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Zaccaria G, Dotti A, Benanti E, Vigliarolo C, Vaienti L. A treatment algorithm for hyaluronic acid filler related complications of the face. J Plast Reconstr Aesthet Surg 2024; 91:207-217. [PMID: 38422922 DOI: 10.1016/j.bjps.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/28/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Throughout the last decade, a notable increase in HA-filler-related complications have been observed, owing to the increase in demand for filler injections and availability of multiple products. OBJECTIVES The aim is to provide practical advice on the best way to prevent and treat HA-filler-related complications. METHODS Thirty patients who experienced visible and/or symptomatic complications localized within the facial area were treated according to our algorithm. Patients with inflammatory lesions underwent antibiotic and anti-inflammatory therapy, followed by hyaluronidase injections. Patients with abscesses were treated with antibiotics, incision, and drainage. Each patient completed the dermatology-specific quality of life questionnaire (DLQI) at the first and last examinations. RESULTS Among the 29 patients who received antibiotic therapy, 3 healed without further treatment. However, 18 received hyaluronidase injections, 9 underwent incision and drainage, and 5 presented with fistulas and developed retracted scars. Moreover, 80% of the patients were completely healed, 13% significantly improved, and 3% did not show any improvement. The DLQI scores analysis showed a notable impact of patients' diseases on their quality of life, mainly in the terms of personal relationships and symptoms, with minor impacts on intimate relationships, ability to work, and study. We demonstrated that our algorithm resulted in a significant improvement in the overall quality of life at the last follow-up (p < 0.001). CONCLUSIONS The use of filler injections requires caution and specific training because they can lead to serious complications. If these complications are recognized promptly, healing can be optimized. Our treatment algorithm demonstrated high rate of healing and significant improvement in the patients' quality of life.
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Affiliation(s)
- Giovanna Zaccaria
- Plastic and Reconstructive Surgery Department, Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy.
| | - Alessandro Dotti
- Plastic, Reconstructive and Aesthetic Surgery Graduate School, Università degli Studi di Milano, Milan, Italy
| | - Elisa Benanti
- Plastic and Reconstructive Surgery Department, Istituto Clinico Città Studi, Milan, Italy
| | - Camilla Vigliarolo
- Plastic, Reconstructive and Aesthetic Surgery Graduate School, Università degli Studi di Milano, Milan, Italy
| | - Luca Vaienti
- Plastic and Reconstructive Surgery Department, Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy; Head of Plastic and Reconstructive Surgery Department, Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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Carbonaro R, Menean M, Cottone G, Alessandri Bonetti M, Vaienti L, Miserocchi E, Bandello F. Endogenous Endophthalmitis Secondary to Infected Cutaneous Basal Cell Carcinoma: A Case Report. Ocul Immunol Inflamm 2024; 32:355-357. [PMID: 36696367 DOI: 10.1080/09273948.2023.2165951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Endogenous endophthalmitis (EE) is a severe intraocular infection due to hematogenous spread of bacteria from an extraocular site. Recognition of the primary source of hematogenous spread of bacteria is essential to establish an adequate therapy and avoid other major complications. Infected cutaneous tumor has never been reported as a possible source of EE. PURPOSE To describe the first case of EE due to hematogenous spread of methicillin-sensitive Staphylococcus aureus from an infected cutaneous basal cell carcinoma. Systemic antibiotic therapy and surgical excision of the cutaneous lesion were performed. CONCLUSION Severe and long-standing skin infections should be considered as a rare cause of EE.
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Affiliation(s)
- Riccardo Carbonaro
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Matteo Menean
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cottone
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Mario Alessandri Bonetti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Luca Vaienti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Alessandri-Bonetti M, Costantino A, Cottone G, Carbonaro R, Cardone F, Amendola F, De Virgilio A, Robotti E, Persichetti P, Vaienti L. Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta-analysis. Laryngoscope 2023; 133:3237-3246. [PMID: 37017244 DOI: 10.1002/lary.30684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores, with the hypothesis that it is able to clinically improve patient-reported nasal obstructive symptoms in the post-operative follow-up. METHODS An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results. RESULTS A total of 2577 patients (males: 65.1%, 95% CI: 59.9-70.2) with a mean age of 33.3 years (n = 1456, 95% CI: 30.4-36.2) were included in this meta-analysis. The pooled baseline NOSE mean score was 68.1 (n = 2577, 95% CI: 64.3-71.9). The pooled MD in NOSE score at 6-months follow-up compared to baseline was -48.8 (n = 1730, 95% CI: -54.6 to -42.9). CONCLUSIONS Functional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score. LEVEL OF EVIDENCE NA Laryngoscope, 133:3237-3246, 2023.
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Affiliation(s)
- Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Giuseppe Cottone
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Riccardo Carbonaro
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Federica Cardone
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesco Amendola
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Enrico Robotti
- Private Practice, Clinica Sant'Apollonia, Via Giovanni Motta, 37-24123, Bergamo, Italy
| | - Paolo Persichetti
- Department of Reconstructive and Aesthetic Plastic Surgery, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo, 200, Rome, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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Nataloni A, Carbonaro R, Amendola F, Vaienti L, Barbanera A, Cottone G, Bonetti MA, Zingaretti N, Zanotti B. History of Cranial Surgery in World War I: Experience on the Italian Front. J Craniofac Surg 2023; 34:2268-2272. [PMID: 37603889 DOI: 10.1097/scs.0000000000009634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/06/2023] [Indexed: 08/23/2023] Open
Abstract
Since ancient history, men have been attempting to intervene when skull trauma occurs. The majority of traumas were always linked to war injuries, and in the modern era, the culprit was reached during World War I. Cranial traumas in wartime were very common, and consequently, physicians in wartime became particularly interested in the subject of cranial traumatology. In the following text, we want to bring to light the experience of some of the pioneers of cranial surgery in Italy during the First Great War. In fact before the war, very few medical officers had received training in central nervous system surgery. In addition, the surgical instruments for that clinical activity were inadequate and obsolete, but to deal with the medical emergency that had arisen on the front lines, the Italian government established Battlefield Medical Schools. And it is also from the reports and lectures of surgeons working on the front lines that the next generations of neurosurgeons were able to develop this surgical field into the complex and well-established surgical specialty that it is today.
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Affiliation(s)
| | - Riccardo Carbonaro
- Plastic Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi
- Università degli Studi di Milano, Milan
| | - Francesco Amendola
- Plastic Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi
- Università degli Studi di Milano, Milan
| | - Luca Vaienti
- Plastic Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi
- Università degli Studi di Milano, Milan
| | - Andrea Barbanera
- CS Neurosurgery, "SS. Antonio and Biagio and Cesare Arrigo" Hospital, Alessandria
| | - Giuseppe Cottone
- Plastic Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi
- Università degli Studi di Milano, Milan
| | - Mario A Bonetti
- Plastic Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi
- Università degli Studi di Milano, Milan
| | - Nicola Zingaretti
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine
| | - Bruno Zanotti
- Neurosurgery Unit, Neuroscience Department, "C. Poma" Hospital, Mantua, Italy
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Alessandri-Bonetti M, Coscarella G, Amendola F, Vaienti L, Persichetti P, Rubin PJ, Egro FM. The Use of Adipose Tissue-Based Therapies on Facial Atrophic Postacne Vulgaris Scars. Facial Plast Surg Aesthet Med 2023. [PMID: 37751219 DOI: 10.1089/fpsam.2023.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Affiliation(s)
- Mario Alessandri-Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesco Amendola
- Department of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Vaienti
- Department of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Peter J Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Amendola F, Ghiringhelli G, Mela A, Miranda S, Dolfato E, Bulgarelli E, Diomedi M, Bonomi S, Vaienti L, Luzzati A. Efficacy of Flap-based Posterior Trunk Reconstruction after Vertebrectomy and Radiation Therapy: A Retrospective Cohort Study. Plast Reconstr Surg Glob Open 2023; 11:e5242. [PMID: 37691698 PMCID: PMC10489417 DOI: 10.1097/gox.0000000000005242] [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: 04/27/2023] [Accepted: 07/12/2023] [Indexed: 09/12/2023]
Abstract
Background Adjuvant radiation therapy following vertebrectomy is a major risk factor for local wound complications such as dehiscence, infection, and skin necrosis. In selected cases, well-vascularized coverage and modification of tension forces on the wound might reduce the risk of postoperative complications and reoperations. We aimed to demonstrate a reduction in general and specific complications in patients undergoing vertebral resection and flap coverage compared with vertebral resection alone. Methods We retrospectively analyzed and collected data from patients diagnosed with a tumor involving the spine and requiring a total or partial posterior vertebrectomy between January 2012 and October 2022, referred to a single tertiary-level orthopedic and trauma center. We included only patients in whom primary closure of the wound was possible but judged to be under excessive tension. Results A total of 145 patients underwent partial or total vertebrectomy for oncological reasons at our tertiary-level trauma hospital. Among these, 73 patients were eventually included according to the inclusion and exclusion criteria: 53 in the orthopedic group and 20 in the orthoplastic group. Considering only patients undergoing radiation therapy, the orthoplastic group showed significantly lower rates of overall complications (33% versus 69%) than the orthopedic group. Conclusions Primary flap coverage, especially in patients receiving RT, reduces the risk of postoperative complications and avoids a second reconstructive operation, consequently reducing patient discomfort, length of hospital stay, and healthcare costs.
