analysis. CONCLUSION This study demonstrates the MFCCFF as an effective and safe procedure for the treatment of the recalcitrant atrophic nonunion of long bones. An association was found between the lengthening of bone healing time and a high BMI, presence of ≥2 previous surgical interventions, and diabetes mellitus, indicating these comorbidities as risk factors (not absolute contraindications) for this microsurgical treatment. So, to our knowledge, the MFCCFF could be the first-choice treatment for atrophic nonunion of long bones.
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Affiliation(s)
- Matteo Guzzini
- Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Davide Ciclamini
- Hand Surgery and Reconstructive Microsurgery Department, CTO Hospital, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Leopoldo Arioli
- Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Paolo Titolo
- Hand Surgery and Reconstructive Microsurgery Department, CTO Hospital, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Carrozzo
- Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Francesca Latini
- Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Bruno Battiston
- Hand Surgery and Reconstructive Microsurgery Department, CTO Hospital, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Andrea Ferretti
- Orthopaedic and Trauma Surgery Unit, A.O.U. Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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Artiaco S, Bosco F, Lusso A, Cioffi LL, Battiston B, Massè A. Flexor Tendon Pulley Injuries: A Systematic Review of the Literature and Current Treatment Options. J Hand Microsurg 2023; 15:247-252. [PMID: 37701320 PMCID: PMC10495204 DOI: 10.1055/s-0042-1749420] [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: 10/17/2022] Open
Abstract
Closed injuries of the finger flexor pulley system are rare among the general population, and most of them occur during rock climbing. During the last few decades, scientific interest on this topic has increased. We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The research was limited from January 2000 to March 2022. PubMed and Scopus databases were investigated for full-text articles published in English, French, and Italian using the following MeSH terms: ([pulley rupture] OR [finger pulley lesion]) AND ([injur*] OR [ruptur*] OR [damage] OR [trauma*]). Initial screening results identified 461 studies, among which 172 were included after including additional records identified through other sources and excluding repeated studies. Finally, four clinical studies were included in the analysis. The methodological quality of the articles was evaluated through the methodological index for nonrandomized studies (MINORS) score. Our search identified four studies that enrolled a total of 189 patients, of whom 164 were male and 25 were female. We finally examined 154 patients with a total of 208 pulleys damaged. Except for the thumb, all fingers were involved. Depending on the type of flexor pulley injury, graded with Schöffl classification, 69 patients underwent a surgical procedure, whereas 85 patients were treated conservatively. Closed finger pulleys injury occurred in rock climbers and non - rock climbers. All patients had excellent results on the Buck-Gramcko score regardless of the return to sports activity. Considering the overall outcomes of the reviewed articles, functional results were satisfactory in both conservative and surgical treatment. Moreover, in grade 3 and 4, surgical results were positive regardless of the specific technique used for finger pulley reconstruction. Only minor complications were reported. Closed flexor tendon pulley injuries require a careful clinical and imaging examination to confirm the diagnosis. In most cases, positive clinical results can be achieved with either conservative or surgical therapy.
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Affiliation(s)
- Stefano Artiaco
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Alessandro Lusso
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Luigi Luca Cioffi
- Department of Orthopaedics and Traumatology, CTO Napoli, Napoli, Italy
| | - Bruno Battiston
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
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Lavorato A, Aruta G, De Marco R, Zeppa P, Titolo P, Colonna MR, Galeano M, Costa AL, Vincitorio F, Garbossa D, Battiston B. Traumatic peripheral nerve injuries: a classification proposal. J Orthop Traumatol 2023; 24:20. [PMID: 37162617 PMCID: PMC10172513 DOI: 10.1186/s10195-023-00695-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 04/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Peripheral nerve injuries (PNIs) include several conditions in which one or more peripheral nerves are damaged. Trauma is one of the most common causes of PNIs and young people are particularly affected. They have a significant impact on patients' quality of life and on the healthcare system, while timing and type of surgical treatment are of the utmost importance to guarantee the most favorable functional recovery. To date, several different classifications of PNIs have been proposed, most of them focusing on just one or few aspects of these complex conditions, such as type of injury, anatomic situation, or prognostic factors. Current classifications do not enable us to have a complete view of this pathology, which includes diagnosis, treatment choice, and possible outcomes. This fragmentation sometimes leads to an ambiguous definition of PNIs and the impossibility of exchanging crucial information between different physicians and healthcare structures, which can create confusion in the choice of therapeutic strategies and timing of surgery. MATERIALS The authors retrospectively analyzed a group of 24 patients treated in their center and applied a new classification for PNI injuries. They chose (a) five injury-related factors, namely nerve involved, lesion site, nerve type (whether motor, sensory or mixed), surrounding tissues (whether soft tissues were involved or not), and lesion type-whether partial/in continuity or complete. An alphanumeric code was applied to each of these classes, and (b) four prognostic codes, related to age, timing, techniques, and comorbidities. RESULTS An alphanumeric code was produced, similar to that used in the AO classification of fractures. CONCLUSIONS The authors propose this novel classification for PNIs, with the main advantage to allow physicians to easily understand the characteristics of nerve lesions, severity, possibility of spontaneous recovery, onset of early complications, need for surgical treatment, and the best surgical approach. LEVEL OF EVIDENCE according to the Oxford 2011 level of evidence, level 2.
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Affiliation(s)
- Andrea Lavorato
- Neurosurgery Unit, Igea Hospital, via Marcona 69, 20129, Milan, Italy
| | - Gelsomina Aruta
- Department of Neurosciences "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Raffaele De Marco
- Department of Neurosciences "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Pietro Zeppa
- Department of Neurosciences "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Paolo Titolo
- Traumatology-Reconstructive Microsurgery, Department of Orthopedics and Traumatology, CTO Hospital, Turin, Italy
| | - Michele Rosario Colonna
- Department Human Pathology, University of Messina, Viale Della Libertà 395, 98121, Messina, Italy.
| | - Mariarosaria Galeano
- Department of Biological Imaging and Morphology, University of Messina, Messina, Italy
| | - Alfio Luca Costa
- Clinic of Plastic Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Francesca Vincitorio
- Department of Neurosciences "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Diego Garbossa
- Department of Neurosciences "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Bruno Battiston
- Traumatology-Reconstructive Microsurgery, Department of Orthopedics and Traumatology, CTO Hospital, Turin, Italy
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Costa AL, Natsis K, Romeo M, Piagkou M, Bassetto F, Tiengo C, Battiston B, Titolo P, Papadopulos N, Colonna MR. Topography of the deep branch of the ulnar nerve between genders: a cadaveric study with potential clinical implications. J Plast Surg Hand Surg 2023; 57:178-180. [PMID: 35100518 DOI: 10.1080/2000656x.2022.2032103] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The lack of meticulous knowledge concerning the topographical anatomy of the deep branch of the ulnar nerve (DUN) may pose difficulties, leading to a delay or a misdiagnosis of a DUN injury. Identification of the DUN is quite difficult without precise anatomical landmarks as reference points. The current study investigates the topography of the DUN between genders, taking as a reference point a well-known landmark, the Kaplan line, used in hand surgery for carpal tunnel release. Twenty-two (15 males and 7 female) fresh frozen adult cadaveric hands were dissected by using magnifying loupes (3.5 and 5.0 x). We marked values proximal to the Kaplan line as positive (+), while we marked distal ones as negative (-). The mean distance DUN-Kaplan line was 1.69 ± 4.45 mm. In male hands, the mean distance was 4.17 ± 1.88 mm, distal to the Kaplan line, while in females, the mean distance was -4.92 ± 0.69 mm proximal to the Kaplan line. Gender dimorphism was detected, with higher statistically significant values in male hands (p = 0.001). Cadaveric studies of the DUN topography, course, and distribution pattern are uncommon. The current study provides an accurate description of the DUN topography, taking the Kaplan line as a reference point, emphasizing gender differences. The DUN is located distally in males and proximally in females. Knowledge of these predictable anatomical relations may help hand surgeons intraoperatively when dealing with a DUN lesion, because of hand trauma or during the decompression of the DUN.
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Affiliation(s)
- Alfio Luca Costa
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy.,Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marco Romeo
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Franco Bassetto
- Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy
| | - Cesare Tiengo
- Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy
| | - Bruno Battiston
- Depatment of Traumatology, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Titolo
- Depatment of Traumatology, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Nikolaos Papadopulos
- Dept. of Plastic Surgery and Hand Surgery, Munich Technical University (TUM), Munich, Germany
| | - Michele Rosario Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
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Bassetto F, Pajardi G, Battiston B, Corain M, Sargenti S, Scarpa C, Novelli C, Tiengo C, Vitali A, Facchin F, Bertolini M, Cara L, Caruso G. Efficacy and safety of Dynavisc® gel in prevention of scar adhesions recurrence after flexor tendons tenolysis in zone 2. Multicenter retrospective cohort study. Ann Ital Chir 2023; 94:529-536. [PMID: 38051506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
AIM Dynavisc® is a novel surgical product made of carboxymethylcellulose (CMC) and Polyethylene Oxide (PEO) designed to reduce post-surgical adhesions in tendons surgery. A multicenter retrospective cohort study was performed to investigate the clinical safety and efficacy of the Dynavisc® gel in reducing post-surgical adhesions after flexor tenolysis in zone 2. MATERIAL OF STUDY Thirty-one patients suffering from stiff finger after flexor tendon repairs in zone 2 treated with standard release with (18 Dynavisc®-treated group) or without (13 controls) anti-adhesion gel application into the flexor tendon sheath and around the site of the tenolysis, were collected in five different hand surgery units. Safety profile and functional outcomes (based on TAM test and the The Quick-DASH questionnaire) were examined from patients' charts and analyzed. RESULTS The application of Dynavisc® posed no safety concerns and it was not related to any additional complication. The Dynavisc®-treated group showed greater progressive improvement of TAM value in all visits with superior TAM value at T(90) and T(180) compared to the control group. DISCUSSION Tendon adhesions are the main cause of flexor tendon surgery failure. Multiple strategies (i.e. robust tendon repair, early rehabilitation and lubricant or barrier agents) have been proposed to minimize their formation. Among different products described in the literature Dynavisc® showed a significant role in limiting adhesions formation in a recent experimental study. CONCLUSIONS This clinical study confirm the safety of Dynavisc® gel application in hand surgery demonstrating its potential long-term benefits after flexor tendon tenolysis. KEY WORDS Flexor Tendon Repair, Tendon Adhesions, Tenolysis.
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Abstract
BACKGROUND Scaphoid proximal pole fractures with avascular necrosis represent a complex surgical problem. Many reconstruction techniques are based on osteosynthesis with a vascularized or nonvascularized bone graft. These procedures do not allow early mobilization and therefore sometimes lead to unsatisfying functional results. In some cases, it is possible to perform a scaphoid hemiarthroplasty using a pyrocarbon implant (adaptive proximal scaphoid implant [APSI]) in place of the necrotic proximal pole, allowing an early mobilization and delaying palliative treatments such as 4-corner arthrodesis or proximal row carpectomy. METHODS In this study, we reviewed all patients who had undergone a scaphoid hemiarthroplasty using APSI in our institutions from 1999 to 2017; the F.U. was performed through radiographic, clinical, and subjective (Disabilities of the Arm, Shoulder, and Hand) analysis. RESULTS The performances of scaphoid proximal pole implants are encouraging; radiographic, clinical, and subjective outcomes were good, and the functional recovery proved to be fast and reliable over time. CONCLUSIONS This study reports our experience in the use of APSI implants, which proved to be a good alternative to traditional techniques for treating avascular necrosis of the proximal pole, still allowing further surgical steps in case of clinical worsening over time (wrist osteoarthritis). These patients are usually young and present high functional demands. Our experience is promising, but we believe that further evaluation over time will be needed.
