Publications by authors named "Alessandro Innocenti"

146 Publications

Color Doppler Sonography Assisted Subcutaneous Mastectomy with Inferior Pedicled Nipple-Areola Complex in Female-to-Male Transsexuals: A Retrospective Cohort Analysis.

Aesthetic Plast Surg 2022 Jul 26. Epub 2022 Jul 26.

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

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http://dx.doi.org/10.1007/s00266-022-03035-xDOI Listing
July 2022

Endoscope-Assisted Minimally Invasive Surgery for the Treatment of Glandular Gynecomastia.

Aesthetic Plast Surg 2022 Jul 26. Epub 2022 Jul 26.

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

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http://dx.doi.org/10.1007/s00266-022-03036-wDOI Listing
July 2022

Post Bariatric Male Chest Re-Shaping Using L-Shaped Excision Technique.

Aesthetic Plast Surg 2022 Jul 26. Epub 2022 Jul 26.

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

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http://dx.doi.org/10.1007/s00266-022-03038-8DOI Listing
July 2022

Foix-Chavany-Marie Syndrome as Result of Acute Bilateral Frontal-Opercular Strokes.

Neurohospitalist 2022 Apr 15;12(2):420-421. Epub 2021 Dec 15.

Neurology & Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

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http://dx.doi.org/10.1177/19418744211052409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995603PMC
April 2022

Incidence of Complications for Different Approaches in Gynecomastia Correction: A Systematic Review of the Literature.

Aesthetic Plast Surg 2022 Feb 9. Epub 2022 Feb 9.

Department of Statistica, Informatica, Applicazioni (DiSIA), University of Florence, Florence, Italy.

Background: Gynecomastia is nowadays a very common disease, affecting a large cohort of patients with different ages. The aim of this literature review is to assess the incidence of complications with all proposed techniques and for combined procedures versus single approach procedures in gynecomastia correction.

Materials And Methods: A systematic review of the literature was performed to identify all reported techniques for gynecomastia correction covering a period from January 1, 1987 to November 1, 2020. For all selected papers, demographic data, proposed technique, and complications' incidence have been recorded.

Results: A total number of 3970 results was obtained from database analysis. A final total number of 94 articles was obtained for 7294 patients analyzed. Patients have been divided into three groups: aspiration techniques, consisting in 874 patients (11,98%), surgical excision techniques, consisting in 2764 patients (37,90%), and combined techniques, consisting in 3656 patients (50,12%). Complications have been recorded for all groups, for a total number of 1407, of which 130 among "Aspiration techniques" group (14,87%), 847 among "Surgical excision techniques" group (30,64%), and 430 in "Combined techniques" group (11,76%).

Conclusions: Several techniques have been proposed in the literature to address gynecomastia, with the potential to greatly improve self-confidence and overall appearance of affected patients. The combined use of surgical excision and aspiration techniques seems to reduce the rate of complications compared to surgical excision alone, but the lack of unique classification and the presence of several surgical techniques still represents a bias in the literature review.

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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http://dx.doi.org/10.1007/s00266-022-02782-1DOI Listing
February 2022

Schwann cell endosome CGRP signals elicit periorbital mechanical allodynia in mice.

Nat Commun 2022 02 3;13(1):646. Epub 2022 Feb 3.

Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy.

Efficacy of monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptor (calcitonin receptor-like receptor/receptor activity modifying protein-1, CLR/RAMP1) implicates peripherally-released CGRP in migraine pain. However, the site and mechanism of CGRP-evoked peripheral pain remain unclear. By cell-selective RAMP1 gene deletion, we reveal that CGRP released from mouse cutaneous trigeminal fibers targets CLR/RAMP1 on surrounding Schwann cells to evoke periorbital mechanical allodynia. CLR/RAMP1 activation in human and mouse Schwann cells generates long-lasting signals from endosomes that evoke cAMP-dependent formation of NO. NO, by gating Schwann cell transient receptor potential ankyrin 1 (TRPA1), releases ROS, which in a feed-forward manner sustain allodynia via nociceptor TRPA1. When encapsulated into nanoparticles that release cargo in acidified endosomes, a CLR/RAMP1 antagonist provides superior inhibition of CGRP signaling and allodynia in mice. Our data suggest that the CGRP-mediated neuronal/Schwann cell pathway mediates allodynia associated with neurogenic inflammation, contributing to the algesic action of CGRP in mice.
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http://dx.doi.org/10.1038/s41467-022-28204-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8813987PMC
February 2022

Suprapubic Liposuction with a Modified Devine's Technique for Buried Penis Release in Adults.

Plast Surg (Oakv) 2022 Feb 29;30(1):86. Epub 2020 Sep 29.

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

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http://dx.doi.org/10.1177/2292550320960408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793754PMC
February 2022

Six-years experience in major scalp defect reconstruction with free flap: analysis of the results.

