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Susini P, Marcaccini G, Giardino FR, Pozzi M, Volanti F, Nisi G, Cuomo R, Grimaldi L. Selective Capsulotomies and Partial Capsulectomy in Implant-Based Breast Reconstruction Revision Surgery. Breast J 2024; 2024:9097040. [PMID: 38444549 PMCID: PMC10914432 DOI: 10.1155/2024/9097040] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/27/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
Background Breast cancer with about 2.3 million diagnoses and 685,000 deaths globally is the most frequent malignancy in the female population. Continuous research has led to oncological and reconstructive advances in the management of breast cancer, thus improving outcomes and decreasing patient morbidity. Nowadays, the submuscular expander and prosthesis (E/P) implant-based breast reconstruction (IBR) accounts for 73% of all reconstructions. Despite its widely accepted efficacy, the technique is not free from complications and up to 28% of cases require revision surgery for mechanical complications such as capsular contracture, implant displacement/rotation, and implant rupture. With this study, the authors report their experience in the management of E/P IBR revision surgery through the technique of Selective Capsulotomies (SCs) and Partial Capsulectomy (PC). Methods A retrospective study was conducted on patients who had previously undergone E/P IBR and presented for revision reconstruction between January 2013 and May 2023 at the Department of Plastic Surgery of the University of Siena, Italy. Reasons for revision included capsular contracture, implant displacement/rotation, and implant rupture. Revision reconstructions involved SC and PC with implant replacement. Fat grafting was also considered. The complication rate was evaluated by analysis of patients' medical records. Patients' satisfaction with the treatment was assessed through a specific questionnaire. Results 32 patients underwent revision surgeries. No early complication occurred. Recurrence rate was assessed at 19% with average follow-up of 59 months (range: 13-114 months). The average time between revision surgery and recurrence was 3 years (range: 1-6 years). 23 patients answered the questionnaire and were overall satisfied with the treatments (8.29/10). Conclusions SC possibly associated to PC is a valuable option for E/P IBR revision surgery with minimal complications, reduced surgical trauma, short operating time, and relatively low recurrence risk. In addition, treated patients are overall satisfied with the results over time.
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Affiliation(s)
- Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Gianluca Marcaccini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Francesco Ruben Giardino
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Mirco Pozzi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Francesco Volanti
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico le Scotte, Via Bracci 16, Siena 53100, Italy
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Pozzi M, Marcaccini G, Giardino FR, El Araby MM, Nisi G, Grimaldi L, Cuomo R. Flowchart in Post-Bariatric Surgery: A Research for the Appropriate Type and Timing of Plasties Reshaping the Body. Aesthetic Plast Surg 2023:10.1007/s00266-023-03763-8. [PMID: 38110738 DOI: 10.1007/s00266-023-03763-8] [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: 07/15/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Obesity is a chronic disease with significant health implications. Bariatric surgery is an effective treatment for obesity-related conditions. However, the timing of post-bariatric body contouring surgery remains uncertain. MATERIALS AND METHODS We conducted a retrospective study of 1336 patients who underwent bariatric surgery. We analyzed weight trends and variations after different types of bariatric procedures. The Pittsburgh Index was used to evaluate body contouring outcomes. RESULTS The majority of patients were women, and sleeve gastrectomy was the most common procedure. Weight loss varied depending on the surgery type, with different outcomes for male and female patients. The Pittsburgh Index remained stable in most cases. CONCLUSION Our findings suggest that the timing of body contouring surgery should be tailored to the type of bariatric procedure performed. Abdominoplasty is recommended as a last procedure for sleeve gastrectomy patients, while gastric bypass patients are suitable candidates for early abdominoplasty. Biliopancreatic diversion patients should stabilize their weight before abdominoplasty. The Pittsburgh Index is a valuable tool for assessing the timing of post-bariatric plastic surgery. Further research is needed to optimize surgical planning and outcomes. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mirco Pozzi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gianluca Marcaccini
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Francesco Ruben Giardino
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mohamed Marzouk El Araby
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Susini P, Nisi G, Pierazzi DM, Giardino FR, Pozzi M, Grimaldi L, Cuomo R. Advances on Capsular Contracture-Prevention and Management Strategies: A Narrative Review of the Literature. Plast Reconstr Surg Glob Open 2023; 11:e5034. [PMID: 37305202 PMCID: PMC10256414 DOI: 10.1097/gox.0000000000005034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023]
Abstract
Capsular contracture (CC) is the most relevant complication of both aesthetic and reconstructive breast implant surgery. For many years, experimental and clinical trials have attempted to analyze CC risk factors, clinical features, and appropriate management strategies. It is commonly accepted that a multifactorial etiology promotes CC development. However, the heterogeneity in patients, implants and surgical techniques make it difficult to suitably compare or analyze specific factors. As a consequence, discordant data are present in literature, and a true systematic review is often limited in its conclusions. Hence, we decided to present a comprehensive review of current theories on prevention and management strategies, rather than a specific "solution" to this complication. Methods The PubMed database was searched for literature regarding CC prevention and management strategies. Pertinent articles in English, published before December 1, 2022, were compared with selection criteria and eventually included in this review. Results Through the initial search, 97 articles were identified, of which 38 were included in the final study. Several articles explored different medical and surgical preventive and therapeutic strategies, showing numerous controversies on appropriate CC management. Conclusions This review provides a clear overview of the complexity of CC. The wide variety of clinical situations in term of patients, implants, and surgical techniques prevent the standardization of CC management strategies. By contrast, a patient-customized approach should be preferred, and different strategies should be considered depending on the specific case. Further research is desirable to better ascertain evidence-based protocols with regard to CC prevention and treatment.
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Affiliation(s)
- Pietro Susini
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Giuseppe Nisi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Diletta Maria Pierazzi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Francesco Ruben Giardino
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Mirco Pozzi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Luca Grimaldi
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Roberto Cuomo
- From the Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
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Giardino FR, Cuomo R, Pozzi M, Marcaccini G, Bacchini S, Marzouk El Araby M, Grimaldi L, Nisi G. Erdheim–Chester Disease of the Breast: First Review and First Case of Isolated Severe Gynecomastia. Diagnostics (Basel) 2023; 13:diagnostics13071239. [PMID: 37046457 PMCID: PMC10093613 DOI: 10.3390/diagnostics13071239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Introduction: Erdheim–Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition.
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Nisi G, Giudice M, Bacchini S, Fasano G, Verre L, Cuomo R, Grimaldi L. To Keep or Not to Keep? The Hamletic Umbilical Dilemma: Preservation versus Reconstruction of the Umbilicus in Vertical Abdominoplasty. J Clin Med 2022; 12:jcm12010078. [PMID: 36614879 PMCID: PMC9821694 DOI: 10.3390/jcm12010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: The role of the umbilical scar and its repositioning remains one of the most important surgical steps in the execution of any type of abdominoplasty, including those involving "inverted-t" or "fleur de lys" incisions. A consequence of this is a surgeon's Hamletic dilemma: to keep or not to keep the original umbilical scar? (2) Methods: A retrospective observational study was conducted on all patients undergoing "T-inverted" abdominoplasty at the Department of Plastic Surgery of the Santa Maria alle Scotte University Hospital, Siena, between January 2018 and December 2020. Twelve months after the surgery we submitted to all patients the U-score questionnaire about their feelings about their umbilicus's appearance. Patients could assign a score from 1 (very dissatisfied) to 4 (very satisfied) to each of the five items of the score. (3) Results: The average of the scores attributed by the nine patients in whom the navel was preserved is 13 (Range 10-17), while in patients on whom a navel reconstruction was performed, the mean score is 16.8 (Range 12-20). The mean score of patients with a reconstructed umbilicus is, therefore, statistically higher than that of the other group of patients (t-value = 3.88, p = 0.000374) with an average increase of 3.8 points. (4) Conclusions: We can state that the reconstruction of a new navel is the right answer to the Hamletic dilemma in patients having undergone vertical or anchor abdominoplasty.