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Affiliation(s)
| | | | | | | | | | | | - Massimo Corain
- Azienda Ospedaliera Universitaria Integrata
Verona, Italy
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11
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Colonna MR, Piagkou M, Monticelli A, Tiengo C, Bassetto F, Sonda R, Battiston B, Titolo P, Tos P, Fazio A, Costa AL, Galeano M, Porzionato A, De Caro R, Cucinotta F, Anastasopoulos N, Papadopulos NA, Geuna S, Natsis K. Lumbrical Muscles Neural Branching Patterns: A Cadaveric Study With Potential Clinical Implications. Hand (N Y) 2022; 17:839-847. [PMID: 33349041 PMCID: PMC9465795 DOI: 10.1177/1558944720963881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum profundus and course distally along the radial side of the corresponding metacarpophalangeal joints, in front of the deep transverse metacarpal ligament. The first and second lumbrical muscles are typically innervated by the median nerve, and third and fourth by the ulnar nerve. A plethora of lumbrical muscle variants has been described, ranging from muscles' absence to reduction in their number or presence of accessory slips. The current cadaveric study highlights typical and variable neural supply of lumbrical muscles. MATERIALS Eight (3 right and 5 left) fresh frozen cadaveric hands of 3 males and 5 females of unknown age were dissected. From the palmar wrist crease, the median and ulnar nerve followed distally to their terminal branches. The ulnar nerve deep branch was dissected and lumbrical muscle innervation patterns were noted. RESULTS The frequency of typical innervations of lumbrical muscles is confirmed. The second lumbrical nerve had a double composition from both the median and ulnar nerves, in 12.5% of the hands. The thickest branch (1.38 mm) originated from the ulnar nerve and supplied the third lumbrical muscle, and the thinnest one (0.67 mm) from the ulnar nerve and supplied the fourth lumbrical muscle. In 54.5%, lumbrical nerve bifurcation was identified. CONCLUSION The complex innervation pattern and the peculiar anatomy of branching to different thirds of the muscle bellies are pointed out. These findings are important in dealing with complex and deep injuries in the palmar region, including transmetacarpal amputations.
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Affiliation(s)
| | - Maria Piagkou
- National and Kapodistrian University of
Athens, Greece
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12
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Fontana M, Rotini M, Battiston B, Artiaco S, Dutto E, Sard A, Colozza A, Vicenti G, Cavallo M, Rotini R. UNSTABLE LESIONS OF THE FOREARM: TERMINOLOGY, EVALUATIVE SCORE AND SYNOPTIC TABLE. Injury 2022; 54 Suppl 1:S85-S95. [PMID: 37032570 DOI: 10.1016/j.injury.2022.09.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 04/11/2023]
Abstract
The term "unstable lesions of the forearm" (ULF) was born to more easily describe how a partial or complete instability of the forearm unit might occur due to a traumatic loss of the transverse or longitudinal connection between the radius and ulna. For such an alteration to occur, at least two of the three main osteoligamentous locks (proximal, middle and distal) must be interrupted, often in association with a radial and/or ulnar fracture. Examining the historical patterns (Monteggia, Galeazzi, Essex-Lopresti and criss-cross lesions) and variants described in the literature, out of a total of 586 recorded interventions for forearm trauma, two elbow teams and one wrist team selected 75 cases of ULF. The aim was to describe the instability depending on its clinical and radiographic features, together with the anatomopathological evolution of the lesions based on the time of diagnosis and treatment. The clinical results, evaluated using a new score (FIPS) the Forearm Italian Performance, revealed a correlation between earlier diagnosis and treatment and a better score. The authors suggest a synoptic table that describes 1) the type of instability (proximal transverse, distal transverse, longitudinal and transverse, proximal and distal transverse), 2) classic patterns and variants with characteristic lesions and evolution over time (acute, chronic dynamic, chronic static) and 3) the three forearm constraints and segmental involvement of radius and/or ulna using an alphanumeric classification. Finally, some generic surgical suggestions are proposed.
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Affiliation(s)
| | | | | | | | | | | | | | - Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
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13
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Colonna MR, Titolo P, Battiston B, Papalia I, Bassetto F, Galeano M, Costa AL. Letter Regarding "Comments on Lumbrical Muscles Neural Branching Patterns: A Cadaveric Study With Potential Clinical Implications". Hand (N Y) 2022; 17:580. [PMID: 34738472 PMCID: PMC9112756 DOI: 10.1177/15589447211052762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michele R. Colonna
- University of Messina, Italy,Michele R. Colonna, University of Messina, Viale della Libertà 395, 98121 Messina, Italy.
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14
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Sicari M, Longhi M, D'Angelo G, Boetto V, Lavorato A, Cocchini L, Beatrici M, Battiston B, Garbossa D, Massazza G, Titolo P. Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review. Eur J Phys Rehabil Med 2022; 58:43-50. [PMID: 34747579 PMCID: PMC9980490 DOI: 10.23736/s1973-9087.21.06886-6] [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: 11/08/2022]
Abstract
INTRODUCTION Obstetric brachial plexus palsy (OBPP) is a flaccid paralysis occurring in the upper limb during birth. The OBPP includes mild lesions with complete spontaneous recovery and severe injuries with no regain of arm function. Among the most promising rehabilitation treatments aimed at improving upper extremity motor activities in individuals with neurological dysfunctions, there is the modified constraint-induced movement therapy (mCIMT). The aim of this systematic review is to assess and synthesize the critical aspects of the use of mCIMT in children with OBPP. EVIDENCE ACQUISITION This systematic review has been carried out according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis). A comprehensive search of the literature was conducted using PubMed, MEDLINE and Evidence Based Medicine Reviews, databases. We enclosed experimental and original articles, case reports and book chapters. Four articles were finally included. EVIDENCE SYNTHESIS One case report tested the feasibility of mCIMT to encourage use of the affected arm in a child with Erb-Duchenne palsy and documented the clinical changes observed. A case series had the purpose to determine if mCIMT in combination with botulinum toxin (BTX-A) improved arm function in 2 children with OBPP. A cohort study compared the use of mCIMT in 19 OBPP and 18 unilateral Cerebral Palsy. A prospective single-blind RCT described mCIMT versus conventional therapy in a group of 39 children with OBPP. CONCLUSIONS This systematic review on the use of mCIMT in children with OBPP shows that there is unanimous agreement that a program should last 2 weeks at least. However, there is no scientific evidence supporting a single common mCIMT protocol in the management of OBPP because of a considerable heterogeneity. Further high methodological studies regarding the application of mCIMT for OBPP and based on larger patients' sample should have the potential to optimize the appropriateness of care provided to infants with OBPP and, therefore, their quality of life.
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Affiliation(s)
- Monica Sicari
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maria Longhi
- Unit of Rehabilitation Medicine, Department of Neuroscience, University Hospital of Modena, Modena, Italy -
| | - Giulia D'Angelo
- Division of Physical Medicine and Rehabilitation, ASLTO3, Turin, Italy
| | - Valentina Boetto
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Lavorato
- Unit of Neurosurgery, Department of Neuroscience "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Lorella Cocchini
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Beatrici
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Bruno Battiston
- Unit of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, Department of Neuroscience "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Titolo
- Unit of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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15
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Crosetti E, Succo G, Battiston B, D'Addabbo F, Tascone M, Maldi E, Bertotto I, Berrone M. Surgical Margins After Computer-Assisted Mandibular Reconstruction: A Retrospective Study. Front Oral Health 2022; 2:806477. [PMID: 35098211 PMCID: PMC8793010 DOI: 10.3389/froh.2021.806477] [Citation(s) in RCA: 1] [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] [Received: 10/31/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: The use of virtual surgical planning in head and neck surgery is growing strongly. In the literature, its validity, accuracy and clinical utility for mandibular reconstruction are widely documented. Virtual planning of surgical bone resection and reconstruction takes place several days before surgery and its very sensitive nature can negatively affect an intervention aimed at maximum precision in term of oncological safety. Methods: The study focuses on a retrospective evaluation of the surgical margins in 26 consecutive cases with oral cavity malignancy and who underwent computer-assisted mandibular resection/reconstruction guided by the different types of bone, periosteal and peri-mandibular tissue involvement. The goal was to analyze the strategic and technical aspects useful to minimize the risk of positive or close margins and to vary the reconstructive strategy in the case of intraoperative findings of a non-radical planned resection. Results: No intraoperative or perioperative complications occurred. In 20 patients, virtual surgical planning permitted mandibular reconstruction to be performed using composite fibular free flaps, characterized by high accuracy and negative bone margins. In the remaining 6 patients, also virtually planned but otherwise reconstructed due to poor general condition (advanced age, severe comorbidity), negative bone margins were obtained. Intraoperative enlargement of the resection was carried out in one case and positive soft tissue margins were observed in another case. Conclusion: The results were satisfactory in terms of oncological radicality and precision. The functional benefits and reduction in operating times, previously demonstrated in other articles also by the authors, seem to justify the side effects related to the risk of modifying the planned surgery. During virtual planning, the surgeons must bear in mind that an unexpected progression of the tumor or a limited planned resection will entail modifying the extent of the resection intraoperatively and nullifying the virtual planning on which the reconstruction was based. Further investigations are necessary to clarify all aspects of virtual surgical planning in this setting.
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Affiliation(s)
- Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Giovanni Succo
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology, Hand and Microsurgery Unit, Orthopedic and Trauma Centre, Azienda Ospedaliero Universitaria (AOU) Città Della Salute e Della Scienza, Turin, Italy
| | | | - Martina Tascone
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Elena Maldi
- Pathology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Mattia Berrone
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
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Costa AL, Papadopulos N, Porzionato A, Natsis K, Bassetto F, Tiengo C, Giunta R, Soldado F, Bertelli JA, Baeza AR, Battiston B, Titolo P, Tos P, Radtke C, Aszmann O, Moschella F, Cordova A, Toia F, Perrotta RE, Ronchi G, Geuna S, Colonna MR. Studying nerve transfers: Searching for a consensus in nerve axons count. J Plast Reconstr Aesthet Surg 2021; 74:2731-2736. [PMID: 33962889 DOI: 10.1016/j.bjps.2021.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
Axonal count is the base for efficient nerve transfer; despite its capital importance, few studies have been published on human material, most research approaches being performed on experimental animal models of nerve injury. Thus, standard analysis methods are still lacking. Quantitative data obtained have to be reproducible and comparable with published data by other research groups. To share results with the scientific community, the standardization of quantitative analysis is a fundamental step. For this purpose, the experiences of the Italian, Austrian, German, Greek, and Iberian-Latin American groups have been compared with each other and with the existing literature to reach a consensus in the fiber count and draw up a protocol that can make future studies from different centers comparable. The search for a standardization of the methodology was aimed to reduce all the factors that are associated with an increase in the variability of the results. All the preferential methods to be used have been suggested. On the other hand, alternative methods and different methods have been identified to achieve the same goal, which in our experience are completely comparable; therefore, they can be used indifferently by the different centers according to their experience and availability.
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Affiliation(s)
- Alfio Luca Costa
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy.
| | - Nikolaos Papadopulos
- Department of Plastic Surgery and Burns, Alexandroupoli University Hospital, Democritus University of Thace, Alexandroupoli, Greece
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, (Chairperson: Professor Dr. K. NATSIS), Medical School, Aristotle University of Thessaloniki, Greece
| | - Franco Bassetto
- Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy
| | - Cesare Tiengo
- Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy
| | - Riccardo Giunta
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), Pettenkoferstraße. 8a, 80336 Munich, Germany
| | - Francisco Soldado
- Pediatric Upper Extremity Surgery and Microsurgery, Vithas San Jose Hospital, Vitoria and Hospital HM nens, Barcelona, Spain
| | - Jayme Augusto Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
| | - Alfonso Rodrìguez Baeza
- Unit of Human Anatomy and Embryology, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, 08193 Barcelona, Spain
| | - Bruno Battiston
- Human Anatomy Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Titolo
- Human Anatomy Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pierluigi Tos
- Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Depatment of Traumatology, Turin, Italy
| | - Christine Radtke
- Hand Surgery and Reconstructive Microsurgery Unit, ASST G Pini-CTO, Milano, Italy
| | - Oscar Aszmann
- Hand Surgery and Reconstructive Microsurgery Unit, ASST G Pini-CTO, Milano, Italy
| | - Francesco Moschella
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesca Toia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Rosario Emanuele Perrotta
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo, Italy
| | - Guilia Ronchi
- Department of Plastic and Reconstructive Surgery, University of Catania, Catania 95100, Italy; Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Stefano Geuna
- Department of Plastic and Reconstructive Surgery, University of Catania, Catania 95100, Italy
| | - Michele Rosario Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
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Isoardo G, Ciullo S, Titolo P, Fontana E, Battiston B, Stella M, Luxardo N, Laino F, Migliaretti G, Stura I, Ardito RB, Adenzato M. The relationship between alexithymia, sensory phenotype and neurophysiological parameters in patients with chronic upper limb neuropathy. J Neural Transm (Vienna) 2021; 128:61-71. [PMID: 33315145 PMCID: PMC7815565 DOI: 10.1007/s00702-020-02282-z] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022]
Abstract
In this study, we investigated the relationship between sensory abnormalities evaluated by quantitative sensory testing (QST) and alexithymia, depression and anxiety in patients with neuropathic pain involving the upper limbs. We enrolled 62 patients (34 with carpal tunnel syndrome, 7 with brachial plexopathy, 3 with cervical painful radiculopathy, 5 with ulnar entrapment neuropathy at elbow and 13 with post-burn hypertrophic scars) and 48 healthy controls. All underwent nerve conduction studies (NCS), evaluation of cold, heat pain and vibration detection threshold (VDT) by QST and evaluation of alexithymia by Toronto Alexithymia Scale (TAS-20), depression by Beck Depression Inventory II (BDI-II), anxiety by State-Trait Anxiety Inventory (STAI-Y), level of psychological distress by 12-item General Health Questionnaire (GHQ-12) and perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS). The general linear model analysis revealed a significant relationship between TAS-20 overall and TAS-20 sub-score for difficulty identifying feelings and VDT z-scores in the left index with no interaction by year of education and sensory NCS results. Our results demonstrated the association between impairment of vibratory sensation of the left hand, reflecting cutaneous mechanoceptor dysfunction, and alexithymia, particularly the difficulty to identify feelings. The importance of delivering to patients with neuropathic pain personalized care that takes into account not only the neurophysiological aspects but also the aspects of mental functioning is discussed.
