1
|
Kalcev G, Cossu G, Preti A, Littera MT, Frau S, Primavera D, Zaccheddu R, Matza V, Ermellino M, Pintus E, Carta MG. Development and Validation of the Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA). Clin Pract Epidemiol Ment Health 2023; 19:e174501792303281. [PMID: 37916197 PMCID: PMC10351347 DOI: 10.2174/17450179-v19-e230419-2022-50] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 11/03/2023]
Abstract
Objective This paper illustrates the preliminary psychometric properties of the Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA), aimed at measuring adaptive characteristics of hyperactivity and goal pursuit in older adults. Methods The 12-item scale was administered to a sample of 120 subjects (older adults) between February 2022 and June 2022. The reliability of AHGA was measured using Cronbach's alpha, and factor structure was established using parallel analysis (PA) and principal component analysis (PCA). Convergent validity was tested against the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). Results All included subjects have an average age of 74.1±5.1 years. AHGA reliability was good (Cronbach's alpha: 0.713 [95%CI: 0.630 to 0.783]). Factor analysis suggested two main components: goal achievement and hyperactivity, which explained 41% of the variance in the data. The results support the convergent validity of the scale: AHGA measures adaptive characteristics of hyperactivity and goal pursuit, in contrast to BRIAN, which measures pathological characteristics. Conclusion The reported findings represent an innovative approach to hyperthymic features by embracing a broader spectrum concept that conceptualizes the potential transition between pathological and adaptive aspects as a continuum.
Collapse
Affiliation(s)
- Goce Kalcev
- Department of Innovation Sciences and Technologies at the University of Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Stèphanie Frau
- Department of Psychology, University of Cagliari, Cagliari, Italy
| | - Diego Primavera
- Azienda Regionale della Salute (ARES, Sardegna), Medio Campidano, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Elisa Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
2
|
Perra A, Galetti A, Zaccheddu R, Locci A, Piludu F, Preti A, Primavera D, Di Natale L, Nardi AE, Kurotshka PK, Cossu G, Sancassiani F, Stella G, De Lorenzo V, Zreik T, Carta MG. A Recovery-Oriented Program for People with Bipolar Disorder through Virtual Reality-Based Cognitive Remediation: Results of a Feasibility Randomized Clinical Trial. J Clin Med 2023; 12:jcm12062142. [PMID: 36983145 PMCID: PMC10056011 DOI: 10.3390/jcm12062142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021
Collapse
Affiliation(s)
- Alessandra Perra
- International PhD in Innovation Sciences and Technologies, University of Cagliari, 09124 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| | - Alessia Galetti
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Aurora Locci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Piludu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, 10125 Turin, Italy
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | | | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Giusy Stella
- Department of Mental Health and Pathological Addiction, ASL 5, 00034 Rome, Italy
| | | | - Thurayya Zreik
- Mental Health Service User Association, 11072070 Beirut, Lebanon
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| |
Collapse
|
3
|
Perra A, De Lorenzo V, Zaccheddu R, Locci A, Piludu F, Preti A, Di Natale L, Galetti A, Nardi AE, Cossu G, Sancassiani F, Barbato S, Cesaretti O, Kurotshka PK, Carta MG. Cognitive Remediation Virtual Reality Tool a Recovery-Oriented Project for People with Bipolar Disorder: Protocol of a Feasibility Randomized Clinical Trial. Clin Pract Epidemiol Ment Health 2022; 18:e174501792208220. [PMID: 37274852 PMCID: PMC10158082 DOI: 10.2174/17450179-v18-e2208220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/27/2022] [Accepted: 07/15/2022] [Indexed: 06/07/2023]
Abstract
Introduction Cognitive deficits are considered a fundamental component of bipolar disorder due to the fact that they negatively impact personal/social functioning. Cognitive remediation interventions are effective in the treatment of various psychosocial disorders, including bipolar disorder. The use of Virtual reality as a rehabilitation tool has produced scientific evidence in recent years, especially in cardiovascular, neurological, and musculoskeletal rehabilitation. This study aims at evaluating the feasibility of a Cognitive Remediation Virtual Reality Program (CEREBRUM) for people with bipolar disorder in psychiatric rehabilitation. Material and Methods Feasibility randomized controlled cross-over clinical study; we randomized 50 people from the Consultation and Psychosomatic Psychiatry Center of the University Hospital of Cagliari (San Giovanni di Dio Civil Hospital) with a diagnosis of bipolar disorder. We propose a cognitive remediation program in virtual reality (CEREBRUM), 3 months with 2 weekly sessions, for the experimental group and a usual care program for the control group (psychiatric visit and/or psychotherapy). Results The results of the trial will be published in international peer-reviewed journals and will be disseminated at international meetings and congress. Discussion This RCT aims, with regards to its feasibility and design, to provide information about a confirmatory trial that evaluates the effectiveness of a Virtual Reality Cognitive Remediation program in psychiatric rehabilitation for the treatment of cognitive dysfunction in people with bipolar disorder. Conclusion The results that we analyzed at the end of the RCT will have an impact on psychiatric rehabilitation research with a focus on improving the application of technologies for mental health.Trial registration: ClinicalTrialsgov NCT05070065, registered on September 2021.
