Publications by authors named "Giorgio De Santis"

87 Publications

Photobiomodulation Therapy: A New Light in the Treatment of Systemic Sclerosis Skin Ulcers.

Rheumatol Ther 2022 Mar 25. Epub 2022 Mar 25.

Scleroderma Unit, Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Policlinico di Modena, Via del Pozzo, 71, 41125, Modena, Italy.

Introduction: Skin ulcers (SU) represent one of the most frequent manifestations of systemic sclerosis (SSc), occurring in almost 50% of scleroderma patients. SSc-SU are often particularly difficult to treat with conventional systemic and local therapies. In this study, a preliminary evaluation of the role and effectiveness of blue light photobiomodulation (PBM) therapy with EmoLED in the treatment of scleroderma skin ulcers (SSc-SU) was performed.

Methods: We retrospectively analyzed 12 consecutive SSc patients with a total of 15 SU on finger hands. All patients were treated with adequate systemic therapy and local treatment for SU; after a standard skin ulcer bed preparation with debridement of all lesions, EmoLED was performed. All patients were locally treated every week during 2 months of follow-up; SU data were collected after 4 weeks (T4) and 8 weeks (T8). Eight SSc patients with comparable SU were also evaluated as controls.

Results: The application of EmoLED in addition to debridement apparently produced faster healing of SU. Complete healing of SU was recorded in 41.6% cases during EmoLED treatment. Significant improvements in SU area, length, and width, wound bed, and related pain were observed in EmoLED patients from T0 to T8. Control subjects treated with standard systemic/local therapies merely showed an amelioration of SU area and width at the end of the follow-up. No procedural or post-procedural adverse events were reported.

Conclusions: The positive clinical results and the absence of side effects suggest that EmoLED could be a promising tool in the management of SSc-SU, with an interesting role to play in the healing process in addition to conventional systemic and local treatments.
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http://dx.doi.org/10.1007/s40744-022-00438-9DOI Listing
March 2022

Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults.

Int J Mol Sci 2022 Feb 22;23(5). Epub 2022 Feb 22.

Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy.

Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different aetiology. Although iatrogenic aetiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent aetiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.
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http://dx.doi.org/10.3390/ijms23052421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910114PMC
February 2022

Filler-induced complications of the lips: 10 years experience with intralesional laser treatment and refinements.

J Plast Reconstr Aesthet Surg 2022 03 15;75(3):1215-1223. Epub 2021 Nov 15.

Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy.

Background: The number of minimally invasive cosmetic procedures has steadily increased every year. In the last decade, the rates of filler injection reactions have also increased. This study presents our experience in the management and treatment of permanent filler complications to the lips. Undoubtedly, in these adverse reactions, the lips are the hallmark that most stigmatizes an unnatural look of the face.

Methods: One hundred and eighty-one patients (168 female and 13 male) with permanent filler complications to the lips were treated from September of 2009 to September of 2019 at the University Hospital of Modena. One hundred and thirty-five patients underwent intralesional laser treatment (ILT). Forty-six patients underwent a stab incision and drainage and 10 of these patients had solid and calcified nodules and therefore underwent a combined technique. Thirty-three patients underwent further cosmetic procedures.

Results: In 95% of patients there was a clinical improvement of which complete resolution in 38.7% and partial improvement in 34.2% of cases. Nine patients stopped the treatment because they were not satisfied. No patient was considered to have worsened after the treatment. Thirty-three patients underwent further treatments.

Conclusions: A systematic combined approach between antibiotic therapy and treatments (ILT and a stab incision) represents the best therapeutic approach in dealing with permanent fillers complications to the lips. This treatment modality allows both the removal of the foreign material and the inflammatory reaction with low morbidity and little cosmetic disfigurement. Further cosmetic procedures may be applied to improve aesthetic appearance once most of the non-resorbable substance has been removed.
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http://dx.doi.org/10.1016/j.bjps.2021.11.042DOI Listing
March 2022

Systemic sclerosis cutaneous expression: Management of skin fibrosis and digital ulcers.

Ann Med Surg (Lond) 2021 Nov 2;71:102984. Epub 2021 Nov 2.