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Affiliation(s)
- Gianluca Isoardo
- Department of Neurosciences and Mental Health, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Stefano Ciullo
- Department of Psychology, University of Turin, Turin, Italy
| | - Paolo Titolo
- Department of Orthopedics and Traumatology, UOD Reconstructive Microsurgery, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Elena Fontana
- Department of Psychology, University of Turin, Turin, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology, UOD Reconstructive Microsurgery, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Maurizio Stella
- Department of Plastic Surgery Burn Center, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Nicola Luxardo
- Department of Anesthesia, Intensive Care and Emergency, Unit of Pain Management and Palliative Care, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Federica Laino
- Department of Anesthesia, Intensive Care and Emergency, Unit of Pain Management and Palliative Care, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Rita B Ardito
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Mauro Adenzato
- Department of Psychology, University of Turin, Turin, Italy
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18
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Toia F, Romeo M, Abate M, Avarotti E, Battiston B, Bruno G, Cannavò F F, Casamichele C, Colonna M, Catena N, Cherubino M, Coppolino S, Galvano N, Giuca G, Gullo S, Internullo G, Lazzerini A, Marcoccio I, Maruccia M, Melloni C, Pajardi G, Pugliese P, Risitano G, Spata G, Tripoli M, Troisi L, Tos P, Cordova A. Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions. Hand Surg Rehabil 2020; 40:139-144. [PMID: 33309793 PMCID: PMC7836699 DOI: 10.1016/j.hansur.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/03/2022]
Abstract
The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also – and paradoxically even at a higher extent – in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.
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Affiliation(s)
- F Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy.
| | - M Romeo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - M Abate
- SSD di Ortopedia, ARNAS Garibaldi, Presidio di Nesima, Via Palermo 636, 95123, Catania (CT), Italy
| | - E Avarotti
- Department of Orthopedics and Traumatology, A.R.N.A.S. Piazza Santa Maria di Gesù 5, 95124, Catania (CT), Italy
| | - B Battiston
- Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, AOU Città della Salute e della Scienza, Via Nizza 138, 10126, Torino (TO), Italy
| | - G Bruno
- Department of Orthopedics and Traumatology, A.O. Vittorio Emanuele, Via Plebiscito 632, 95122, Catania (CT), Italy
| | - F Cannavò F
- U.O.S.D. Plastic Surgery A.O. Papardo, Contrada Papardo, 98158, Messina (ME), Italy
| | - C Casamichele
- Department of Orthopedics and Traumatology, A.O. "G. Paolo II", Contrada Cisternazzi, 97010, Ragusa (RG), Italy
| | - M Colonna
- Plastic Surgery Unit, Department of Human Pathology, University of Messina, Via Consolare Valeria1, 98124, Messina (ME), Italy
| | - N Catena
- Pediatric Orthopedic and Traumatology Unit, Children's Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Via Spalto Marengo 46, 15121, Alessandria (AL), Italy
| | - M Cherubino
- Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Via Ravasi 2, 21100, Varese (VA), Italy
| | - S Coppolino
- Hospital S. Vincenzo, Contrada Sirina, 98039, Taormina (ME), Italy
| | - N Galvano
- Department of Orthopedics and Traumatology A.O.U.P." Paolo Giaccone", Via Del Vespro 127, 90127 Palermo (PA), Italy
| | - G Giuca
- Department of Orthopedics Ospedale Maggiore, Via Resistenza Partigiana, 97015, Modica (RG), Italy
| | - S Gullo
- Department of Hand Surgery and Traumatology, A.R.N.A.S., Piazza Nicola Leotta 4, 90127, Palermo (PA), Italy
| | - G Internullo
- Department of Orthopedics, Ospedale Gravina, Via Portosalvo 9, 95041, Caltagirone (CT), Italy
| | - A Lazzerini
- Hand Surgery and Microsurgery Unit, IRCCS Humanitas Clinical Institute, Via Alessandro Manzoni 6, 20089, Milano (MI), Italy
| | - I Marcoccio
- Orthopedic Microsurgery and Upper Limb Surgery, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia (BS), Italy
| | - M Maruccia
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70122, Bari (BR), Italy
| | - C Melloni
- Plastic and Reconstructive Surgery A.O. P. Borsellino, Contrada Cardilla 1, 91025, Marsala (TP), Italy
| | - G Pajardi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Pugliese
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - G Risitano
- ABC Medical, Via Porto Salvo 2, 98121, Messina (ME), Italy
| | - G Spata
- Hand Surgery, Polyclinic Morgagni, Via del Bosco 105, 95030, Catania (CT), Italy
| | - M Tripoli
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - L Troisi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Tos
- Hand Surgery and Reconstructive Microsurgery Unit, Orthopedic Institute G. Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122, Milano (MI), Italy
| | - A Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
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Artiaco S, Fusini F, Sard A, Dutto E, Massè A, Battiston B. Fracture-dislocations of the forearm joint: a systematic review of the literature and a comprehensive locker-based classification system. J Orthop Traumatol 2020; 21:21. [PMID: 33263862 PMCID: PMC7710780 DOI: 10.1186/s10195-020-00562-8] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Monteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture-dislocation of the forearm. Uncommon variants and rare traumatic patterns of forearm fracture-dislocations have sometimes been reported in literature. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts. METHODS A comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture-dislocation of the forearm. Essex-Lopresti injury, Monteggia and Galeazzi fracture-dislocations, and proximal and/or distal radioulnar joint dislocations were sought. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1 [including proximal radioulnar joint (PRUJ) dislocation with or without radial head fractures], middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3 [including distal radioulnar joint (DRUJ) dislocation with or without distal radial fractures]. RESULTS Eighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture-dislocation were included. Three historical reviews were added separately to the process. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. In addition to fracture-dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors' knowledge, allowed us to include all types of dislocation and fracture-dislocation of the forearm joint reported in literature. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture-dislocations) of the forearm joint. CONCLUSIONS All injury patterns may be previously identified using an alphanumeric code. This might avoid confusion in forearm fracture-dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Stefano Artiaco
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126 Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, University of Turin, via Zuretti 29, 10126 Turin, Italy
| | - Arman Sard
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126 Turin, Italy
| | - Elisa Dutto
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126 Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, University of Turin, via Zuretti 29, 10126 Turin, Italy
| | - Bruno Battiston
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Centre, AOU Città Della Salute E Della Scienza Di Torino, via Zuretti 29, 10126 Turin, Italy
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20
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Titolo P, Lavorato A, Isoardo G, Vincitorio F, Garbossa D, Battiston B. Transfer of the peroneal component of the sciatic nerve in total brachial plexus lesion: An anatomical feasibility study. Injury 2020; 51:2904-2909. [PMID: 32201119 DOI: 10.1016/j.injury.2020.03.015] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
Closed brachial plexus lesions (BPLs) are generally associated with a traumatic mechanism of forced traction between the neck and the shoulder-arm complex. For brachial plexus reconstruction different techniques have been proposed with donor motor nerves like intercostal nerves, or the ipsilateral cervical plexus, the phrenic nerve, the contralateral C7 root, and many others. Despite all these surgical possibilities, the overall recovery is generally poor and not satisfactory. The principal drawback is linked to the loss of upper limb proprioception, in a way that dramatically influences even a good motor recovery, so in complete BPLs the sensory loss still represents a debilitating problem. In this anatomical feasibility study, the possibility to transfer the peroneal component of the sciatic nerve as a donor for complete BPLs has been evaluated. This technique would conceptually bring an important motor and sensory contribution to the upper limb using pure motor and sensory branches of the sciatic nerve. Performing immediate tendon transfer for foot drop palsy could significantly decrease the morbidity of the surgical procedure.
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Affiliation(s)
- Paolo Titolo
- OU Traumatology-Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Torino, Italy
| | - Andrea Lavorato
- OU Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy.
| | - Gianluca Isoardo
- Centre for Pain Treatment, Department of Anesthesiology, Resuscitation and Intensive Care, Città della Salute e della Scienza di Torino - Molinette Hospital, Italy
| | | | - Diego Garbossa
- OU Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy
| | - Bruno Battiston
- OU Traumatology-Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Torino, Italy
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21
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Giardi D, Crosio A, Rold ID, Magistroni E, Tos P, Titolo P, Battiston B, Ciclamini D. Long-term clinical results of 33 thumb replantations. Injury 2020; 51 Suppl 4:S71-S76. [PMID: 33208270 DOI: 10.1016/j.injury.2020.11.006] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Thumb replantation following complete amputation is a relatively frequent and well-established surgical procedure. In literature many studies report a discrepancy between the objective measurements and the subjective satisfaction of the patients. Nowadays, evaluation of the patient long-term benefit obtained by replantation is uncertain. The aim of this study was to consider the long-term results of 33 thumb replantation procedures. METHODS The period considered is from January 1997 to December 2015, 33 subjects fulfilled the study inclusion criteria and were included in the study. We evaluated in each patient: ROM (performing Kapandji test), level and mechanism of amputation, force peak of three grips using Dexter dynamometer (five-handle, key, tri-digital grips), sensibility (using Disk-Criminator and aesthesiometers of Semmes-Weinstein) and subjective perception of disability (using DASH questionnaire). RESULTS All patients were males, 94% of them returned to their previous occupation. Average follow-up was 9±4 years. The prevalent mechanism of injury was a combined amputation in 58% of cases. Levels involved in more than half of patients were interphalangeal joints and proximal phalanxes. Ratios of strength recovery were: for the five-handle grip equal to 0.90±0.28 kg (p=0.63), 0.78±0.30 kg (p=0.64) for key grip and 0.75±0.32 kg (p=0.78) for tri-digital grip. Results for Kapandji test was 8±2 and for DASH test was 16±21. The protective tactile threshold was recovered in 49% of patients; S2PD test resulted positive in 54% and D2PD test in 39% of cases. CONCLUSIONS Results confirm and strengthen evidence of positive long-term functional outcomes of thumb replantation interventions.
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Affiliation(s)
| | - Alessandro Crosio
- Department of hand surgery and reconstructive microsurgery, Hospital trauma centre "Gaetano Pini", Milan, Italy
| | - Ilaria Da Rold
- Department of Physical Medicine and Rehabilitation, Hospital trauma centre, Turin, Italy
| | - Ernesta Magistroni
- Department of Physical Medicine and Rehabilitation, Hospital trauma centre, Turin, Italy
| | - Pierluigi Tos
- Department of hand surgery and reconstructive microsurgery, Hospital trauma centre "Gaetano Pini", Milan, Italy
| | - Paolo Titolo
- Department of hand surgery and reconstructive microsurgery; Hospital trauma centre; Turin, Italy
| | - Bruno Battiston
- Operative Unit of Musculoskeletal Traumatology, Hospital trauma centre, Turin, Italy
| | - Davide Ciclamini
- Department of Reconstructive Microsurgery, Hospital trauma centre, Turin, Italy
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22
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Artiaco S, Ciclamini D, Teodori J, Dutto E, Benigno T, Battiston B. One bone forearm with vascularized fibular graft. Clinical experience and literature review. Injury 2020; 51:2962-2965. [PMID: 32571550 DOI: 10.1016/j.injury.2020.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/23/2020] [Accepted: 06/13/2020] [Indexed: 02/02/2023]
Abstract
One-Bone-Forearm (OBF) is a procedure in which the proximal stump of the ulna is fixed to the distal stump of the radius. Historically, the indications for OBF have been represented by forearm instability due to trauma, infection, tumor resection, and congenital deformities with severe radius and ulna bone loss. When major bone loss prevents direct fixation between ulna and radius a Vascularized Fibular Bone Graft (VFBG) may allow forearm bone reconstruction and fixation. In this study we report our clinical experience in 4 cases of OBF with VFBG performed in 3 patients. Compared to standard OBF technique with direct osteodesis, OBF with VFBG showed similar clinical results and high rate of healing even in case of bone infection. Moreover, composite osteocutaneous VFBG might concurrently allow to treat local soft tissue defects.