Collapse
Affiliation(s)
- Alessandra Perra
- International Ph.D. in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Aurora Locci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Piludu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Alessia Galetti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Peter Konstantin Kurotshka
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Department of General Practice, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
4
|
Velluzzi F, Cossu G, Fosci M, Montisci R, Zaccheddu R, Minerba L, Musu M, Pintus E, Fortin D, Romano F, Aviles Gonzalez CI, Melis P, Deledda A, Loviselli A, Carta MG. Effect of a Low-Moderate Exercise Program on Dysmetabolism in Older Adults: Results of a Randomized Controlled Trial. Nutrients 2022; 14:nu14163337. [PMID: 36014843 PMCID: PMC9413492 DOI: 10.3390/nu14163337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/11/2022] Open
Abstract
Physical exercise has been shown to improve dysmetabolism in older adults, reducing cardiovascular risk, while its role in preventing dysmetabolism is less known. Moreover, most of the trials use exercise programs that are difficult to put into daily practice. The purpose of this Randomized Controlled Trial (RCT) was to evaluate the effectiveness of a 3-month moderate exercise program in improving or preventing dysmetabolism in 120 older adults, randomly selected for the exercise program (experimental group) or cultural activities (control group). None of the subjects were following a hypocaloric diet, and all of them reported healthy eating habits. Anthropometric (Body Mass Index (BMI) and Waist Circumference (WC)) and metabolic variables (fasting plasma glucose (FPG), High-Density Lipoprotein Cholesterol (HDL-C), and triglycerides (TG)) were assessed at baseline (T0) and at the end of the trial (T1). Dysmetabolism was defined by the presence of an increased WC plus at least two metabolic alterations. At T0, the two groups did not differ by sex, age, education, BMI, WC, FPG, HDL-C levels, and prevalence of dysmetabolism. The mean BMI value indicated overweight, and WC values were higher than the cut-off. At T1, a slight reduction in the number of people with dysmetabolism was found only in the experimental group. However, none of the individuals without dysmetabolism at T0 in the experimental group developed it at T1, while 11.4% developed it in the control group (p = 0.032). This study highlights that a moderate exercise program, accessible in daily practice, can prevent dysmetabolism in older adults, even while being overweight, while if dysmetabolism is already present, more prolonged combined nutritional and exercise interventions will be needed.