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Affiliation(s)
| | | | | | | | - Elisa Dolfato
- From the Ospedale Galeazzi, Sant'Ambrogio, Milan, Italy
| | | | | | | | - Luca Vaienti
- From the Ospedale Galeazzi, Sant'Ambrogio, Milan, Italy
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Alessandri-Bonetti M, Conforti C, Amendola F, Carbonaro R, Cirami M, Vaienti L. Pustular Psoriasis Triggered by a Subcutaneous Tissue Expander. Dermatol Pract Concept 2023; 13:dpc.1302a99. [PMID: 37196264 DOI: 10.5826/dpc.1302a99] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 05/19/2023] Open
Affiliation(s)
- Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Galeazzi, Milan, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Francesco Amendola
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Galeazzi, Milan, Italy
| | - Riccardo Carbonaro
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Galeazzi, Milan, Italy
| | - Manuela Cirami
- Department of Pathology, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Galeazzi, Milan, Italy
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Amendola F, Cottone G, Alessandri-Bonetti M, Borelli F, Catapano S, Carbonaro R, Riccardi F, Vaienti L. Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review. Indian J Plast Surg 2023; 56:6-12. [PMID: 36998929 PMCID: PMC10049807 DOI: 10.1055/s-0042-1758452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Hidradenitis suppurativa (HS) is a chronic, debilitating, recurrent, auto-inflammatory disease of the pilosebaceous units of the skin. The axillary region is the most affected anatomical site and its reconstructive options include skin grafts, local random plasties, regional axial flaps, and regional perforator flaps. The main aim of this systematic review is to identify the best surgical technique for axillary reconstruction in the context of HS, in terms of efficacy and safety. Methods We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol build-up. The literature search was performed using MEDLINE, Embase, and Cochrane library databases, updated to March 2021. Quality was assessed for each study, through the National Institutes of Health Quality Assessment Tool. Results A total of 23 studies were included in the final analysis. We reviewed a total of 394 axillary reconstructions in 313 patients affected by HS Hurley Stage II or III. Skin grafts were associated with the highest overall complication rate (37%), and highest rate of reconstruction failure (22%). Between thoraco-dorsal artery perforator flap, posterior arm flap, and parascapular flap, the latter showed fewer total complications, recurrences, and failures. Conclusion Regional axial flaps should be considered as the best surgical approach in the management of advanced HS. The parascapular flap emerges as the most effective and safest option for axillary reconstruction. Local random flaps might be considered only for selected minor excisions, due to the higher risk of recurrence. The use of skin grafts for axillary reconstruction is discouraged.
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Affiliation(s)
- Francesco Amendola
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giuseppe Cottone
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesco Borelli
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Simone Catapano
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Riccardo Carbonaro
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesca Riccardi
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
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Amendola F, Barbasse L, Carbonaro R, Alessandri-Bonetti M, Cottone G, Riccio M, De Francesco F, Vaienti L, Serror K. The Acute Achilles Tendon Rupture: An Evidence-Based Approach from the Diagnosis to the Treatment. Medicina (B Aires) 2022; 58:medicina58091195. [PMID: 36143872 PMCID: PMC9500605 DOI: 10.3390/medicina58091195] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objective: Acute Achilles tendon rupture (AATR) is a common injury with a significant impact on daily living. Although various systematic reviews and meta-analyses have been written on the topic, no actual consensus exists on the best treatment. We aimed to collect the highest quality of evidence on the subject and to produce a document to which to refer, from the diagnosis to the final treatment. Material and Methods: Inclusion criteria were systematic reviews discussing Achilles tendon rupture, concerning either diagnostic criteria, classification, or treatment; English language; clearly stated inclusion and exclusion criteria for patients’ selection. Results: Thirteen systematic reviews were included in the study. A strong consensus exists about the higher risk of re-rupture associated with non-operative treatment and a higher risk of complications associated with surgical repair. Conclusions: The combination of minimally invasive repair and accelerated functional rehabilitation seems to offer the best results in the treatment of Achilles tendon rupture.
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Affiliation(s)
- Francesco Amendola
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Léa Barbasse
- Plastic and Reconstructive Department, AP-HP, Hôpital Saint-Louis, 75010 Paris, France
| | - Riccardo Carbonaro
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Mario Alessandri-Bonetti
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Giuseppe Cottone
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Michele Riccio
- Hand Surgery Unit, Department of Plastic and Reconstructive Surgery, Azienda “Ospedali Riuniti”, Via Conca 21, 60126 Ancona, Italy
| | - Francesco De Francesco
- Hand Surgery Unit, Department of Plastic and Reconstructive Surgery, Azienda “Ospedali Riuniti”, Via Conca 21, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-0715963945
| | - Luca Vaienti
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Kevin Serror
- Plastic and Reconstructive Department, AP-HP, Hôpital Saint-Louis, 75010 Paris, France
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Blanch A, Zingarello V, Young K, Rodriguez-Baeza A, Vaienti L, Riccardi F. “Single access upper blepharoplasty and lower lid lateral fat pad removal: a proven technique with low recurrence rate”. J Plast Reconstr Aesthet Surg 2022; 75:4297-4303. [DOI: 10.1016/j.bjps.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 06/24/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
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Alessandri-Bonetti M, Costantino A, Gallo Afflitto G, Carbonaro R, Amendola F, Catapano S, Cottone G, Borelli F, Vaienti L. Anxiety and depression mood disorder in patients with nasal septal deviation: A systematic review and meta-analysis. Am J Otolaryngol 2022; 43:103517. [PMID: 35714499 DOI: 10.1016/j.amjoto.2022.103517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nasal septal deviation (NSD) is one of the most prevalent upper airway diseases causing airway obstruction, and it can negatively impact patients' quality of life (QoL). OBJECTIVE The aim of this study was to determine the risk of anxiety and depression mood disorders in patients with NSD. METHODS A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed on PubMed/MEDLINE, Scopus and Google Scholar. Raw affect size data were pooled comparing standardized between group mean differences. RESULTS A total of 625 patients (males: 53 %, n = 280/525) with a mean age of 32.4 years (n = 375, 95 % CI: 25.3-39.4) were included. The pooled standardized mean differences (SMD) for the prevalence of the anxiety disorder was 1.17 (n = 625, 95 % CI: 0.34-2.0). The pooled SMD for the prevalence of the depression disorder was 0.30 (n = 490, 95 % CI: 0.12-0.48). CONCLUSION Prevalence of anxiety and depression mood disorders is higher in patients with NSD compared to controls. These diseases should be investigated and considered during the diagnostic and therapeutic process to improve the QoL of patients with NSD.
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Affiliation(s)
- Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Riccardo Carbonaro
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Francesco Amendola
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Simone Catapano
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe Cottone
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Francesco Borelli
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
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Cottone G, Amendola F, Strada C, Bagnato MC, Brambilla R, De Francesco F, Vaienti L. Comparison of Efficacy among Three Dermal Substitutes in the Management of Critical Lower-Limb Wounds: The Largest Biases-Reduced Single-Center Retrospective Cohort Study in Literature. Medicina (Kaunas) 2021; 57:medicina57121367. [PMID: 34946312 PMCID: PMC8708540 DOI: 10.3390/medicina57121367] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
Abstract
Background and objectives: The skin recently became the main focus of regenerative medicine and, in this context, skin substitutes are fully entering into the plastic surgeon’s armamentarium. Among the various types of skin substitutes, dermal substitutes (DSs) are the most used. Our study aims to retrospectively compare three renowned and extremely similar DS in the management of critical lower limb wounds in the largest cohort analysis currently present in literature. Materials and Methods: We followed a strict protocol of application and evaluation of the DS for each patient and wound and, after a meticulous bias reduction process, we compared final outcomes in terms of efficacy and speed in achieving the defect coverage. Results: Among patients who did not receive a skin graft after the DS, we registered a wound healed surface of 50% for Pelnac, 52% for Integra, and 19% for Nevelia, after 30 days from the external silicon layer removal; among those who received a skin graft after the DS, we observed a significantly lower mean percentage of graft take after 7 days with Pelnac (53%) compared to Integra and Nevelia (92% and 80%, respectively). The overall percentage of wound healed surface obtained after 30 days from the external silicon sheet removal, either with or without skin graft, was 71% for Pelnac, 63% for Integra and 63% for Nevelia. We also ran a sub-group analysis only including grafted wounds with a negative microbiological test and the mean percentage of graft take was similar this time. Eventually, we assessed the influence of the wound’s “chronicity” on its healing, comparing the mean graft take only in “acute” wounds who received a skin graft and it resulted 63% for Pelnac, 91% for Integra and 75% for Nevelia. Conclusions: Integra demonstrates the highest rate of skin graft viability and the highest rate of skin graft takes after 7 days. Pelnac shows the quickest induction of secondary healing in acute wounds. Nevelia is not different from Integra and shows a superior graft take compared to Pelnac, but features the lowest secondary healing induction rate. No differences exist between the three DSs in terms of wound healing after 30 days from the skin graft or from the removal of the external silicon layer.