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Affiliation(s)
- S Artiaco
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center,AOU Cittàdella Salute e dellaScienza di Torino, via Zuretti 29, 10126, Turin, Italy.
| | - D Ciclamini
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center,AOU Cittàdella Salute e dellaScienza di Torino, via Zuretti 29, 10126, Turin, Italy
| | - J Teodori
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center,AOU Cittàdella Salute e dellaScienza di Torino, via Zuretti 29, 10126, Turin, Italy
| | - E Dutto
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center,AOU Cittàdella Salute e dellaScienza di Torino, via Zuretti 29, 10126, Turin, Italy
| | - T Benigno
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center,AOU Cittàdella Salute e dellaScienza di Torino, via Zuretti 29, 10126, Turin, Italy
| | - B Battiston
- Department of Orthopaedic and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center,AOU Cittàdella Salute e dellaScienza di Torino, via Zuretti 29, 10126, Turin, Italy
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23
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Colzani G, Lavorato A, Vincitorio F, Garbossa D, Battiston B, Titolo P. Surgery and CoVid-19 pandemic's effects on the fragile psychosocial background in tetraplegic patients: psychological considerations. J Neurosurg Sci 2020; 66:73-74. [PMID: 33252208 DOI: 10.23736/s0390-5616.20.05208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giulia Colzani
- Hand Surgery, Microsurgery and Reconstructive Unit, Orthopaedics and Traumatology Department, CTO Hospital, Turin, Italy -
| | | | | | | | - Bruno Battiston
- Hand Surgery, Microsurgery and Reconstructive Unit, Orthopaedics and Traumatology Department, CTO Hospital, Turin, Italy
| | - Paolo Titolo
- Hand Surgery, Microsurgery and Reconstructive Unit, Orthopaedics and Traumatology Department, CTO Hospital, Turin, Italy
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24
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Falcone M, Preto M, Timpano M, Ciclamini D, Crosio A, Giacalone F, Battiston B, Tos P, Gontero P. The surgical outcomes of radial artery forearm free-flap phalloplasty in transgender men: single-centre experience and systematic review of the current literature. Int J Impot Res 2020; 33:737-745. [PMID: 33603245 DOI: 10.1038/s41443-021-00414-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
Radial artery forearm free-flap (RAFFF) phalloplasty is considered by most authors as the gold-standard technique for genital gender-affirming surgery (GGAS). RAFFF surgical complications have rarely been investigated, and the aim of this study and literature review is to analyse and focus on the surgical technique and its postoperative vascular complications. From May 2016 to January 2020, a consecutive series of 25 transgender men who underwent GGAS were enrolled in the present study. Age, BMI and smoking habits were recorded for all patients. Overall, vascular flap complications occurred in 20% of cases. Complete flap loss due to acute arterial thrombosis was recorded in a single case (4%). In 8% of cases, limited ventro-proximal arterial ischaemia was detected, while in the remaining 8% of cases, venous ventral ischaemia was reported. These results were compared with the current literature results. Indeed, from our analysis, the number of flap veins (<2) was the only predictive factor for vascular complications. In conclusion, RAFFF represents a reliable option for total phallic construction, leading to satisfactory results in terms of flap survival. To optimize the surgical outcomes, venous vascular drainage should be recommended.
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Affiliation(s)
- Marco Falcone
- Department of Neurourology, Unità Spinale Unipolare, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Mirko Preto
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Massimiliano Timpano
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Ciclamini
- Department of Orthopedic, Microsurgery Unit, CTO Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Crosio
- Hand Surgery and Reconstructive Microsurgery Department, CTO, ASST Gaetano Pini, Milan, Italy
| | - Francesco Giacalone
- Department of Orthopedic, Microsurgery Unit, CTO Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bruno Battiston
- Department of Orthopedic, Microsurgery Unit, CTO Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pierluigi Tos
- Hand Surgery and Reconstructive Microsurgery Department, CTO, ASST Gaetano Pini, Milan, Italy
| | - Paolo Gontero
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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25
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Battiston B, Artiaco S, Ciclamini D. The Robotic Scope can be a Useful Tool for Hand and Microsurgical Procedures during the COVID-19 Pandemic. J Hand Microsurg 2020; 13:255-256. [PMID: 34744389 DOI: 10.1055/s-0040-1716667] [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] Open
Affiliation(s)
- Bruno Battiston
- Department of Orthopaedics and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center CTO, Turin, Italy
| | - Stefano Artiaco
- Department of Orthopaedics and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center CTO, Turin, Italy
| | - Davide Ciclamini
- Department of Orthopaedics and Traumatology, Hand and Microsurgery Unit, Orthopaedic and Trauma Center CTO, Turin, Italy
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26
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Ferracini R, Bistolfi A, Guidotti C, Artiaco S, Battista A, Battiston B, Perale G. Bone Loss in Distal Radial Fractures Treated with A Composite Xenohybrid Bone Substitute: A Two Years Follow-Up Retrospective Study. Materials (Basel) 2020; 13:E4040. [PMID: 32933036 PMCID: PMC7558122 DOI: 10.3390/ma13184040] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
(1) Background: Recently, surgical treatment of distal radius fractures has increased exponentially. Many locking plates' fixation systems have been developed allowing a more stable reduction and early mobilization. Sometimes, open reduction and fixation of distal radius fractures may leave a residual bone loss requiring grafting. This retrospective study reports clinical and radiologic outcomes of distal radius fractures treated with xenohybrid bone grafting in order to assess (i) the safety of the investigated bone graft; (ii) its radiological integration and biomechanical performances, and (iii) clinical outcomes of the patients; (2) Methods: We performed a retrospective study on a cohort of 19 patients. Preoperative X-ray and CT scan were performed. The mean clinical and radiographical follow-up was two years. Safety of the xenohybrid bone graft was constantly evaluated. Clinical results were assessed through the DASH score and Mayo wrist score; (3) Results: No adverse reactions, infections, and local or general complication were related to the use of xenohybrid bone graft. The radiolucency of the xenografts suggested progressive osteointegration. No evidence of bone graft resorption was detected. All the patients reached consolidation with good to excellent clinical results; and (4) Conclusions: Clinical and radiological data demonstrated that xenohybrid bone grafting promotes new bone formation and healing in osteopenic areas caused by fracture reduction.
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Affiliation(s)
- Riccardo Ferracini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Viale Benedetto XV n6, 16132 Genova, Italy
| | - Alessandro Bistolfi
- Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Via Zuretti 29, 10126 Turin, Italy; (A.B.); (S.A.); (B.B.)
| | - Claudio Guidotti
- Medical School, University of Turin, 10100 Turin, Italy; (C.G.); (A.B.)
| | - Stefano Artiaco
- Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Via Zuretti 29, 10126 Turin, Italy; (A.B.); (S.A.); (B.B.)
| | - Agnese Battista
- Medical School, University of Turin, 10100 Turin, Italy; (C.G.); (A.B.)
| | - Bruno Battiston
- Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Via Zuretti 29, 10126 Turin, Italy; (A.B.); (S.A.); (B.B.)
| | - Giuseppe Perale
- Industrie Biomediche Insubri S.A., Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland;
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27
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Battiston B, Ciclamini D, Tang JB. Compound or Specially Designed Flaps in the Lower Extremities. Clin Plast Surg 2020; 47:535-546. [PMID: 32892799 DOI: 10.1016/j.cps.2020.06.006] [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: 11/26/2022]
Abstract
Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular.
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Affiliation(s)
- Bruno Battiston
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy.
| | - Davide Ciclamini
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy
| | - Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
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28
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Ferrero M, di Summa PG, Giacalone F, Senesi L, Sapino G, Battiston B. Salvage of advanced carpal collapse: proximal row carpectomy with pyrocarbon resurfacing of the capitate versus four-corner arthrodesis. J Hand Surg Eur Vol 2020; 45:687-692. [PMID: 32787664 DOI: 10.1177/1753193420931416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 02/03/2023]
Abstract
In this retrospective study we report on two comparable groups of patients with advanced carpal arthritis treated with either proximal row carpectomy combined with a pyrocarbon resurfacing of the capitate (31 patients) or a four-corner arthrodesis and dorsal plating (26 patients). Follow-up time was 46 months (24-118). Except for a modestly higher radial wrist deviation in the patients treated with four-corner arthrodesis, there were no significant differences in outcomes between the groups. Asymptomatic progression of osteoarthritis in the lunate fossa was observed in four cases in both groups. Two cases were converted to a total wrist arthrodesis in the pyrocarbon group compared with one case in the four-corner arthrodesis group. Although four-corner arthrodesis remains the reference standard in the treatment of wrist osteoarthritis with involvement of the midcarpal joint, proximal row carpectomy combined with pyrocarbon resurfacing of the capitate is an alternative option. It can even be used in selected cases with erosion of the lunate fossa.Level of evidence: III.
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Affiliation(s)
- Matteo Ferrero
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pietro G di Summa
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Francesco Giacalone
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Letizia Senesi
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gianluca Sapino
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Bruno Battiston
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
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Costa AL, Titolo P, Battiston B, Colonna MR. Letter regarding "Ozcelik et al. A novel nerve transfer: The first palmar interosseous motor branch of the ulnar nerve to the recurrent motor branch of the median nerve. Injury.2020. Doi: 10.1016/j.injury.2020.02.119". Injury 2020; 51:1689-1690. [PMID: 32439106 DOI: 10.1016/j.injury.2020.04.038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Alfio Luca Costa
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Via Consolare Valeria 1, Messina 98125, Italy.
| | - Paolo Titolo
- Depatment of Traumatology, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Bruno Battiston
- Depatment of Traumatology, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Rosario Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Via Consolare Valeria 1, Messina 98125, Italy
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Vincitorio F, Cofano F, Colzani G, Titolo P, Lavorato A, Battiston B, Garbossa D. Letter to the Editor Regarding "Opinion Piece: Microsurgery in COVID-19-Positive Patients". World Neurosurg 2020; 139:712-713. [PMID: 32454197 PMCID: PMC7245318 DOI: 10.1016/j.wneu.2020.05.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Francesca Vincitorio
- Neurosurgery Unit, Department of Neuroscience, University of Turin, The City of Health and Science, Turin, Italy; Unit of Spine Surgery, Humanitas Cellini - Gradenigo, Turin, Italy.
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience, University of Turin, The City of Health and Science, Turin, Italy; Unit of Spine Surgery, Humanitas Cellini - Gradenigo, Turin, Italy
| | - Giulia Colzani
- UOC Traumatology - Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Turin, Italy
| | - Paolo Titolo
- UOC Traumatology - Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Turin, Italy
| | - Andrea Lavorato
- Neurosurgery Unit, Department of Neuroscience, University of Turin, The City of Health and Science, Turin, Italy
| | - Bruno Battiston
- UOC Traumatology - Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Turin, Italy
| | - D Garbossa
- Neurosurgery Unit, Department of Neuroscience, University of Turin, The City of Health and Science, Turin, Italy
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Baldassarre BM, Lavorato A, Titolo P, Colonna MR, Vincitorio F, Colzani G, Garbossa D, Battiston B. Principles of Cortical Plasticity in Peripheral Nerve Surgery. Surg Technol Int 2020; 36:444-452. [PMID: 32359164] [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: 06/11/2023]
Abstract
Cortical plasticity is a finely regulated process that allows the central nervous system (CNS) to change in response to internal and external stimuli. While these modifications occur throughout normal brain development, interestingly, they are also elicited after peripheral nerve injury and surgery. This article provides an overview of the principle mechanisms of synaptic, neuronal, cortical and subcortical neuroplasticity, with special attention to cortical and subcortical modifications-as suggested by modern neuroimaging techniques-after peripheral nerve surgery. The main nerve transfer techniques for the superior extremities and their effect on cortical plasticity are also described.