Department of Rheumatology, Division of Rheumatology, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.

Systemic sclerosis is a connective tissue disease with cutaneous involvement. Clinical manifestations result from the balance of inflammations/autoimmunity process and fibrogenesis. Patients suffer from skin ulcers, non-ulcerative lesions including digital pitting scars, telangiectasias, subungual hyperkeratosis, abrasions, fissures, and subcutaneous calcinosis. A review about the pathophysiology of the disease, the physical examination of the patients, the instrumental assessment, and possible treatments is performed.
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http://dx.doi.org/10.1016/j.amsu.2021.102984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8606707PMC
November 2021

Reply: Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect.

Plast Reconstr Surg 2021 12;148(6):1054e-1055e

Division of Plastic Surgery, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1097/PRS.0000000000008541DOI Listing
December 2021

Surgical treatment of pressure injuries in children: A multicentre experience.

Wound Repair Regen 2021 11 2;29(6):961-972. Epub 2021 Sep 2.

Pediatric Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1-17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.
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http://dx.doi.org/10.1111/wrr.12964DOI Listing
November 2021

Microfragmented adipose tissue is associated with improved ex vivo performance linked to HOXB7 and b-FGF expression.

Stem Cell Res Ther 2021 08 28;12(1):481. Epub 2021 Aug 28.

Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy.

Introduction: Adipose tissue (AT) has become a source of mesenchymal stromal/stem cells (MSC) for regenerative medicine applications, in particular skeletal disorders. Several enzymatic or mechanical procedures have been proposed to process AT with the aim to isolate cells that can be locally implanted. How AT is processed may impact its properties. Thus, we compared AT processed by centrifugation (C-AT) to microfragmentation (MF-AT). Focusing on MF-AT, we subsequently assessed the impact of synovial fluid (SF) alone on both MF-AT and isolated AT-MSC to better understand their cartilage repair mechanisms.

Materials And Methods: MF-AT and C-AT from the same donors were compared by histology and qRT-PCR immediately after isolation or as ex vivo cultures using a micro-tissue pellet system. The in vitro impact of SF on MF-AT and AT-MSC was assessed by histological staining and molecular analysis.

Results: The main AT histological features (i.e., increased extracellular matrix and cellularity) of the freshly isolated or ex vivo-cultured MF-AT persisted compared to C-AT, which rapidly deteriorated during culture. Based on our previous studies of HOX genes in MSC, we investigated the involvement of Homeobox Protein HOX-B7 (HOXB7) and its target basic Fibroblast Growth Factor (bFGF) in the molecular mechanism underlying the improved performance of MF-AT. Indeed, both these biomarkers were more prominent in freshly isolated MF-AT compared to C-AT. SF alone preserved the AT histological features of MF-AT, together with HOXB7 and bFGF expression. Increased cell performance was also observed in isolated AT-MSC after SF treatment concomitant with enhanced HOXB7 expression, although there was no apparent association with bFGF.

Conclusions: Our findings show that MF has a positive effect on the maintenance of AT histology and may trigger the expression of trophic factors that improve tissue repair by processed AT.
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http://dx.doi.org/10.1186/s13287-021-02540-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399787PMC
August 2021

Adaptive Proximal Scaphoid Implant stability despite a perilunate dislocation: a case report.

Acta Biomed 2021 07 26;92(S3):e2021001. Epub 2021 Jul 26.

Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena.

Background: We present the case of a 22 y.o. male patient suffering from scaphoid non-union with avascular necrosis of the proximal pole and initial degenerative arthritis.

Case Report: He referred to our institution with functional impairment and persistent pain (VAS 8\10). The patient underwent the positioning of the small size Adaptive Proximal Scaphoid Implant (APSI), without fixation, through an open dorsal approach and radial styloidectomy. The post-operative course was uneventful, and the patient could resume his daily routine without limitations. 5 years later the patient returned to our department referring a dorsal perilunate dislocation on the same hand. Unexpectedly no implant dislocation occurred and we were able to reduce the perilunate dislocation maintaining the same implant. At 30-month follow-up the patient was pain free (VAS 0\10) with almost completely recovered function of the hand and wrist.