Collapse
Affiliation(s)
- Fernanda Velluzzi
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Michele Fosci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Mario Musu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Elisa Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Dario Fortin
- Department of Psychology and Cognitive Science, University of Trento, 38123 Trento, Italy
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Unitelma Sapienza University, 00185 Rome, Italy
| | - Cesar Ivan Aviles Gonzalez
- Departamento de Facultad de Ciencias de la Salud, Universidad Popular del Cesar, Valledupar 200002, Colombia
| | - Paola Melis
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Andrea Deledda
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Andrea Loviselli
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| |
Collapse
|
5
|
Carta MG, Cossu G, Pintus E, Zaccheddu R, Callia O, Conti G, Pintus M, Aviles Gonzalez CI, Massidda MV, Mura G, Sardu C, Contu P, Minerba L, Demontis R, Pau M, Finco G, Cocco E, Penna MP, Orr G, Kalcev G, Cabras F, Lorrai S, Loviselli A, Velluzzi F, Monticone M, Cacace E, Musu M, Rongioletti F, Cauli A, Ruggiero V, Scano A, Crisafulli A, Cosentino S, Atzori L, Massa E, Mela Q, Fortin D, Migliaccio G, Machado S, Romano F, Preti A. Moderate Exercise Improves Cognitive Function in Healthy Elderly People: Results of a Randomized Controlled Trial. Clin Pract Epidemiol Ment Health 2021; 17:75-80. [PMID: 34733346 PMCID: PMC8493830 DOI: 10.2174/1745017902117010075] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 01/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023]
Abstract
Background Physical activity in the elderly is recommended by international guidelines to protect against cognitive decline and functional impairment. Objective This Randomized Controlled Trial (RCT) was set up to verify whether medium-intensity physical activity in elderly people living in the community is effective in improving cognitive performance. Design RCT with parallel and balanced large groups. Setting Academic university hospital and Olympic gyms. Subjects People aged 65 years old and older of both genders living at home holding a medical certificate for suitability in non-competitive physical activity. Methods Participants were randomized to a 12-week, 3 sessions per week moderate physical activity program or to a control condition focused on cultural and recreational activities in groups of the same size and timing as the active intervention group. The active phase integrated a mixture of aerobic and anaerobic exercises, including drills of "life movements", strength and balance. The primary outcome was: any change in Addenbrooke's Cognitive Examination Revised (ACE-R) and its subscales. Results At the end of the trial, 52 people completed the active intervention, and 53 people completed the control condition. People in the active intervention improved on the ACE-R (ANOVA: F(1;102)=4.32, p=0.040), and also showed better performances on the memory (F(1;102)=5.40 p=0.022) and visual-space skills subscales of the ACE-R (F(1;102)=4.09 p=0.046). Conclusion A moderate-intensity exercise administered for a relatively short period of 12 weeks is capable of improving cognitive performance in a sample of elderly people who live independently in their homes.Clinical Trials Registration No: NCT03858114.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Elisa Pintus
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Rosanna Zaccheddu
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Omar Callia
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Giuliana Conti
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Mirra Pintus
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | | | - Maria Valeria Massidda
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy.,Department of Medical Sciences and Publcic Health, University of Cagliari, Cagliari, Italy.,Dipartimento di Ingegneria Meccanica, Università degli studi di Cagliari, Chimica e Dei Materiali, Cagliari, Italy.,Department of Education, University of Cagliari, Psychology and Philosophy, Cagliari, Italy.,Department of Psychology and Cognitive Science, University of Trento, Trento, Italy.,Comitato Olimpico Nazionale Italiano, Sezione Sardegna, Rome, Italy.,Departament of Sports Methods and Techniques, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.,Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados-RJ, Brazil.,Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy.,Dipartimento di Neuroscienze, Università degli studi di Torino, Turin, Italy
| | - Gioia Mura
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Claudia Sardu
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Paolo Contu
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Publcic Health, University of Cagliari, Cagliari, Italy
| | - Roberto Demontis
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Dipartimento di Ingegneria Meccanica, Università degli studi di Cagliari, Chimica e Dei Materiali, Cagliari, Italy
| | - Gabriele Finco
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | | | - Germano Orr
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Goce Kalcev
- Comitato Olimpico Nazionale Italiano, Sezione Sardegna, Rome, Italy
| | - Federico Cabras
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Stefano Lorrai
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Andrea Loviselli