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Affiliation(s)
- Giuseppe Cottone
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20126 Milan, Italy; (G.C.); (F.A.); (L.V.)
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Francesco Amendola
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20126 Milan, Italy; (G.C.); (F.A.); (L.V.)
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Carlo Strada
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Maria Chiara Bagnato
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
| | - Roberto Brambilla
- Istituti Clinici Zucchi, Via Bartolomeo Zucchi 24, 20052 Monza, Italy;
| | - Francesco De Francesco
- Hand Surgery Unit, Department of Plastic and Reconstructive Surgery, Azienda “Ospedali Riuniti”, Via Conca 21, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-0715963945
| | - Luca Vaienti
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20126 Milan, Italy; (G.C.); (F.A.); (L.V.)
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (C.S.); (M.C.B.)
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13
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Riccardi F, Catapano S, Cottone G, Zilio D, Vaienti L. Esthetic and Functional Improvement of Asymmetric Lower Limb Overgrowth in a Proteus Syndrome Patient: a Combined Surgical Technique. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AbstractProteus syndrome is a rare, sporadic, congenital syndrome that causes asymmetric and disproportionate overgrowth of limbs, connective tissue nevi, epidermal nevi, alteration of adipose tissue, and vascular malformations. Genetic mosaicism, such as activating mutations involving protein kinase AKT1, phosphoinositide 3 kinase (PI3-K), and phosphatase and tensin homolog (PTEN), may be important causes of Proteus syndrome. However, many patients have no evidence of mutations in these genes. Currently, the diagnosis is clinical and based on phenotypic features. This article reports a case of Proteus syndrome in a 14-year-old female patient who presented with linear epidermal nevi, viscera anomalies, and adipose tissue dysregulation. She showed an asymmetric progressive overgrowth of the right lower limb after birth bringing relevant functional and esthetic consequences. Therefore, she asked a plastic surgery consultation and a surgical treatment with a combined technique was planned. With our approach, we were able to reduce leg diameter and improve joint mobility reliably and safely with satisfying esthetic results.
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14
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Marangi GF, Segreto F, Alessandri-Bonetti M, Coscarella G, Panasiti V, Vaienti L, Persichetti P. Basal cell carcinoma arising within port-wine stain. Int J Dermatol 2021; 61:e269-e270. [PMID: 34628637 DOI: 10.1111/ijd.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni Francesco Marangi
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Francesco Segreto
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, IRCSS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giulia Coscarella
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Vincenzo Panasiti
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, IRCSS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Paolo Persichetti
- Department of Reconstructive and Aesthetic Plastic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy
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15
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Mazzaccaro D, Giannetta M, Malacrida G, Zilio D, Modafferi A, Righini P, Marrocco‐Trischitta MM, Vaienti L, Nano G. Sudden rupture of small aneurysm of the radial artery in a patient with COVID-19 pneumonia. Clin Case Rep 2021; 9:e04285. [PMID: 34194791 PMCID: PMC8222755 DOI: 10.1002/ccr3.4285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/17/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022] Open
Abstract
In patients with COVID-19, even small radial aneurysm may suddenly rupture.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular SurgeryIRCCS Policlinico San DonatoMilanItaly
| | - Matteo Giannetta
- Operative Unit of Vascular SurgeryIRCCS Policlinico San DonatoMilanItaly
| | - Giovanni Malacrida
- Operative Unit of Vascular SurgeryIRCCS Policlinico San DonatoMilanItaly
| | - Dino Zilio
- Operative Unit of Plastic SurgeryIRCCS Policlinico San DonatoMilanItaly
| | - Alfredo Modafferi
- Operative Unit of Vascular SurgeryIRCCS Policlinico San DonatoMilanItaly
| | - Paolo Righini
- Operative Unit of Vascular SurgeryIRCCS Policlinico San DonatoMilanItaly
| | | | - Luca Vaienti
- Operative Unit of Plastic SurgeryIRCCS Policlinico San DonatoMilanItaly
| | - Giovanni Nano
- Operative Unit of Vascular SurgeryIRCCS Policlinico San DonatoMilanItaly
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
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16
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Vaienti S, Nazzaro G, Grancini A, Calzari P, Zaccaria G, Veraldi S, Vaienti L. Lymph Node Involvement in Axillary Hidradenitis Suppurativa: A Clinical, Ultrasonographic and Bacteriological Study Conducted during Radical Surgery. J Clin Med 2021; 10:jcm10071433. [PMID: 33916058 PMCID: PMC8037287 DOI: 10.3390/jcm10071433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/14/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory and chronic-recurrent disease of the hair follicle. Its aetiopathogenesis is not completely known. Although bacterial colonization and superinfection are clinically relevant, lymph node involvement has rarely been studied. OBJECTIVES In this pilot retrospective study, we evaluated the clinical and microbiological nodal involvement in patients with axillary hidradenitis suppurativa. MATERIALS AND METHODS We retrospectively analyzed patients suffering from axillary hidradenitis suppurativa and referred to the Dermatology Unit of the Foundation Ca' Granda Ospedale Maggiore Policlinico in Milan between October 2018 and November 2019. The sampling procedure took place during the surgical excision of lesions at the Operative Unit of Plastic and Reconstructive Surgery of Policlinico San Donato Hospital. Three types of sample were sent to microbiological analysis: exudate swab, axillary lymph node, fistula. RESULT In total, we recruited 10 patients. Two of them underwent bilateral axillary surgery. Nine lymph nodes were analyzed. In one patient, bacterial culture in lymph nodes, skin lesions and fistulae matched. CONCLUSIONS Unequivocable conclusions cannot be drawn due to the low number of patients. Further studies are necessary to confirm the preliminary results of our retrospective pilot study.
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Affiliation(s)
- Silvia Vaienti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; (S.V.); (P.C.); (S.V.)
| | - Gianluca Nazzaro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; (S.V.); (P.C.); (S.V.)
- Dermatology Unit, Foundation IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255035127; Fax: +39-0255034734
| | - Anna Grancini
- Microbiology Laboratory, Foundation IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy;
| | - Paolo Calzari
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; (S.V.); (P.C.); (S.V.)
| | - Giovanna Zaccaria
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy;
| | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS, Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; (S.V.); (P.C.); (S.V.)
| | - Luca Vaienti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San Donato Milanese, 20097 Milan, Italy;
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17
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Marchesi A, Amendola F, Garieri P, Steinberger Z, Vaienti L. Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa: A Study of Quality of Life. Ann Plast Surg 2021; 86:201-205. [PMID: 32881748 DOI: 10.1097/sap.0000000000002482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin pathology characterized by the occurrence of inflamed and swollen lesions, with a devastating impact of the disease on patient's quality of life. Wide local excision (WLE) of the affected tissue is the criterion-standard treatment, but there is no general consensus on the best reconstructive technique. The aim of this article is to evaluate the quality of life before and after WLE combined with pedicled perforator flap reconstruction, in patients suffering from HS. METHODS We analyzed 26 consecutive patients suffering from Hurley stage III HS. Every patient underwent WLE, followed by reconstruction with pedicled perforator flap. Dermatology Quality of Life Index (DLQI) tests were administered to every patient preoperatively and 6 months after surgery, when the clinical condition was considered stable. Dermatology Quality of Life Index scores were compared in terms of means with Student t test. Linear regression studies were used to compare the changes in DLQI score with the surgical and clinical variables. RESULTS Axillary area involvement was found in 21 of 27 patients; 6 patients had more than 1 body region involved. Thirty-two pedicled perforator flaps were performed, and 22 were thoracodorsal artery perforator flaps. Mean DLQI test score before the first operation was 21.31 ± 4.79; the average DLQI score after the last follow-up was 5 ± 2.95 (P < 0.0001). Dermatology Quality of Life Index scores were not influenced by complications including reoperation. There were also no correlations found between DLQI score delta and number of reoperation (-0.18) or days of hospital stay (-0.13). CONCLUSIONS Wide local excision followed by pedicled perforator flap reconstruction allows a radical excision of HS areas with short postoperative healing periods. Dermatology Quality of Life Index scores confirmed high levels of patients' satisfaction. Disadvantages of this technique include difficult learning curve, long operating time, and a nonnegligible complications rate.
