Publications by authors named "Franco Bassetto"

156 Publications

Xeroderma Pigmentosum: A Genetic Condition Skin Cancer Correlated-A Systematic Review.

Biomed Res Int 2022 18;2022:8549532. Epub 2022 Jul 18.

Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Via Giustiniani 2, Padova 35128, Italy.

Background: Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder of UV radiation-induced damage repair that is characterized by photosensitivity and a propensity for developing, among many others, skin cancers at an early age. This systematic review focused on the correlation between the clinical, pathological, and genetic aspects of XP and skin cancer.

Methods: A systematic review was conducted through a literature search of online databases PubMed, Cochrane Library, SciELO, and Google Scholar. Search terms were "Xeroderma pigmentosum", "XP", "XPC", "Nucleotide excision repair", "NER", "POLH", "Dry pigmented skin", and "UV sensitive syndrome" meshed with the terms "Skin cancer", "Melanoma", and "NMSC".

Results: After 504 abstracts screening, 13 full-text articles were assessed for eligibility, and 3 of them were excluded. Ten articles were selected for qualitative assessment.

Conclusions: Patients with XP usually suffer shorter lives due to skin cancer and neurodegenerative disease. Deletion/alteration of a distinct gene allele can produce different types of cancer. The XPC and XP-E variants are more likely to have skin cancer than patients in other complement groups, and the most common cause of death for these patients is skin cancer (metastatic melanoma or invasive SCC). Still, aggressive preventative measures to minimize UV radiation exposure can retard the course of the disease and improve the quality of life.
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http://dx.doi.org/10.1155/2022/8549532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313971PMC
July 2022

Gluteal Region Reshaping of Massive Weight Loss Patients-A Decision-Making Strategy.

Arch Plast Surg 2022 May 27;49(3):289-295. Epub 2022 May 27.

Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, Padova University, Padova, Italy.

 Massive weight loss (MWL) is a very common presentation that you may face as a plastic surgeon. Each patient has his own individual criteria, so, you should work according to a well-organized plan, especially when such cases have concerns about their gluteal area contour that were neglected before by many surgeons. A decision-making strategy was used to give a personalized treatment for targeting gluteal region reshaping of MWL patients.  This study considered all patients with MWL subjected to buttock reshaping. There was no randomization in treatment; there was a case-by-case assessment. We analyzed the features of the buttocks, the type of surgery performed, the outcomes, and the complications.  Fifty two patients were included (41 females and 11 males), ages ranged between 21 and 66 years. Demographic data, preoperative body mass index (BMI), duration of surgery, type of surgery, and postoperative complications were collected. Statistically significant improvements were observed in gluteal ptosis and patient satisfaction grades.  Aesthetic improvement of the buttocks involves either augmentation or contouring that may be obtained by liposculpture, surgical lifting, or combination. Patients with MWL have high expectations and are often treated with multiple procedures. Thus, an easy strategic approach personalized on each patient to treat multiple adjacent areas in one operation is necessary. Adipose tissue distribution, gluteal skin status, and BMI were the main factors that can forcefully affect our plan to guarantee reduction of unpleasant results and complications and improve patient satisfaction.
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http://dx.doi.org/10.1055/s-0042-1748640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142265PMC
May 2022

Deep inferior epigastric perforator flap preoperative planning: A comparative analysis between dynamic infrared thermography, computerized tomography angiography, and hand-held Doppler.

Microsurgery 2022 Jun 6. Epub 2022 Jun 6.

Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua, Italy.

Introduction: Hand-held Doppler (HHD) sonography and computerized tomography angiography (CTA) are the common assessment tools for deep inferior epigastric perforator (DIEP) flap preoperative planning. CTA is considered the gold standard method for preoperative perforator mapping but necessitates contrast medium and X-ray exposure. Dynamic infrared thermography (DIRT) does not have these drawbacks and allows the detection of hot and cold spots on a given body area. Our study aimed to compare DIRT, HHD, and CTA in perforator mapping for breast reconstruction using DIEP flap.

Patients And Methods: From March to September 2020, 12 consecutive patients scheduled for DIEP flap breast reconstruction were preoperatively investigated with HHD, CTA, and DIRT. The patients' mean age was 53 and the mean BMI was 29.23 kg/m . All the reconstructions were due to breast cancer. The results of preoperative perforator mapping on the lower abdomen were compared among the three techniques. All the evidence was compared to the intraoperative findings, during flap harvesting, to establish if the techniques were able to correctly locate the perforator.

Results: We detected 178 perforators intraoperatively, 178 with CTA, 178 with DIRT, and 125 with HHD. The latter revealed a lower number of perforator vessels for each patient (10.42 ± 3.58), compared with CTA (14.83 ± 3.04) and DIRT (14.83 ± 4.76). DIRT resulted superior to HHD (p < .05), while no statistically significant difference (p > .05) was found between DIRT and CTA. We calculated a mean sensitivity of 93.87% for CTA, 69.02% for HHD, and 92.06% for DIRT.