Conclusion: In order to minimize implant dislocation, both an adequate scaphoid resection and the choice of the right implant size (which should be lightly downsized compared to the scaphoid resection) are of paramount importance. At the same time, the capsuloplasty should be carefully performed at the right tension, providing adequate stability to the implant. This technique provided satisfactory functional results in a long-term follow-up, even in a young and active patient. Moreover, it does not preclude or complicate the possibility of resorting to different surgical procedures in case of necessity, whilst maintaining the same implant.
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http://dx.doi.org/10.23750/abm.v92iS3.9470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420832PMC
July 2021

Upper limb traumatic injuries: A concise overview of reconstructive options.

Ann Med Surg (Lond) 2021 Jun 27;66:102418. Epub 2021 May 27.

Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.

Different options for upper limb reconstruction are described in literature: advancement or rotation flaps, regional flaps and free flaps are the most common. Local and regional flaps can represent the reconstructive options for small defects while large wounds require the use of free flaps or distant pedicled flaps. In case of large wound, the use of free flaps rather than distant pedicle flaps is usually preferred. To choose the best reconstructive option, it is essential for the surgeon to have a general overview about the different methods. In this review the Authors will refer to the most commonly used methods to cover soft tissues injuries affecting the dorsum and the palm of the hand and the forearm (excluding fingers). The aim is to show all flap reconstructive options so as to support the inexperienced surgeon during the management of traumatic injuries of the upper limb.
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http://dx.doi.org/10.1016/j.amsu.2021.102418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188247PMC
June 2021

Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments.

J Pers Med 2021 May 12;11(5). Epub 2021 May 12.

Division of Plastic and Reconstructive Surgery, Department of Medical and Surgical Sciences, Modena Policlinico Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy.

Breast cancer-related lymphedema (BCRL) represents a global healthcare issue affecting the emotional and life quality of breast cancer survivors significantly. The clinical presentation is characterized by swelling of the affected upper limb, that may be accompanied by atrophic skin findings, pain and recurrent cellulitis. Cardinal principles of lymphedema management are the use of complex decongestive therapy and patient education. Recently, new microsurgery procedures have been reported with interesting results, bringing in a new opportunity to care postmastectomy lymphedema. However, many aspects of the disease are still debated in the medical community, including clinical examination, imaging techniques, patient selection and proper treatment. Here we will review these aspects and the current literature.
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http://dx.doi.org/10.3390/jpm11050402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151072PMC
May 2021

Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review.

Microsurgery 2021 Sep 7;41(6):584-593. Epub 2021 May 7.

Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy.

Background: Prelamination is a reconstructive technique providing fasciomucosal or composite flaps with low donor-site morbidity. We conducted a systematic review of retrospective studies to assess the application of prelaminated flaps in reconstructive surgery of head and neck cancer patients, and to evaluate the advantages and disadvantages of this technique.

Methods: This systematic review adhered to the recommendations of the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analysis) 2009 guidelines. A computerized MEDLINE search was performed using the PubMed service of the U.S. National Library of Medicine (www.pubmed.org) and Scopus database (www.scopus.com), running the following search string: "prelamination OR prelaminated AND flap." Two authors screened the articles, then selected and extracted data on malignancies characteristics, reconstructive techniques, outcomes and complications.

Results: A total of 19 articles were selected and reviewed from 128 identified. Seven of 19 articles were case reports, 12 articles were case series. One-hundred-two patients underwent reconstructive treatment by prelamination technique using a wide variety of flaps (92 free, 10 pedicled). The sites of reconstruction were oral cavity (66 floor of the mouth, 3 retromolar trigone, 6 hard palate, 4 cheek, 4 tongue), 8 facial skin (5 of them sited on the nose), 4 oropharyngeal defects, 1 laryngotracheal region. No case of total flap loss was reported. Partial flap loss or shrinkage requiring minor surgical revisions was observed in 18 patients (17.6%). Primary closure of the donor site was achieved in 97 cases (97%) and 3 (3%) required revision surgery of the donor site.

