Publications by authors named "Alessandro Innocenti"

129 Publications

Oromandibular reconstruction with double-skin paddle fibular free flap: A systematic review and meta-analysis.

Microsurgery 2021 Jul 6. Epub 2021 Jul 6.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

Background: Reconstruction of complex head and neck defects is challenging, especially when more than one soft-tissue subunit is involved. The osteocutaneous fibular flap underwent continual evolution to improve its soft-tissue characteristics, such as including a second skin island. The purpose of this study was to evaluate outcomes regarding oromandibular reconstruction with a double-skin paddle fibular free flap (DSPFFF) using three different techniques: central de-epithelialized skin paddle, distally-based double-skin paddle (DSP), or proximally and distally-based DSP.

Methods: A systematic review was performed in December 2020 using Pubmed and MedLine Ovid databases according to the PRISMA guidelines. A meta-analysis of functional outcome and complications was performed to estimate single incidence rates.

Results: A total of 449 patients were included, with a follow-up of 1-84 months, where 330 patients underwent reconstruction with the first technique, 23 patients with the second technique, and 96 patients with the third technique. The meta-analysis showed an overall good functional outcome and a low-complication rate for oromandibular reconstruction with DSPFFF. A better functional outcome and a lower complication rate were found when a distally-based DSPFFF was harvested compared to a proximally and distally-based DSPFFF.

Conclusion: The DSPFFF was found to be useful and reliable for reconstructing composite and extensive head and neck defects, with an overall good functional outcome and a low-complication rate. The meta-analysis showed a better positive outcome on distally-based DSPFFF rather than proximally and distally-based DSPFFF. In addition, distally-based DSPFFF showed a lower complications rate when compared with proximally and distally-based DSPFFF.
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http://dx.doi.org/10.1002/micr.30786DOI Listing
July 2021

Immediate-implant-based-breast-reconstruction with two-stage expander-implant reconstruction versus one-stage-reconstruction with acellular dermal matrix: analysis of patients' satisfaction.

Acta Biomed 2021 07 1;92(3):e2021228. Epub 2021 Jul 1.

Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence.

Background The aim of this retrospective study is to evaluate the patient-reported outcome after immediate ADM-assisted implant- based breast reconstruction. Material and Methods Patients underwent breast reconstruction from 2015 to 2019 have been retrospectively divided into group A (partial subpectoral implant and ADM and group B (expander/implant). For each patient we evaluated retrospectively postoperative complications and patients' satisfaction. Results 26 patients from the case group and 40 from the control group completed the BREAST-Q. The incidence of complications in the cases was 18.4%, while in the control group was 20.4%.  We found no statistical difference in most of the domains and in the mean score of the questionnaire (mean score cases=69.0±14.4 vs controls=68.4±15.7; p=0.888). A significant difference results only in the domains Q2a and Q2b, sensation of rippling. Conclusions. The use of ADM in one-stage reconstruction allows to perform breast reconstruction in only one surgery, with similar complication rates and patient satisfaction.
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http://dx.doi.org/10.23750/abm.v92i3.9916DOI Listing
July 2021

Rhino-oropharingeal osteoradionecrotic soft-tissue and bony defect reconstruction with submental artery island flap: a case report.

Br J Neurosurg 2021 Jun 29:1-3. Epub 2021 Jun 29.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

Background: The submental artery island flap is widely used in head and neck reconstruction, since it is easy and quick to harvest, and it can be successfully used for the coverage of perioral, intraoral and facial defects. We used this technique for the reconstruction of a complex soft-tissue and bony defect of rhino-oropharinx.

Case Report: Osteoradionecrosis of rhino-oropharingeal posterior wall with C2 necrotic body exposure occurred in a 77-year-old woman. After the failure of reconstruction with a Hadad-Bassagasteguy flap, a submental island flap with cervical spine stabilization was planned to be performed in a one-stage operation. The anterior arc of C1 and odontoid process of C2 were removed and, according to the defect size, a submental island flap was designed in an elliptical fashion. The flap was rotated 180° and tunnelized under the left parapharingeal-prevertebral space, then it was positioned in the rhino-oropharinx and fixed with reabsorbable sutures. The donor site was closed primarily. No peri- or post-operative complications occurred, neither in the recipient nor in the donor-site. At the latest follow-up, 15 months postoperatively, the patient was able to speak without any impairment and started swallowing rehabilitation with good results and an aesthetically satisfactory outcome.