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Affiliation(s)
- Bianca Maria Baldassarre
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Andrea Lavorato
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Paolo Titolo
- UOC Traumatology-Reconstructive Microsurgery, Department of Orthopedics and Traumatology, CTO Hospital, Torino, Italy
| | - Michele Rosario Colonna
- UOC Traumatology-Reconstructive Microsurgery, Department of Orthopedics and Traumatology, CTO Hospital, Torino, Italy
| | - Francesca Vincitorio
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Giulia Colzani
- UOC Traumatology-Reconstructive Microsurgery, Department of Orthopedics and Traumatology, CTO Hospital, Torino, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Bruno Battiston
- UOC Traumatology-Reconstructive Microsurgery, Department of Orthopedics and Traumatology, CTO Hospital, Torino, Italy
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32
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Artiaco S, Fusini F, Pennacchio G, Colzani G, Battiston B, Bianchi P. Sarcopenia in distal radius fractures: systematic review of the literature and current findings. Eur J Orthop Surg Traumatol 2020; 30:1251-1255. [PMID: 32415433 DOI: 10.1007/s00590-020-02697-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/06/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, strength and physical ability. Although proximal femur fractures are one of the major burdens affecting the ageing population, distal radius fractures are equally important for frequency, clinical and social consequences. The aim of this study is to evaluate the incidence of sarcopenia in distal radius fractures and clinical implications in functional recovery. MATERIALS AND METHODS Scopus and PubMed search was performed to find relationship between sarcopenia and distal radius fractures. Literature search was performed between 2009 and 2019 including clinical trials and clinical studies related to "sarcopenia and distal radius fracture" and "sarcopenia and wrist fracture". After identification, studies were screened and analysed through the Oxford Level of Evidence. RESULTS According to the inclusion and exclusion criteria, five articles were included. Four articles analysed the incidence of sarcopenia and its role as a risk factor in patients with distal radial fractures, while one article focused on sarcopenia and clinical results of surgical treatment of distal radius fractures. Incidence of sarcopenia in patients older than 50 years with distal radius fracture varied between 29.7% and 31.7%. Patients with distal radial fractures did not show a significant inferior muscle mass than control group in examined population. Functional results of surgery were significantly inferior in sarcopenic patients than control group (no sarcopenia). CONCLUSIONS About 30% of patients older than 50 years with distal radius fracture suffered by sarcopenia; sarcopenic patients surgically treated had worse clinical results than no sarcopenic patients. Further studies with larger samples are needed to confirm these preliminary results.
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Affiliation(s)
- Stefano Artiaco
- Department of Orthopaedics and Traumatology, Hand Upper Limb Surgery Unit, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10126, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Hand Upper Limb Surgery Unit, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10126, Turin, Italy.
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Via S. Rocchetto99, 12084, Mondovì, Italy.
| | - Gioacchino Pennacchio
- Orthopaedic and Traumatology Unit, S. Maria Della Pietà Hospital, Nola, Naples, Italy
| | - Giulia Colzani
- Department of Orthopaedics and Traumatology, Hand Upper Limb Surgery Unit, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10126, Turin, Italy
| | - Bruno Battiston
- Department of Orthopaedics and Traumatology, Hand Upper Limb Surgery Unit, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10126, Turin, Italy
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Magistroni E, Parodi G, Fop F, Battiston B, Dahlin LB. Cold intolerance and neuropathic pain after peripheral nerve injury in upper extremity. J Peripher Nerv Syst 2020; 25:184-190. [PMID: 32297385 DOI: 10.1111/jns.12376] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/28/2020] [Accepted: 04/05/2020] [Indexed: 02/01/2023]
Abstract
Cold intolerance and pain can be a substantial problem in patients with peripheral nerve injury. We aimed at investigating the relationships among sensory recovery, cold intolerance, and neuropathic pain in patients affected by upper limb peripheral nerve injury (Sunderland type V) treated with microsurgical repair, followed by early sensory re-education. In a cross-sectional clinical study, 100 patients (male/female 81/19; age 40.5 ± 14.8 years and follow-up 17 ± 5 months, mean ± SD), with microsurgical nerve repair and reconstruction in the upper extremity and subsequent early sensory re-education, were evaluated, using Cold Intolerance Symptoms Severity questionnaire-Italian version (CISS-it, cut-off pathology >30/100 points), CISS questionnaire-12 item version (CISS-12, 0-46 points-grouping: healthy that means no cold intolerance [0-14], mild [15-24], moderate [25-34], severe [35-42], very severe [43-46] cold intolerance), probability of neuropathic pain (DouleurNeuropathique-4; [DN4] 4/10), deep and superficial sensibility, tactile threshold (monofilaments), and two-point discrimination (cutoff S2; Medical Research Council scale for sensory function; [MRC-scale]). A high CISS score is associated with possible neuropathic pain (DN4 ≥ 4). Both a low CISS-it score (ie, < 30) and DN4 < 4 is associated with good sensory recovery (MRC ≥ 2). In conclusion patients affected by upper limb peripheral nerve injuries with higher CISS scores more often suffer from cold intolerance and neuropathic pain, and the better their sensory recovery is, the less likely they are to suffer from cold intolerance and neuropathic pain.
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Affiliation(s)
- Ernesta Magistroni
- Department of Orthopaedics, Traumatology and Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Academic Unit, Traumatologic Orthopaedic Center, Citta' della Salute e della Scienza di Torino, Turin, Italy
| | - Giulia Parodi
- Department of Orthopaedics, Traumatology and Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Academic Unit, Traumatologic Orthopaedic Center, Citta' della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio Fop
- Department of Medical Sciences, Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Citta' della Salute e della Scienza di Torino" University Hospital, Universita' degli Studi di Torino, Turin, Italy
| | - Bruno Battiston
- Department of Orthopaedics, Traumatology and Physical Medicine and Rehabilitation, Hand and Microsurgery Unit, Traumatologic Orthopaedic Center, Citta' della Salute e della Scienza di Torino, Turin, Italy
| | - Lars B Dahlin
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden
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Ciclamini D, Antonini A, Tos P, Crosio A, Piccato A, Battiston B. Treatment of chronic Osteomyelitis with vascularized bone flaps in one-stage-procedure. HANDCHIR MIKROCHIR P 2020; 52:116-122. [PMID: 32259858 DOI: 10.1055/a-1075-2402] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Chronic osteomyelitis is a long-standing infection of the bone. Treatment is often combined, using antibiotics and surgery (with radical debridement and secondary or concomitant reconstruction). One-stage management is an alternative approach, with few reported cases in literature. PATIENTS/MATERIAL AND METHODS We carried out an observational retrospective multicenter study to evaluate the results of one-stage reconstructions with vascularized bone flaps. We assessed bone and infection healing in 14 cases, with a mean follow-up of 63.6 months. RESULTS Bone union was obtained in 10 cases (71.4 %) in a mean period of 7.9 months. Nonunion occurred in 4 cases (28.6 %), 2 of them with infection persistence. Bone nonunion risk increases in polymicrobial infections (p = 0.0269) and in compromised hosts (p = 0.0110). Infection healing was achieved in 11 cases (78.6 %). Fistula recurred in 3 cases of forearm osteomyelitis (21.4 %) in 10 months on average. Infection recurrence is associated with polymicrobial infections (p = 0.0378) and is higher in internal fixation and compromised hosts with no statistically significant relation. CONCLUSIONS One-stage surgical treatment seems to be an effective approach in selected patients, in particular when an important impairment of local soft tissue and bone exposure are present, and immediate bone coverage with vascularized soft tissue is needed. Most complications occurred in compromised hosts and in patients with polymicrobial cultures. Further research, with comparison between one and two-stage procedures, is needed in order to strengthen the level of evidence.
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Affiliation(s)
- Davide Ciclamini
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino
| | | | - Pierluigi Tos
- ASST (Azienda Socio Sanitaria Territoriale) Gaetano Pini CTO di Milano Azienda Socio Sanitaria Territoriale Gaetano Pini
| | - Alessandro Crosio
- ASST (Azienda Socio Sanitaria Territoriale) Gaetano Pini CTO di Milano Azienda Socio Sanitaria Territoriale Gaetano Pini
| | - Alice Piccato
- Università degli Studi di Torino Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino
| | - Bruno Battiston
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino
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Morandi A, Zambon A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Marengoni A, Bellelli G, Rispoli V, Malara A, Spadea F, Di Cello S, Ceravolo F, Fabiano F, Chiaradia G, Gabriele A, Lenino P, Andrea T, Settembrini V, Capomolla D, Citrino A, Scriva A, Bruno I, Secchi R, De Martino E, Muccinelli R, Lupi G, Paonessa P, Fabbri A, Passuti MT, Castellari S, Po A, Gaggioli G, Varesi M, Moneti P, Capurso S, Latini V, Ghidotti S, Riccardelli F, Macchi M, Rigo R, Claudio P, Angelo B, Flavio C, Benedetta B, Boffelli S, Cassinadri A, Franzoni S, Spazzini E, Andretto D, Tonini G, Andreani L, Coralli M, Balotta A, Cancelliere R, Ballardini G, Simoncelli M, Mancini A, Strazzacapa M, Fabio S, De Filippi F, Giudice C, Dentizzi C, Azzini M, Cazzadori M, Mastroeni V, Bertassello P, Claudia Benati HS, Nesta E, Tobaldini C, Guerini F, Elena T, Mombelloni P, Fontanini F, Gabriella L, Pizzorni C, Oliverio M, Del Grosso LL, Giavedoni C, Bidoli G, Mazzei B, Corsonello A, Fusco S, Vena S, De Vuono T, Maiuri G, Luca FF, Andrea A, Giovanni S, Rossella N, Castegnaro E, De Rosa S, Sechi RB, Benvenuti E, Del Lungo I, Giardini S, Giulietti C, Mauro DB, Eleonora B, Roberto F, Paolo B, DuranteMangoni E, Testoni M, Fabio DS, Loredana S, Valeria S, Fabiano M, Annabella DG, Salvatore DC, Martina P, Greco A, Grazia D, Daniele S, Gianluca R, Renzo G, Sergio M, Morena B, Vitali M, Marina P, Paolo DC, Irene F, Cristina S, Alessandra F, Orlandini F, La Regina M, Desirée A, Mirella F, Marco F, Mario B, Paola P, Giuliana B, Riccardo B, Michela T, Eleonora C, Padulo F, Cristina M, Dario R, Giancarla M, Guido R, Elena M, Prete C, Marileda N, Federica S, Igor B, Nicole B, Elena R, Paolillo C, Riccardi A, Claudia B, Barbara R, Francesca M, Silvia V, Chiara C, Ilaria DL, Oliver B, Mauro C, Eleonora M, Giuseppe P, Rosaria T, Maria C, Davide D, Stefania C, Marco C, Massimo P, Bertoletti E, Luca S, Martina DF, Paola V, Lia S, Sandro C, Valentina DS, Erminia B, Paola C, Romina R, Minisola S, D'Amico F, Luciano C, Pasquale A, Ilaria L, Francesca C, Guglielmo S, Marco E, Sara R, Paola A, Claudio A, Francesco R, Caronzolo F, Alessandro C, Simona M, Lara F, Paola R, Simonetta C, Antonella C, Generoso U, Fernando G, Giuliano C, Emanuela S, Grippa A, Mariolina S, Alessandro D, Chiara P, Giulia L, Alessandro G, Famularo S, Sandini M, Pinotti E, Gianotti L, Antonella B, Lombardo G, Giulia P, Sante G, Rossi A, Rubele S, Sant S, Marco V, Danila C, Fabio R, Bandirali MP, Nicoletta C, Pipicella T, Laura B, Paolo T, Luciano T, Leonello A, Margherita S, Stefania DN, Pierluigi DS, Laura R, Fabiana T, Giovanna C, Antonino S, Antonino A, Felice C, Giuseppe B, Danilo F, Giovanna DB, Francesco L, Salini S, Angela BM, De Filippi F, Giorgetta C, Francesco C, Giovanni G, Paola C, Gerardo B, Silvio R, Letizia S, Sabrina P, Davide B, Rosaria RM, Maria