Conclusion: Prelamination is an effective and versatile technique, with low donor-site morbidity. Further studies would be needed to investigate the impact on the patient's oncologic outcome. More comparative studies with standard reconstructive techniques are essential to understand when it is worth performing this sophisticated procedure.
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http://dx.doi.org/10.1002/micr.30751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518088PMC
September 2021

Standardization and Selection of High-risk Patients for Surgical Wound Infections in Plastic Surgery.

Plast Reconstr Surg Glob Open 2021 Mar 23;9(3):e3472. Epub 2021 Mar 23.

Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy.

Background: The aim of the present study was to show that the Infection Risk Index (IRI), based on only 3 factors (wound classification, American Society of Anesthesiologists score, and duration of surgery), can be used to standardize selection of infection high-risk patients undergoing different surgical procedures in Plastic Surgery.

Methods: In our Division of Plastic Surgery at Modena University Hospital, we studied 3 groups of patients: Group A (122 post-bariatric abdominoplasties), Group B (223 bilateral reduction mammoplasties), and Group C (201 tissue losses with first intention healing). For each group, we compared surgical site infection (SSI) rate and ratio between patients with 0 or 1 risk factors (IRI score 0 or 1) and patients with 2 or 3 risk factors (IRI score 2 or 3).

Results: In group A, patients with IRI score 0-1 showed an SSI Ratio of 2.97%, whereas patients with IRI score 2-3 developed an SSI ratio of 27.27%. In group B, patients with IRI score 0-1 showed an SSI ratio of 2.99%, whereas patients with IRI score 2-3 developed an SSI ratio of 18.18%. In group C, patients with IRI score 0-1 showed an SSI ratio of 7.62%, whereas patients with IRI score 2-3 developed an SSI ratio of 30.77%.

Conclusions: Existing infection risk calculators are procedure-specific and time-consuming. IRI score is simple, fast, and unspecific but is able to identify patients at high or low risk of postoperative infections. Our results suggest the utility of IRI score in refining the infection risk stratification profile in Plastic Surgery.
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http://dx.doi.org/10.1097/GOX.0000000000003472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062150PMC
March 2021

WSRM 2019 in Bologna: A Great Success beyond Expectations!

J Reconstr Microsurg 2021 03 1;37(3):181. Epub 2021 Mar 1.

Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, Universita degli Studi di Palermo Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche, University of Palermo, Palermo, Italy.

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http://dx.doi.org/10.1055/s-0041-1723780DOI Listing
March 2021

Autologous fat grafting in the treatment of a scleroderma stump-skin ulcer: a case report.

Case Reports Plast Surg Hand Surg 2021 Feb 12;8(1):18-22. Epub 2021 Feb 12.

Plastic Surgery Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy.

Here we describe the case of a 60-year-old-woman with systemic sclerosis sent to our Scleroderma Unit to treat digital stumps. The stumps were successfully treated with autologous fat grafting (crown-shape infiltration). Our technique of autologous lipotransfer improved wound healing in a scleroderma patient with stump-digital ulcers where all other options failed.
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http://dx.doi.org/10.1080/23320885.2021.1881521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889081PMC
February 2021

Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect.

Plast Reconstr Surg 2021 03;147(3):585-591

From the Division of Plastic Surgery, University of Modena and Reggio Emilia.

Background: Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. The minimally invasive intralesional laser treatment can remove foreign substances and the inflammatory reaction, eventually leaving depression and scar tissue in the treated area. Fat grafting can restore volume loss and improve scar tissue.

Methods: From March of 2010 to February of 2017, 33 patients were studied. All of them had suffered from inflammatory reactions to permanent facial fillers and had been treated with the 808-nm diode laser at the authors' institution. The evacuation of material had left facial asymmetry and visible depression. To restore facial aesthetic units, fat grafting was performed. The minimum follow-up was 6 months.

Results: Volume restoration was recognized (according to the Global Aesthetic Improvement Scale) as significantly improved in 22 patients, moderately improved in eight patients, and slightly improved in three patients. Improvement in atrophic and scarred tissues (with an apparent thickening of the skin or even elimination of scars) was also assessed with the following results: 25 patients were very much improved and eight were moderately improved.