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Affiliation(s)
- Giuseppe Nisi
- Department of Medicine, Surgery and Neuroscience—Plastic and Reconstructive Surgery Unit, University of Siena, 53100 Siena, Italy
| | - Martino Giudice
- Department of Medicine, Surgery and Neuroscience—Plastic and Reconstructive Surgery Unit, University of Siena, 53100 Siena, Italy
- Correspondence:
| | - Stefano Bacchini
- Department of Medicine, Surgery and Neuroscience—Plastic and Reconstructive Surgery Unit, University of Siena, 53100 Siena, Italy
| | - Giorgio Fasano
- Department of Medicine, Surgery and Neuroscience—Plastic and Reconstructive Surgery Unit, University of Siena, 53100 Siena, Italy
| | - Luigi Verre
- Department of Medicine, Surgery and Neurosciences—Surgical Oncology Unit, University of Siena, 53100 Siena, Italy
| | - Roberto Cuomo
- Department of Medicine, Surgery and Neuroscience—Plastic and Reconstructive Surgery Unit, University of Siena, 53100 Siena, Italy
| | - Luca Grimaldi
- Department of Medicine, Surgery and Neuroscience—Plastic and Reconstructive Surgery Unit, University of Siena, 53100 Siena, Italy
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Pozzi M, Cuomo R, Giardino FR, Brandi C, Nisi G, Grimaldi L. A case of necrotizing fasciitis from a pedicure: when beauty centers become life-threatening. Acta Biomed 2022; 93:e2022126. [PMID: 35671116 PMCID: PMC10510979 DOI: 10.23750/abm.v93is1.9492] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION in a historical moment where there is an increasing use of beauty center, we report a case of necrotizing fasciitis occurred after a pedicure, with the aim of clarifying the safety of these aesthetic treatments. CASE REPORT we discuss a case of left foot necrotizing fasciitis as consequence of removing a plantar callus. The patient is a 49 years old man; he is hypertensive, and diabetic not controlled. We report our experience showing the clinical manifestation and the tricky profile of the patient; then we reflect on the safety profiles of these aesthetic treatments. DISCUSSION some bacterial infections of soft tissue after pedicure and manicure are reported in Literature. Mycobacteria seems to play a prevalent role, mostly after a peculiar practice of "fish pedicure". Our experience shows how the combination between a patient with complicated profile and poor hygienic measures can have catastrophic consequences. CONCLUSION the aim of this article is to raise awareness on the serious consequences that can arise from banal aesthetic procedures. Furthermore, we want to recommend more control over these treatments performed in Beauty Salon, considering the large turnout of people, even clinically sensitive.
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Waldner FA, Sadeghi P, Grimaldi L, Nisi G, Calomino N, Cuomo R. Tissue Adhesive: Current Uses and Strengths. J INVEST SURG 2022; 35:1415-1416. [PMID: 35331077 DOI: 10.1080/08941939.2022.2052211] [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: 10/18/2022]
Affiliation(s)
- Francesca Allegra Waldner
- Plastic and Reconstructive Surgery Unit - Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Payam Sadeghi
- Plastic Surgery Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - Luca Grimaldi
- Plastic and Reconstructive Surgery Unit - Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic and Reconstructive Surgery Unit - Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Natale Calomino
- General Surgery Unit - Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic and Reconstructive Surgery Unit - Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
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Fasano G, Grimaldi L, Nisi G, Calomino N, Cuomo R. The Regenerative Effects of Botulinum Toxin A: New Perspectives. J INVEST SURG 2022; 35:1074-1075. [DOI: 10.1080/08941939.2021.2008553] [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: 10/19/2022]
Affiliation(s)
- Giorgio Fasano
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - Luca Grimaldi
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - Giuseppe Nisi
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - Natale Calomino
- General Surgery Unit, Department of General Surgery, S. Maria Alle Scotte Hospital, Siena, Italy
| | - Roberto Cuomo
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
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Sisti A, Dalfino G, Pica Alfieri E, Cuomo R, Sadeghi P, Nisi G, Grimaldi L. Recurrence of breast ptosis after mastopexy - a prospective pilot study. Acta Chir Plast 2022; 64:18-22. [PMID: 35397776 DOI: 10.48095/ccachp202218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Breast ptosis is characterized by severe volumetric deficiency of the upper pole, excess of skin in the lower pole and descent of the nipple-areola complex (NAC). Mastopexy, also known as breast lifting, is the surgical operation aimed to reshape the ptotic breast. Recurrence of breast ptosis after mastopexy is common but to the best of our knowledge no study before has measured it. PURPOSE The aim of this study was to measure the recurrence of breast ptosis after mastopexy in a prospective study. MATERIALS AND METHODS Female patients affected by unilateral or bilateral moderate or severe breast ptosis were enrolled in the study. All the patients underwent mastopexy performed only with the removal of skin excess following a Wise pattern. The jugular notch-nipple distance was measured before surgery, immediately after surgery and after 1, 3, 6 and 12 months. RESULTS Ten patients were included in the study, four underwent unilateral mastopexy and six underwent bilateral mastopexy. The lifting of the NAC, measured in the immediate post-operative period, ranged from 3 to 8.5 cm, with an average value of 6.3 cm. This lifting, one year after surgery, ranged from 2 to 7 cm, with an average value of 4.6 cm. The percentage loss of the NAC lifting one year after surgery compared to the immediate post-operative time ranged from 12.5 to 41.7%, with an average value of 27.5%. CONCLUSION In our case series, the lifting of the NAC obtained immediately after surgery showed an average loss of 27.5% one year after surgery. Even if limited by the low number of patients included, this pilot study is eye-opening on a very common phenomenon that occurs after mastopexy. The patients should be informed about the possible recurrence of the breast ptosis.
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Sisti A, Huayllani MT, Boczar D, Restrepo DJ, Cinotto G, Lu X, Cuomo R, Grimaldi L, Nisi G, Forte AJ. Umbilical Reconstruction Techniques: A Literature Review. Aesthetic Plast Surg 2021; 45:1078-1096. [PMID: 33098045 DOI: 10.1007/s00266-020-01989-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are many instances in which sacrificing the umbilicus is unavoidable. Umbilical reconstruction (umbiliconeoplasty) is an important surgical procedure to complete the abdomen's reconstruction and to give again a pleasant cosmetic appearance. OBJECTIVES To provide a complete overview of all surgical techniques for umbiliconeoplasty described in the literature. METHODS PubMed database was queried using 'umbilical and reconstruction', 'umbilicus and reconstruction', 'navel and reconstruction', 'umbiliconeoplasty', 'neo-omphaloplasty' or 'umbilicaneoplasty' to select the papers dealing with the reconstruction of the umbilicus. RESULTS Sixty different techniques for the reconstruction of the missing umbilicus were described in 77 papers. Local skin flaps and the purse-string suture technique were the most frequently described techniques. The Three flaps technique, the Four flaps technique and the 2 Lateral rectangular pedicle lateral flaps technique were the most popular local flap techniques. Indications ranged from congenital pediatric defects to reconstruction during abdominoplasty. CONCLUSIONS Several surgical techniques were described for umbilicus reconstruction. While there is not a universal algorithm for the choice of the technique, the surgeon may decide which technique to use based on other surgeons' experiences reports. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Andrea Sisti
- Division of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Maria T Huayllani
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - David J Restrepo
- University of Texas Health Science Center at San Antonio (UTHSCSA) General Surgery, San Antonio, TX, USA
| | - Gabriela Cinotto
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Roberto Cuomo
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
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Cuomo R, Giardino FR, Pozzi M, Nisi G, Sisti A, Han J, Nuzzo A, Muratori A, Cigna E, Losco L, Grimaldi L. Management of skin damage of health workers' face: the role of plastic surgery in the time of Pandemic. Acta Biomed 2021; 92:e2021185. [PMID: 33988151 PMCID: PMC8182579 DOI: 10.23750/abm.v92i2.11006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022]
Abstract
Background and aim: The Sars-Cov-2 virus is characterized by a being highly contagiousness, and this is the reason why massive use of personal protective equipment is required by medical and paramedical staff of the COVID-19 dedicated departments. The aim of this manuscript is to describe and share our experience in the prevention and treatment of the personal protective equipment related pressure sores and other skin alterations in the medical and paramedical staff. Methods: All healthcare workers with PPE-related skin damages were registered at time 0. Age, sex, profession, type of skin damage, diseases and possible drugs were registered. Results: Two strategies were employed: the first strategy was to immediately treat the skin and the second one was to prevent pressure wounds formation both in already affected healthcare workers and the recurrence in healed staff. Three weeks after the two strategies were used, the incidence rate PPE-related skin damage was reduced in a statistically significant way. Conclusions: Proper management helps in reducing the incidence of pressure ulcers related to personal protective devices in Covid-19 Units. Skin prevention and hydration, have been obtained achieved by using products applied at home, autonomously.