DA, Raffaele P, Valeria PG, Palmieri VO, Palasciano G, Belfiore A, Portincasa P, Carlo S, Vincenzo S, Alessia D, Valiani V, Carolina B, Tiziana C, Daniela L, Giuseppe M, Francesca C, Giordano C, Roberto S, Paola T, Ugo P, Federica R, Giacomo P, Castellano M, Anna G, Domenico C, Elisa C, Federica C, Antonietta CM, Luigi M, Fabio L, Salvatore B, Giuseppe M, Gelosa G, Viviana AT, Piras V, Giorgio B, Andrea C, Alessandra B, Coen D, Magliola R, Milanesio D, Muzzulini CL, Paolo F, Marinella T, Sofia CM, Marta B, March A, Siano P, Capo G, Napoletano R, Cecilia P, Mancini C, Del Buono C, De Bartolomeo G, Addolorata M, Carmen C, Roberto C, Nitti MT, Giovanni VA, Moschettini G, Franco M, Daniela R, D'Amico G, Mirella P, Endrizzi C, Trotta L, Ciarambino T, Orazio Z, Felici A, Emanuela T, Marta S, Thomas F, Giacomo T, Ignazio DF, Andrea B, Giuseppe O, Emanuela F, Serena A, Elena D, Pavan S, Anna C, Serena B, Erika N, Roberto S, Elena S, Manuela P, Francesca A, Angelo T, Piazzani F, Lunelli A, Dimori S, Margotta A, Soglia T, Postacchini D, Brunelli R, Santini S, Francavilla M, Macchiati I, Sorvillo F, Giuli C, Mecocci P, Longo A, Perticone F, Addesi D, Rosa PC, Bencardino G, Falbo T, Grillo N, Marco F, Mirella F, Fantò F, Isaia G, Pezzilli S, Bergamo D, Furno E, Rrodhe S, Lucarini S, Dijk B, Dall'Acqua F, Cappelletto F, Calvani D, Becheri D, Giuseppe M, Costanza M, Vito A, Francesca B, Magherini L, Novella M, Franca B, Lucia Gambardella PM, Valente C, Ilaria B, Alice F, Bo M, Porrino P, Ceci G, Giuliana B, Michela T, Eleonora C, Ettore E, Camellini C, Servello A, Grassi A, Rozzini R, Tironi S, Grassi MG, Troisi E, Carlo C, Simona Gabriella DS, Flaminia F, Federica R, Beatrice P, Sofia T, Gabutto A, Quazzo L, Rosatello A, Suraci D, Tagliabue B, Perrone C, Ferrara L, Castagna A, Tremolada ML, Giuseppe C, Stefano B, Davide O, Piano S, Serviddio G, Lo Buglio A, Gurrera T, Merlo V, Rovai C, Cotroneo AM, Carlucci R, Abbaldo A, Monzani F, Qasem AA, Bini G, Tafuto S, Galli G, Bruni AC, Mancuso G, Mancuso G, Calipari D, Giuseppe Massimiliano DL, Bernardini B, Corsini C, Michele C, Sara DF, Cagnin A, Fragiacomo F, Pompanin S, Piero A, Marco C, Zurlo A, Guerra G, Pala M, Menozzi L, Gatti CD, Magon S, Roberto M, Alfredo DG, Fabio F, Ruana T, Elisa M, Benedetta B, Christian M, Marco P, Massimo G, Di Francesco V, Faccioli S, Pellizzari L, Giorgia F, Barbagallo G, Lunardelli ML, Martini E, Ferrari E, Macchiarulo M, Corneli M, Bacci M, Battaglia G, Anastasio L, Lo Storto MS, Seresin C, Simonato M, Loreggian M, Cestonaro F, Durando M, Latella R, Mazzoleni M, Russo G, Ponte M, Valchera A, Salustri G, Petritola D, Costa A, Sinforiani E, Cotta MR, Piano S, Pizio RN, Cester A, Formilan M, Pietro B, Carbone P, Cazzaniga I, Appollonio I, Cereda D, Stabile A, Xhani R, Acampora R, Tremolizzo L, Federico P, Antonio C, Valerio P, Cesare B, Zhirajr M, Giovanni V, Maria A, Mariaelena S, Bottacchi E, Bucciantini E, Di Giovanni M, Franchi F, Lucchetti L, Mariani C, Grande G, Rapazzini P, Marco M, Romanelli G, Marengoni A, Franco N, Alessio M, Stefano B, Nicola L, Laura P, Nazario P, Carlo C, Chiara G, Soccorso P, Andrea S, Luca B, Francesca S, Roberto A, Marco F, Anna C, Francesco C, Anna C, Fugazza L, Guerrini C, De Paduanis G, Iallonardo L, Palumbo P, Zuliani G, Ortolani B, Capatti E, Soavi C, Bianchi L, Francesconi D, Miselli A, Gloria B, Tommaso R, Chiara P, Agata MM, Marco D, Luca M, Gianluca G, Suardi T, Mazzone A, Zaccarini C, Manuela R, Mirra G, Muti E, Bottura R, Gianpaolo M, Secreto P, Bisio E, Cecchettani M, Naldi T, Pallavicino A, Pugliese M, Iozzo RC, Grassi G, Michele B, Raffaella D, Fosca QT, Giorgio GC, Giovanni P, Ernesto C, Soccorso P, Mannironi A, Giorli E, Oberti S, Fierro B, Piccoli T, Giacalone F, Mandas A, Serchisu L, Costaggiu D, Pinna E, Orrù F, Mannai M, Cordioli Z, Pelizzari L, Turcato E, Arduini P, Cacace C, Chiloiro R, Cimino R, Ruberto C, Giovanni R, Pietro G, Laura G, Alberto C, Pietro G, Carmen R, Santo PD, Andriolli A, Burattin G, Rossi L, Andreolli Antonino CG, Giuseppe C, Tezza F, Maddalena P, Laura S, Crippa P, Aloisio P, Di Monda T, Malighetti A, Galbassini G, Salutis D, Ivaldi C, Russo AM, Bennati E, Pino E, Zavarise G, Pesci A, Suigo G, Faverio P, Andrea G, Sabrina P, Zanasi M, Moniello G, Rostagno C, Cartei A, Polidori G, Ungar A, Melis MR, Martellini E, Enrico M, Monica T, Antonella G, Giovanna L, Migliorini M, Caramelli F, Battiston B, Berardino M, Cavallo S, Alessandro M, Anna S, Lombardi B, D'Ippolito P, Furini A, Villani D, Clara R, Guarneri M, Paolucci S, Bassi A, Coiro P, De Angelis D, Morone G, Venturiero V, Palleschi L, Raganato P, Di Niro G, Rosa CA, Loredana B, Imoscopi A, Isaia G, Tibaldi V, Bottignole G G, Calvi E, Clementi C, Zanocchi M, Agosta L, Nortarelli A, Provenzano G, Mari D, Romano FY, Rosini F, Mansi M, Rossi S, Geriatria AR, Inzaghi L, Bonini G, Rossi P, Potena A, Lichii M, Candiani T, Grimaldi W, Bertani E, Alessandra P, Calogero P, Pinto D, Bernardi R, Nicolino F, Galetti C, Gianstefani A, Giulia C, Lorenzo M, Odetti P, Monacelli F, Prefumo M, Fiammetta M, Canepa M, Minaglia C, Paolisso G, Rizzo MR, Prestano R, Dalise AM, Barra D, Bosco LD, Asprinio V, Dallape L, Perina E, Incalzi RA, Bartoli IR, Pluderi A, Maina A, Pecoraro E, Sciarra M, Prudente A, Paola M, Francesca M, Manuel V, Luisella C, Maria PL, Tina S, Benini L, Levato F, Mhiuta V, Alius F, Davidoaia D, Giardini V, Garancini M, Bellamoli C, Terranova L, Bozzini C, Tosoni P, Provoli E, Cascone L, Dioli A, Ferrarin G, Gabutto A, Bucci A, Bua G, Fenu S, Bianchi G, Casella S, Romano V, Maurizio P, Mascherona I, Belotti G, Cavaliere S, Cuni E, Merciuc N, Oberti R, Veneziani S, Capoferri E, De Bernardi E, Colombo K, Bravi M, Nicoletta N, D'Arcangelo P, Montenegro N, Galli G, Montanari R, Lamanna P, Gasperini B, Isabella M, Stefania D, Gaia A, Filippo C, Palamà C, Di Emidio C, Scarpini E, Arighi A, Fumagalli G, Basilico P, De Amicis Margherita M, Marta M, Diletta M, D'Amico F, Granata A, Rostagno C, Ranalli C, Cammilli A, Cavallini MC, Tricca M, Natella D, Gabbani L, Tesi F, Martella L, Gurrera T, Imbrici R, Guerrini G, Scotuzzi AM, Sozzi F, Valenti L, Chiarello A, Monia M, Pilotto A, Prete C, Senesi B, Meta AC, Pendenza E, Monzani F, Pasqualetti G, Polini A, Tognini S, Ballino E, Cherubini A, Dell'Aquila G, Gasparrini PM, Marotti E, Migale M, Scrimieri A, Falsetti L, Salvi A, Toigo G, Ceschia G, Rosso A, Tongiorgi C, Scarpa C, Maurizio P, De Dominicis L, Pucci E, Renzi S, Cartechini E, Tomassini PF, Del Gobbo M, Ugenti F, Romeo P, Nardelli A, Lauretani F, Visioli S, Montanari I, Ermini F, Giordano A, Pigato G, Simeone E, Barbujani M, Giampieri M, Amoruso R, Piccinini M, Ferrari C, Gambetti C, Sfrappini M, Semeraro L, Striuli R, Mariani C, Pelliccioni G, Marinelli D, Fabi K, Rossi T, Pesallaccia M, Sabbatini D, Gobbi B, Cerqua R, Tagliani G, Schlauser E, Caser L, Caramello E, Sandigliano F, Rosso G, Ferrari A, Bendini C, Luisa DM, Casella M, Prampolini R, Scevola M, Vitale E, Roberto B, Carlo F, Sergio F, Alberto S, Daniela Z, Giulia B, Serena G, Michele B, Maugeri D, Sorace R, Anzaldi M, De Gesu R, Morrone G, Davolio F, Fabbo A, Palmieri M, Barbagallo G, Zoli M, Forti P, Pirazzoli L, Fabbri E, Terenzi L, Bergolari F, Wenter C, Ruffini I, Insam M, Abraham E, Kirchlechner C, Cucinotta D, Antonino L, Basile G, Grazia AM, Parise P, Boccali A, Amici S, Gambacorta M, Ferrari A, Lasagni A, Lovati R, Giovinazzo F, Kimak E, Zappa P, Medici F, Lo Castro M, Mauro F, De Luca A, Sancesario G, Martorana A, Scaricamazza B, Toniolo S, Di Lorenzo F, Liguori C, Lasco A, Basile G, Vita N, Giomi M, Dimori S, Forte F, Padovani A, Rozzini L, Ceraso A, Salvatore C, Padovani A, Cottino M, Vitali S, Marelli E, Tripi G, Miceli S, Urso G, Grioni G, Vezzadini G, Misaggi G, Forlani C, Avanzi S, Serena S, Claudia C, Marilena V, Alberto L, Diego G, Alessandro G, Iemolo F, Giordano A, Sanzaro E, D'Asta G, Proietto M, Carnemolla A, Razza G, Spadaro D, Bertolotti M, Mussi C, Neviani F, Roberto C, Valentina G, Linda M, Francesca V, Tarozzi A, Balestri F, Monica T, Mannarino G, Tesi F, Bigolari M, Natale A, Grassi S, Bottaro C, Stefanelli S, Bovone U, Tortorolo U, Quadri R, Leone G, Ponzetto M, Frasson P, Annoni G, Bellelli G, Bruni A, Confalonieri R, Corsi M, Moretti D, Teruzzi F, Umidi S, Mazzola P, Perego S, Persico I, Olivieri G, Bonfanti A, Hajnalka S, Galeazzi M, Massariello F, Anzuini A, Caffarra P, Barocco F, Spallazzi M, Paolo CG, Simonetta M, Andrea A, Chioatto P, Bortolamei S, Soattin L, Ruotolo G, Beneamino B, Pietro G, Giuseppe B, Carmen R, Castagna A, Bertazzoli M, Rota E, Adobati A, Scarpa A, Granziera S, Zuccher P, Fabbro AD, Zara D, Lo Nigro A, Franchetti L, Toniolo M, Marcuzzo C, Piano S, Rollone M, Guerriero F, Sgarlata C, Massè A, Berardino M, Cavallo S, Anna S, Zatti G, Piatti M, Graci J, Benati G, Boschi F, Biondi M, Fiumi N, Erika T, Locatelli SM, Mauri S, Beretta M, Margheritis L, Desideri G, Liberatore E, Carucci AC, Bonino P, Caput M, Antonietti MP, Polistena G, De la Pierre F, Mari M, Massignani P, Tombesi F, Selvaggio F, Verbo B, Bodoni P, Marchionni N, Mossello E, Cavallini MC, Sabatini T, Mussio E, Magni E, Bianchetti A, Crucitti A, Titoldini G, Cossu B, Fascendini S, Licini C, Tomasoni A, Calderazzo M, Daniela T, Valentina L, Ferrari A, Prampolini R, Melotti RM, Lilli A, Buda S, Adversi M, Noro G, Turco R, Ubezio MC, Mantovani AR, Viola MC, Serrati C, Pretta S, Infante M, Gentile S, Morandi A, D'Ambrosio V, Mazzanti P, Brambilla C, Sportelli S, Platto C, Faraci B, Quattrocchi D, Pernigotti LM, Pisu C, Sicuro F, Oliverio M, Del Grosso LL, Zagnoni P, Ghiglia S, Mosca M, Corazzin I, Deola M, Biagini CA, Bencini F, Cantini C, Tonon E, Pierinelli S, Onofrj M, Thomas A, Filomena B, Bonanni L, Gabriella C, Comi G, Magnani G, Santangelo R, Mazzeo S, Giuseppe M, Francesca C, Giordano C, Roberto S, Barbieri C, Giroldi L, Davolio F, Bandini F, Masina M, Malservisi S, Cicognani A, Ricca L, Ricca L, Piccininni M, Ferrari C, Gambetti C, Tassinari T, Brogi D, Sugo A, Alessandra F, Sonia M, Valerio V, Andrea UC, Enrico C, Vera RF, Assunta S, Gianmaria Z, Mauro P, Pietro B, Roberto M, Salvatore C, Barone A, Razzano M, Giuseppe I, Angela B, Francesco S, Valeria D, Federico G, Lucia P, Antonella V, Elisabetta DC, Cristina R, Nadia C, Maria S, Luciano A, Chiara C, Bini P, Pignata M, Enrico B, Maria V, Giovanni C, Giorgio C, Andrea T, Marco M, Anna C, Piera R, Alberto Z, Ceccon A, Magrin L, Marin S, Barbara S, Marco M, Laura G, Matteo M, Marco P, Caterina PM, Carla R, Federica G, Clara T, Melania C, Giampaolo B, Stefano G, Valeria G, Lucia M, Giovambattista D, Ester L, Cecilia CA, Maurizio T, Alessandra F, Vera RF, Nadia B, Grillo A, Arenare F, Tonino M, David K, Giorgio VP, Ubaldo B, Vincenzo S, Stefano M, Marino F, Busonera Flavio MT, Paolo A, Monica M, Francesco B. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia. J Am Med Dir Assoc 2020; 21:486-492.e7. [DOI: 10.1016/j.jamda.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
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Abstract
PURPOSE To present our experience in the management of acute large bone defects treated with the use of vascularized fibular grafts supported by Ilizarov circular external frames. PATIENTS AND METHODS During a period of 6 years (from 2007 to 2013) 8 patients with acute large bone defects (IVB according to Winquist modified classification) were treated at our institution with early bone reconstruction by means of microvascular fibular grafts. All patients were evaluated by the use of the following parameters: X-ray consolidation, discharge time, duration of treatment, malalignment of the lower limb and final leg length discrepancy, knee and ankle mobility (ROM), pain (VAS), number of eventual additive treatments (plastic surgery, etc.), walking independence (use of crutches), possibility to get back to work, subjective evaluation about the treatment and the result (SF-36, personal feelings about circular external fixator dressing) RESULTS: The mean treatment time, often connected to the mean consolidation time, was 61 weeks and the mean number of operations was 7.6. Six of the eight patients got back to their previous daily activities and work, without any further issues. DISCUSSION based on our experience, Ilizarov and fibular vascular grafts are not alternatives, as often reported in literature. Their combined use, especially in lesions as those classified as Winquist IV B, can represent an effective tool in the surgeon's hands to solve the most difficult cases of acute bone loss caused by severe high-energy traumas.