Conclusion: The submental island flap may be a reliable and versatile flap for reconstruction of head and neck defects, even though in the rhino-oropharingeal posterior wall.
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http://dx.doi.org/10.1080/02688697.2021.1941758DOI Listing
June 2021

Gynecomastia and Chest Masculinization: An Updated Comprehensive Reconstructive Algorithm.

Aesthetic Plast Surg 2021 May 3. Epub 2021 May 3.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

Background: Gynecomastia is a common finding in males. Clinical aspect varies widely in world populations showing peculiar hallmarks according to different body shapes reflecting personal expectations; therefore, a surgical plan must be tailored on individual basis to all type of patients.

Materials And Method: A total of 522 patients, treated for bilateral gynecomastia from January 2007 to January 2019, were included and reviewed in this retrospective study. Considering physical status BMI, muscular trophism, hypertrophy of the mammary region, nipple-areola disorder, gland and skin cover consistency, a four-tier classification system has been used to classify the deformity and to assess a surgical plan. In all cases, a subcutaneous mastectomy was performed under direct vision.

Results: No recurrence of the deformity was observed as well as major complications such as necrosis, and high level of satisfaction was observed in all groups. No breast cancer was found at the histological examinations Operative time ranged from 25 minutes up to 120 minutes and hospitalization time ranged from 1 to 3 days.

Conclusion: Since the physical status is strictly related to the clinical features of the disorder, a comprehensive classification system and a reconstructive algorithm are proposed.

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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http://dx.doi.org/10.1007/s00266-021-02275-7DOI Listing
May 2021

A Safer Way to Harvest a Superthin Perforator Flap.

Plast Reconstr Surg 2021 03;147(3):466-469

From the Department of Plastic and Reconstructive Microsurgery, Careggi Universital Hospital.

Summary: The updated knowledge of perforasome anatomy and the evolution of microsurgical techniques have enabled surgeons to safely harvest a thin flap. Recently, the anterolateral thigh perforator flap, the current workhorse in soft-tissue reconstruction, has started to be designed and harvested on the superficial fascia, which divides the deep from the superficial fat. This allows elevation of a very thin flap tailored to the defect. Faithful to the ultrathin concept, in an attempt to make flap dissection simpler and safer, the authors describe a revisited harvesting technique of superthin anterolateral thigh perforator flap. This study presents the outlined technique performed in 16 patients with complex soft-tissue defects after trauma or tumor ablation. All of them underwent primary reconstruction using superthin anterolateral thigh perforator free flaps by superficial fascia elevation harvested according to the described surgical procedure. Complications and functional outcomes were assessed. The authors' series of anterolateral thigh perforator superthin flaps demonstrated an overall 100 percent survival rate. Of 16 anterolateral thigh perforators, 12 (75 percent) had no complications and four (25 percent) had minor complications. No major complications such as total flap loss requiring additional salvage surgery were reported. In no case was secondary debulking performed. The superthin anterolateral thigh perforator flap harvested with the described approach was used successfully in microsurgical reconstruction, providing an excellent outer skin cover tailored to the defect. The dissection procedure was safe, quick, simple, and free of major complications. With minimal donor- and recipient-site morbidity, it provided great aesthetic results, avoiding secondary operations.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000007676DOI Listing
March 2021

Chemotherapy-induced myasthenic crisis in thymoma treated with primary chemotherapy with curative intent on mechanical ventilation: a case report and review of the literature.

J Med Case Rep 2021 Feb 2;15(1):32. Epub 2021 Feb 2.

Niguarda Cancer Center, Struttura Complessa Oncologia Falck, Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Background: Thymoma is an uncommon cancer often associated with myasthenia gravis, an autoimmune disorder of the neuromuscular junction characterized by muscular fatigability. In patients with advanced nonmetastatic thymoma, primary chemotherapy may be required to induce tumor shrinkage and to achieve radical resection. Cancer chemotherapy has been anecdotally reported as a trigger factor for worsening of myasthenia gravis in thymic epithelial cancers. The study of uncommon cases of chemotherapy-related myasthenic crisis is warranted to gain knowledge of clinical situations requiring intensive care support in the case of life-threatening respiratory failure.