Conclusion: DIRT is a useful tool in the preoperative planning of DIEP flaps, as it provides information about the location of perforators and the hemodynamic properties of angiosomes. It is easy to use, and it does not involve ionizing radiation. DIRT could represent an innovative and promising implementation of CTA and HHD techniques for preoperative perforator mapping in DIEP breast reconstruction.
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http://dx.doi.org/10.1002/micr.30927DOI Listing
June 2022

Preclinical Development of Bioengineered Allografts Derived from Decellularized Human Diaphragm.

Biomedicines 2022 Mar 22;10(4). Epub 2022 Mar 22.

Section of Human Anatomy, Department of Neuroscience, University of Padova, 35121 Padova, Italy.

Volumetric muscle loss (VML) is the traumatic/surgical loss of skeletal muscle, causing aesthetic damage and functional impairment. Suboptimal current surgical treatments are driving research towards the development of optimised regenerative therapies. The grafting of bioengineered scaffolds derived from decellularized skeletal muscle may be a valid option to promote structural and functional healing. In this work, a cellular human diaphragm was considered as a scaffold material for VML treatment. Decellularization occurred through four detergent-enzymatic protocols involving (1) sodium dodecyl sulfate (SDS), (2) SDS + Tergitol, (3) sodium deoxycholate, and (4) Tergitol. After decellularization, cells, DNA (≤50 ng/mg of tissue), and muscle fibres were efficiently removed, with the preservation of collagen/elastin and 60%-70% of the glycosaminoglycan component. The detergent-enzymatic treatments did not affect the expression of specific extracellular matrix markers (Collagen I and IV, Laminin), while causing the loss of HLA-DR expression to produce non-immunogenic grafts. Adipose-derived stem cells grown by indirect co-culture with decellularized samples maintained 80%-90% viability, demonstrating the biosafety of the scaffolds. Overall, the tested protocols were quite equivalent, with the patches treated by SDS + Tergitol showing better collagen preservation. After subcutaneous implant in Balb/c mice, these acellular diaphragmatic grafts did not elicit a severe immune reaction, integrating with the host tissue.
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http://dx.doi.org/10.3390/biomedicines10040739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031975PMC
March 2022

Complete Implant Wrapping with Porcine-Derived Acellular Dermal Matrix for the Treatment of Capsular Contracture in Breast Reconstruction: A Case-Control Study.

Aesthetic Plast Surg 2022 Mar 29. Epub 2022 Mar 29.

Plastic and Reconstructive Surgery Unit, Neuroscience Department, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.

Background: Capsular contracture (CC) represents one of the most common complications in breast reconstruction surgery, impairing final result and patients' well-being. The role of acellular dermal matrixes (ADM) has been widely described for the treatment and prevention of contracture. The aim of the study was to evaluate the efficacy and safety of complete implant coverage with porcine-derived ADM in preventing CC limiting complications. In addition, patients' reported outcomes were evaluated in order to define the role of ADM in improving sexual, physical and psychosocial well-being and satisfaction.

Methods: 42 patients who underwent surgical treatment of 46 contracted reconstructed breasts from May 2018th to May 2019th were collected in the two groups (ADM group vs. Control group).

Results: The ADM group showed lower rate of CC recurrence and a higher rate of implant losses and minor complications. A significant difference was observed in red breast syndrome (27.3% in the ADM group vs. absent in control the group) and skin ulceration rates (18.2% in the ADM group vs. 4.18% in the control group). As for patients' perceived outcomes, the ADM group showed a statistically significant higher postoperative Satisfaction of Breast Scale score compared to the control group. In addition, a significant difference was observed in the improvement of Physical Well-Being of the Chest Scale and the Satisfaction of Breast Scale after surgery, in favor to the ADM group.

Conclusion: Complete implant coverage with ADM may reduce the risk of CC recurrence in breast reconstruction. An accurate patient selection allows minimizing complications improving patient well-being and satisfaction.

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/s00266-022-02826-6DOI Listing
March 2022

A New CT Analysis of Abdominal Wall after DIEP Flap Harvesting.

Diagnostics (Basel) 2022 Mar 11;12(3). Epub 2022 Mar 11.

Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, 35128 Padua, Italy.

The abdominal microsurgical flap based on the deep inferior epigastric artery perforator (DIEP) flap has become the most popular option worldwide for autologous breast reconstruction. Several authors have investigated the results of reconstructed breasts, but the literature lacks systematic reviews exploring the donor site of the abdominal wall. To fulfil our aims, a new diagnostic muscle imaging analysis was designed and implemented. This study focused on rectus abdominal muscle morphology and function in a single series of 12 consecutive patients analysed before and after breast reconstruction with a microsurgical DIEP flap. Patients were divided into two groups, namely, "ipsilateral reconstruction" and "contralateral reconstruction", depending on the side of the flap harvest and breast reconstruction, then evaluated by computed tomography (CT) scans scheduled for tumor staging, and clinically examined by a physiatrist. Numerous alterations in muscle physiology were observed due to surgical dissection of perforator vessels, and rectus muscle distress without functional impairment was a common result. Postoperatively, patients undergoing "contralateral reconstruction" appeared to exhibit fewer rectus muscle alterations. Overall, only three patients were impacted by a long-term deterioration in their quality of life. On the basis of the newly developed and implemented diagnostic approach, we concluded that DIEP microsurgical breast reconstruction is a safe procedure without major complications at the donor site, even if long-term alterations of the rectus muscle are a common finding.
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http://dx.doi.org/10.3390/diagnostics12030683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947670PMC
March 2022

Acute Calcium Pyrophosphate Crystal Arthritis of the Wrist Elicited by Anti-COVID-19 Vaccination After Carpal Tunnel Release.