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Affiliation(s)
- Andrea Marchesi
- From the Plastic Surgery, Hand Surgery and Reconstructive Microsurgery Department, Ospedale San Gerardo, Monza
| | - Francesco Amendola
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Pietro Garieri
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Luca Vaienti
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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18
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Amendola F, Cottone G, Zaccaria G, Riccardi F, Catapano S, Vaienti L. Severe A-line infections in COVID-19 patients: A novel management algorithm in an emergency setting. J Plast Reconstr Aesthet Surg 2020; 74:1633-1701. [PMID: 33386265 PMCID: PMC7837094 DOI: 10.1016/j.bjps.2020.12.065] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Francesco Amendola
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Italy
| | - Giuseppe Cottone
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Italy.
| | - Giovanna Zaccaria
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena Azienda Ospedaliero-Universitaria di Modena, Via Largo del Pozzo, 71, 41125 Modena, Italy
| | - Francesca Riccardi
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Italy
| | - Simone Catapano
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Italy
| | - Luca Vaienti
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Italy
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19
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Amendola F, Cottone G, Zilio D, Borelli F, Cross KJ, Vaienti L. Levator palpebrae superioris muscle advancement for steinert myotonic dystrophy eyelid ptosis. J Plast Reconstr Aesthet Surg 2020; 74:1355-1401. [PMID: 33358128 DOI: 10.1016/j.bjps.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/30/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Francesco Amendola
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy
| | - Giuseppe Cottone
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy.
| | - Dino Zilio
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy
| | - Francesco Borelli
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy
| | - Kevin J Cross
- Plastic surgeon in private practice in Philadelphia (2200 Arch Street Suite 120, Philadelphia, PA 19103) and affiliated with Penn Presbyterian Medical Center, Philadelphia, PA, United States
| | - Luca Vaienti
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy
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20
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Vaienti L, Cottone G, Zaccaria G, Rampino Cordaro E, Amendola F. One-Step Approach for Infections After Achilles Tendon Open Repair: The Distally Based Peroneus Brevis Muscle Flap. INT J LOW EXTR WOUND 2020; 21:436-442. [PMID: 32844700 DOI: 10.1177/1534734620951540] [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: 11/17/2022]
Abstract
The aim of this single-center, retrospective study is to demonstrate the effectiveness of distally based peroneus brevis muscle flap as first therapeutic option for infections after Achilles tendon open repair. We retrospectively analyzed 14 consecutive patients with complete Achilles tendon rupture and developing surgical site infection after an attempt of open surgical repair. Every patient was reconstructed with distally base peroneus brevis muscle flap. The primary outcome was the return to work and the initiation of full weight-bearing. Secondary outcomes were complication rate and time needed to return to work. A review of the literature was conducted to better define the actual standard treatment. Each patient returned to work. No flap necrosis occurred. Two minor healing delays and one hematoma were reported. Median time to wound healing was 17 days (interquartile range [IQR] = 13-20). Median time to full weight-bearing was 52 days (IQR = 47-55). Median follow-up (FU) was 21 months. Distally based peroneus brevis flap is a safe treatment for surgical site infections after Achilles tendon rupture repair. Patients regained full weight-bearing after a median time of 52 days from the surgical reconstruction. No major complications were observed. This flap clearly emerges as first reconstructive option for complications after surgery of Achilles tendon region.
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Affiliation(s)
- Luca Vaienti
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Giovanna Zaccaria
- Policlinico di Modena Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
| | - Emanuele Rampino Cordaro
- Presidio Ospedaliero Universitario Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, Udine, Friuli-Venezia Giulia, Italy
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21
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De Francesco F, Busato A, Mannucci S, Zingaretti N, Cottone G, Amendola F, De Francesco M, Merigo F, Riccio V, Vaienti L, Parodi PC, Sbarbati A, Riccio M. Artificial dermal substitutes for tissue regeneration: comparison of the clinical outcomes and histological findings of two templates. J Int Med Res 2020; 48:300060520945508. [PMID: 32790486 PMCID: PMC7427157 DOI: 10.1177/0300060520945508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Artificial dermal substitutes (DSs) are fundamental in physiological wound healing to ensure consistent and enduring wound closure and provide a suitable scaffold to repair tissue. We compared the clinical and histological features of two DSs, Pelnac and Integra, in the treatment of traumatic and iatrogenic skin defects. METHODS This prospective observational study involved 71 randomly selected patients from our hospital. Wound healing was analyzed using the Wound Surface Area Assessment, the Vancouver Scar Scale, and a visual analog scale. Histological and immunohistochemical evaluations were also performed. RESULTS At 2 weeks, greater regeneration with respect to proliferation of the epidermis and renewal of the dermis was observed with Pelnac than with Integra. At 4 weeks, the dermis had regenerated with both DSs. Both templates induced renewed collagen and revascularization. Differences in the Vancouver Scar Scale score were statistically significant at 4 weeks and 1 year. Pelnac produced a significant increase in contraction at 2 weeks with increasing effectiveness at 4 weeks. Integra produced a higher percentage reduction in the wound surface area and a shorter healing time than Pelnac for wounds >1.5 cm deep. CONCLUSION Our observational data indicate that both DSs are effective and applicable in different clinical contexts.
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Affiliation(s)
- Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, AOU “Ospedali Riuniti”, Ancona, Italy
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
| | - Alice Busato
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Silvia Mannucci
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Nicola Zingaretti
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), University of Udine, Italy
| | - Giuseppe Cottone
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Francesco Amendola
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | | | - Flavia Merigo
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Valentina Riccio
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, MC, Italy
| | - Luca Vaienti
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Pier Camillo Parodi
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), University of Udine, Italy
| | - Andrea Sbarbati
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
- Department of Neuroscience, Biomedicine and Movement, Human Anatomy and Histology Section, University of Verona, Verona, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AOU “Ospedali Riuniti”, Ancona, Italy
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Montelabbate (PU), Italy
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22
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Zingaretti N, Galvano F, Vittorini P, De Francesco F, Almesberger D, Riccio M, Vaienti L, Parodi PC. Smooth Prosthesis: Our Experience and Current State of Art in the Use of Smooth Sub-muscular Silicone Gel Breast Implants. Aesthetic Plast Surg 2019; 43:1454-1466. [PMID: 31342127 DOI: 10.1007/s00266-019-01464-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this clinical review is to provide an overview of the use of silicone gel-filled breast implants placed in the sub-muscular position, with a focus on complication rates reported for both smooth and textured implants. Furthermore, our experience in this field is also reviewed. METHODS MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central and Google Scholar databases were reviewed to identify the literature related to smooth breast implants. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 98 applicable articles. Of these, just a few articles were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search. RESULTS Eight articles report the risk of capsular contracture when the breast implants were placed in the sub-muscular position. Six of these articles report a similar rate of capsular contracture in smooth and textured implants. Local complications such as wrinkling, late seroma and double capsules were found to be associated with the use of textured breast implants (4 articles). All articles concerning BIA-ALCL reported a total absence occurring in smooth breast implants. All cases have been associated with textured mammary prostheses. CONCLUSION With our expertise in the field and the results of this up-to-date literature review, it can be concluded that there are no significant advantages of using one type of implant surface over the other when placed in the sub-pectoral position. 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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Marchesi A, Amendola F, Bordone F, Sterlicchio M, Ponti V, Marcelli S, Tosi D, Zaccaria G, Vaienti L. Muscle electrical activity after perforator flap surgery: a pilot cohort study. Eur J Plast Surg 2019. [DOI: 10.1007/s00238-019-01581-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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De Biasio F, Zingaretti N, De Lorenzi F, Riccio M, Vaienti L, Parodi PC. Reduction Mammaplasty for Breast Symmetrisation in Implant-Based Reconstructions. Aesthetic Plast Surg 2017; 41:773-781. [PMID: 28374302 DOI: 10.1007/s00266-017-0867-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/03/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Healthy breast surgery constitutes an important step to achieve symmetry in unilateral implant-based reconstructions. We analysed long-term results of breast symmetry obtained with reduction mammaplasties, and we evaluated whether different glandular pedicles may better preserve long-term stability. METHOD Between 2006 and 2012, 90 patients underwent mastectomy and immediate reconstruction with tissue expanders and simultaneous contralateral reduction mammaplasty. In 30 patients, a superior nipple-areola pedicle was harvested (GROUP A), in another 30 patients a medial pedicle was performed (GROUP B), and an inferior pedicle was used in the remaining 30 women (GROUP C). An objective evaluation of the reconstructed breast and the reduced one was performed at 1 and 24 months after surgery. One-way ANOVA and Tukey's HSD tests were used for analysis. Furthermore, three independent plastic surgeons filled out a questionnaire to assess aesthetic results. RESULTS Measurements of the reconstructed breasts showed similar variations between 1- and 24-month evaluations within the three groups with no significant difference (P value >0.05). Measurements of the reduced breast at the 1- and 24-month follow-up (Tukey's test) revealed significant differences among the three groups. Patients from GROUP C showed a significantly higher decrease in Δ nipple-lower clavicle margin distance and Δ nipple-inframammary fold compared to GROUP A and B (P value = 0.01). Surgeons' assessments revealed no statistically significant difference between the three groups. CONCLUSION Superior or medial pedicle reduction mammaplasties seem to better preserve breast shape and position, and they maintain a more similar appearance to the contralateral prosthetic breast over time. LEVEL OF EVIDENCE IV 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)