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Affiliation(s)
| | - Francesco Ruben Giardino
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Mirco Pozzi
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Giuseppe Nisi
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Andrea Sisti
- Visiting Researcher - Department of Plastic Surgery, Cleveland Clinic Ohio, USA.
| | - Jingjian Han
- Jining First People's Hospital - Jining Medical University - Jining city - People's Republic of China.
| | - Angelo Nuzzo
- COVID Department - Intensive Care Unit - University of Siena - Italy.
| | - Alessia Muratori
- COVID Department - Intensive Care Unit - University of Siena - Italy.
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; Pisa, Italy.
| | - Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; Pisa, Italy.
| | - Luca Grimaldi
- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
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Pierazzi DM, Pica Alfieri E, Cuomo R, Bocchiotti MA, Grimaldi L, Donniacuo A, Zerini I, Nisi G. Ligasure™ Impact and Ligasure™ Small Jaw in Body Contouring after Massive Weight Loss: A New Perspective. J INVEST SURG 2021; 35:659-666. [PMID: 33691572 DOI: 10.1080/08941939.2021.1897714] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The most effective dissection technique for elevating flaps in body contouring is still controversial, particularly in high-risk massive weight loss (MWL) patients. LigaSure (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and improve outcomes. The aim of this study is to investigate the effectiveness of LigaSure Impact and LigaSure Small Jaw in body contouring after MWL compared with conventional technique. MATERIAL AND METHODS Patients who underwent abdominoplasty, mastopexy, brachioplasty and thigh lift after MWL at a single center from 1 December 2018 to 1 March 2020 were retrospectively reviewed. In each procedure patients were divided into two groups according to the dissection technique: LigaSure group and monopolar electrosurgery group. Patients characteristics, perioperative details and postoperative complications were evaluated. RESULTS Fourty-five patients underwent abdominoplasty, twenty-six mastopexy, twenty brachioplasty and sixteen medial thigh lift. Using LigaSure, operative time was longer in abdominoplasty and thigh lift, but shorter in mastopexy and brachioplasty. Although not statistically significant, the amount of blood and serum recorded from drains in the first 36 hours was reduced in LigaSure groups. Additional analgesic intake was reduced with LigaSure as well as postoperative subjective pain. In all body contouring procedures statistically significant difference was found in days of hospital stay favoring LigaSure groups. Complications occurred most frequently in control groups compared to LigaSure groups. CONCLUSION LigaSure Impact and LigaSure Small Jaw may be beneficial in improving outcomes because they might reduce fluids drainage, analgesics intake, hospital stay and postoperative complications.
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Affiliation(s)
- Diletta Maria Pierazzi
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Edoardo Pica Alfieri
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Roberto Cuomo
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Maria Alessandra Bocchiotti
- Division of Plastic and Reconstructive Surgery; Department of Surgery, Città della Salute e della Scienza Hospital, Molinette Ospital Unit, University of Turin, Italy
| | - Luca Grimaldi
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | | | - Irene Zerini
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
| | - Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Italy
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Diluiso G, Cuomo R, Volanti F, Nisi G, Aglianò M, Giardino FR, Losco L, Grimaldi L. Clinical Outcomes in Breast Cancer: Innovations and Ideas Commentary on "Expression of CDK13 was Associated with Clinical Outcomes and Expression of HIF-1 and Beclin1 in Breast Cancer Patients". J INVEST SURG 2020; 35:448-449. [PMID: 33371758 DOI: 10.1080/08941939.2020.1861137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Giuseppe Diluiso
- Department of Medicine, Surgery and Neuroscience, Unit of Plastic Surgery, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Department of Medicine, Surgery and Neuroscience, Unit of Plastic Surgery, University of Siena, Siena, Italy
| | - Francesco Volanti
- Department of Medicine, Surgery and Neuroscience, Unit of Plastic Surgery, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Department of Medicine, Surgery and Neuroscience, Unit of Plastic Surgery, University of Siena, Siena, Italy
| | - Margherita Aglianò
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Ruben Giardino
- Department of Medicine, Surgery and Neuroscience, Unit of Plastic Surgery, University of Siena, Siena, Italy
| | - Luigi Losco
- Department of Translational Research and New Technologies in Medicine and Surgery, Plastic Surgery Unit, University of Pisa, Pisa, Italy
| | - Luca Grimaldi
- Department of Medicine, Surgery and Neuroscience, Unit of Plastic Surgery, University of Siena, Siena, Italy
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14
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Nisi G, Pierazzi DM, Pica Alfieri E, Cuomo R, Zerini I, Grimaldi L. Nipple reconstruction on mastectomy scar: The "double flap" technique. J Plast Reconstr Aesthet Surg 2020; 74:1101-1160. [PMID: 33189615 DOI: 10.1016/j.bjps.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/02/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Diletta Maria Pierazzi
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Edoardo Pica Alfieri
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy.
| | - Roberto Cuomo
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Irene Zerini
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
| | - Luca Grimaldi
- Division of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, "Santa Maria alle Scotte" Hospital, University of Siena, Viale Bracci 16, 53100 Siena, Italy
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15
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Cuomo R, Giardino FR, Nisi G, Han J, Diluiso G, Tresoldi MM, Pieretti G, Brandi C, Grimaldi L. Fat graft for reducing pain in chronic wounds. Wound Repair Regen 2020; 28:780-788. [PMID: 32706138 DOI: 10.1111/wrr.12846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Chronic wounds are one of the most important challenge for regenerative surgery. Plastic surgeon can use fat graft to increase wound healing because its growth factors can enhance tissue regeneration. In a recent study, the authors evaluated a reduction of pain in a cohort of patients submitted to breast reconstruction with breast implant and lipofilling, putting into evidence that growth factors in fat graft can reduce post-surgical pain. The aim of this work is to evaluate ultra-filtered fat graft potential in reducing pain in chronic wounds. PATIENTS AND METHODS Fifty new patients with chronic wounds of different etiology were recruited for this study and divided into two groups: A, treatment and B, control. Twenty-five patients per group. Negative pressure therapy dressing was applied after surgical debridement. Three days later patients in group A received ultrafiltered fat graft. Pain was evaluated with preoperative Visual Analogic Scale, repeated twice a day for 14 days and finally 21 days from procedures. RESULTS In group A (treated patients), pain was lower. These data were confirmed even after 7 days. The overall statistical analysis of the average of all values (SD 1.72) confirmed that the differences were significant at the 95% with the Chi-square test and analysis of variance (P value < .05). CONCLUSIONS The ultra-filtered fat graft placed on the wound bed and edges was effective in reducing pain in chronic wounds. The reduction of pain was statistically significant.