Am J Case Rep 2022 Mar 12;23:e934833. Epub 2022 Mar 12.

Plastic and Reconstructive Surgery Unit, Padua University Hospital, Padua, Italy.

BACKGROUND Calcium pyrophosphate dihydrate deposition disease includes a variety of clinical syndromes, including acute calcium pyrophosphate (CPP) crystal arthritis. Most patients with CPP crystal arthritis have a primary/idiopathic form presenting with severe pain, swelling, and stiffness. COVID-19 infection, which originated in China in December 2019, required extraordinary efforts to develop and test new vaccines to halt the pandemic. The Vaxzervria vaccine has shown excellent safety and efficacy in phase 3 trials with a mechanism based on the expression of the SARS-CoV-2 spike protein gene coding for the S-antigen, which stimulates the immune response. CASE REPORT We describe an acute event of crystal arthritis after a carpal tunnel syndrome release followed by administration of the second dose of anti-COVID-19 Vaccine Oxford-AstraZeneca (ChAdOx1 nCoV-19). Medical treatment resulted in full resolution of the symptoms in 2 weeks. CONCLUSIONS Although most episodes of acute arthritis happen spontaneously, certain factors may trigger the acute CPP crystal arthritis such as intercurrent illnesses or surgeries. Although the association between carpal tunnel syndrome and CPP arthritis has been known for over 40 years, surgical release of the carpal ligament has always been associated with full resolution of symptoms. This is the first case report describing an exacerbation after carpal canal release, concomitant with the administration of the vaccine. According to our opinion, the vaccination associated with a prior surgery in the same anatomical site could have synergically triggered the arthritis flare-up, in a predisposed patient, with a mechanism still unknown.
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http://dx.doi.org/10.12659/AJCR.934833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8924853PMC
March 2022

Management of Severe Wound Infections after Body Contouring Procedures in Post-Bariatric Surgery Patients with Negative-Pressure Wound Therapy with Instillation.

Plast Reconstr Surg 2022 04;149(4):839e-841e

Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy.

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http://dx.doi.org/10.1097/PRS.0000000000008917DOI Listing
April 2022

Topography of the deep branch of the ulnar nerve between genders: a cadaveric study with potential clinical implications.

J Plast Surg Hand Surg 2022 Jan 31:1-3. Epub 2022 Jan 31.

Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy.

The lack of meticulous knowledge concerning the topographical anatomy of the deep branch of the ulnar nerve (DUN) may pose difficulties, leading to a delay or a misdiagnosis of a DUN injury. Identification of the DUN is quite difficult without precise anatomical landmarks as reference points. The current study investigates the topography of the DUN between genders, taking as a reference point a well-known landmark, the Kaplan line, used in hand surgery for carpal tunnel release. Twenty-two (15 males and 7 female) fresh frozen adult cadaveric hands were dissected by using magnifying loupes (3.5 and 5.0 x). We marked values proximal to the Kaplan line as positive (+), while we marked distal ones as negative (-). The mean distance DUN-Kaplan line was 1.69 ± 4.45 mm. In male hands, the mean distance was 4.17 ± 1.88 mm, distal to the Kaplan line, while in females, the mean distance was -4.92 ± 0.69 mm proximal to the Kaplan line. Gender dimorphism was detected, with higher statistically significant values in male hands ( = 0.001). Cadaveric studies of the DUN topography, course, and distribution pattern are uncommon. The current study provides an accurate description of the DUN topography, taking the Kaplan line as a reference point, emphasizing gender differences. The DUN is located distally in males and proximally in females. Knowledge of these predictable anatomical relations may help hand surgeons intraoperatively when dealing with a DUN lesion, because of hand trauma or during the decompression of the DUN.
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http://dx.doi.org/10.1080/2000656X.2022.2032103DOI Listing
January 2022

The Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma: A Comprehensive Review and Clinical Recommendations by a Panel of Experts.

Cancers (Basel) 2022 Jan 13;14(2). Epub 2022 Jan 13.

Unit of Cancer Genetics, Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), 07100 Sassari, Italy.