- Fabrizio De Biasio
- Department of Plastic and Reconstructive Surgery, Breast Unit, University of Udine, C/o Ospedale "S. Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy
| | - Nicola Zingaretti
- Department of Plastic and Reconstructive Surgery, Breast Unit, University of Udine, C/o Ospedale "S. Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, Breast Unit, AOU "Ospedali Riuniti", Ancona, Italy
| | - Luca Vaienti
- Department of Plastic Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Pier Camillo Parodi
- Department of Plastic and Reconstructive Surgery, Breast Unit, University of Udine, C/o Ospedale "S. Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy
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Marchesi A, Marcelli S, Parodi PC, Perrotta RE, Riccio M, Vaienti L. Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature. Aesthetic Plast Surg 2017; 41:352-358. [PMID: 28062962 DOI: 10.1007/s00266-016-0754-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/25/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks. MATERIALS AND METHODS We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set. RESULTS Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients. CONCLUSIONS In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response. 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 Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
| | - Stefano Marcelli
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
| | - Pier C Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Rosario E Perrotta
- Department of Medical and Surgery Specialties, Section of Plastic Surgery, University of Catania, Catania, Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Luca Vaienti
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
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Gazzola R, Piozzi E, Vaienti L, Wilhelm Baruffaldi Preis F. Therapeutic Algorithm for Congenital Ptosis Repair with Levator Resection and Frontalis Suspension: Results and Literature Review. Semin Ophthalmol 2017; 33:454-460. [PMID: 28296517 DOI: 10.1080/08820538.2017.1297840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several treatments have been described for the treatment of congenital ptosis, but there are few studies that analyze the effectiveness of a therapeutic approach rather than a single technique. AIMS In this study, we aim to evaluate the effectiveness of our therapeutic algorithm, which relies on levator muscle resection and frontalis suspension with silicone rods, polytetrafluoroethylene (PTFE), or autologous fascia lata. METHODS We retrospectively analyzed all patients affected by congenital ptosis who underwent corrective surgery at a single department between January 1998 and January 2016. RESULTS A total of 116 procedures were performed in 86 patients, accounting for 35 levator resections, 67 frontalis suspensions, and 14 revisions. A satisfactory result was observed in 65 cases after one procedure (75.6%). Complications occurred in 13 cases after primary surgery (15.1%). Ptosis relapse was observed in 25 cases after primary procedure (21.5%). Frontalis suspension displayed a higher number of complications than levator resection (22.2% vs 3.1%, p=0.02). CONCLUSION Our therapeutic algorithm was effective in 75.6% after one procedure. Frontalis suspension procedures encountered a higher rate of complication than levator resection. Fascia lata should be preferred to silicon rods whenever possible due to the lower recurrence rate. These issues confirm the therapeutic algorithm, although larger prospective studies are necessary to validate our approach.
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Affiliation(s)
- Riccardo Gazzola
- a Plastic Surgery Department, Policlinico di Monza , Monza , Italy
| | - Elena Piozzi
- b Pediatric Ophtalmology Department , Ospedale Niguarda Cà Granda , Milan , Italy
| | - Luca Vaienti
- c Plastic Surgery Department , IRCCS Policlinico San Donato , San Donato Milanese , Italy
| | - Franz Wilhelm Baruffaldi Preis
- d Plastic and Reconstructive Surgery Service , Ospedale San Raffaele , Milan , Italy.,e Plastic and Reconstructive Surgery Department , IRCCS Istituto Ortopedico Galeazzi , Milan , Italy
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De Biasio F, Zingaretti N, Marchesi A, Vaienti L, Almesberger D, Parodi PC. A Simple and Effective Technique of Breast Remodelling After Conserving Surgery for Lower Quadrants Breast Cancer. Aesthetic Plast Surg 2016; 40:887-895. [PMID: 27704197 DOI: 10.1007/s00266-016-0709-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Quadrantectomy is an oncologically safe procedure for the treatment of early-stage breast cancer, but it often results in poor aesthetic outcomes such as breast shape deformity, which is more visible if the tumour is located in the lower pole. We recommend the use of the transverse incision, which retains the oncological advantages of the quadrantectomy while leading to better aesthetical results. METHOD We evaluated the clinical results of 24 patients with breast cancer who underwent quadrantectomy of the lower breast pole and volume replacement with remodelling through three posterior scorings from January 2012 to January 2014, with cosmetic evaluations performed according to the criteria set by the Japanese Breast Cancer Society. RESULTS Minimum follow-up after surgery was 2 years, with an average of 28.4 months. Among treated patients, the percentage of complications was extremely low and the degree of satisfaction fairly good. Moreover, the assessment of the medical team matched patient self-assessments. CONCLUSION Immediate breast reconstruction of a defect performed after a quadrantectomy of the lower breast pole using the "posterior scoring technique" provided better cosmetic results compared to the transposition of residual breast tissue. This technique provides reliable and reproducible results, and it also appears to be rather successful on patients with small-moderate breasts in the absence of a certain degree of ptosis, therefore increasing its already considerable appeal. LEVEL OF EVIDENCE V This journal requires that the 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)
- Fabrizio De Biasio
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy
| | - Nicola Zingaretti
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy.
| | - Andrea Marchesi
- Plastic Surgery Department, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luca Vaienti
- Plastic Surgery Department, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Daria Almesberger
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy
| | - Pier Camillo Parodi
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy
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Calori GM, Mazza EL, Vaienti L, Mazzola S, Colombo A, Gala L, Colombo M. Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects. Injury 2016; 47 Suppl 6:S77-S82. [PMID: 28040091 DOI: 10.1016/s0020-1383(16)30843-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. PATIENTS AND METHODS In this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9-36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. RESULTS In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded. One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. CONCLUSION When proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.
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Affiliation(s)
- Giorgio M Calori
- Reparative Orthopaedic Surgery Department - ASST Pini-CTO, University of Milan, Italy
| | - Emilio Luigi Mazza
- Reparative Orthopaedic Surgery Department - ASST Pini-CTO, University of Milan, Italy
| | - Luca Vaienti
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, University of Milan, Italy
| | - Simone Mazzola
- Reparative Orthopaedic Surgery Department - ASST Pini-CTO, University of Milan, Italy
| | - Alessandra Colombo
- Reparative Orthopaedic Surgery Department - ASST Pini-CTO, University of Milan, Italy
| | - Luca Gala
- Second division - ASST Pini-CTO, University of Milan, Italy
| | - Massimiliano Colombo
- Reparative Orthopaedic Surgery Department - ASST Pini-CTO, University of Milan, Italy.
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Marchesi A, Parodi PC, Brioschi M, Riccio M, Perrotta RE, Colombo M, Calori GM, Vaienti L. Soft-tissue defects of the Achilles tendon region: Management and reconstructive ladder. Review of the literature. Injury 2016; 47 Suppl 4:S147-S153. [PMID: 27492062 DOI: 10.1016/j.injury.2016.07.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Defects of the Achilles tendon region represent a challenge for reconstructive surgeons. Several options are available but there is still no reconstructive ladder for this specific and tricky area. An up-to-date reconstructive ladder according to local and general conditions is proposed based on our multicentre experience and an extensive review of the English literature on PubMed. MATERIALS AND METHODS An extensive review of the English literature was performed on PubMed using the following key-words: "Achilles region", "heel", "soft-tissue reconstruction", "flaps", "grafts" and "dermal substitutes". RESULTS A total of 69 complete papers were selected, covering the last thirty years' literature. Although most of the studies were based on limited case-series, local and general conditions were always reported. A comprehensive reconstructive ladder of all the available reconstructive techniques for the Achilles region has been created based on our personal multicentre experience and the results of the literature review. CONCLUSIONS The reconstructive ladder is a concept that is still a mainstay in plastic surgery and guides decisions in the repair strategy for soft tissue defects. The optimal solution, according to the experience of the surgeon and the wishes of the patient, is the one that implies less sacrifice of the donor site. Perforator flaps should be the first-line option for small-to-moderate defects; the distally-based sural flap is the most reported for moderate-to-large defects of the Achilles region, and free flaps should be reserved mainly for complex and wide reconstructions.