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Affiliation(s)
- Roberto Cuomo
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesco R Giardino
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jingjian Han
- Jining First People's Hospital, Jining Medical University, Jining city, China
| | - Giuseppe Diluiso
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco M Tresoldi
- Plastic and Reconstructive Surgery Unit, Maugeri Clinic Scientific Institutes, Pavia, Italy.,Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gorizio Pieretti
- Multidisciplinary Department of Medical and Dental Specialties, University "Luigi Vanvitelli"-Plastic Surgery Unit, Naples, Italy
| | - Cesare Brandi
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Grimaldi
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Cuomo R, Giardino FR, Neri A, Nisi G, Brandi C, Zerini I, Jingjian H, Grimaldi L. Optimization of Prepectoral Breast Reconstruction. Breast Care (Basel) 2020; 16:36-42. [PMID: 33716630 DOI: 10.1159/000506347] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/05/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Acellular dermal matrix (ADM) were introduced in the early 2000s and more recently permitted new protocols for breast reconstruction allowing a short operative time with improved outcomes until the new muscle-sparing breast reconstruction proposed in 2014 using the Braxon® ADM. The aim of this research is to propose a technique to improve the aesthetic outcome using Braxon ADM with prepectoral implants. Materials and Methods The enrolled patients were submitted to a nipple skin-sparing mastectomy leaving 1 additional centimeter of subcutis on the proximal part of the upper pole of the breast (see Surgical Technique). Aesthetic outcomes were compared to those obtained with traditional breast reconstruction with prosthesis and the Braxon ADM placed in the prepectoral space. Mean values of aesthetic outcomes were analyzed using the Student t test, and the κ test was used to analyze interobserver variability. Results The overall aesthetic score was improved of 29.6% of the patients; in particular the most improved score was that for contour (+98.01%). Statistical significance was found for contour, upper pole definition, and total score average (p < 0.05). The κ test showed interobserver variability with a good level of agreement on contour (κ = 0.832). Conclusions The proposed technique has allowed attainment of good results in terms of aesthetic outcomes. In a small sample we did not register any particular complications but we verified a better satisfaction on the evaluation of the aesthetic result (level of evidence: 3).
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Affiliation(s)
- Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Ruben Giardino
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro Neri
- Unit of General and Oncological Surgery, S. Maria Alle Scotte Hospital, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Cesare Brandi
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Irene Zerini
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Han Jingjian
- Jining First People's Hospital, Jining Medical University, Jining City, China
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
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17
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Pica Alfieri E, Sisti A, Nisi G, Brandi C, Grimaldi L, D'Aniello C. A giant keratoacanthoma of the cheek. Acta Biomed 2019; 90:580-582. [PMID: 31910189 PMCID: PMC7233768 DOI: 10.23750/abm.v90i4.7409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/21/2018] [Indexed: 11/23/2022]
Abstract
Keratoacanthoma (KA) is a cutaneous tumor arising on sun-exposed skin and characterized by self-limiting growth and involution. We reported a case of a 92-year-old man presented a 4.5x3.5 cm nodular lesion with a central keratin-filled crater on his left cheek. We performed surgical excision and histopathological examination revealed a keratoacanthoma with perineural invasion. A close follow-up was carried out. (www.actabiomedica.it).
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Affiliation(s)
- Edoardo Pica Alfieri
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience; University Hospital "Santa Maria alle Scotte", Siena, Italy; University of Siena.
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18
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Cuomo R, Diluiso G, Ruben Giardino F, Nisi G, Grimaldi L. The Present and the Future of ALT Free Flap: Regeneration Concept in Lower Extremities Reconstruction. J INVEST SURG 2019; 34:643-644. [DOI: 10.1080/08941939.2019.1679295] [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] [Indexed: 01/13/2023]
Affiliation(s)
- Roberto Cuomo
- Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital – Viale Mario Bracci, Siena, SI, Italy
| | - Giuseppe Diluiso
- Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital – Viale Mario Bracci, Siena, SI, Italy
| | - Francesco Ruben Giardino
- Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital – Viale Mario Bracci, Siena, SI, Italy
| | - Giuseppe Nisi
- Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital – Viale Mario Bracci, Siena, SI, Italy
| | - Luca Grimaldi
- Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital – Viale Mario Bracci, Siena, SI, Italy
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Giardino FR, Cuomo R, Nisi G, Brandi C, Grimaldi L. Different Roles Played by Adipose-Derived Stem Cells in Peripheral Nerve Regeneration: State of the Art. J INVEST SURG 2019; 34:534-535. [PMID: 31588842 DOI: 10.1080/08941939.2019.1671559] [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] [Indexed: 01/05/2023]
Affiliation(s)
- Francesco Ruben Giardino
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Cesare Brandi
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
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20
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Affiliation(s)
- Roberto Cuomo
- Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Giuseppe Nisi
- Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Cesare Brandi
- Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Luca Grimaldi
- Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Siena, SI, Italy
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21
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Sisti A, Oliver JD, Nisi G. Fenestrated adipofascial reverse flap for the reconstruction of fingertip amputations. Microsurgery 2019; 39:575. [PMID: 31268559 DOI: 10.1002/micr.30480] [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] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/10/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea Sisti
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Italy
| | - Jeremie D Oliver
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery, Santa Maria alle Scotte Hospital, University of Siena, Italy
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Sisti A, Oliver JD, Huayllani MT, Boczar D, Restrepo DJ, Nisi G, Forte AJ. Superior Labial Artery: Anatomical Considerations. Aesthet Surg J 2019; 39:NP307-NP308. [PMID: 31100103 DOI: 10.1093/asj/sjz046] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrea Sisti
- Division of Plastic and Reconstructive Surgery, S. Maria alle Scotte Hospital, University of Siena, Italy
| | - Jeremie D Oliver
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Maria T Huayllani
- Division of Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Daniel Boczar
- Division of Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - David J Restrepo
- Division of Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Giuseppe Nisi
- Division of Plastic and Reconstructive Surgery, S. Maria alle Scotte Hospital, University of Siena, Italy
| | - Antonio J Forte
- Division of Plastic Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
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Cuomo R, Grimaldi L, Nisi G, Zerini I, Giardino FR, Brandi C. Ultraportable Devices for Negative Pressure Wound Therapy: First Comparative Analysis. J INVEST SURG 2019; 34:335-343. [DOI: 10.1080/08941939.2019.1616009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Irene Zerini
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Francesco Ruben Giardino
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Cesare Brandi
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
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Affiliation(s)
- Roberto Cuomo
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital - Viale Mario Bracci, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital - Viale Mario Bracci, Siena, Italy
| | - Cesare Brandi
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital - Viale Mario Bracci, Siena, Italy
| | - Francesco Ruben Giardino
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital - Viale Mario Bracci, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital - Viale Mario Bracci, Siena, Italy
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25
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Affiliation(s)
- Roberto Cuomo
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital, Siena, Italy
| | - Cesare Brandi
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic Surgery, University of Siena - Santa Maria Alle Scotte Hospital, Siena, Italy
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26
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Affiliation(s)
- Roberto Cuomo
- Department of Medicine, Surgery and Neuroscience ? Plastic Surgery Unit, Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Andrea Sisti
- Department of Medicine, Surgery and Neuroscience ? Plastic Surgery Unit, Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Luca Grimaldi
- Department of Medicine, Surgery and Neuroscience ? Plastic Surgery Unit, Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Giuseppe Nisi
- Department of Medicine, Surgery and Neuroscience ? Plastic Surgery Unit, Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Cesare Brandi
- Department of Medicine, Surgery and Neuroscience ? Plastic Surgery Unit, Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital, Siena, SI, Italy
| | - Carlo D’Aniello
- Department of Medicine, Surgery and Neuroscience ? Plastic Surgery Unit, Unit of Plastic Surgery, University of Siena – Santa Maria Alle Scotte Hospital, Siena, SI, Italy
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Brandi C, Cuomo R, Nisi G, Grimaldi L, D'Aniello C. Face Rejuvenation: a new combinated protocol for biorevitalization. Acta Biomed 2018; 89:400-405. [PMID: 30333466 PMCID: PMC6502127 DOI: 10.23750/abm.v89i3.6162] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/20/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The slowing of the aging process is subject of great research and attention in modern society, particularly aging of face. Processes involved are very complex. Mesotherapy. hyaluronic acid and carbon dioxide injection can be used for biorevitalization and skin rejuvenation. METHODS Three groups were made and 62 patients were enrolled. Patients with superficial wrinkles of the face, neck and/or décolleté, without presence of nasolabial folds and marionette wrinkles were included in group 1. Patients with superficial/medium depth wrinkles of the face, neck and/or décolleté, with moderate nasolabial folds but no marionette wrinkles were included in group 2. Patients with deep wrinkles of the face, with deep nasolabial folds and marionette wrinkles were included in group 3. Patients were treated with three different protocols that included injections of amino acids, vitamins and hyaluronic acid in association with carbon dioxide injection. We submitted the PAIS and GAIS scales and we analyzed the scores obtained with Wilcoxon's and Kolmogorov-Smirnov's tests. Statistical Product and Service Solutions (SPSS) softare was used. The p-value was considered acceptable if inferior to 0,05 (p>0,05). RESULTS In according with these tests, the differences of values at one week and at the end of the study are significant (p<0,05) for both PAIS and GAIS. No side effects were reported. CONCLUSIONS Protocol treatment used in this study gave statistically valid results in the rejuvenation of face for mild, moderate and severe aging.