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Fernanda Velluzzi
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Marco Monticone
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Enrico Cacace
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Mario Musu
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Alberto Cauli
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Valeria Ruggiero
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Alessandra Scano
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Sofia Cosentino
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Laura Atzori
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Elena Massa
- Dipartimento di Sanità Pubblica, Università degli studi di Cagliari, Cagliari, Italy
| | - Quirico Mela
- Department of Medical Sciences and Publcic Health, University of Cagliari, Cagliari, Italy
| | - Dario Fortin
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | | | - Sergio Machado
- Departament of Sports Methods and Techniques, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.,Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados-RJ, Brazil
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy
| | - Antonio Preti
- Dipartimento di Neuroscienze, Università degli studi di Torino, Turin, Italy
| |
Collapse
|
6
|
Araco A, Zaccheddu R, Araco F, Gravante G. Methicillin-resistant superinfection of the wound after body-contouring abdominal surgery. Aesthetic Plast Surg 2008; 32:681-3. [PMID: 18491177 DOI: 10.1007/s00266-008-9177-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 08/03/2007] [Accepted: 09/11/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND This report presents the case of a patient who underwent abdominal body-contouring surgery, then later experienced a severe deep infection and a methicillin-resistant (MRSA) superinfection. CASE REPORT A 56-year-old female ex-smoker presented, after massive weight loss, with skin excesses on the abdomen and flanks. She underwent an abdominoplasty with muscle plication and flank liposuction. On postoperative day 14, the woman presented with a deep wound infection, then 1 week later with MRSA superinfection. Since then, two surgical debridements and specific intravenous antibiotics have been necessary for a cure and to avoid septicemic complications. Complete wound closure was achieved only after 3 months of therapy, but a massive retractile and painful scar remained. CONCLUSION Concomitant risk factors for wound infections (obesity, smoking, flap undermining) determined a rare but potentially fatal wound complication after body-contouring abdominoplasty. This complication was presented to alert plastic and general surgeons to such postoperative infections and to the possibility of a nonconservative approach.
Collapse
Affiliation(s)
- A Araco
- Dolan Park Hospital, Bromsgrove, United Kingdom
| | | | | | | |
Collapse
|
7
|
Gherardini G, Thomas R, Basoccu G, Zaccheddu R, Fortunato L, Cortino P, Evans GR, Matarasso A, D'Aiuto M, D'Aiuto G. Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy. Int Surg 2001; 86:246-51. [PMID: 12056470] [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: 02/25/2023] Open
Abstract
Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap after skin-sparing mastectomy is becoming an increasingly performed procedure in patients with ductal carcinoma in situ, early invasive breast cancer, and prophylactic mastectomy. Through a periareolar approach, it is possible to remove the breast parenchyma along with the nipple areola complex, preserving almost all the original skin envelope and the inframmamary fold. The TRAM flap is used to recreate the volume and shape of the original breast. This technique has higher quality and easier reconstruction. The major disadvantages, extensive scar and donor site skin color mismatch, are reduced to a minimum level because the former is limited at the natural border of the nipple areola and the latter can be effectively concealed with proper nipple reconstruction. Thirty-one patients with a mean age of 39 years (range, 26-50 years) who had undergone unilateral or bilateral mastectomy for early breast cancer and immediate breast reconstruction with the pedicled TRAM flap were retrospectively reviewed. Requirements for the skin-sparing mastectomy technique include suitability of donor site tissue for autologous tissue, early breast cancer or ductal carcinoma in situ, and adequate size and shape matching of the contralateral breast. There was no observed local recur- rence during the follow-up period (mean, 20 months; range, 11-30 months). Complications at the recipient site include mastectomy skin flap partial necrosis in 2 patients and cellulitis of the transferred flap in 1 patient. No total or partial flap necrosis was observed. One patient developed abdominal bulging 1 month after the operation, during the administration of chemotherapy. All reconstruction was considered very satisfactory from an aesthetic perspective by the surgeon and the patient. The nicer aesthetic result with oncological safety is achieved with immediate breast reconstruction with the TRAM flap after skin-sparing mastectomy. The risk of local recurrence is not higher compared with more radical surgical techniques.
Collapse
Affiliation(s)
- G Gherardini
- Department of Surgery, National Cancer Center, Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|