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Affiliation(s)
- A Marchesi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, San Donato Milanese, Via Morandi, 30 - 20097, Milan, Italy.
| | - P C Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - M Brioschi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato. Università degli Studi di Milano, San Donato Milanese, Milan, Italy
| | - M Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - R E Perrotta
- Department of Medical and Surgery Specialties, Section of Plastic Surgery, University of Catania, Catania, Italy
| | - M Colombo
- Orthopaedic Reparative Surgery Department, Orthopaedic Institute Gaetano Pini, University of Milan, Italy
| | - G M Calori
- Orthopaedic Reparative Surgery Department, Orthopaedic Institute Gaetano Pini, University of Milan, Italy
| | - L Vaienti
- Department of Plastic and Reconstructive Surgery. I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, San Donato Milanese, Milan, Italy
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Vaienti L, Vourtsis S, Urzola V. Compartment Syndrome of the Forearm Following an Electromyographic Assessment. ACTA ACUST UNITED AC 2016; 30:656-7. [PMID: 16154672 DOI: 10.1016/j.jhsb.2005.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 07/21/2005] [Indexed: 10/25/2022]
Abstract
We present a case of compartment syndrome after electromyographic study of the upper limbs. The cause was the unintentional punction and laceration of the ulnar artery while the electromyography was being performed.
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Affiliation(s)
- L Vaienti
- U.O. Chirurgia Plastica Istituto Policlinico, San Donato, San Donato Milanese, Italy.
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Iachettini S, Valaperta R, Marchesi A, Perfetti A, Cuomo G, Fossati B, Vaienti L, Costa E, Meola G, Cardani R. Tibialis anterior muscle needle biopsy and sensitive biomolecular methods: a useful tool in myotonic dystrophy type 1. Eur J Histochem 2015; 59:2562. [PMID: 26708183 PMCID: PMC4698615 DOI: 10.4081/ejh.2015.2562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/25/2015] [Accepted: 10/03/2015] [Indexed: 01/30/2023] Open
Abstract
Myotonic dystrophy type 1 (DM1) is a neuromuscular disorder caused by a CTG repeat expansion in 3'UTR of DMPK gene. This mutation causes accumulation of toxic RNA in nuclear foci leading to splicing misregulation of specific genes. In view of future clinical trials with antisense oligonucleotides in DM1 patients, it is important to set up sensitive and minimally-invasive tools to monitor the efficacy of treatments on skeletal muscle. A tibialis anterior (TA) muscle sample of about 60 mg was obtained from 5 DM1 patients and 5 healthy subjects through a needle biopsy. A fragment of about 40 mg was used for histological examination and a fragment of about 20 mg was used for biomolecular analysis. The TA fragments obtained with the minimally-invasive needle biopsy technique is enough to perform all the histopathological and biomolecular evaluations useful to monitor a clinical trial on DM1 patients.
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Abstract
Giant congenital pigmented naevi is a great reconstructive challenge for the pediatric and plastic surgeons. Due to the increased risk of malignant transformation in such lesions, many procedures have been used to remove giant congenital naevi like dermoabrasion, laser treatment or surgical excision combined with reconstruction through skin expansion or skin grafting; among these, only a complete excision can offer an efficacious treatment. In our centre we use the "tissue expansion" technique in order to achieve a sufficient quantity of normal skin to perform a both staged and radical excision of these giant lesions.
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Affiliation(s)
- A Marchesi
- Università degli Studi di Milano, I.R.C.C.S. Policlinico San Donato
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Marchesi M, Marchesi A, Calori GM, Cireni LV, Sileo G, Merzagora I, Zoia R, Vaienti L, Morini O. A sneaky surgical emergency: Acute compartment syndrome. Retrospective analysis of 66 closed claims, medico-legal pitfalls and damages evaluation. Injury 2014; 45 Suppl 6:S16-20. [PMID: 25457313 DOI: 10.1016/j.injury.2014.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute compartment syndrome (ACS) is a clinical condition with potentially dramatic consequences, therefore, it is important to recognise and treat it early. Good management of ACS minimises or avoids the sequelae associated with a late diagnosis, and may also reduce the risk of malpractice claims. The aim of this article was to evaluate different errors ascribed to the surgeon and to identify how the damage was evaluated. MATERIALS AND METHODS A total of 66 completed and closed ACS cases were selected. The following were analysed for each case: clinical management before and after diagnosis of ACS, imputed errors, professional fault, damage evaluation and quantification. Particular attention was paid to distinguishing between impairment because of primary injury and iatrogenic impairment. Statistical analyses were performed using Fisher's exact test and Pearson's correlation. RESULTS The most common presenting symptom was pain. Delay in the diagnosis, and hence delay in decompression, was common in the study. A total of 48 out of 66 cases resolved with the verdict of iatrogenic damage, which varied from 12% to 75% of global capability of the person. A total of $394,780 out of $574,680 (average payment) derived from a medical error. CONCLUSIONS ACS is a clinical emergency that requires continuous clinical surveillance from both medical and nursing staff. The related damage should be evaluated in two parts: damage deriving from the trauma, so that it is considered inevitable and independent from the surgeon's conduct, and damage deriving from a surgeon's error, which is eligible for an indemnity payment.
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Affiliation(s)
- M Marchesi
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy.
| | - A Marchesi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy.
| | - G M Calori
- Orthopaedic Reparative Surgery Department, Orthopaedic Institute Gaetano Pini, University of Milan, Italy.
| | - L V Cireni
- Vascular Surgery Service, Istituto Auxologico Italiano, Italy.
| | - G Sileo
- Dipartimento di Medicina Sperimentale, Università degli Studi di Milano-Bicocca, Italy.
| | - I Merzagora
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy.
| | - R Zoia
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy.
| | - L Vaienti
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy.
| | - O Morini
- Dipartimento di Medicina Sperimentale - Cattedra di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano-Bicocca, Italy.
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Riccio M, Pangrazi PP, Parodi PC, Vaienti L, Marchesini A, Neuendorf AD, Bottegoni C, Tos P, Geuna S. The amnion muscle combined graft (AMCG) conduits: a new alternative in the repair of wide substance loss of peripheral nerves. Microsurgery 2014; 34:616-22. [PMID: 25131514 DOI: 10.1002/micr.22306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/26/2014] [Accepted: 07/28/2014] [Indexed: 12/13/2022]
Abstract
The use of autologous sural nerve grafts is still the current gold standard for the repair of peripheral nerve injuries with wide substance losses, but with a poor rate of functional recovery after repair of mixed and motor nerves, a limited donor nerve supply, and morbidity of donor site. At present, tubulization through the muscle vein combined graft, is a viable alternative to the nerve autografts and certainly is a matter of tissue engineering still open to continuous development, although this technique is currently limited to a critical gap of 3 cm with less favorable results for motor function recovery. In this report, we present a completely new tubulization method, the amnion muscle combined graft (AMCG) technique, that consists in the combination of the human amniotic membrane hollow conduit with autologous skeletal muscle fragments for repairing the substance loss of peripheral nerves and recover both sensory and motor functions. In a series of five patients with loss of substance of the median nerve ranging 3-5 cm at the wrist, excellent results graded as S4 in two cases, S3+ in two cases, and S3 in one case; M4 in four cases and M3 in one case were achieved. No iatrogenic damage due to withdrawal of a healthy nerve from donor site was observed. This technique allows to repair extensive loss of substance up to 5 cm with a good sensory and motor recovery. The AMCG thus may be considered a reasonable alternative to traditional nerve autograft in selected clinical conditions.
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Affiliation(s)
- Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
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Leone F, Benanti E, Marchesi A, Marcelli S, Gazzola R, Vaienti L. Surgical excision of Infantile Haemangiomas: a technical refinement to prevent bleeding complications. Pediatr Med Chir 2014; 36:7. [PMID: 25573642 DOI: 10.4081/pmc.2014.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/13/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of the study is to improve operative speed and precision of haemangiomas excision. METHODS CASE-REPORT haemangioma is a common affection of the 8% of the population during the neonatal period. In complicated cases and involution sequelae surgical treatment is the first choice. The Authors propose a surgical refinement to prevent intraoperative bleeding. METHODS several suture stitches were placed around the hemangioma. The edges of the lesion became more defined, thus allowing accurate excision. RESULTS AND CONCLUSIONS Haemangiomas are characterized by rich blood supply. Surgery is often hindered by massive bleeding and Temporary placement of full-thickness sutures, surrounding the hemangioma, allowed a noticeable improvement in hemostasis precision and greater definition of the margins of the hemangioma.