Cutaneous squamous cell carcinomas (CSCC) account for about 20% of all keratinocyte carcinomas, which are the most common form of cancer. Heterogeneity of treatments and low mortality are a challenge in obtaining accurate incidence data and consistent registration in cancer registries. Indeed, CSCC mostly presents as an indolent, low-risk lesion, with five-year cure rates greater than 90% after surgical excision, and only few tumors are associated with a high-risk of local or distant relapse; therefore, it is particularly relevant to identify high-risk lesions among all other low-risk CSCCs for the proper diagnostic and therapeutic management. Chemotherapy achieves mostly short-lived responses that do not lead to a curative effect and are associated with severe toxicities. Due to an etiopathogenesis largely relying on chronic UV radiation exposure, CSCC is among the tumors with the highest rate of somatic mutations, which are associated with increased response rates to immunotherapy. Thanks to such strong pre-clinical rationale, clinical trials led to the approval of anti-PD-1 cemiplimab by the FDA (Food and Drug Administration) and EMA (European Medicines Agency), and anti-PD-1 pembrolizumab by the FDA only. Here, we provide a literature review and clinical recommendations by a panel of experts regarding the diagnosis, treatment, and follow-up of CSCC.
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http://dx.doi.org/10.3390/cancers14020377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773547PMC
January 2022

A Misdiagnosed Desmoplastic Neurotropic Melanoma of the Scalp: A Challenging Case for the Pathologist and Surgeon.

Acta Dermatovenerol Croat 2021 Dec;29(3):154-158

Paolo Toninello, MD, Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Padua, Italy;

Desmoplastic neurotropic melanoma (DNM) is a rare melanoma subtype that shows tropism for the nerves, perineural invasion correlates to higher rate of local recurrence, poorer prognosis and worse morbidity. Given the paucity of typical melanoma features, both clinical and pathological, this confusing skin cancer may act as a pretender, thus leading clinician to misdiagnosis and subsequent inappropriate conservative treatment. Sarcomatoid-like cells rearrangement and absence of pigmentation can lead towards sarcoma diagnosis, so specific skills are required to pathologist to properly recognize this melanoma subtype. In this case report, we present an example of how challenging can be the diagnosis, and how it can affect clinical outcome.
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December 2021

Merkel Cell Carcinoma: Evaluation of the Clinico-Pathological Characteristics, Treatment Strategies and Prognostic Factors in a Monocentric Retrospective Series (n=143).

Front Oncol 2021 17;11:737842. Epub 2021 Dec 17.

Independent Statistician, Solagna, Italy.

Background: Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. The incidence of the disease has undergone a significant increase in recent years, which is caused by an increase in the average age of the population and in the use of immunosuppressive therapies. MCC is an aggressive pathology, which metastasizes early to the lymph nodes. These characteristics impose an accurate diagnostic analysis of the regional lymph node district with radiography, clinical examination and sentinel node biopsy. In recent years, there has been a breakthrough in the treatment of the advanced pathology thanks to the introduction of monoclonal antibodies acting on the PD-1/PD-L1 axis. This study aimed to describe the clinico-pathological characteristics, treatment strategies and prognostic factors of MCC.

Methods: A retrospective cohort study was conducted involving 143 consecutive patients who were diagnosed and/or treated for MCC. These patients were referred to the Veneto Institute of Oncology IOV-IRCCS and to the University Hospital of Padua (a third-level center) in the period between December 1991 and January 2020. In the majority of cases, diagnosis took place at the IOV. However, some patients were diagnosed elsewhere and subsequently referred to the IOV for a review of the diagnosis or to begin specific therapeutic regimens.

Results: 143 patients, with an average age of 71 years, were affected mainly with autoimmune and neoplastic comorbidities. Our analysis has shown that age, autoimmune comorbidities and the use of therapy with immunomodulating drugs (which include corticosteroids, statins and beta-blockers) are associated with a negative prognosis. In this sense, male sex is also a negative prognostic factor.

Conclusions: Autoimmune and neoplastic comorbidities were frequent in the studied population. The use of drugs with immunomodulatory effects was also found to be a common feature of the population under examination. The use of this type of medication is considered a negative prognostic factor. The relevance of a multidisciplinary approach to the patient with MCC is confirmed, with the aim of assessing the risks and benefits related to the use of immunomodulating therapy in the individual patient.
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http://dx.doi.org/10.3389/fonc.2021.737842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718393PMC
December 2021

Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review.

Front Oncol 2021 7;11:783257. Epub 2021 Dec 7.

Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy.

Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.
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http://dx.doi.org/10.3389/fonc.2021.783257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690035PMC
December 2021

Extended latissimus dorsi flap with propeller ascending design for reconstruction of a complex lateral lumbar defect: A case report and review of the literature.

Microsurgery 2022 May 19;42(4):366-371. Epub 2021 Nov 19.

Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy.

Lateral lumbar defects are rarely encountered and difficult to manage because of the limited reach of loco-regional flaps and the unfavorable position of recipient vessels for microsurgical transfer. The purpose of this report is to describe the innovative application of an extended latissimus dorsi (LD) flap with propeller ascending design in the field of lumbar reconstruction, reviewing current reconstructive options accepted for lateral lumbar defect. A 68-year-old male patient underwent wide full thickness resection for a solitary hepatocellular carcinoma metastatic lesion arising in the left lumbar region, resulting in an extensive soft-tissue defect (20 x 13 cm) with deep structures exposure. An extended LD flap with propeller ascending orientation was obliquely designed, with the distal third of the skin island laying over the trapezius muscle. The skin paddle measured 34 x 9 cm. The flap, including a cuff of proximal LD muscle spared by the oncological resection and a fasciocutaneous superior extension, underwent 90°clockwise rotation on the main thoracodorsal artery perforator and further caudal advancement allowed by section of the LD cranial tendinous insertion. The rotation-advancement movement allowed tension-free flap insetting, while donor site was closed by primary intention. The post-operative course was uneventful without any complications registered. At 12-months follow-up, a satisfactory result and a stable coverage were achieved. Due to the surgical complexity traditionally associated with the repair of defects located in the lumbar region, the case reported may help to provide a new alternative solution to extend the indications of local flaps in similar cases and simplify such reconstructions.
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http://dx.doi.org/10.1002/micr.30842DOI Listing
May 2022