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Sisti A, Cuomo R, Milonia L, Tassinari J, Castagna A, Brandi C, Grimaldi L, D'Aniello C, Nisi G. Complications associated with brachioplasty: a literature review. Acta Biomed 2018; 88:393-402. [PMID: 29350652 PMCID: PMC6166161 DOI: 10.23750/abm.v88i4.5609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/18/2016] [Indexed: 11/23/2022]
Abstract
Background: Paralleling the growth of bariatric surgery, the demand for post-bariatric body-contouring surgery is increasing. Weight loss is the main cause, although not the only one, that drives patients to arm lift surgery. Several surgical techniques have been proposed over the years. Our aim was to consider the complications and outcomes according to the performed technique, through a wide review of the literature. Methods: A search on PubMed/Medline was performed using “brachioplasty”, “upper arm lifting”, and “techniques” as key words. Embase, Medline (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar were searched as well. As inclusion criteria, we selected the clinical studies describing techniques of brachioplasty. We excluded the papers in which complications related to brachioplasty were not specified. We also excluded literature-review articles. Results: We found 27 studies from 1995 to 2015. Overall, 1065 patients were treated. Different techniques were applied. Complications were observed in 308/1065 patients (28.9%). The most frequent complications were hypertrophic scarring, seroma and hematoma. Surgical revision rate ranged from 0 to 21 percent. Nerve damage occurred in a modest percentage of patients (16/1065, 1.5%). No major complications, such as thromboembolism and sepsis, were observed. Conclusions: Brachioplasty is a safe surgical procedure. All the brachioplasty techniques showed positive outcomes, in term of patients’ satisfaction and clinical results. Nevertheless, minor complications occurred in a high percentage of patients, regardless the performed surgical procedure. Patients should be informed about the possible formation of hypertrophic scars and nerve injuries. (www.actabiomedica.it)
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Cuomo R, Grimaldi L, Brandi C, Sisti A, Nisi G. Vaginoplasty: What's New From 1946 to Date Commentary on: Vaginoplasty with Acellular Dermal Matrix after Radical Resection for Carcinoma of the Uterine Cervix. J INVEST SURG 2018; 32:186-188. [PMID: 29333882 DOI: 10.1080/08941939.2017.1411544] [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] [Indexed: 02/02/2023]
Affiliation(s)
- Roberto Cuomo
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Luca Grimaldi
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Cesare Brandi
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Andrea Sisti
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
| | - Giuseppe Nisi
- a Unit of Plastic Surgery, University of Siena, Santa Maria Alle Scotte Hospital, Viale Mario Bracci, Siena ( SI ), Italy
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Sisti A, Fallaha A, Tassinari J, Nisi G, Grimaldi L, Eisendle K. Melanoma in situ mimicking a Lichen planus-like keratosis. Acta Biomed 2018; 88:496-498. [PMID: 29350666 PMCID: PMC6166163 DOI: 10.23750/abm.v88i4.5699] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/09/2016] [Indexed: 11/23/2022]
Abstract
The incidence of melanoma has steadily increased over the past three decades. Melanoma in situ (MIS), defined as melanoma that is limited to the epidermis, contributes to a disproportionately high percentage of this rising incidence. Amelanotic melanoma presents as an erythematous macule or plaque and may initially be misdiagnosed as an inflammatory disorder. We report a case of amelonatic MIS raised on non-sun-exposed skin, inducing a lichen planus-like keratosis as inflammatory reaction, which clinically masked the melanoma. (www.actabiomedica.it)
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Affiliation(s)
- Andrea Sisti
- General and Specialist Surgery Department, Plastic Surgery Division, University of Siena, Italy.
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Abstract
Median and Ulnar nerve palsy is a devastating condition that compromise hand function. A procedure of tendon transfer may be helpful to restore the movements by linking palsy muscles to other muscles able to contract. Scientific discoveries and technological innovations have profoundly changed this kind of surgery; studies on sarcomeres, for example, changed the concept of tensioning. To date we know that muscle strength and its contraction capacity depends on many factors (not only tensioning) such as sarcomeres length, cellular cytoskeleton and extracellular matrix composition: all of these factors interact together and in a ways not still fully understood, determining the complex concept of "movement." Technology made possible the production of smaller and more complex prostheses so to open new frontiers for modulation of the tendon length during grasping. These devices, currently studied on computer models, on cadaver or on animals, behaved great impetus to research but are still not suitable for implantation in humans. Challenges are still numerous: for example obtain more biocompatible implantable device, find new surgical approach, new ways to obtain better results for this kind of patients.
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Affiliation(s)
- Roberto Cuomo
- a Unit of Plastic Surgery , University of Siena, Santa Maria Alle Scotte Hospital , Siena ( SI ), Italy
| | - Luca Grimaldi
- a Unit of Plastic Surgery , University of Siena, Santa Maria Alle Scotte Hospital , Siena ( SI ), Italy
| | - Giuseppe Nisi
- a Unit of Plastic Surgery , University of Siena, Santa Maria Alle Scotte Hospital , Siena ( SI ), Italy
| | - Cesare Brandi
- a Unit of Plastic Surgery , University of Siena, Santa Maria Alle Scotte Hospital , Siena ( SI ), Italy
| | - Carlo D'Aniello
- a Unit of Plastic Surgery , University of Siena, Santa Maria Alle Scotte Hospital , Siena ( SI ), Italy
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Cuomo R, Nisi G, Grimaldi L, Brandi C, D'Aniello C. Use of ultraportable vacuum therapy systems in the treatment of venous leg ulcer. Acta Biomed 2017; 88:297-301. [PMID: 29083334 PMCID: PMC6142840 DOI: 10.23750/abm.v88i3.5737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/28/2017] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The high incidence of venous leg ulcers and the difficult to give a complete healing involves in an increase of costs for National Health System. Main therapies to obtain a fast healing are compressive bandages, treatment of abnormal venous flow and in-situ-strategies of wound care. Negative pressure therapy does not conventionally used, because these systems not allow the use of compression bandages. Recently the development of ultraportable devices has improved the compliance and the results. METHODS Ten patients with venous chronic ulcer on the lower extremities were recruited for this study: all patients had venous leg ulcers from at least one year. We treated the patients with autologous partial thickness skin graft and subsequently we applied NANOVA device included in compressive bandage. We used NANOVA for fourteen days and after we made traditional medications. We submitted a questionnaire to evaluate the impact of dressing and NANOVA device in the quality of life of patients. RESULTS The device contributed to the formation of granulation tissue and increased the success rate of autologous skin graft without limiting mobility of patient. In addition to this, we have been able to perform compression bandages thanks to small size of this device. Eight ulcers healed within 90 days of medication. CONCLUSIONS We believe that ultraportable negative pressure systems are useful devices for treatment of venous leg ulcers because them allows to realize a compressive bandage without mobility limitations.
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Cuomo R, Grimaldi L, Brandi C, Nisi G, D'Aniello C. Skin graft donor site: a procedure for a faster healing. Acta Biomed 2017; 88:310-314. [PMID: 29083336 PMCID: PMC6142839 DOI: 10.23750/abm.v88i3.5736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/28/2017] [Accepted: 09/15/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The authors want to evaluate the efficacy of fibrillary tabotamp dressing in skin graft-donor site. A comparison was made with Vaseline gauzes. Tabotamp is an absorbable haemostatic product of Ethicon (Johnson and Johnson) obtained by sterile and oxidized regenerated cellulose (Rayon). It is used for mild to moderate bleeding. MATERIALS AND METHODS 276 patients were subject to skin graft and divided into two group: Group A and Group B. The donor site of patients in Group A was medicated with fibrillary tabotamp, while the patients of Group B were medicated only with Vaseline gauze. We recorded infection, timing of healing, number of dressing change, the pain felt during and after the dressing change with visual analog scale (VAS) and a questionnaire. RESULTS Patients allocated in Group A healed faster than the Group B. Questionnaires and VAS analysis showed lower pain felt, lower intake of pain drugs and lower infection rate in the Group A than the Group B. Analysis of coast showed lower dressing change in Group A than the Group B. CONCLUSION We believe that the use of tabotamp is a very viable alternative to improve healing.