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Affiliation(s)
- F Leone
- Plastic Surgery Department, Università degli Studi di Milano, IRCCS Policlinico San Donato Milanese, Milano.
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Semprini G, Cattin F, Zanin C, Lazzaro L, Cedolini C, Vaienti L, Parodi PC. About locoregional recurrence risk after lipofilling in breast cancer patients: our experience. MINERVA CHIR 2014; 69:91-96. [PMID: 24847895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Lipofilling is a part of the clinical practice for breast reshaping in patients who underwent surgery for breast cancer. A strong debate in the Literature is open about a higher risk of cancer relapse caused by growth factors produced by adipocyte stem cells after their engraftment in the recipient tissue. Nowadays there is no agreement over the use of autologous fat tissue for the correction of aesthetic defects following breast conservative surgery. METHODS We have considered 151 patients who underwent a breast conservative surgery in the period April 2004-April 2009, followed by one or more lipofilling sessions in the period June 2006-August 2012. A careful pre-operative evaluation of the tumor characteristics has been made, through imaging exams, MRI included. An intraoperative evaluation of the tumor dimensions and its distance from the surgical edges has also been made, followed by a microscopic analysis through a shaving technique. Lipofilling has been offered to all the patients on average 24 months after surgery. RESULTS We have found no cancer relapses after a mean follow up of 45 months (17-76) after lipofilling and of 69 (27-100) months after surgery. CONCLUSIONS Considering oncologic surgery, we can affirm that lipofilling is safe for the risk of cancer relapses, if performed using all the parameters included in our clinical protocol.
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Affiliation(s)
- G Semprini
- Plastic and Reconstructive Surgery Department University of Udine, Udine, Italy -
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Marchesi A, Parodi PC, Brioschi M, Marchesi M, Bruni B, Cangi MG, Vaienti L. Tattoo ink-related cutaneous pseudolymphoma: a rare but significant complication. Case report and review of the literature. Aesthetic Plast Surg 2014; 38:471-8. [PMID: 24570180 DOI: 10.1007/s00266-014-0287-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The demand for decorative tattoos is steadily growing worldwide, and in the US it is estimated that up to 24% of adults has one or more tattoos. Subsequently, the number of tattoo-related complications is increasing. Among these, lymphoproliferative disorders play a minor but important role. The aim of this article is to arouse the awareness of plastic surgeons and dermatologists about this rare but serious complication and to stimulate stricter clinical control of their tattooed patients. METHODS We report a new case of tattoo-related cutaneous pseudolymphoma (CPL) and perform a review of the last 30 years of literature on the topic in PubMed. RESULTS Apart from this new case, only 18 cases of CPL have been reported in PubMed so far. In contrast to the classic knowledge, the T cell was the predominant phenotype in 68% of cases. Red is confirmed to be the most involved ink. Topical and intralesional steroids, laser therapy, and surgery were used for treatment of CPL. CONCLUSIONS Even if CPL is a very rare and benign complication, we should not forget that in rare cases pseudolymphoma may evolve into a true lymphoma. Diagnosis is still difficult and is based on anamnestic, clinical, and histopathological data. From the review of the literature, the T cell predominance suggests a reclassification of tattoo-induced CPL and there is not a gold standard treatment yet. Finally, once a pseudolymphoma is diagnosed, there must be a long follow-up because of the possibility to transform into a malignancy. 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)
- Andrea Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy,
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Marchesi A, Parodi PC, Brioschi M, Sileo G, Marchesi M, Vaienti L. Giant Merkel cell carcinoma of the lower limb: case report and review of the literature. J Cutan Med Surg 2014; 17:351-5. [PMID: 24067857 DOI: 10.2310/7750.2013.12121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine malignancy that usually grows rapidly at the head and neck. Giant forms at the lower limbs are rarely reported and usually affect patients in the eighth decade or older. METHODS We report the case of a 60-year-old man who presented with a giant MCC on his right thigh. We managed this case by applying the 2012 updated guidelines and reviewed all cases of giant MCC of the lower limbs reported in the literature. RESULTS At the 4-month follow-up, the patient showed complete remission. CONCLUSION Giant forms of MCC are still treated as typical cases of MCC, when these patients show a very poor prognosis. In young and adult people, such as our case, wide surgical excisions, sentinel lymph node biopsy in clinically negative node cases, radiotherapy of the regional drain area, and a strict follow-up should be routinely performed to improve patients' survival.
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Marchesi A, Marchesi M, Parodi P, Vaienti L, Brambilla R, Brioschi M. Allogeneic epidermal substitutes in the treatment of chronic diabetic leg and foot ulcers. ACTA ACUST UNITED AC 2014. [DOI: 10.4103/2347-9264.139706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Hyaluronidases, a family of enzymes that are able to degrade hyaluronic acid (HA), are employed in medicine to increase drug diffusion and reverse the effects of HA filler injections. Hyaluronidases are able to dissolve subcutaneous nodules or to correct excessive quantities of injected filler. Knowledge of the use, methods of application, and adverse effects of hyaluronidases is essential for the aesthetic practitioner. Therefore, we performed an extensive review of the available literature from 1928 to 2011 and compared the different enzymes available, recording each author's indications regarding usage and side effects.
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Semprini G, Cattin F, Vaienti L, Brizzolari M, Cedolini C, Parodi P. Oncoplastic surgery and cancer relapses: Cosmetic and oncological results in 489 patients. Breast 2013; 22:946-51. [DOI: 10.1016/j.breast.2013.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/18/2012] [Accepted: 05/05/2013] [Indexed: 12/22/2022] Open
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Marchesi A, Parodi PC, Palitta G, Marchesi M, Vaienti L. A "polypoid" nipple: an unusual case of epidermoid cyst. J Plast Reconstr Aesthet Surg 2013; 67:e27-8. [PMID: 23972391 DOI: 10.1016/j.bjps.2013.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 07/25/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy
| | - Pier Camillo Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Giovanni Palitta
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy
| | - Matteo Marchesi
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Milano, Italy
| | - Luca Vaienti
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy.
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Marchesi A, Leone F, Menicanti C, Parodi PC, Vaienti L. A 'migrant' mass of the forehead: diagnosis and treatment. J Plast Reconstr Aesthet Surg 2013; 66:e310-2. [PMID: 23668953 DOI: 10.1016/j.bjps.2013.03.042] [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: 06/03/2012] [Revised: 11/22/2012] [Accepted: 03/31/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary cutaneous large B-cell lymphoma, leg type, is a rare and aggressive neoplasm as defined by the World Health Organization/European Organisation for Research and Treatment of Cancer classification of cutaneous lymphomas. In some cases this disease may simulate other forms of benign or malignant solid tumours. MATERIAL We present a case of a 74-year-old man showing a quickly 'migrant' mass on his forehead. First skin biopsy, ultrasound and magnetic resonance images were not significant. A deeper biopsy revealed a pathology consistent with a primary cutaneous diffuse large B-cell lymphoma leg type. RESULTS The patient was successfully treated with only local radiotherapy (total dose: 32.4 Gy). At 1-year follow-up there were no recurrences. DISCUSSION To the best of our knowledge, this is the second case of a primary cutaneous diffuse large B-cell lymphoma leg type developed as a quickly 'migrant' lesion. In contrast with the first report, our case developed in a non-leg site. From these two cases, we should bear in mind that aggressive and quickly migrant cutaneous or subcutaneous masses might mask a lymphomatous disease.
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Affiliation(s)
- A Marchesi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
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Vaienti L, Gazzola R, Marchesi A, Leone F, Benanti E, Randelli P. An useful technical trick to reduce the pedicle twisting in propeller flaps: the polar safety stitch (PSS). Eur J Plast Surg 2013. [DOI: 10.1007/s00238-012-0766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vaienti L, Gazzola R, Benanti E, Leone F, Marchesi A, Parodi PC, Riccio M. Failure by congestion of pedicled and free flaps for reconstruction of lower limbs after trauma: the role of negative-pressure wound therapy. J Orthop Traumatol 2013; 14:213-7. [PMID: 23543100 PMCID: PMC3751448 DOI: 10.1007/s10195-013-0236-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 03/09/2013] [Indexed: 02/06/2023] Open
Abstract
Lower limb reconstruction with pedicled or free flaps can be commonly compromised by venous insufficiency. This complication often leads to partial/complete flap necrosis and increases the risk of superinfection. Negative-pressure wound therapy (NPWT) is known to increase local blood flow, decrease edema, promote tissue granulation, and reduce the likelihood of soft tissue infection. This study aims to evaluate the effectiveness of NPWT in the treatment of congested pedicled and free flaps of the lower limb after reconstructions in lower limb traumas. A retrospective analysis was performed on four congested (pedicled and free) flaps on the lower limbs. NPWT was applied in all cases after partial flap debridement. NPWT was able to improve and resolve tissue edema and venous insufficiency, avoid further flap necrosis, and promote granulation. On NPWT removal, a split-thickness skin graft was applied on the wound, achieving complete and uneventful healing. NPWT is a useful instrument in managing flaps affected by venous insufficiency in lower limb reconstruction, although larger studies are necessary to better define the effectiveness and indications of NPWT in this setting.