Acta Biomed 2022 01 19;92(6):e2021301. Epub 2022 Jan 19.

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

Introduction The purposes of this study were to report 10-years experiences in microsurgical reconstruction of major scalp defects, comparing outcomes, evaluating complications.  Materials and methods From November to July 2015, 10 consecutive patients underwent microsurgical procedures for severe scalp defects. Results The average age was 55,1 years ranging from 6 to 87 years. The mean follow-up was 16.7 months ranging from 12 to 24 months. The size of the lesions ranged from 9x10 to 16x20cm. The average hospital stay was 20 days ranging from 8 to 43 days. Mean operative times was 5.3 h ranging from 5 to 6.45 h. Free flaps included 8 Latissimus Dorsi flaps (LD) and 2 anterolateral thigh flaps (ALT). The superficial temporal vessels were used as recipient vessels in 9 cases while the superior Thyroid artery was used in remaining case. Discussion For large or complex lesions, the use of free flaps is mandatory. Nowadays LD and ALT flaps are among the most common reconstructive choices for scalp defects reconstructions. Older age does not contraindicate the operation procedure nevertheless in younger patients the size of vessels is proportionately larger and pristine.   Conclusion Microvascular free tissue transfer is the mainstay of scalp defects coverage. In our series early complications are less common and concerning than late complications and in fact reoperations are mainly required to manage these latter. Advanced age should be not consider a contraindication for free flap surgery and the procedure can be considered safe and reliable in both old and young population.
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http://dx.doi.org/10.23750/abm.v92i6.10089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8823577PMC
January 2022

Patients Decision-Making Characteristics Affects Gynecomastia Treatment Satisfaction: A Multicenter Study Using the BODY-Q Chest Module.

Aesthetic Plast Surg 2022 Apr 29;46(Suppl 1):50-51. Epub 2021 Nov 29.

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

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http://dx.doi.org/10.1007/s00266-021-02688-4DOI Listing
April 2022

Aesthetic Outcome of Gynecomastia Management with Conventional Liposuction and Cross-Chest Liposuction: A Prospective Comparative Study.

Aesthetic Plast Surg 2021 Nov 29. Epub 2021 Nov 29.

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

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http://dx.doi.org/10.1007/s00266-021-02687-5DOI Listing
November 2021

The role of VFG in wrist arthrodesis: Long term results in a series of 11 patients and literature review.

Injury 2021 Dec 18;52(12):3624-3634. Epub 2021 Nov 18.

Department of Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Via Taddeo Alderotti, 56, Florence 50139, Italy. Electronic address:

Background: Total wrist fusion (TWF) is indicated for longstanding degenerative, posttraumatic and/or post-oncological conditions to provide pain relief and wrist stability at partial expense of wrist motion.

Patients And Methods: A total of 11 consecutive patients who had completed TWF with Vascularized Fibula Graft (VFG) for massive distal radius defects were identified retrospectively from our center using inpatient records. We evaluated bone fusion times and long term functional outcomes following the procedure. Post-operative grip strength (GS) and prono-supination were objectively measured. The new Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to rate disability and symptoms; pre- and post- operative pain with the Visual Analog Scale (VAS) was assessed. A literature review of the present studies about TWF with VFG was performed, with the aim of comparing long-term functional results of the surgical techniques so far reported in the English literature.

Results: Our experience with TWF using VFG appeared slightly better than that found in the literature. The procedure was successful in all the cases, achieving bone union in 4,8 months on average. Complication rate was 27,2%, no flap loss was recorded. There were no wrist instability, deformation or dislocation; mean pronation/supination (P/S) was 57,5°/61,2° Average grip strength resulted 59% of the contralateral side. Mean recorded levels of visual analog scale (VAS) for pain postoperatively were 2,32 ± 0,792, which improved significantly from the pre-operatively value of 7,90 ± 0,79. Mean overall satisfaction was good and all the patients comfortably returned to normal activities.

Conclusions: Wrist arthrodesis by means of VFG resulted to be an effective and reliable option in dealing with massive defects of distal radius with involvement of radio-carpal joint. Although the cohort analyzed is relatively small and definitive conclusions cannot be drawn, the long term radiographs and the overall functional outcomes encourage to use the described surgical option over other techniques, such as prosthetic replacement and non-vascularized bone grafts.
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http://dx.doi.org/10.1016/j.injury.2021.11.004DOI Listing
December 2021

The use of resected SMAS as autologous graft for the correction of nasolabial folds during rejuvenating procedures.

Acta Biomed 2021 11 3;92(5):e2021299. Epub 2021 Nov 3.

Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence.

Background And Aim: Despite several techniques are proposed, treatment of nasolabial folds is often challenging. During rejuvenation procedures, the SMAS could be redraped or partially resected during the procedure. The aim of this study is to investigate the use of obtained SMAS strip as autologous graft, because of its solid but pliable consistence and fatty composition, to correct nasolabial folds during procedures with SMAS resection.Methods Between 2015 and 2018, 23 patients underwent SMAS graft for nasolabial fold correction. All procedures were performed under local anesthesia and no other cosmetic treatments, including HA fillers, have been done in the past 12 months.