Conclusions: This is the first study on filler-induced complications of the face treated by intralesional laser treatment followed by lipofilling. A systematic approach to volume restoration is proposed to patients who had filler removal of the face. There was a high degree of patient satisfaction with this technique.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000007611DOI Listing
March 2021

Extended and unusual indications in jaw reconstruction with the fibula flap: An overview based on our 30-year experience.

Ann Med Surg (Lond) 2021 Feb 5;62:37-42. Epub 2021 Jan 5.

Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.

Since the introduction of fibula flap as a reconstructive technique, an evolution of indications has been observed. Our first report of a traumatic mandibular reconstruction using fibula flap was in 1992. The vast majority of indications for surgery, are: malignant tumors, benign neoplasms, osteoradionecrosis and traumas. Nevertheless, extended indications have been described such as the treatment of dentoalveolar defect without bone discontinuity or reconstruction of maxilla defect up to type III (A and B), according to Cordeiro's classification. Unusual indications include cleft palate malformations with bone discontinuity less than 6 cm. Moreover, a particular attention should be focus on fibula flap harvest with more innovative technologies than traditional use of monopolar or bipolar and their advantages in pre and postoperative management.
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http://dx.doi.org/10.1016/j.amsu.2020.12.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806501PMC
February 2021

Tip of the Tongue Reconstruction with Prelaminated Fasciomucosal Radial Forearm Free Flap.

Plast Reconstr Surg Glob Open 2020 Dec 2;8(12):e3226. Epub 2020 Dec 2.

Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, Modena, Italy.

Tongue cancer is the most common malignant neoplasm of the oral cavity. Occurrence in the tip of the tongue (TOT) is rare. We describe a case report of a TOT tumor excision and reconstruction with a prelaminated fasciomucosal radial forearm free flap. A 41-year-old white man was referred to our department for a squamous cell carcinoma of the tip of the tongue. The patient worked as an air traffic control official; therefore, conservation of speech intelligibility, both in Italian and English language, was of paramount importance. A transoral excision of TOT, bilateral selective neck dissection, and reconstruction with prelaminated fasciomucosal radial forearm free flap were performed. Adjuvant radiotherapy was necessary. The patient was completely re-established as an air traffic control officer. Successful tongue reconstruction of smaller defects depends on thinness, pliability of flap, and conservation of tongue mobility. Surgical options for TOT reconstruction are facial artery muscolomucosa flap, Zhao flap, radial forearm free flap, or primary suture. In the authors' opinion, a fasciomucosal prelaminated RFFF offers a series of advantages for TOT reconstruction. The absence of subcutaneous tissue makes the PFRFFF much thinner than fascio-cutaneous flaps. Compared with mucosal loco-regional flaps, prelaminated flaps allow the preservation of oral mucosa lining while providing adequate bulk and reduced scar formation for optimal func- tional recovery. In our case report, the fasciomucosal flap allowed an adequate reconstruction of TOT volume with good functional and aesthetic outcomes. The flap's added bulk and its minimal scar retraction granted free tongue movement and optimal speech intelligibility.
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http://dx.doi.org/10.1097/GOX.0000000000003226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787281PMC
December 2020

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

Factors related to delayed treatment: A case report of a huge cutaneous horn and review of the literature.

Ann Med Surg (Lond) 2020 Dec 10;60:384-388. Epub 2020 Nov 10.

Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.

We present a case of a man with a giant cutaneous horn over his frontal region. This case has been presented for the size of the lesion, due to delayed treatment, and to illustrate the reasons why the growth of this lesion has been possible in a western country, in the 21st century. It was a solitary, not painful lesion which caused significant aesthetic problems. The diagnosis was based on an ultrasonographic study and the treatment of choice was a surgical excision. This case is an opportunity to review the literature about the cutaneous horns, to talk about the main causes of delayed diagnosis and treatment of cutaneous lesions and, to define the role of the specialist in the assessment of emotions and patient support.
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http://dx.doi.org/10.1016/j.amsu.2020.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670244PMC
December 2020

Soft tissue coverage of the upper limb: A flap reconstruction overview.

Ann Med Surg (Lond) 2020 Dec 6;60:338-343. Epub 2020 Nov 6.

Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.