Case Presentation: We report a case of an 18-year-old Caucasian woman with advanced Masaoka-Koga stage III type B2 thymoma and myasthenia gravis on treatment with pyridostigmine, steroids and intravenous immunoglobulins, who developed a myasthenic crisis 2 hours after initiation of cyclophosphamide/doxorubicin/cisplatin primary chemotherapy. Because of severe acute respiratory failure, emergency tracheal intubation, mechanical ventilation, and temporary (2 hours) discontinuation of chemotherapy were needed. Considering the curative intent of the multimodal therapeutic program, we elected to resume primary chemotherapy administration while the patient remained on mechanical ventilation. After 24 hours, the recovery of adequate respiratory function allowed successful weaning from respiratory support, and no further adverse events occurred. After 3 weeks, upon plasma exchange initiation with amelioration of myasthenic symptoms, a second course of chemotherapy was given, and in week 6, having documented partial tumor remission, the patient underwent radical surgery (R0) and then consolidation radiation therapy with 50.4 Gy in 28 fractions in weeks 15-20.

Conclusions: This case report, together with the only four available in a review of the literature, highlights that chemotherapy may carry the risk of myasthenic crisis in patients affected by thymoma and myasthenia gravis. To our knowledge, this is the first reported case of chemotherapy continuation on mechanical ventilation in a patient with chemotherapy-induced myasthenic crisis requiring tracheal intubation. The lesson learned from the present case is that, in selected cases of advanced thymoma, the paradoxical worsening of myasthenia gravis during chemotherapy should not be considered an absolute contraindication for the continuation of primary chemotherapy with curative intent.
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http://dx.doi.org/10.1186/s13256-020-02601-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852190PMC
February 2021

Release of pseudosyndactyly in recessive dystrophic epidermolysis bullosa using a dermal regeneration template glove: the Foggia experience.

Orphanet J Rare Dis 2021 01 28;16(1):52. Epub 2021 Jan 28.

Department of Plastic and Reconstructive Surgery, Ospedali Riuniti University of Foggia, Viale Pinto1, 71100, Foggia, Italy.

Background: Epidermolysis bullosa (EB) comprises a heterogeneous group of rare genetic diseases associated with skin blistering caused by minimal trauma. A major and common EB subtype, recessive dystrophic EB (RDEB), is characterized by altered wound healing, inflammatory dysbalance and fibrotic changes associated with reduced to absent collagen VII. Because of its exposed position and its continued use in daily activities, the hand is constantly at risk of microtrauma and is therefore one of the organs most affected by the disease with highly disabling deformities that represent a challenging field in hand surgery practice.

Methods: The authors present their experience in the microsurgical treatment of pseudosyndactylies comparing the classic dressing with vaseline gauze with an innovative "glove protocol" using Integra dermal regeneration template. The endpoints analyzed were: healing times, hospital stay time, discomfort for the patient, free-recurrence interval, follow-up range and major complications.

Results: A total of 34 procedures were performed on 24 RDEB patients with hand deformities. Compared with the dressing with vaseline gauze, microsurgery followed by application of dermal regeneration template gloves allowed a significant reduction of hospital stay, healing time, and dressing pain as well as an increased recurrence-free interval.

Conclusions: The microsurgical approach followed by our new protocol described in the study has been beneficial in providing consistent and successful long-term results for these patients.
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http://dx.doi.org/10.1186/s13023-021-01697-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845051PMC
January 2021

Case Report: Postacute Rehabilitation of Guillain-Barré Syndrome and Cerebral Vasculitis-Like Pattern Accompanied by SARS-CoV-2 Infection.

Front Neurol 2020 7;11:602554. Epub 2021 Jan 7.