Safety of autologous fat grafting in breast cancer: a multicenter Italian study among 17 senonetwork breast units autologous fat grafting safety: a multicenter Italian retrospective study.

Breast Cancer Res Treat 2022 Jan 9;191(2):355-363. Epub 2021 Nov 9.

Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy.

Background: Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure's oncological safety has been clearly documented at present.

Patients And Methods: We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes.

Results: With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan-Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41-1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34-1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19-4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12-2.98, p = 0.543).

Conclusions: Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.
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http://dx.doi.org/10.1007/s10549-021-06444-9DOI Listing
January 2022

New perspectives in regenerative medicine and surgery: the bioactive composite therapies (BACTs).

Eur J Plast Surg 2022 29;45(1):1-25. Epub 2021 Oct 29.

Plastic and Reconstructive Surgery Unit, University of Padua, Padua, Italy.

Regenerative medicine and surgery is a rapidly expanding branch of translational research in tissue engineering, cellular and molecular biology. To date, the methods to improve cell intake, survival, and isolation need to comply with a complex and still unclear regulatory frame, becoming everyday more restrictive and often limiting the effectiveness and outcome of the therapeutic choices. Thus, the authors developed a novel 360° regenerative strategy based on the synergic action of several new components called the bioactive composite therapies (BACTs) to improve grafted cells intake, and survival in total compliance with the legal and ethical limits of the current regulatory frame. The rationale at the origin of this new technology is based on the evidence that cells need supportive substrate to survive in vitro and this observation, applying the concept of translational medicine, is true also in vivo. Bioactive composite mixtures (BACMs) are tailor-made bioactive mixtures containing several bioactive components that support cells' survival and induce a regenerative response in vivo by stimulating the recipient site to act as an in situ real bioreactor. Many different tissues have been used in the past for the isolation of cells, molecules, and growth factors, but the adipose tissue and its stromal vascular fraction (SVF) remains the most valuable, abundant, safe, and reliable source of regenerative components and particularly of adipose-derived stems cells (ADSCs). The role of plastic surgeons as the historical experts in all the most advanced techniques for harvesting, manipulating, and grafting adipose tissue is fundamental in this constant process of expansion of regenerative procedures. In this article, we analyze the main causes of cell death and the strategies for preventing it, and we present all the technical steps for preparing the main components of BACMs and the different mixing modalities to obtain the most efficient regenerative action on different clinical and pathological conditions. The second section of this work is dedicated to the logical and sequential evolution from simple bioactive composite grafts (BACGs) that distinguished our initial approach to regenerative medicine, to BACTs where many other fundamental technical steps are analyzed and integrated for supporting and enhancing the most efficient regenerative activity. Level of Evidence: Not gradable.
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http://dx.doi.org/10.1007/s00238-021-01874-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554210PMC
October 2021

Management of Acute and Chronic Wounds Using Negative Pressure Wound Therapy With Instillation and Dwell Time: A Retrospective Review of a 100-Patient Cohort in Padova, Italy.

Wounds 2021 08 14. Epub 2021 Aug 14.

Clinic of Plastic Surgery, Department of Neurosciences, University Hospital of Padova, Padova, Italy.

Introduction: The presence of debris covering a wound surface significantly impedes progression toward closure. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) of topical wound solutions is a versatile tool that can be applied to various wound types to promote wound healing. At the University Hospital of Padova in Padova, Italy, NPWTi-d has been incorporated into wound management plans that include debridement and antibiotic therapy, as necessary, for a diverse population of patients with open wounds, including acute, chronic, and infected wounds.

Objective: A retrospective analysis of 100 patients (53 male, 47 female; age range, 22-95 years) who underwent NPWTi-d was performed, and key healing outcomes observed in subgroups differentiated by sex, wound etiology, initial wound size, and topical instillation solution were reported.

Materials And Methods: Wound types included vascular ulcers, surgical wounds, dehiscences, and trauma; anatomic location of the wounds varied. Negative pressure wound therapy with instillation (0.05% sodium hypochlorite, normal saline, or 0.25% acetic acid) was implemented with a dwell time of 3 minutes to 10 minutes, followed by a negative pressure cycle length of 2 hours to 3.5 hours at -75 mm Hg to -125 mm Hg. Dressings were changed approximately every 3 days.