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Sisti A, Tassinari J, Cuomo R, Milonia L, Nisi G, Brandi C, D'Aniello C, Grimaldi L. A case of extramammary inguinal Paget disease in a male patient: surgical treatment with an abdominal advancement cutaneous flap. Acta Biomed 2017; 88:79-81. [PMID: 28467338 PMCID: PMC6166191 DOI: 10.23750/abm.v88i1.5608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022]
Abstract
Extramammary Paget disease (EMPD) is a rare neoplasm. The clinical case of a 55-year-old man with a two-year history of a pruritic, painless erythematous skin rash on the inguinal region and scrotum is described. After a delay due to improper diagnosis and improper treatments, the patient came to the attention of the Division of plastic surgery. He underwent a punch biopsy and the pathology report came back as EMPD. Surgical excision was carried out, and an abdominal advancement cutaneous flap was performed for the defect repair. This is the first description of a reconstruction after surgical removal of inguinal EMPD with a flap of this type and we think that this type of treatment can be useful and reliable for disease localization in the groin area, especially for patients that present an excess of abdominal skin.
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Cuomo R, Nisi G, Grimaldi L, Brandi C, D'Aniello C. Silicone breast implants and echocardiographic interactions: A brand new study. Indian J Plast Surg 2017; 49:430-431. [PMID: 28216833 PMCID: PMC5288928 DOI: 10.4103/0970-0358.197233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Roberto Cuomo
- Department of Plastic and Reconstructive Surgery, University of Siena, Santa Maria Alle Scotte Hospital, M. Bracci Street, Siena 53100, Italy
| | - Giuseppe Nisi
- Department of Plastic and Reconstructive Surgery, University of Siena, Santa Maria Alle Scotte Hospital, M. Bracci Street, Siena 53100, Italy
| | - Luca Grimaldi
- Department of Plastic and Reconstructive Surgery, University of Siena, Santa Maria Alle Scotte Hospital, M. Bracci Street, Siena 53100, Italy
| | - Cesare Brandi
- Department of Plastic and Reconstructive Surgery, University of Siena, Santa Maria Alle Scotte Hospital, M. Bracci Street, Siena 53100, Italy
| | - Carlo D'Aniello
- Department of Plastic and Reconstructive Surgery, University of Siena, Santa Maria Alle Scotte Hospital, M. Bracci Street, Siena 53100, Italy
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Cuomo R, Nisi G, Grimaldi L, Brandi C, D’Aniello C. Use of ultraportable vacuum therapy systems in the treatment of venous leg ulcer. Acta Biomed 2017. [PMID: 29083334 PMCID: PMC6142840 DOI: 10.23750/abm.v%vi%i.5737] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The high incidence of venous leg ulcers and the difficult to give a complete healing involves in an increase of costs for National Health System. Main therapies to obtain a fast healing are compressive bandages, treatment of abnormal venous flow and in-situ-strategies of wound care. Negative pressure therapy does not conventionally used, because these systems not allow the use of compression bandages. Recently the development of ultraportable devices has improved the compliance and the results. METHODS Ten patients with venous chronic ulcer on the lower extremities were recruited for this study: all patients had venous leg ulcers from at least one year. We treated the patients with autologous partial thickness skin graft and subsequently we applied NANOVA device included in compressive bandage. We used NANOVA for fourteen days and after we made traditional medications. We submitted a questionnaire to evaluate the impact of dressing and NANOVA device in the quality of life of patients. RESULTS The device contributed to the formation of granulation tissue and increased the success rate of autologous skin graft without limiting mobility of patient. In addition to this, we have been able to perform compression bandages thanks to small size of this device. Eight ulcers healed within 90 days of medication. CONCLUSIONS We believe that ultraportable negative pressure systems are useful devices for treatment of venous leg ulcers because them allows to realize a compressive bandage without mobility limitations.
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Affiliation(s)
- Roberto Cuomo
- Correspondence: Roberto Cuomo Unit of Plastic and Reconstructive Surgery University of Siena, Hospital Santa Maria Alle Scotte Mario Bracci Street – 53100 Siena (SI) - Italy Tel/fax: +0039-0577585158 E-mail:
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Abstract
BACKGROUND The authors want to evaluate the efficacy of fibrillary tabotamp dressing in skin graft-donor site. A comparison was made with Vaseline gauzes. Tabotamp is an absorbable haemostatic product of Ethicon (Johnson and Johnson) obtained by sterile and oxidized regenerated cellulose (Rayon). It is used for mild to moderate bleeding. MATERIALS AND METHODS 276 patients were subject to skin graft and divided into two group: Group A and Group B. The donor site of patients in Group A was medicated with fibrillary tabotamp, while the patients of Group B were medicated only with Vaseline gauze. We recorded infection, timing of healing, number of dressing change, the pain felt during and after the dressing change with visual analog scale (VAS) and a questionnaire. RESULTS Patients allocated in Group A healed faster than the Group B. Questionnaires and VAS analysis showed lower pain felt, lower intake of pain drugs and lower infection rate in the Group A than the Group B. Analysis of coast showed lower dressing change in Group A than the Group B. CONCLUSION We believe that the use of tabotamp is a very viable alternative to improve healing.
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Affiliation(s)
- Roberto Cuomo
- Correspondence: Roberto Cuomo, M.D. Plastic and Reconstructive Surgery Unit Santa Maria Alle Scotte Hospital Viale Mario Bracci - 53100 Siena, Italy Tel/fax: +0039-0577-585158 E-mail:
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Idone F, Sisti A, Tassinari J, Nisi G. Fenestrated Adipofascial Reverse Flap: A Modified Technique for the Reconstruction of Fingertip Amputations. J INVEST SURG 2016; 30:353-358. [PMID: 27901645 DOI: 10.1080/08941939.2016.1251667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS OF THE STUDY Fingertip injuries can be treated in different ways, including shortening with primary closure, skin graft, and local or distant flaps. Several local flaps for the reconstruction of the amputated fingertip were described. We present our experience with a new concept of homodigital adipofascial reverse flap that avoids the second surgical stage and allows a complete and anatomically perfect reconstruction of nail bed, with preservation of the nail lamina. MATERIALS AND METHODS Between March 2014 and February 2015, five patients with digital amputations (distally to the nail matrix) were treated using the Fenestrated Adipofascial Reverse (F.A.R.) flap. The patients were evaluated measuring 2-point discrimination (2PD) value and range of motion of the distal interphalangeal joint (DIP). Scar evaluation was performed using the Vancouver Scar Scale (VSS). RESULTS All the flaps completely survived. A normal nail grow has been observed in first two-three months of post operatory follow-up. Length of the digits was preserved and good aesthetic as functional outcome were archive. The F.A.R. flap provided excellent coverage of fingertip defects and preserved finger length. After 1 year of follow, the mean static 2PD value at the reconstructed finger was 4.2 mm (range 3-5 mm), reconstructed fingers' mean range of motion for the DIP joint was 78 degrees and the VSS score ranged from 0 to 2 (mean score: 0.6). No complications were reported. CONCLUSIONS F.A.R. flap is one of the most useful techniques in order to achieve all the goals in fingertip reconstruction.