Department of Rehabilitation Medicine and Neurorehabilitation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

The main clinical manifestation of the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is respiratory issues. Neurological manifestations are being increasingly recognized, including febrile seizures, headache, dizziness, and myalgia, as well as encephalopathy, encephalitis, stroke, and acute peripheral nerve diseases. Cerebral vasculitis is rarely reported. We describe a case of SARS-CoV-2 interstitial pneumonia complicated by flaccid tetraplegia due to Guillain-Barré Syndrome (GBS) associated with a cerebral vasculitis-like pattern. A 62-year-old man was hospitalized for cough, fever, and severe respiratory failure requiring tracheal intubation and invasive ventilation. The chest Computerized Tomography (CT) showed images related to interstitial pneumonia and the subsequent nasopharyngeal swab confirmed the presence of SARS-CoV-2 infection. During the hospitalization, there was a progressive deterioration of the senses associated with areflexic flaccid tetraplegia. The treatment with high doses of immunoglobulin G (IgG) led to the immediate improvement of the general conditions and a partial response in terms of recovery of the upper limb and of the distal lower limb movements. Subsequently the patient was admitted to our Rehabilitation Unit, where he received an intensive rehabilitation treatment consisting of physiotherapy and occupational therapy. Two months later the patient was discharged at home and able to walk independently even for long distances thanks to the use of Ankle-Foot Orthosis (AFO). In this report, we present the case of a patient with peripheral and central neurological damage occurred later severe pneumonia induced by SARS-CoV-2. The Immunoglobulin G therapy allowed the patient to benefit considerably from early rehabilitation, reaching the walking, increasing the independence in daily living tasks, and enabling safe discharge from hospital to home. Related neurologic complications of SARS-CoV-2 infection suffer a lack of understanding and further investigations should be conducted.
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http://dx.doi.org/10.3389/fneur.2020.602554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817886PMC
January 2021

Endoscopic Axillary Approach Improves Patient Satisfaction of Gynecomastia Subcutaneous Mastectomy: A Cross-Sectional Study using the BODY-Q Chest Module.

Aesthetic Plast Surg 2021 Jan 15. Epub 2021 Jan 15.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-02086-2DOI Listing
January 2021

The Vacuum-Assisted Breast Biopsy System is an Effective Strategy for the Treatment of Gynecomastia.

Aesthetic Plast Surg 2021 Jan 5. Epub 2021 Jan 5.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-02053-xDOI Listing
January 2021

Circumlateral Vertical Augmentation Mastopexy for the Correction of Ptosis and Hypoplasia of the Lower Medial Quadrant in Tuberous Breast Deformity.

Aesthetic Plast Surg 2021 Jan 5. Epub 2021 Jan 5.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-02055-9DOI Listing
January 2021

"Bifidus Pedicle", the Use of Bilobed Superomedial Pedicle for Breast Reshaping Following Upper Outer Quadrantectomy: A New Oncoplastic Breast Surgery Technique.

Aesthetic Plast Surg 2021 Aug 5;45(4):1925-1926. Epub 2021 Jan 5.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-02059-5DOI Listing
August 2021

Reconstruction of upper limb soft-tissue defects after sarcoma resection with free flaps: A systematic review.

J Plast Reconstr Aesthet Surg 2021 Apr 8;74(4):755-767. Epub 2020 Nov 8.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

Background And Objectives: Upper limb preservation after soft tissue sarcoma (STS) surgical excision is now the accepted gold standard and it often requires reconstruction with free flaps. The purpose of this review is to summarize current literature on upper limb reconstruction with free flaps after STS resection.

Methods: A systematic review was performed in July 2019 in PubMed and MedLine Ovid databases according to the PRISMA guidelines.

Results: A total of 17 studies were included in the final analysis, with 132 patients. The most common diagnosis was Malignant Fibrous Histiocytoma. The most frequent timing of flap coverage was immediate. The success rate was almost always 100%. The length of follow-up was reported in 11 studies with a range of 2-187 months. The most commonly reported patient-centered outcome was the MSTS Score. Based on the evidence of the literature collected, we divided the upper limb into four parts (shoulder, elbow and arm, forearm and wrist, and hand) and described the most common and functional free flaps used for reconstruction after STS resection.