Different opinions about the reconstructive choice for upper limb are described in literature: advancement or rotation flaps, regional flaps and free flaps are the most common reconstructive options. Local and regional flaps can be used to cover small defects while large wounds require the use of free flaps or distant pedicled flaps. The coverage of large wounds opens a discussion about when to use free flaps and when distant pedicled flaps. This review will describe the different methods used for the coverage of soft tissues injuries affecting hand and/or forearm (excluding fingers). The aim is to show all flap reconstructive options in order to support the inexperienced surgeon during the management of traumatic injuries of the upper limb.
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http://dx.doi.org/10.1016/j.amsu.2020.10.069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666305PMC
December 2020

Meta-analysis of the effects of venous super-drainage in deep inferior epigastric artery perforator flaps for breast reconstruction.

Microsurgery 2021 Feb 10;41(2):186-195. Epub 2020 Nov 10.

Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Introduction: Venous congestion is the most common vascular complication of the deep inferior epigastric artery perforator (DIEP) flaps. Adding a second venous drainage by anastomosing a flap vein and a recipient vein (super-drainage) is considered the solution of choice. Evidence to support this procedure, had not yet been confirmed by an analysis of the literature. We aimed to provide this evidence.

Materials And Methods: We searched the literature (MedLine, Scopus, EMBASE, Cochrane Library, and Google Scholar), for studies discussing venous congestion and venous super-drainage in DIEP flap for breast reconstruction. Thirteen of the 35 articles compared results between one or two venous anastomoses. Meta-analysis was performed following PRISMA guidelines. Pooled risk ratio (RRs) for congestion, fat necrosis, partial necrosis, and total necrosis with corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model with the Mantel-Haenszel method. The need to return to surgery (95% CI) was estimated with a random effect model using the DerSimonian and Liard method.

Results: We showed a statistically significant advantage of super-drainage to reduce the venous congestion of the flap (RR: 0.12, 95% CI: 0.04-0.34, p-value <.001), partial flap necrosis (RR: 0.50, 95% CI: 0.30-0.84, p-value .008), total flap necrosis (RR: 0.31, 95% CI: 0.11-0.85, p-value .023), and the need to take the patient back to surgery for perfusion-related complications (RR: 0.45, 95% CI: 0.21-0.99, p value .048).

Conclusions: Performing a second venous anastomosis between the SIEV and a recipient vein (venous superdrainage) reduces venous congestion and related complications in DIEP flaps for breast reconstruction.
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http://dx.doi.org/10.1002/micr.30682DOI Listing
February 2021

Laparoscopically Assisted Transperineal Approach in the Management of a Giant Pelvic Lipoma.

Plast Reconstr Surg Glob Open 2020 Sep 23;8(9):e3065. Epub 2020 Sep 23.

Division of Plastic Surgery, University of Modena and Reggio Emilia; and Division of Urology, University of Modena and Reggio Emilia, Modena, Italy.

Giant lipomas affecting the retroperitoneum and pelvis are quite rare. The surgical management of these lesions may be technically demanding and controversies exist with respect to diagnosis, competences being involved, type of surgical approach, radicality, and timing. A unique case presentation of a giant lipoma occupying the whole pelvis and the gluteal region is presented. Due to its size, many anatomical areas are involved, requiring the expertise of multiple specialists to treat. After multidisciplinary counseling, the lesion is radically resected in one stage by using a new videolaparoscopically assisted transperineal access to the pelvis. This type of surgical approach may be of interest for resecting pelvic tumors in women and men.
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http://dx.doi.org/10.1097/GOX.0000000000003065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544394PMC
September 2020

Plastic Surgeons in the Middle of the Coronavirus Disease 2019 Pandemic Storm in Italy.

Plast Reconstr Surg Glob Open 2020 May 6;8(5):e2889. Epub 2020 May 6.

Division of Plastic Surgery, Modena University Hospital, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1097/GOX.0000000000002889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572072PMC
May 2020

Management of Personal Protective Equipment in Plastic Surgery in the Era of Coronavirus Disease.

Plast Reconstr Surg Glob Open 2020 May 21;8(5):e2879. Epub 2020 May 21.

Division of Plastic Surgery, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1097/GOX.0000000000002879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572223PMC
May 2020

The Use of Cold Atmospheric Plasma Device in Flap Elevation.