Results: After a median of 11 days (range, 1-35 days), the wound surface area significantly decreased (P <.0001), percentage of infected wounds declined from 72% to 46%, and wound closure was attained in 91% of cases. A significant reduction in wound surface area was detected in both sexes, small- and medium-sized wounds, vascular ulcers, surgical wounds, dehiscences, trauma wounds, and pressure ulcers (P <.05). This effect was detected in wounds regardless of topical instillation solution (P <.0001).

Conclusions: This study showed that NPWTi-d is a valuable treatment option in a variety of circumstances and can help the clinician achieve a range of therapy goals based on individual patient needs.
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http://dx.doi.org/10.25270/wnds/081421.01DOI Listing
August 2021

Smartphones in Sterile Bags to Help Plastic Surgeons in Telemedicine.

Plast Reconstr Surg Glob Open 2021 Oct 4;9(10):e3821. Epub 2021 Oct 4.

Department of Neurosciences, Clinic of Plastic Reconstructive and Aesthetic Surgery, Padova University Hospital, Padua, Italy.

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http://dx.doi.org/10.1097/GOX.0000000000003821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489893PMC
October 2021

Combining traditional and microsurgical reconstruction after a complex hand trauma with multiple tissue defects. A case report.

Ann Ital Chir 2021 Jul 12;10. Epub 2021 Jul 12.

Complex injuries involving bones, tendons and soft tissues of the hand still represent a difficult challenge for reconstructive surgeons. Hereby, we present a case of a man suffering from a complex crush injury of the right hand that led to a wide three-dimensional defect with loss of two metacarpal bones, extensor tendons and skin. For composite hand defects, the most common surgical approach provides for a one-stage composite reconstruction or for an early restoration of bone and skin, with delayed tendon grafts. For the peculiarity of the defect, a one-stage reconstruction was not feasible. Hence, we opted for a two-stage reconstruction but the usual surgical steps have been inverted. First we secured tendon and skin restoration through a composite teno-cutaneous radial free flap. A month later, we reconstructed the two metacarpals with a modified Masquelet technique using fibular cortical graft. This strategy allowed the patient to start an early rehabilitation program and obtain a satisfactory recovery of his dominant hand. KEY WORDS: Composite flap, Hand trauma, Hand reconstruction, Microsurgery.
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July 2021

Hand and Upper Limb Malformations in Italy: A Multicentric Study.

J Hand Surg Asian Pac Vol 2021 Sep;26(3):345-350

Hand Surgery and Microsurgery Unit, Pediatric Orthopedic and Traumatology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.

Although hand and upper limb malformations are quite frequent, up to now very few reports have been published on epidemiology. The aim of this study is to evaluate the number of infants who presented with hand and upper limb malformations from 2010 to 2015 in Italy. A retrospective analysis of a pediatric population presenting with hand and upper extremity malformations was carried out, gathering reports achieved from eight Italian Centers of pediatric hand surgery. Other factors such as gender, date and region of birth, family distribution of malformations and associated syndromes, were analysed. Out of 3,100,421 live births, 765 children presented with hand and upper limb malformations. The incidence was 2,5/10,000 live births with a predominance of males and the right side. Radial polydactyly was the anomaly with the highest percentage, closely followed by simple syndactyly, simbrachidactyly and complex syndactyly. Less common conditions were the triphalangic thumb, thumb in palm, proximal radioulnar synostosis and Sprengel deformity. Inheritance of and familial predisposition to those malformations was recorded in 25 cases, while 84 children presented with syndromes related to hand anomalies. In conclusion the incidence of hand and upper extremity malformations in Italy is lower than that registered in other countries. The retrospective nature of the study combined with the fact that some defects frequently evade pediatric hand surgeon consultations are some possible limitations of the study. However, our data confirmed that, in spite of the decrease in the birth rate in Italy, the trend of congenital hand disorders maintained a stable trend. We aim to integrate this study with a prospective analysis and to involve the institutional health authorities in other countries so as to register the correct incidence of hand and upper extremity defects.
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http://dx.doi.org/10.1142/S2424835521500302DOI Listing
September 2021

Fluorescent Light Energy and Chronic Lesions: A Winning Association.

Plast Reconstr Surg Glob Open 2021 Jul 13;9(7):e3667. Epub 2021 Jul 13.

Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Padua, Italy.

Background: Chronic ulcers represent a challenge for healthcare professionals and a large expense for national health care systems for their difficulty in achieving complete healing and for their high incidence of recurrence. With the progressive aging of the general population, the incidence of these injuries will only increase, further affecting the public health budget, hence the need to find new strategies for their management. The purpose of this study was to share the experience of the Complex Operational Unit of Plastic Surgery of the University Hospital of Padua with fluorescent light energy therapy, outlining its role in the treatment of chronic ulcers in the daily use outside the previous EUREKA study.

Methods: In this case series study, we enrolled 15 patients with chronic ulcers of any etiology between January 2018 and July 2019 and we treated them using fluorescence light energy. We evaluated efficacy and safety endpoints reporting data in excel files completed by medical staff during the study.

Results: The study confirms the effectiveness of fluorescent light energy inducing chronic ulcer healing, regardless of etiology, or at least preparing the lesions for a skin graft closure surgery. The system showed a low rate of complications established by patient adherence to treatment. Patients also reported a reduction in pain both at home and during outpatient dressings.