Conclusions: Free flaps in the treatment of STS of the upper extremity have a good overall outcome, with a low postoperative complication rate. A wide array of free flaps is available for reconstruction, and the choice of flap is based on defect size, types of tissue required, postoperative functional goal, and surgeon preference. A greater degree of standardization is needed in the reporting of patient-centered outcomes to facilitate future comparative studies.
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http://dx.doi.org/10.1016/j.bjps.2020.10.065DOI Listing
April 2021

Expected Reduction of the Nipple-Areolar Complex over Time After Treatment of Gynecomastia with Ultrasound-Assisted Liposuction Mastectomy Compared to Subcutaneous Mastectomy Alone.

Aesthetic Plast Surg 2021 06 30;45(3):1350-1351. Epub 2020 Nov 30.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-02052-yDOI Listing
June 2021

Changes in Lid Crease Measurements in Levator Advancement for Ptosis.

Ann Plast Surg 2021 06;86(6):731

Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence Italy

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http://dx.doi.org/10.1097/SAP.0000000000002530DOI Listing
June 2021

A Modified Technique Using Levator Aponeurosis-Muller Muscle-Reinforced Plication for Blepharoptosis Correction.

Ann Plast Surg 2021 03;86(3):365

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy

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http://dx.doi.org/10.1097/SAP.0000000000002496DOI Listing
March 2021

D-SUN Method to Prevent Double-Bubble Deformity in Broad Base Breasts with High-Rising Inframammary Fold.

Aesthetic Plast Surg 2021 04 6;45(2):817-818. Epub 2020 Jul 6.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-01856-2DOI Listing
April 2021

Reverse-flow latissimus dorsi myocutaneous flap in a multi-step approach for complex back defect reconstruction: A case report.

Microsurgery 2020 Jul 4;40(5):604-607. Epub 2020 Jun 4.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

Reconstruction of complex back defects is challenging for reconstructive surgeons, as it should preserve function, provide adequate coverage, and minimize morbidity. We present a case of multiple-step reconstruction after resection of a large squamous cell carcinoma recurrence in a 68-year-old man, with local perforator flaps and a reverse-flow latissimus dorsi myocutaneous flap. After radical excision, four propeller perforator flaps were harvested to cover a 30 × 25 cm defect, based on the dorsal branch of the fifth posterior intercostal arteries (right 20 × 9 cm, left 17 × 9 cm) and on the superior gluteal arteries (right 20 × 11 cm, left 21 × 12 cm) bilaterally. In the second step, bilateral propeller perforator flaps based on the fourth lumbar arteries (right 18 × 13 cm, left 23 × 11 cm) were transposed to cover the residual loss of tissues. After 5 months, a recurrence occurred on the left midback. A wide en bloc excision of the last three ribs and pulmonary pleura was performed, and the synthetic mesh used for thoracic wall reconstruction was covered with an ipsilateral 20 × 10 cm reverse-flow latissimus dorsi myocutaneous flap based on the serratus anterior branch. All the flaps healed uneventfully and there were no donor-site complications. Two years postoperatively, the patient had a cosmetically acceptable result without any functional impairment. The reverse-flow latissimus dorsi myocutaneous flap can represent a salvage procedure in back complex defects reconstruction, especially when other local flaps have already been harvested in previous reconstructive procedures.
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http://dx.doi.org/10.1002/micr.30615DOI Listing
July 2020

Infraorbital groove correction by microfat injection after lower blepharoplasty.

J Plast Reconstr Aesthet Surg 2020 12 18;73(12):2239-2260. Epub 2020 May 18.

Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2020.05.004DOI Listing
December 2020

The Long-Term Static and Dynamic Effects of Surgical Release of the Tear Trough Ligament and Origins of the Orbicularis Oculi in Lower Eyelid Blepharoplasty.

Plast Reconstr Surg 2020 06;145(6):1101e-1102e

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

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http://dx.doi.org/10.1097/PRS.0000000000006875DOI Listing
June 2020

Evaluation of Residual Neuro-Muscular Integrity in the Orbicularis Oculi Muscle After Lower Eyelid Transcutaneous Blepharoplasty According to Reidy Adamson-s Flap.