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Affiliation(s)
- Francesco Idone
- a Jalisco Plastic and Reconstructive Institute, University of Guadalajara , Guadalajara , México
| | - Andrea Sisti
- b Division of Plastic and Reconstructive Surgery , Department of Medicine , Surgery and Neuroscience, University of Siena , Siena , Italy
| | - Juri Tassinari
- b Division of Plastic and Reconstructive Surgery , Department of Medicine , Surgery and Neuroscience, University of Siena , Siena , Italy
| | - Giuseppe Nisi
- b Division of Plastic and Reconstructive Surgery , Department of Medicine , Surgery and Neuroscience, University of Siena , Siena , Italy
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D'Aniello C, Cuomo R, Grimaldi L, Brandi C, Sisti A, Tassinari J, Nisi G. Superior Pedicle Mammaplasty without Parenchymal Incisions after Massive Weight Loss. J INVEST SURG 2016; 30:410-420. [PMID: 27780374 DOI: 10.1080/08941939.2016.1240837] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND After considerable weight loss, the breast suffers significant deformation. The ptotic breast is characterized by a lack of superior pole, tissue excess in the inferior pole, down-migration of nipple-areola complex (NAC) with redundancy of skin tissue. The authors describe a mastopexy technique based on a modulated and progressive reshaping, back rotation, and suspension of mammary gland parenchyma without parenchymal incisions. METHODS Forty-five patients with bilateral moderate or severe breast ptosis underwent mastopexy from January 2011 to January 2014 with complete detachment of breast from the pectoralis major muscle and the plication of parenchyma without any parenchymal incision. Patients were followed up for one year, reporting any complication, and measuring the jugulum-NAC distance. The outcomes were assessed by the patients as well as the surgical team. RESULTS The aesthetic outcomes were good or excellent in all patients. The new mammary contour and the distance between the jugular fossa and the nipple were stable during this time with a good filling of upper pole. No major complications were reported. CONCLUSIONS This technique gave good breast shape, long-term projection, and upper pole fullness, without parenchymal incisions. It restores breast shape and projection, especially in post-bariatric patients. A similar technique has not been described yet.
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Affiliation(s)
- Carlo D'Aniello
- a Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, S.Maria alle Scotte Hospital, University of Siena , Italy
| | - Roberto Cuomo
- a Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, S.Maria alle Scotte Hospital, University of Siena , Italy
| | - Luca Grimaldi
- a Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, S.Maria alle Scotte Hospital, University of Siena , Italy
| | - Cesare Brandi
- a Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, S.Maria alle Scotte Hospital, University of Siena , Italy
| | - Andrea Sisti
- a Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, S.Maria alle Scotte Hospital, University of Siena , Italy
| | - Juri Tassinari
- a Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, S.Maria alle Scotte Hospital, University of Siena , Italy
| | - Giuseppe Nisi
- a Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, S.Maria alle Scotte Hospital, University of Siena , Italy
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Sisti A, Tassinari J, Nisi G, Grimaldi L, Sisti G, DI Tommaso M, Fambrini M. Synchronous and Metachronous Malignancies After Malignant Struma Ovarii in the SEER Database. In Vivo 2016; 30:713-716. [PMID: 27566096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Second primary tumors (SPTs) often occur, either synchronous or metachronous. Struma ovarii is a rare ovarian tumor represented by thyroid tissue in the ovary. Among other factors, production of thyroid hormones by the tumor or a shared genetic predisposition can further influence the development of SPTs. The occurrence of SPT, either synchronous or metachronous, following a long follow-up, has never been considered extensively. PATIENTS AND METHODS We analyzed the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2011 to follow-up all the cases of malignant struma ovarii in an effort of calculate the occurrence of SPTs in this cohort of patients. RESULTS We identified 21 patients with malignant struma ovarii in the period between January 1973 and December 2011. In a follow-up period of 219.57 person-years, 3 patients had SPT. One patient had synchronous thyroid sclerosing carcinoma, 1 patient had metachronous papillary adenocarcinoma with a latent time of 7 years and 1 patient had synchronous salivary ductal carcinoma. CONCLUSION Up to date, only thyroid synchronous tumors have been reported in the literature. A synchronous and a metachronous thyroid tumor, plus a synchronous salivary gland tumor, were found. A significant association between malignant struma ovarii and thyroid/salivary gland cancer is herein demonstrated.
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Affiliation(s)
- Andrea Sisti
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Juri Tassinari
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Giovanni Sisti
- Department of Health Sciences, Division of Obstetrics and Gynecology, University of Florence, AOU Careggi, Florence, Italy
| | - Mariarosaria DI Tommaso
- Department of Health Sciences, Division of Obstetrics and Gynecology, University of Florence, AOU Careggi, Florence, Italy
| | - Massimiliano Fambrini
- Department of Biomedical, Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Florence, AOU Careggi, Florence, Italy
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Sisti A, D'Aniello C, Fortezza L, Tassinari J, Cuomo R, Grimaldi L, Nisi G. Propeller Flaps: A Literature Review. In Vivo 2016; 30:351-373. [PMID: 27381596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 04/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Since their introduction in 1991, propeller flaps are increasingly used as a surgical approach to loss of substance. The aim of this study was to evaluate the indications and to verify the outcomes and the complication rates using this reconstructing technique through a literature review. MATERIALS AND METHODS A search on PubMed was performed using "propeller flap", "fasciocutaneous flap", "local flap" or "pedicled flap" as key words. We selected clinical studies using propeller flaps as a reconstructing technique. RESULTS We found 119 studies from 1991 to 2015. Overall, 1,315 propeller flaps were reported in 1,242 patients. Most frequent indications included loss of substance following tumor excision, repair of trauma-induced injuries, burn scar contractures, pressure sores and chronic infections. Complications were observed in 281/1242 patients (22.6%) occurring more frequently in the lower limbs (31.8%). Partial flap necrosis and venous congestion were the most frequent complications. The complications' rate was significantly higher in infants (<10 years old) and in the older population (>70 years old) but there was not a significant difference between the sexes. Trend of complication rate has not improved during the last years. CONCLUSION Propeller flaps showed a great success rate with low morbidity, quick recovery, good aesthetic outcomes and reduced cost. The quality and volume of the transferred soft tissue, the scar orientation and the possibility of direct donor site closure should be considered in order to avoid complications. Indications for propeller flaps are small- or medium-sized defects located in a well-vascularized area with healthy surrounding tissues.
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Affiliation(s)
- Andrea Sisti
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Carlo D'Aniello
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Leonardo Fortezza
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Juri Tassinari
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
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Idone F, Sisti A, Tassinari J, Nisi G. Cooling Composite Graft for Distal Finger Amputation: A Reliable Alternative to Microsurgery Implantation. In Vivo 2016; 30:501-505. [PMID: 27381615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Finger amputations are the most common injuries to the upper limb. There are many options in the management of fingertip or finger amputations. We report our experience using cooling composite graft (Hirase technique) for distal finger amputation, as alternative to microsurgery implantation. PATIENTS AND METHODS We collected a case series of eight patients and report on the clinical outcomes after a 10-month follow-up period. RESULTS The amputated part survived almost completely in six patients; in these cases, the fingertip amputations were classified, according to the Allen classification, as level I in two cases, level II in three cases and level III in one case. CONCLUSION Re-implantation of an amputated finger with the Hirase technique is possible and can provide good distal soft-tissue coverage and recovery of sensory and motor functions. We believe that re-attachment of the amputated portion as a composite graft represents an important alternative to microsurgery.
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Affiliation(s)
- Francesco Idone
- Jalisco Plastic and Reconstructive Institute, University of Guadalajara, Guadalajara, Mexico
| | - Andrea Sisti
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Juri Tassinari
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
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Sisti A, Cuomo R, Zerini I, Tassinari J, Brandi C, Grimaldi L, D'Aniello C, Nisi G. Complications Associated With Medial Thigh Lift: A Comprehensive Literature Review. J Cutan Aesthet Surg 2016; 8:191-7. [PMID: 26865783 PMCID: PMC4728900 DOI: 10.4103/0974-2077.172189] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications. Our aim was to consider the complications and outcomes according to the performed technique, through a wide and comprehensive review of the literature. A search on PubMed/Medline was performed using “medial thighplasty”, “medial thigh lifting” and “technique” as key words. As inclusion criteria, we selected the clinical studies describing techniques of medial thighplasty. We excluded the papers in which complications related to medial thighplasty were not specified. We also excluded literature-review articles. We found 16 studies from 1988 to 2015. Overall, 447 patients were treated. Different techniques were applied. Complications were observed in 191/447 patients (42.72%). The most frequent complications were wound dehiscence(18.34%) and seroma (8.05%). No major complications, such as thromboembolism and sepsis, were observed. Minor complications occurred in a high percent of patients, regardless of the performed surgical procedure. Patients should be informed about the possible occurrence of wound dehiscence and seroma, as common complications associated with this surgical procedure.