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Affiliation(s)
- L Vaienti
- Plastic Surgery Department, IRCCS Policlinico San Donato, Università degli Studi di Milano, Piazza Malan, 20097, San Donato Milanese, Milan, Italy.
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Vaienti L, Merle M, Battiston B, Villani F, Gazzola R. Perineural fat grafting in the treatment of painful end-neuromas of the upper limb: a pilot study. J Hand Surg Eur Vol 2013; 38:36-42. [PMID: 22415427 DOI: 10.1177/1753193412441122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the effectiveness and middle-term durability of the results achieved with perineural fat grafting of painful neuromas of the upper limb. We retrospectively analysed eight patients, affected by eight neuromas, treated by neuroma excision and fat grafting around the proximal nerve stump. Clinical parameters, the disabilities of the arm shoulder and hand score, and the visual analogue scale were recorded at 2, 6 and 12 months after surgery. A reduction of 23.2% was observed in the mean disabilities of the arm shoulder and hand scores at 12 months. The spontaneous baseline visual analogue scale score showed a mean improvement of 22% at 12 months, although not this was not statistically significant. Perineural fat grafting is a quick and useful procedure and could represent a useful primary operation in the treatment of pain syndromes of neuropatic origin.
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Affiliation(s)
- L Vaienti
- Plastic Surgery Department Università degli Studi di Milano, IRCCS Policlinico San Donato, Milan, Italy.
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Vaienti L, Di Matteo A, Gazzola R, Pierannunzii L, Palitta G, Marchesi A. First results with the immediate reconstructive strategy for internal hardware exposure in non-united fractures of the distal third of the leg: case series and literature review. J Orthop Surg Res 2012; 7:30. [PMID: 22929129 PMCID: PMC3489621 DOI: 10.1186/1749-799x-7-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 06/01/2012] [Indexed: 11/26/2022] Open
Abstract
Background Fractures of the distal third of the leg are increasingly common and are often handled by open reduction and internal fixation. Exposure and infection of internal hardware could occur, especially after high energy traumas, requiring hardware removal and delayed soft tissue reconstruction. Nevertheless immediate soft tissue reconstruction without internal hardware removal is still possible in selected patients. In this study the effectiveness and the complications of immediate soft tissue reconstruction without internal hardware removal is analyzed. Methods 13 patients, affected by internal hardware exposure in the distal leg, treated with immediate soft tissue reconstruction with pedicled flaps and hardware retention, are retrospectively analyzed, with special regard to flap survival and wound infection. Results Wound infection was observed in 10 cases before surgery and in 5 cases surgical debridement was necessary before reconstruction which was performed in a separate operative session. After reconstruction, wound dehiscence and infection occurred in 5 cases, and in 3 cases removal of internal hardware was necessary in order to achieve the complete healing of dehiscence. In one case the previous flap failed but prompt reconstruction with a sural fasciocutaneous flap was performed without hardware removal and without complications. Pre-operative infection and late reconstructive surgery are predictive for higher rates of post-operative complications (respectively p 0.018 and p 0.028). Conclusion Our approach achieved full recovery in 53.8% of the treated cases after one-step surgery, therefore reducing hospitalization and allowing early mobilization. Controlled trials are needed to confirm the effectiveness of this strategy, although the present case series shows encouraging results.
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Affiliation(s)
- Luca Vaienti
- Plastic Surgery Department, Università degli Studi di Milano, IRCCS Policlinico San Donato, Piazza Malan, 20097 San Donato Milanese, Milan, Italy.
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Villani F, Uribe-Echevarria B, Vaienti L. Distal interphalangeal joint arthrodesis for degenerative osteoarthritis with compression screw: results in 102 digits. J Hand Surg Am 2012; 37:1330-4. [PMID: 22537584 DOI: 10.1016/j.jhsa.2012.02.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 02/29/2012] [Accepted: 02/29/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess objective and subjective outcomes of distal interphalangeal joint arthrodesis with a headless compression screw for degenerative osteoarthritis. METHODS We retrospectively analyzed 102 cases of distal interphalangeal joint arthrodesis performed with headless compression screws on 59 patients. We included only primary cases of degenerative osteoarthritis with a minimum follow-up of 7 months. We identified appropriate bone coaptation and hardware positioning on postoperative radiographs in all digits. The mean follow-up period was 26 months (range, 7-67 mo). RESULTS In 89 of 102 cases, patients were fully satisfied; in 9 cases, they were satisfied. Four complications occurred: 2 cases of prominent hardware, 1 complex regional pain syndrome type 1, and 1 symptomatic bony callus on the fused joint. Secondary surgery was required in each of these 4 cases. No nonunion, malunion, nail dystrophy, pseudarthrosis, or infection occurred. All arthrodeses healed. CONCLUSIONS Distal interphalangeal joint arthrodesis with headless compression screws was shown to be safe and effective in cases of degenerative osteoarthritis, with a low complication rate.
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Affiliation(s)
- Federico Villani
- U. O. Chirurgia Plastica-IRCCS Policlinico San Donato, Piazza E. Malan, 20097 San Donato Milanese, Italy.
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Vaienti L, Zilio D, Di Matteo A, Riccio M, Marchesi A. Central upper lip reconstruction by two vermillion flaps and a rotational skin flap. Dermatology 2012; 224:130-3. [PMID: 22572156 DOI: 10.1159/000338026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 03/13/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lip cancer is the most frequent malignant neoplasm of the oral cavity. Defects larger than one-fourth of total upper lip length require reconstruction by established techniques or multiple procedures. METHODS The patient was a 53-year-old man who presented with a 1.5 cm basal cell carcinoma in the central upper lip. Two opposed vermillion flaps were designed and advanced following radical tumor excision to create a new skin-vermilion border. A rotational skin flap was prepared to maintain the normal aspect of the filter area. RESULTS The patient was evaluated 1 year after the operation. He showed well-healed flaps with excellent aesthetic and functional results of the filter area and Cupid's bow. CONCLUSION Within certain limits (maximum one-third of total upper lip length), double vermillion opposing flaps with a rotational skin flap appear to be a valid method for upper lip reconstruction.
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Affiliation(s)
- Luca Vaienti
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Milano, Italy.
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Marchesi A, Marchesi M, Fasulo FC, Morini O, Vaienti L. Mammaplasties and medicolegal issues: 50 cases of litigation in aesthetic surgery of the breast. Aesthetic Plast Surg 2012; 36:122-7. [PMID: 21725718 DOI: 10.1007/s00266-011-9768-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 06/07/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aesthetic surgery procedures are increasing all over the world, and so are related medicolegal questions and litigation cases. Aesthetic mammaplasties represent a very important part of this field and consequently many cases of error appear. Most of these errors lead to litigation from which plastic surgeons rarely can be exonerated. The aim of this article was to evaluate different errors ascribed to the plastic surgeon, the rate of cases in which professional responsibility has been identified, and the type of guilt imputed. METHODS Each case is based on the evaluation of both documentation used by the judge and the relationships of two specialists involved in the assessment of the presumed error. In every case, problems complained about by the patient and the eventually related error of the surgeon were analyzed. Moreover, the eventual identification of professional responsibility, the quantified damage, and its possible reduction by another corrective operation were considered. RESULTS The cases studied (N=50) were divided into 34 cases of augmentation mammaplasty, 11 cases of reduction mammaplasty, and 5 cases of mastopexy. Most of the problems complained about by patients were in the preoperative and intraoperative phases. In only 10% of the cases was the informed consent contested and an expected reduction of the damage was individuated in less than half of cases. CONCLUSIONS The evaluation of aesthetic damage is a tricky question due to different aspects such as the psychological component or the frequent lack of adequate photographic documentation of the patient before the operation. Moreover, whenever possible reduction of the damage is proposed, the patient's willingness to undergo another operation, with all its related costs and benefits, must be considered.
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Affiliation(s)
- A Marchesi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 20097, San Donato Milanese, MI, Italy.
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