Aesthetic Plast Surg 2020 10 26;44(5):1577-1583. Epub 2020 May 26.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

Background: The aging process affects skin, muscle and fat of the eyes in a different manner. Their individual rejuvenation would require specific surgical treatment according to their particular demands during lower eyelid blepharoplasty. This would require the separate management of the skin and the muscle by separating them into two different flaps. Basing on the anatomy, during sub-ciliary myocutaneous incision in conventional lower eyelid transcutaneous blepharoplasty most of innervations of the lower orbicularis oculi muscle are transected and denervation sequelae at the pretarsal orbicularis oculi muscle would be expected. However, sub/ciliary approach is still popular. The absence of signs or symptom of denervation of in our large case series even though injury to the motor innervation of the orbicularis oculi muscle during the operation led the authors to investigate the discrepancy between the anatomical concept and clinical outcomes. The study aimed to investigate the residual functionality of the orbicularis oculi muscle after lower eyelid transcutaneous blepharoplasty according to Reidy Adamson-s flap.

Materials And Methods: Ten patients were enrolled in the study. Orbicularis oculi muscle functionality was investigated with electroneurography before and at least 6 months after the surgical procedure. Investigated parameters are: Compound Muscle Action Potential (CMAP) as expressions of quantity of activated muscular fibers by the electrical stimulation of the facial nerve. Pre- and post-op collected data were compared and statistically analyzed.

Results: The mean age was 52.9; minimum follow-up 6 months; twenty eyes were investigated; 1 patient was excluded. Postoperative data did not show any significant reduction in the CMAP at all.

Conclusion: The study suggests that the buccal branch and medial branch of the zygomatic nerve of the facial nerve supplies efficiently to the orbicularis oculi innervation.

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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http://dx.doi.org/10.1007/s00266-020-01783-2DOI Listing
October 2020

Our 10 Years' Experience in Breast Asymmetry Correction.

Aesthetic Plast Surg 2020 10 14;44(5):1898-1899. Epub 2020 May 14.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-01746-7DOI Listing
October 2020

External Quilting: New Technique to Avoid Haematoma in Gynaecomastia Surgery.

Aesthetic Plast Surg 2021 04 24;45(2):831-832. Epub 2020 Apr 24.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-01734-xDOI Listing
April 2021

Mandibular ramus and condyle reconstruction with vascularized proximal fibular epiphyseal transfer in the pediatric patient: A case report.

Microsurgery 2020 Oct 14;40(7):818-822. Epub 2020 Apr 14.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.

Mandibular reconstruction in skeletally immature patients is challenging for the Plastic Surgeon. Indeed, it requires replacement of the bony defect with restoration of the growth capability and joint function, when condyle is involved. Vascularized transfer of the proximal epiphysis of the fibula meets all these reconstructive requirements providing an adequate bone stock which also contains a growth plate and an articular surface. The purpose of this article is to report a case of mandibular reconstruction in a 13-year-old boy who underwent resection of a high-grade osteosarcoma involving mandibular angle, ramus, and condyle. A fibular free flap including proximal epiphysis, with its growth plate and the articular surface, was harvested based on the anterior tibial vessels. The fibular head articular surface was placed facing the articular fossa of the temporal bone. A reverse-flow end-to-end anastomosis was performed with the facial vessels. Postoperatively, no infection nor anastomosis complications occurred. Surgical sites healed uneventfully. At latest follow-up, 1 year after surgery, no signs of recurrence were observed. The transferred bone survived and the growth plate was clearly open. Both functional and aesthetic outcomes were rated as good, with maximal mouth opening of more than 4 cm, neither impairment to mastication, deglutition nor phonation was observed. This technique may be a good option for pediatric reconstruction of large bony and articular mandibular defects, where functional restoration of temporomandibular joint and the growing capacity of the bone should be contemporary.
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http://dx.doi.org/10.1002/micr.30589DOI Listing
October 2020

Why do We Need Anatomical Implants? Science and Rationale for Maintaining Their Availability and Use in Breast Surgery.

Aesthetic Plast Surg 2021 04 2;45(2):822-824. Epub 2020 Apr 2.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-01694-2DOI Listing
April 2021

Prospective Analysis and Comparison of Periareolar Excision (Delivery) and Pull-Through Technique for the Treatment of Gynecomastia.