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Affiliation(s)
- B Battiston
- Orthopaedic Dpt., Città della Salute e della Scienza, Torino, Italy.
| | - D Santoro
- Orthopaedic Dpt., Città della Salute e della Scienza, Torino, Italy
| | - R Lo Baido
- Orthopaedic Dpt., Città della Salute e della Scienza, Torino, Italy
| | - F Pasquero
- Orthopaedic Dpt., Città della Salute e della Scienza, Torino, Italy
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Ciclamini D, Tos P, Guzzini M, Soldati A, Crosio A, Battiston B. The medial femoral condyle free corticoperiosteal flap versus traditional bone graft for treatment of nonunions of long bones: a retrospective comparative cohort study. Injury 2019; 50 Suppl 5:S54-S58. [PMID: 31711649 DOI: 10.1016/j.injury.2019.10.049] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fracture healing is a complex process and many factors change the local biology of the fracture and reduce the physiologic repair process. Since 1991 the free vascularised corticoperiosteal graft has been proposed to treat nonunions. In this study we compare the healing rate and the healing time of the free vascularised corticoperiosteal graft harvested from medial femoral condyle versus the traditional cancellous bone graft from the iliac crest combined with other biologic or pharmacologic factors. We performed a retrospective cohort study. The main measures of outcomes were the rate of bone union and the mean healing time from surgery. The authors performed 10 free vascularised corticoperiosteal grafts in the cohort A and 10 patients received traditional cancellous bone graft plus other biologic or pharmacologic treatment in the same period in the cohort B. The mean follow up in cohort A was 18.6 months with a healing rate of 100% (10/10). In cohort B the mean follow up was 22.5 month with a healing rate of 90%. The mean time to obtain union (healing time) in the group that was treated with the free flap procedure was significantly shorter, 3.2 months versus a mean time of 8.8 months in the other group. Some studies describe a high healing rate of recalcitrant nonunions with treatments different from vascularized bone flaps: it is difficult to compare the results of vascularized bone transfers with the results of other case series. Our groups are very homogeneous even if it is difficult to define correct inclusion criteria because there is still no agreement about what is defined a recalcitrant or difficult nonunion, and the number of trials of previous surgery before to perform a vascularized free flap. Even if our study cohort is small, we have demonstrated that the MFCCF generally seems to give a better healing chance with a shorter healing time compared to other treatments.
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Affiliation(s)
- Davide Ciclamini
- Orthopaedics and Traumatology II, Surgery of the Hand and Upper Limb, AOU Città della Salute e della Scienza, CTO Hospital, Turin, Italy
| | - Pierluigi Tos
- Microsurgery and Surgery of the Hand, Gaetano Pini Hospital, Milan, Italy
| | - Matteo Guzzini
- Orthopaedics and Traumatology Department, University of Rome "La Sapienza" - AO Sant'Andrea, Rome, Italy
| | - Alessandra Soldati
- Orthopaedics and Traumatology Department, Ospedale del Mare, Naples, Italy
| | - Alessandro Crosio
- Orthopaedics and Traumatology II, Surgery of the Hand and Upper Limb, AOU Città della Salute e della Scienza, CTO Hospital, Turin, Italy
| | - Bruno Battiston
- Orthopaedics and Traumatology II, Surgery of the Hand and Upper Limb, AOU Città della Salute e della Scienza, CTO Hospital, Turin, Italy.
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Georgescu AV, Battiston B, Matei IR, Soucacos PN, Bumbasirevic M, Toia F, Tos P. Emergency toe-to-hand transfer for post-traumatic finger reconstruction: A multicenter case series. Injury 2019; 50 Suppl 5:S88-S94. [PMID: 31708087 DOI: 10.1016/j.injury.2019.10.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this paper was to evaluate the outcomes of a homogenous series of emergency with a toe-to-hand transfer reconstructions with a different timing: immediate (same surgical step with the debridement), primary (in the first 24 h), early (24-72 h after the debridement) or delayed (72 h-7 days). MATERIALS AND METHODS Between 2001 and 2011, 31 patients received an immediate reconstruction with a toe-to-hand transfer. Data on indications, timing, type of surgery, complications and outcomes (sensory and motor recovery, patient satisfaction) were extrapolated and recorded. RESULTS Most of the procedures in our series (71%) were performed in the first 24 h. Survival rate was 100%. The only complications were 3 venous thrombosis (10%), solved with surgical re-exploration. Only 1 patient required secondary surgery for web deepening. No functional problems were recorded at the donor site. Sensibility recovery was acceptable in all patients; toe mobility was higher for the reconstructed thumb (85%) than for other digits (77%). Patient satisfaction was high with regard to functional results and lower but acceptable with regard to the aesthetic outcome. There was no difference in satisfaction rate of patients treated within 24 h or within 7 days. CONCLUSION No conclusive evidence exists in favor of an immediate versus a primary, early or delayed emergency reconstruction. Emergency toe transfer for finger reconstruction is a safe procedure and its outcomes are comparable to those reported in the literature for secondary reconstruction. Immediate reconstruction has the advantage of an easier dissection, but early or delayed reconstruction gives more time to discuss with the patient and to plan surgery.
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Affiliation(s)
- Alexandru Valentin Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, Clinic Hospital of Recovery, University of Medicine ``Iuliu Hatieganu'', Cluj Napoca, Romania
| | - Bruno Battiston
- UOD Reconstructive Microsurgery, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Ileana Rodica Matei
- Department of Plastic Surgery and Reconstructive Microsurgery, Clinic Hospital of Recovery, University of Medicine ``Iuliu Hatieganu'', Cluj Napoca, Romania
| | - Panayotis N Soucacos
- "Panayotis N. Soucacos" Orthopaedic Research & Education Center (OREC), National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Marko Bumbasirevic
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Serbia; School of Medicine, University of Belgrade, Serbia
| | - Francesca Toia
- UOD Reconstructive Microsurgery, AOU Città della Salute e della Scienza di Torino, Torino, Italy; Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Pierluigi Tos
- UOD Reconstructive Microsurgery, AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Georgescu AV, Battiston B, Soucacos PN. European Federation of Societies for Microsurgery (EFSM): Our ongoing commitment to education and advancement of the field. Injury 2019; 50 Suppl 5:S1-S2. [PMID: 31787328 DOI: 10.1016/j.injury.2019.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Alexandru Valentin Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, Clinic Hospital of Recovery, University of Medicine "Iuliu Hatieganu", Cluj Napoca, Romania
| | - Bruno Battiston
- UOD Reconstructive Microsurgery, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Panayotis N Soucacos
- "Panayotis N. Soucacos" Orthopaedic Research & Education Center (OREC), National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece.
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Artiaco S, Fusini F, Colzani G, Massè A, Battiston B. Chronic Essex-Lopresti injury: a systematic review of current treatment options. Int Orthop 2019; 43:1413-1420. [PMID: 29572641 DOI: 10.1007/s00264-018-3888-9] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Essex-Lopresti lesion (ELL) is a severe injury. Most of ELL is recognized in chronic phase representing a therapeutic challenge for orthopaedic surgeons. The aim of this systematic review is to highlight and criticize current concepts in the surgical treatment. MATERIALS AND METHODS The search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. A comprehensive research of Pubmed database was made using the following Mesh term: ((Essex-Lopresti injury) OR (Essex Lopresti) OR (distal radio ulnar dissociation) OR (distal radio ulnar dislocation) OR (longitudinal forearm instability)). Quality assessment of each article was performed according to Coleman score by two authors. RESULTS Eight full articles were included to the systematic review. Surgical treatment was differentiated in five categories according to the most common procedure reported in clinical series. The mean Coleman Score was 51.13 ± 9.76. DISCUSSION Case series reported in the literature include a limited number of patients with chronic ELL. Currently, salvage procedure devoted to treat a wrong diagnosis and an incorrect treatment is used. Radial head replacement together with ulnar shortening osteotomy and interosseous membrane reconstruction are the most common treatments of choice, but at present, there is not yet a shared scheme of management for patients with chronic ELL. CONCLUSIONS According to current literature, a case-by-case treatment must always be considered. Further investigations, with higher level of evidence, quality of study design, and number of patients, are needed to better assess clinical results and complication of each technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stefano Artiaco
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Via Zuretti, 10126, Torino, Italy
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Via Zuretti, 10126, Torino, Italy.
| | - Giulia Colzani
- Department of Orthopaedics and Traumatology, Policlinico di Modena, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Via Zuretti, 10126, Torino, Italy
| | - Bruno Battiston
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Via Zuretti, 10126, Torino, Italy
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Ciclamini D, Tos P, Monticelli A, Crosio A, De Blasi P, Battiston B. Flexor digitorum superficialis tenodesis for treatment of flexible swan neck deformity of fingers. Comparison between two surgical techniques to fix the tendon: A pilot study. J Plast Reconstr Aesthet Surg 2019; 72:1418-1433. [PMID: 31043337 DOI: 10.1016/j.bjps.2019.04.006] [Citation(s) in RCA: 1] [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: 03/26/2017] [Revised: 03/27/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Affiliation(s)
- D Ciclamini
- UOC Orthopaedics and Traumatology 2 - Surgery for the Hand and Upper Limb, Department of Orthopaedics and Traumatology, AOU City of Health and Science, Turin, Italy
| | - P Tos
- UOC Surgery of the Hand and Reconstructive Microsurgery, Gaetano Pini - CTO Hospital, Milan, Italy
| | - A Monticelli
- Plastic Surgery Department, AOU Padova, Padua, Italy
| | - A Crosio
- UOC Surgery of the Hand and Reconstructive Microsurgery, Gaetano Pini - CTO Hospital, Milan, Italy.
| | - P De Blasi
- Department of Economics and Statistics, University of Turin, Italy
| | - B Battiston
- UOC Orthopaedics and Traumatology 2 - Surgery for the Hand and Upper Limb, Department of Orthopaedics and Traumatology, AOU City of Health and Science, Turin, Italy
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Costa AL, Cucinotta F, Fazio A, Delia G, Galeano M, Stagno d'Alcontres F, Battiston B, Tos P, Georgescu A, Colonna MR. Anterolateral Thigh Flap in a Chicken Model: A Novel Perforator Training Model. J Reconstr Microsurg 2019; 35:485-488. [PMID: 30795017 DOI: 10.1055/s-0039-1679882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. METHODS A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. RESULTS The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ = 0.04) and 0.84 (σ = 0.06) mm, respectively. The mean dissection time to raise the flap was 88 (σ = 7) min. CONCLUSION This is the first description of a nonliving biological simulation model for training in perforator flap dissection that mimics an ALT flap. As an ex vivo chicken model, it is a cost effective and readily accessible model suitable for repeated practice.