Conclusion: Based on our experience, fluorescent light energy shows an excellent safety and efficacy profile in chronic ulcers no more responsive to traditional dressings and/or surgery.
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http://dx.doi.org/10.1097/GOX.0000000000003667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277272PMC
July 2021

Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study.

J Plast Reconstr Aesthet Surg 2021 Dec 22;74(12):3281-3288. Epub 2021 Jun 22.

Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.

Background: Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient- or procedure-related risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8).

Methods: A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-related, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models.

Results: Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients >65 years of age and <75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population.

Conclusions: Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification.
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http://dx.doi.org/10.1016/j.bjps.2021.05.048DOI Listing
December 2021

Invited Response on: Comment on "The Role of Portable Incisional Negative Pressure Wound Therapy (piNPWT) in Reducing Local Complications of Post-bariatric Brachioplasty: A Case-Control Study".

Aesthetic Plast Surg 2022 02 9;46(1):550-551. Epub 2021 Jul 9.

Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padova, Via Nicolò Giustininani 2, Padua, 35128, Italy.

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http://dx.doi.org/10.1007/s00266-021-02453-7DOI Listing
February 2022

Nutritional Support for Bariatric Surgery Patients: The Skin beyond the Fat.

Nutrients 2021 May 6;13(5). Epub 2021 May 6.

Department of Biomedical Sciences, University of Padova, 35122 Padua, Italy.

Body contouring surgery after the massive weight loss due to bariatric surgery deals with different kinds of complications. The aim of this review is to analyze the role that some nutrients may play in tissue healing after surgery, thus helping plastic surgeons to improve the aesthetic and health outcomes in massive weight loss patients under a multidisciplinary approach. As a matter of fact, preoperative nutritional deficiencies have been shown for vitamins and minerals in a large percentage of post-bariatric patients. Preoperative deficiencies mainly concern iron, zinc, selenium, and vitamins (both fat-soluble and water-soluble), but also total protein. During the postoperative period, these problems may increase because of the patients' very low intake of vitamins and minerals after bariatric surgery (below 50% of the recommended dietary allowance) and the patients' low compliance with the suggested multivitamin supplementation (approximately 60%). In the postoperative period, more attention should be given to nutritional aspects in regard to the length of absorptive area and the percentage of weight loss.
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http://dx.doi.org/10.3390/nu13051565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148584PMC
May 2021

Neurofibromin Deficiency and Extracellular Matrix Cooperate to Increase Transforming Potential through FAK-Dependent Signaling.

Cancers (Basel) 2021 May 12;13(10). Epub 2021 May 12.

Department of Surgery, Oncology and Gastroenterology, Veneto Institute of Oncology IOV-IRCCS, University of Padova, 35128 Padova, Italy.

Plexiform neurofibromas (Pnfs) are benign peripheral nerve sheath tumors that are major features of the human genetic syndrome, neurofibromatosis type 1 (NF1). Pnfs are derived from Schwann cells (SCs) undergoing loss of heterozygosity (LOH) at the locus in an milieu and thus are variably lacking in the key Ras-controlling protein, neurofibromin (Nfn). As these SCs are embedded in a dense desmoplastic milieu of stromal cells and abnormal extracellular matrix (ECM), cell-cell cooperativity (CCC) and the molecular microenvironment play essential roles in Pnf progression towards a malignant peripheral nerve sheath tumor (MPNST). The complexity of Pnf biology makes treatment challenging. The only approved drug, the MEK inhibitor Selumetinib, displays a variable and partial therapeutic response. Here, we explored ECM contributions to the growth of cells lacking Nfn. In a 3D in vitro culture, loss sensitizes cells to signals from a Pnf-mimicking ECM through focal adhesion kinase (FAK) hyperactivation. This hyperactivation correlated with phosphorylation of the downstream effectors, Src, ERK, and AKT, and with colony formation. Expression of the GAP-related domain of Nfn only partially decreased activation of this signaling pathway and only slowed down 3D colony growth of cells lacking Nfn. However, combinatorial treatment with both the FAK inhibitor Defactinib (VS-6063) and Selumetinib (AZD6244) fully suppressed colony growth. These observations pave the way for a new combined therapeutic strategy simultaneously interfering with both intracellular signals and the interplay between the various tumor cells and the ECM.
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http://dx.doi.org/10.3390/cancers13102329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150846PMC
May 2021

Studying nerve transfers: Searching for a consensus in nerve axons count.

J Plast Reconstr Aesthet Surg 2021 Oct 5;74(10):2731-2736. Epub 2021 Apr 5.

Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy.