Aesthetic Plast Surg 2020 06 17;44(3):1089-1090. Epub 2020 Mar 17.

Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale dei Mille 129, 50131, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-020-01676-4DOI Listing
June 2020

Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers.

Aesthetic Plast Surg 2020 04 26;44(2):611-612. Epub 2019 Dec 26.

Plastic and Reconstructive Microsurgery, CTO Careggi University Hospital, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-019-01591-3DOI Listing
April 2020

Antioxidants, Dietary Fatty Acids, and Sperm: A Virtual Reality Applied Game for Scientific Dissemination.

Oxid Med Cell Longev 2019 11;2019:2065639. Epub 2019 Nov 11.

Department of Social, Political and Cognitive Sciences, University of Siena, Palazzo San Niccolò, via Roma, 56, 53100 Siena, Italy.

Fatty acid (FA) profile appears to be critical to infertility, and the effects of dietary FAs on sperm FA content are a current focus of studies in the field of nutrition and reproduction. Starting from a validated "OXISTRESS" model in which modification of FA content results to influence reactive oxygen species, antioxidants, isoprostanes, cytokines, sperm kinetic, and acrosome reaction, we developed a virtual reality game where the player, in order to improve the health of some virtual spermatozoa, is called to take dietary choices and then discover their consequences on the main biological aspects. In the LabVR of the University of Siena, a team of VR environment designer and developer used Unity development engine to make the experience run on Oculus Quest and a wireless 6DOF (six degrees of freedom of movement in 3D space) VR Headset. In the game, the player is immersed in the epididymis and observes closer how dietary n-3 may change the sperm plasma membrane and consequently modify sperm traits. A simulation game in the virtual reality may represent a tool to give greater visibility to scientific data in the relevance of appropriate dietary habits in the human health.
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http://dx.doi.org/10.1155/2019/2065639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877968PMC
June 2020

A clinical, pathological and immunohistochemical series of 9 cases of primary cutaneous apocrine carcinomas of the head and neck.

Australas J Dermatol 2020 May 17;61(2):e189-e195. Epub 2019 Nov 17.

Cancer Research "Attilia Pofferi" Foundation, Pistoia, Italy.

Background/objectives: Primary cutaneous apocrine carcinoma is a rare malignant adnexal skin tumour that can recur locally, spread to regional lymph nodes and metastatize to visceral organs. Wide dissemination and death from disease are much less common. The axilla is the most common site of presentation. It is infrequently reported in the head and neck region.

Methods: All cases diagnosed as primary cutaneous apocrine carcinoma of the head and neck were retrospectively collected from the archives of the Division of Pathological Anatomy, University of Florence from 1996 to 2016. There was no history or clinical evidence of breast cancer. Clinical data and follow-up were collected by the clinicians.

Results: Nine cases were found, with a mean age of 76 years, ranging in size between 0.3 and 3.5 cm. Clinically, they were frequently mistaken for basal cell carcinomas. Histopathologically, all the tumours showed decapitation secretion, a tubular, solid or mixed (tubulo-papillary and solid-tubular) growth pattern and were predominantly classified as grade 2 tumours. GCDFP-15 and hormone receptors were variably expressed. HER2 and podoplanin were negative in all cases. In one case, spreading to regional lymph nodes was observed. No cases were associated with death due to the disease.

Conclusion: As immunohistochemical analysis lacks specificity in distinguishing primary cutaneous apocrine carcinoma from a cutaneous metastasis of breast carcinoma, detailed clinical history, breast examination, adequate treatment and follow-up are necessary to confirm a diagnosis of primary cutaneous apocrine carcinoma.
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http://dx.doi.org/10.1111/ajd.13199DOI Listing
May 2020

Correction of High-Grade Pseudogynecomastia After Massive Weight Loss: Modified Inferior Dermoglandular Pedicled Transverse Scar Reduction.

Aesthetic Plast Surg 2021 02 4;45(1):367-368. Epub 2019 Oct 4.

Plastic and Reconstructive Microsurgery, CTO Careggi University Hospital, Florence, Italy.

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http://dx.doi.org/10.1007/s00266-019-01509-zDOI Listing
February 2021
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