Results: 22 patients were declared eligible for the study. 20 patients were female, accounting for 90,91%. Mean age was 53 years old. Ancillary procedures were performed in 17 patients, including upper blepharoplasty (3, 13,63%), upper and lower blepharoplasty (5, 22,73%) and submental neck lift with platysma plication (15, 68,18%). Mean follow-up was 9 months. No major complications have been recorded: only 1 case of minimal hematoma in the retroauricular region have been recorded and 1 patient required laser treatment for pathological scars. At follow-up, graft is completely integrated into the mid-fat compartment. As evinced from the FACE-Q analysis, the overall satisfaction rate is extremely high. These are very convincing data regarding the effectiveness of the technique and, despite a little bit longer downtime, is not invasive and led to natural long-lasting results event during motion.

Conclusions: The use of SMAS graft during face-lift as nasolabial fold filler results in a satisfactory but natural filling of the folds, reducing the need for lateral tension and therefore assuring more natural results. Since its nature, SMAS, reduced in width to properly fit into the nasolabial fold, can be considered as an optimal autologous graft for replenish loss volumes of the face with aging.
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http://dx.doi.org/10.23750/abm.v92i5.10056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689304PMC
November 2021

Percutaneous Intradermal Purse-String Closure for Correction of Male Tuberous Nipple-Areola Complex Deformity.

Aesthetic Plast Surg 2021 Oct 20. Epub 2021 Oct 20.

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

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http://dx.doi.org/10.1007/s00266-021-02591-yDOI Listing
October 2021

Reconstruction after complete mandibular avulsion with double-paddle fibular free flap. A case report.

Microsurgery 2021 Nov 23;41(8):782-786. Epub 2021 Sep 23.

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

Reconstruction after maxillofacial trauma is extremely challenging. During the past several decades, the chimeric fibular-free flap has emerged as a leading reconstructive option for head and neck compound defects. This report describes a unique case of total mandibular reconstruction using a double-paddle osteocutaneous fibular free flap after facial traumatic injury. A 45-year-old man presented a severe maxillofacial trauma with complete mandibular avulsion. The shortest segment of a 24-cm fibular flap was used to reconstruct the symphysis while the longest segments were placed to rebuild the mandibular body. Microvascular anastomoses were performed with the external jugular vein and facial artery. The distal skin island (10 × 5 cm) was sutured to cover the endo-oral defect while the proximal one (12 × 6 cm) to restore the external tissues continuity of the facial lower third. The postoperative course was uneventful. One year after flap reconstruction, a first commissuroplasty was performed. After 3 months, secondary commissuroplasty was performed with an Estlander flap to rebuild the right lower lip. At latest follow-up, 60 months postoperatively, the patient was able to tolerate soft diet with maximal mouth opening of more than 4 cm; no impairment to mastication, deglutition, or phonation was observed. Speech was normal and the aesthetic outcome was judged good. Double-paddle fibular free flap allows reconstruction of extremely challenging defects, such in case of complete mandibular avulsion. The proximal perforator can provide extended soft-tissue coverage and greater volume than traditional osteocutaneous flaps, avoiding two flaps simultaneous harvest.
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http://dx.doi.org/10.1002/micr.30813DOI Listing
November 2021

On the nanoscopic structural heterogeneity of liquid -alkyl carboxylic acids.

Phys Chem Chem Phys 2021 Sep 22;23(36):20282-20287. Epub 2021 Sep 22.

Helmholtz Institute Ulm (HIU), Helmholtzstrasse 11, Ulm 89081, Germany.

Herein we report the first in-depth structural characterisation of simple linear carboxylic acids with alkyl tail length ranging from one to six carbon atoms. By means of the SWAXS technique, a pronounced nanoscopic heterogeneity evolving along the aliphatic portion of the molecule is highlighted. classical molecular dynamics, the origin of such heterogeneity is unambiguously assigned to the existence of aliphatic domains resulting from the self-segregation of the polar and apolar portions of the molecules. Furthermore, the structural correlation of aliphatic-separated polar domains is responsible for observing the so-called "pre-peak" in the SAXS region.
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http://dx.doi.org/10.1039/d1cp02846dDOI Listing
September 2021

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

Microsurgery 2021 Oct 6;41(7):676-687. 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
October 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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343747PMC
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 10 3;45(5):2118-2126. 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
October 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 2022 Apr 15;46(Suppl 1):166-167. 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
April 2022

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

Aesthetic Plast Surg 2022 Apr 5;46(Suppl 1):156-157. 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
April 2022

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

Aesthetic Plast Surg 2022 Apr 5;46(Suppl 1):158-159. 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
April 2022

"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 08 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
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