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Affiliation(s)
- Andrea Sisti
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Irene Zerini
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Juri Tassinari
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Cesare Brandi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Carlo D'Aniello
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
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Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti MA, Roviello F, D'Aniello C, Nisi G. Nipple-areola complex reconstruction techniques: A literature review. Eur J Surg Oncol 2016; 42:441-65. [PMID: 26868167 DOI: 10.1016/j.ejso.2016.01.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/07/2015] [Accepted: 01/06/2016] [Indexed: 11/30/2022] Open
Abstract
Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis.
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Affiliation(s)
- A Sisti
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
| | - L Grimaldi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - J Tassinari
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - R Cuomo
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - L Fortezza
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - M A Bocchiotti
- Department of Plastic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy
| | - F Roviello
- Oncologic Surgery, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - C D'Aniello
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - G Nisi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
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Nisi G, Cuomo R, Brandi C, Grimaldi L, Sisti A, D'Aniello C. Carbon dioxide therapy and hyaluronic acid for cosmetic correction of the nasolabial folds. J Cosmet Dermatol 2016; 15:169-75. [DOI: 10.1111/jocd.12213] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Nisi
- General and Specialistic Surgery Department; Plastic Surgery Division; “S. Maria alle Scotte” Polyclinic; University of Siena; Siena Italy
| | - Roberto Cuomo
- General and Specialistic Surgery Department; Plastic Surgery Division; “S. Maria alle Scotte” Polyclinic; University of Siena; Siena Italy
| | - Cesare Brandi
- General and Specialistic Surgery Department; Plastic Surgery Division; “S. Maria alle Scotte” Polyclinic; University of Siena; Siena Italy
| | - Luca Grimaldi
- General and Specialistic Surgery Department; Plastic Surgery Division; “S. Maria alle Scotte” Polyclinic; University of Siena; Siena Italy
| | - Andrea Sisti
- General and Specialistic Surgery Department; Plastic Surgery Division; “S. Maria alle Scotte” Polyclinic; University of Siena; Siena Italy
| | - Carlo D'Aniello
- General and Specialistic Surgery Department; Plastic Surgery Division; “S. Maria alle Scotte” Polyclinic; University of Siena; Siena Italy
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Nisi G, Barberi L, Ceccaccio L, Cuomo R, Sisti A, Castagna A, Zerini I, Brandi C, Grimaldi L, D'Aniello C. Effect of repeated subcutaneous injections of carbon dioxide (CO2) on inflammation linked to hypoxia in adipose tissue graft. Eur Rev Med Pharmacol Sci 2015; 19:4501-4506. [PMID: 26698245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The purposes of this study was to assess the effect of repeated subcutaneous injections of CO2 on adipose tissue graft survival in immunosuppressed female nude mice. The authors designed an experimental study using volume measures, histopathological analysis and nuclear magnetic resonance of fat graft. The effect of repeated subcutaneous injection of CO2 is not yet investigated MATERIALS AND METHODS Approximately 0.5 ml of human fat were transplanted in a group of female nude mice. The mice were treated with 3 injections of 80 µl each carbon dioxide (total 240 µl) for 7 weeks. Initially, in vivo measurements were conducted and subsequently a comprehensive histopathological analysis was performed. RESULTS The presence of inflammation was graded absent to minimal in animals treated with CO2 while a minimal to moderate grade was assigned to the control group. CONCLUSIONS CO2 injection enhances the inflammatory response of the implanted tissue and reduces the reabsorption rate. The treatment may improve the graft survival in a more prolonged time-frame.
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Affiliation(s)
- G Nisi
- Department of General and Specialist Surgery, Plastic Surgery Division, Siena, Italy.
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Cuomo R, Russo F, Sisti A, Nisi G, Grimaldi L, Brandi C, D'Aniello C. Abdominoplasty in Mildly Obese Patients (BMI 30-35 kg/m2): Metabolic, Biochemical and Complication Analysis at One Year. In Vivo 2015; 29:757-761. [PMID: 26546533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIM Dermolipectomy dramatically improves the quality of life of previously obese patients. Fat removal in patients undergoing liposuction and reduction mammoplasty has positive effects, but no data regarding sequelae of abdominal dermolipectomy on metabolism have been reported. Thus, the aim of the present study was to assess metabolic and biochemical modifications occurring after abdominoplasty. A correlation between the results and the rate of complications was also evaluated. PATIENTS AND METHODS One hundred and twenty-eight patients with body mass index (BMI) between 30 and 35 kg/m(2) were enrolled. Clinical assessment, anthropometric measurements, blood biochemical analysis (fasting plasma glucose, total cholesterol, free fatty acids, plasma insulin), plasma adipocytokines (leptin, adiponectin,resistin), levels of inflammatory markers [tumor necrosis factor-alpha (TNFα), interleukin-6 (IL6), C-reactive protein (CRP)] and insulin sensitivity by Homeostasis Model Assessment were performed three times. RESULTS The average age was 37.6 years. At baseline, the mean (±SD) BMI of patients overall was 33.44 (±2.3) kg/m(2) and the amount of fat surgically removed was 1,578.33 (±1,013.02) g. A significant decrease in BMI at 1 year was found. Adiponectin levels were found to have significantly increased (p<0.05) in long-term evaluation. We noted significant increases in the mean TNFα (p<0.05), IL6 (p<0.01) and CRP (p<0.05), with a return to baseline values of all variables. The majority of patients were satisfied with the surgical procedure after 12 months. We noted a lower rate (10%) of complications in patients whose blood analysis showed an increase of adiponectin. CONCLUSION Abdominal dermolipectomy is a safe surgical procedure that improves the quality of life of previously obese patients from an aesthetic functional view. A statistically significant increase of adiponectin after the procedure was found. A low level of adiponectin after surgery indicates a higher probability of complications.
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Affiliation(s)
- Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, University of Siena, Siena, Italy
| | - Francesco Russo
- Unit of Plastic and Reconstructive Surgery, University of Siena, Siena, Italy
| | - Andrea Sisti
- Unit of Plastic and Reconstructive Surgery, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic and Reconstructive Surgery, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, University of Siena, Siena, Italy
| | - Cesare Brandi
- Unit of Plastic and Reconstructive Surgery, University of Siena, Siena, Italy
| | - Carlo D'Aniello
- Unit of Plastic and Reconstructive Surgery, University of Siena, Siena, Italy
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Cuomo R, Nisi G, Grimaldi L, Brandi C, Sisti A, D'Aniello C. Immunosuppression and Abdominal Wall Defects: Use of Autologous Dermis. In Vivo 2015; 29:753-755. [PMID: 26546532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The purpose of the present study was to analyze the use of autologous dermis compared to non-biological meshes in repair of abdominal wall defects in patients with redundant skin and immunosuppression. PATIENTS AND METHODS Eighteen patients with abdominal wall defects, immunosuppression and with redundant skin were divided into two groups: Group A consisted of 11 patients treated with autologous dermis. In these patients, autologous dermis was isolated from the amount of skin resected from the inferior abdominal region that was used as a reinforcement of fascial margins above the defect. Group B consisted of seven patients treated with non-biological meshes We evaluated the infection rate of these groups. RESULTS The infection rate was significantly lower in group A patients. CONCLUSION The transplantation of autologous dermis as a reinforcement for the reconstruction of abdominal wall defects is reasonable for highly selected patients. The use of the dermis was proven useful and we found a lower rate of infection and recurrence.
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Affiliation(s)
- Roberto Cuomo
- Plastic Surgery Division, General and Specialist Surgery Department, S. Maria alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, General and Specialist Surgery Department, S. Maria alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Division, General and Specialist Surgery Department, S. Maria alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Cesare Brandi
- Plastic Surgery Division, General and Specialist Surgery Department, S. Maria alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Andrea Sisti
- Plastic Surgery Division, General and Specialist Surgery Department, S. Maria alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Carlo D'Aniello
- Plastic Surgery Division, General and Specialist Surgery Department, S. Maria alle Scotte Polyclinic, University of Siena, Siena, Italy
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