Axonal count is the base for efficient nerve transfer; despite its capital importance, few studies have been published on human material, most research approaches being performed on experimental animal models of nerve injury. Thus, standard analysis methods are still lacking. Quantitative data obtained have to be reproducible and comparable with published data by other research groups. To share results with the scientific community, the standardization of quantitative analysis is a fundamental step. For this purpose, the experiences of the Italian, Austrian, German, Greek, and Iberian-Latin American groups have been compared with each other and with the existing literature to reach a consensus in the fiber count and draw up a protocol that can make future studies from different centers comparable. The search for a standardization of the methodology was aimed to reduce all the factors that are associated with an increase in the variability of the results. All the preferential methods to be used have been suggested. On the other hand, alternative methods and different methods have been identified to achieve the same goal, which in our experience are completely comparable; therefore, they can be used indifferently by the different centers according to their experience and availability.
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http://dx.doi.org/10.1016/j.bjps.2021.03.064DOI Listing
October 2021

The Molecular Landscape of Primary Acral Melanoma: A Multicenter Study of the Italian Melanoma Intergroup (IMI).

Int J Mol Sci 2021 Apr 7;22(8). Epub 2021 Apr 7.

Pathological Anatomy Unit, Padua University Hospital, 35128 Padua, Italy.

Acral melanoma (AM) is a rare and aggressive subtype of melanoma affecting the palms, soles, and nail apparatus with similar incidence among different ethnicities. AM is unrelated to ultraviolet radiation and has a low mutation burden but frequent chromosomal rearrangements and gene amplifications. Next generation sequencing of 33 genes and somatic copy number variation (CNV) analysis with genome-wide single nucleotide polymorphism arrays were performed in order to molecularly characterize 48 primary AMs of Italian patients in association with clinicopathological and prognostic features. was the most commonly mutated gene, followed by and , whereas promoter, , and were less frequently mutated. Gains and losses were recurrently found in the 1q, 6p, 7, 8q, 20 and 22 chromosomes involving , , , , , , and genes, and in the 6q, 9, 10, 11q and 16q chromosomes including , , and genes, respectively. This study confirmed the variety of gene mutations and the high load of CNV in primary AM. Some genomic alterations were associated with histologic prognostic features. mutations, found with a higher rate than previously reported, correlated with a low Breslow thickness, low mitotic count, low CNV of the AMs, and with early-stage of disease.
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http://dx.doi.org/10.3390/ijms22083826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067752PMC
April 2021

Melanoma of Unknown Primary: Evaluation of the Characteristics, Treatment Strategies, Prognostic Factors in a Monocentric Retrospective Study.

Front Oncol 2021 5;11:627527. Epub 2021 Mar 5.

Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.

Background: Melanoma of unknown primary (MUP), accounts for up to 3% of all melanomas and consists of a histologically confirmed melanoma metastasis to either lymph nodes, (sub)cutaneous tissue, or visceral sites without any evidence of a primary cutaneous, ocular, or mucosal melanoma. This study aimed to investigate the characteristics, treatment strategies, and prognostic factors of MUP patients, in order to shed some light on the clinical behavior of this malignancy.

Methods: All the consecutive patients with a diagnosis of MUP referring to our institutions between 1985 and 2018 were considered in this retrospective cohort study. The records of 173 patients with a suspected diagnosis of MUP were retrospectively evaluated for inclusion in the study. Patient selection was performed according to the Das Gupta criteria, and a total of 127 MUP patients were finally included in the study, representing 2.7% of the patients diagnosed with melanoma skin cancer at our institutions during the same study period. A second cohort of all consecutive 417 MKP patients with AJCC stages IIIB-IV, referring tions in the period considered (1985-2018), was included in the study to compare survival between MUP and MKP patients. All the diagnoses were based on histopathologic, cytologic and immunohistochemical examination of the metastases. All tumors were re-staged according to the 2018 American Joint Committee on Cancer (AJCC) 8 Edition.

Results: Median follow-up was 32 months (IQR: 15-84). 3-year progression-free survival (PFS) was 54%, while 3-year overall survival (OS) was 62%. Worse OS and PFS were associated with older age (P = 0.0001 for OS; P = 0.008 for PFS), stage IV (P < 0.0001 for OS; P = 0.0001 for PFS) and higher Charlson Comorbidity Index (P < 0.0001 for OS and P = 0.01 for PFS). Patients with lymph node disease showed longer PFS (P = 0.001) and OS (P = 0.0008) than those with (sub)cutis disease. Complete lymph node dissection (CLND) was the most common surgical treatment; a worse OS in these patients was associated with the number of positive lymph nodes (P = 0.01), without significant association with the number of retrieved lymph nodes (P = 0.79). Survival rates were lower in patients undergoing chemotherapy (CT) and target therapy (TT), and higher in those receiving immunotherapy (IT). 417 patients with AJCC stages IIIB-IV of Melanoma Known Primary (MKP) were included for the survival comparison with MUP. 3-year PFS rates were 54 and 58% in MUP and MKP, respectively (P = 0.30); 3-year OS rates were 62 and 70% in MUP and MKP, respectively (P = 0.40).

Conclusions: The most common clinical scenario of our series was a male patient around 59 years with lymph node disease. We report that CLND associated with IT was the best treatment in terms of survival outcome. In the current era of IT and TT for melanoma, new studies have to clarify the impact of novel drugs on MUP.
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http://dx.doi.org/10.3389/fonc.2021.627527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977284PMC
March 2021
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