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Affiliation(s)
- Alfio Luca Costa
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | | | - Antonina Fazio
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | - Gabriele Delia
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | - Mariarosaria Galeano
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | | | - Bruno Battiston
- Department of Traumatology, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Pierluigi Tos
- Department of Orthopaedics and Traumatology for Hand, ASST Gaetano Pini, Milan, Italy
| | - Alexandru Georgescu
- Department of Plastic Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Michele Rosario Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
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Crosio A, Fornasari BE, Gambarotta G, Geuna S, Raimondo S, Battiston B, Tos P, Ronchi G. Chitosan tubes enriched with fresh skeletal muscle fibers for delayed repair of peripheral nerve defects. Neural Regen Res 2019; 14:1079-1084. [PMID: 30762022 PMCID: PMC6404480 DOI: 10.4103/1673-5374.250628] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Indexed: 01/15/2023] Open
Abstract
Nerve regeneration after delayed nerve repair is often unsuccessful. Indeed, the expression of genes associated with regeneration, including neurotrophic and gliotrophic factors, is drastically reduced in the distal stump of chronically transected nerves; moreover, Schwann cells undergo atrophy, losing their ability to sustain regeneration. In the present study, to provide a three-dimensional environment and trophic factors supporting Schwann cell activity and axon re-growth, we combined the use of an effective conduit (a chitosan tube) with a promising intraluminal structure (fresh longitudinal skeletal muscle fibers). This enriched conduit was used to repair a 10-mm rat median nerve gap after 3-month delay and functional and morphometrical analyses were performed 4 months after nerve reconstruction. Our data show that the enriched chitosan conduit is as effective as the hollow chitosan conduit in promoting nerve regeneration, and its efficacy is not statistically different from the autograft, considered the "gold standard" technique for nerve reconstruction. Since hollow tubes not always lead to good results after long defects (> 20 mm), we believe that the conduit enriched with fresh muscle fibers could be a promising strategy to repair longer gaps, as muscle fibers create a favorable three-dimensional environment and release trophic factors. All procedures were approved by the Bioethical Committee of the University of Torino and by the Italian Ministry of Health (approval number: 864/2016/PR) on September 14, 2016.
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Affiliation(s)
- Alessandro Crosio
- Department of Orthopedics and Traumatology II - Surgery for Hand and Upper Limb - AOU Città della Salute e della Scienza di Torino - CTO Hospital, Torino, Italy
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology II - Surgery for Hand and Upper Limb - AOU Città della Salute e della Scienza di Torino - CTO Hospital, Torino, Italy
| | - Pierluigi Tos
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Milano, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
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Colonna MR, Pino D, Battiston B, d'Alcontres FS, Natsis K, Bassetto F, Papadopulos NA, Tiengo C, Geuna S. Distal nerve transfer from the median nerve lumbrical fibers to the distal ulnar nerve motor branches in the palm: An anatomical cadaveric study. Microsurgery 2018; 39:434-440. [DOI: 10.1002/micr.30402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/23/2018] [Accepted: 10/26/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Michele R. Colonna
- Department of Human Pathology of the Adult, The Child and the AdolescentUniversity of Messina Messina Italy
| | - Davide Pino
- Comprensorio Sanitario di BolzanoPlastic Surgery Bolzano Italy
| | - Bruno Battiston
- Department of TraumatologyAzienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino Turin Italy
| | | | - Konstantinos Natsis
- Department of Anatomy and Surgical AnatomyAristotle University of Thessaloniki, Faculty of Health Sciences, School of Medicine Thessaloniki Greece
| | - Franco Bassetto
- Padua University HospitalClinic of Plastic Surgery Padua Italy
| | - Nikolaos A. Papadopulos
- Alexandroupoli University General Hospital, Department of Plastic Surgery and BurnsDemocritus University of Thrace Alexandroupoli Greece
| | - Cesare Tiengo
- Padua University HospitalClinic of Plastic Surgery Padua Italy
| | - Stefano Geuna
- University of Turin School of MedicineClinical & Biological Sciences Turin Italy
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Daghino W, Aprato A, Bistolfi A, Filipponi M, Battiston B, Massè A. Free composite groin flap to solve a complex loss of tissue in a traumatic injury of the foot: A case report. Injury 2018; 49 Suppl 4:S25-S28. [PMID: 30526948 DOI: 10.1016/j.injury.2018.11.032] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023]
Abstract
Severe traumatic losses of soft tissues and bone at foot and ankle level are often treated by means of amputation, but this may involve important psychological and anatomic consequences for the patient. If there are good vascular conditions, reconstruction by means of composite free flaps is often the only alternative to this demolitive treatment. The transfer of composite free flaps that include vascularized bone from various donor sites may provide anatomical reconstruction and recovery of function of the foot and ankle. If plantar skin and its sensation are present, these techniques may represent a good choice in the treatment of complex injuries of the foot, and by means of skeletal morphological reconstruction, they may give good functional results. With these premises, we report a case in which was used a groin flap to fill and solve a complex defect of bone and soft tissues of midfoot in a gunshot injury.
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Affiliation(s)
- W Daghino
- University of Turin, Orthopaedic Clinic, C.T.O. Hospital, Turin, Italy.
| | - A Aprato
- University of Turin, Orthopaedic Clinic, C.T.O. Hospital, Turin, Italy
| | - A Bistolfi
- University of Turin, Orthopaedic Clinic, C.T.O. Hospital, Turin, Italy
| | | | - B Battiston
- Hand and upper limb surgery, C.T.O. Hospital, Turin, Italy
| | - A Massè
- University of Turin, Orthopaedic Clinic, C.T.O. Hospital, Turin, Italy
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Marchesini A, Raimondo S, Zingaretti N, Riccio V, Battiston B, Provinciali M, Geuna S, Riccio M. The amnion muscle combined graft (AMCG) conduits in nerves repair: an anatomical and experimental study on a rat model. J Mater Sci Mater Med 2018; 29:120. [PMID: 30032327 DOI: 10.1007/s10856-018-6126-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
The amnion muscle combined graft (AMCG) conduits showed good clinical results in peripheral nerves gap repair. It combines the human amniotic membrane with autologous skeletal muscle fibres. These results seem attributable to the biological characteristics of human amniotic membrane: Pluripotency, anti-inflammatory and low immunogenicity.We here evaluate the final outcome of nerve regeneration morphologically and functionally, across the AMCG compared to nerve autograft. Fourteen Wistar rats were divided into two groups: In Group A, including 6 rats, the left forelimb was treated performing a 1.5 cm length gap on median nerve that was then reconstructed with a reverse autograft. In Group B, including 8 rats, the gap was reconstructed with AMCG. Functional results were evaluated at 30, 60 and 90 days performing grasping tests. Morphological and stereological analyses were performed at T90 using high-resolution light microscopy and design-based stereology. The AMCG conduits revealed nerve fibres regeneration and functional recovery. Functional recovery was observed in both groups with AMCG conduits group showing lower values and a regeneration of median nerves with more myelinated fibres with the same axon size, but thinner myelin than the autograft group. Though the autograft remains the gold standard to restore wide nerve gaps, the AMCG conduit has proved to be effective in enabling nerve regeneration through a critical rat's nerve gap of 15 mm. These findings empirically support the great clinical results obtained using AMCG conduit to restore traumatic nerve's gap from 3 to 6 cm of mixed forearm nerves.
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Affiliation(s)
- Andrea Marchesini
- Department of Reconstructive Plastic Surgery - Hand Surgery, Azienda Ospedaliero - Universitaria Ospedali Riuniti di Ancona, Ancona, (AN), Italy.
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Orbassano, (TO), Italy
| | - Nicola Zingaretti
- Department of Plastic and Reconstructive Surgery, University of Udine, Ospedale "S. Maria della Misericordia", Udine, (UD), Italy
| | - Valentina Riccio
- Department of Veterinary Medicine, School of Veterinary Surgery, Ospedale Veterinario Didattico San Sollecito, University of Camerino, Matelica, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology - Hand surgery Unit, C.T.O. Hospital, Torino, (TO), Italy
| | - Mauro Provinciali
- Advanced Technology Center for Aging Research, Scientific Technological Area, IRCCS-INRCA, Experimental Animal Models for Aging Unit, Scientific Technological Area, IRCCS-INRCA, Via Birarelli 8, Ancona, 60121, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Orbassano, (TO), Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery - Hand Surgery, Azienda Ospedaliero - Universitaria Ospedali Riuniti di Ancona, Ancona, (AN), Italy
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Abstract
Background The “spare parts” approach to the reconstruction of below knee amputation, applied in acute trauma patients, can also be employed in elective surgery, ensuring knee salvage and a sensitive stump and enabling tissue harvesting without further donor-site morbidity.
Methods We present a series of eight cases, where leg amputation due to trauma or its sequelae was followed by reconstruction with skin or a composite flap from the foot. An osteocutaneous flap was used in two emergency patients with below knee amputation, where it allowed stump elongation and knee coverage, and in five secondary procedures, where it provided both stump length and sensitive skin coverage. The skin of the foot was used in one case to cover the tibial stump. Fixation was accomplished with 2-mm Kirschner wires in the emergency patients and with an external fixator (n = 5) or by internal fixation (n = 1) in the elective procedures. Any complications were minor. Secondary compression with an external fixator was required in one emergency patient due to delayed bone healing.
Results All knees healed. Sensibility was restored in all patients with a posterior tibial nerve suture (S4) and was well preserved in those without nerve coaptation. No patients reported problems with the prosthesis at a minimum follow-up of 3 years. Knee flexion and extension were comparable to those of the contralateral limb.
Conclusion The “spare parts” concept is a reliable approach to tibial stump reconstruction. External fixation in elective procedures allowed immediate weight bearing and bone healing. In emergency patients, rapid fixation with wires provided satisfactory results.
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Affiliation(s)
- Pierluigi Tos
- UOC Hand Surgery and Reconstructive Microsurgery Unit, ASST G Pini-CTO, Milano, Italy
| | - Andrea Antonini
- UOC Septic Orthopaedics Unit, ASL II Savonese, Savona, Italy
| | - Pierfrancesco Pugliese
- UOC Orthopaedics and Traumatology, Hand Surgery and Microsurgery, AOU City of Health and Science, Torino, Italy
| | - Bernardino Panero
- UOC Orthopaedics and Traumatology, Hand Surgery and Microsurgery, AOU City of Health and Science, Torino, Italy
| | - Davide Ciclamini
- UOC Orthopaedics and Traumatology, Hand Surgery and Microsurgery, AOU City of Health and Science, Torino, Italy
| | - Bruno Battiston
- UOC Orthopaedics and Traumatology, Hand Surgery and Microsurgery, AOU City of Health and Science, Torino, Italy
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Abstract
Many surgical techniques are available for the repair of peripheral nerve defects. Autologous nerve grafts are the gold standard for most clinical conditions. In selected cases, alternative types of reconstructions are performed to fill the nerve gap. Non-nervous autologous tissue-based conduits or synthetic ones are alternatives to nerve autografts. Allografts represent another new field of interest. Decision making in the treatment of nerve defects is based on timing of referral, level of the injury, type of lesion, and size of any gap. This review focuses on current clinical practice, influenced by the numerous new experimental researches.
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Affiliation(s)
- Bruno Battiston
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy.
| | - Paolo Titolo
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy
| | - Davide Ciclamini
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy
| | - Bernardino Panero
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy
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Abstract
Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular.
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Affiliation(s)
- Bruno Battiston
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy.
| | - Davide Ciclamini
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy
| | - Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
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Battiston B, Castelli PG, Ferrari C, Ghiggio P, Nobile G, Tos PL, Vasone L. A comparative analysis of arthrodesis vs. suspension arthroplasty in the treatment of CM arthritis of the thumb. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s0266-7681(97)80104-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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]
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