Plast Reconstr Surg Glob Open 2020 May 22;8(5):e2815. Epub 2020 May 22.

Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1097/GOX.0000000000002815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572129PMC
May 2020

How to Design and Harvest a Propeller Flap.

Semin Plast Surg 2020 Aug 22;34(3):152-160. Epub 2020 Sep 22.

Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania.

Propeller flaps are local flaps based either on a subcutaneous pedicle, a single perforator, or vessels entering the flap in such a way so as to allow the flap to rotate on their axis. Depending on the kind of pedicle and the anatomical area, the preoperative investigation and the harvesting techniques may vary. An adequate knowledge of skin and subcutaneous tissue perfusion in the different areas of the body is very important to plan a propeller flap to be successful. The surgeon should begin by finding the most suitable perforators in the area surrounding the defect using available technology. The position, size, and shape of the flap are planned about this point. For perforator-pedicled propeller flaps, the procedure starts with an exploration from the margins of the defect or through a dedicated incision to visualize any perforators in the surroundings. The most suitable perforator is selected and isolated, the skin island is replanned, and the flap is harvested and rotated into the defect. The variations in surgical technique for other types of propellers and in specific anatomical areas are also described. Compared with free flaps, propeller flaps have the advantage of a simpler, shorter operation, without the need for a recipient vessel for microanastomosis. Yet, from a technical point of view, an adequate experience in dissecting perforators and the use of magnifying glasses are almost always required.
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http://dx.doi.org/10.1055/s-0040-1714271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542207PMC
August 2020

Chronic Knee and Ankle Pain Treatment through Selective Microsurgical Approaches: A Minimally Invasive Option in the Treatment Algorithm for Refractory Lower Limb Pain.

J Reconstr Microsurg 2021 Mar 7;37(3):234-241. Epub 2020 Oct 7.

Department of Plastic, Reconstructive and Aesthetic Surgery, Global Plastic Surgery, Lausanne, Switzerland.

Background:  Injury or compression of a sensory nerve is an under-reported source of disabling pain in the lower limb. It is known that peripheral nerve microsurgeons can reconstruct and rewire injured nerves to relieve chronic pain but this option remains not completely understood and ignored by most orthopaedic surgeons, neurologists, and pain therapists. In this paper, we describe our experience with knee and ankle peripheral nerve surgery to improve the condition of patients suffering from chronic, posttraumatic lower limb pain.

Patients And Methods:  Between 2015 and 2018, a retrospective investigation was performed including patients who underwent ankle and knee nerve surgery for posttraumatic chronic pain with at least 1 year of follow-up. Previous surgeries or type of trauma, pain location and characteristics, type of operation (reconstruction, decompression, or denervation), and number of nerves operated were listed. Selective neuropathy was confirmed by ultrasound-guided nerve blocks. Outcome was assessed combining the visual analogue scale (VAS) score at rest and during movement, functional indexes, drug use, and ability to work.

Results:  A total of 34 patients (14 knee and 20 ankle) were included in this study. A statistically significant difference ( < 0.05%) in postoperative pain at rest and during activity was seen in both groups of patients. Good to excellent outcomes were recorded in 92 and 80% of patients treated, respectively, at the knee and the ankle levels. No major complications occurred, while a secondary procedure due to neuroma recurrence was necessary in seven patients (three knees and four ankles).

Conclusion:  Peripheral nerve microsurgery is a useful and minimally invasive tool to be added in the algorithm of treatment of chronic knee and ankle pain. Physicians should be trained to suspect a neuropathic origin of pain in absence of musculoskeletal signs of pathology, especially following trauma or surgeries.
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http://dx.doi.org/10.1055/s-0040-1717100DOI Listing
March 2021

The Telematic solutions in plastic surgery during COVID-19 pandemic.

Acta Biomed 2020 07 28;91(3):ahead of print. Epub 2020 Jul 28.

Division of Plastic Surgery, Modena University Hospital.

During the COVID-19 pandemic, surgical elective procedures were stopped in our plastic surgery unit. Limitations for consultations and for follow-up of previous surgical procedures were imposed in order to minimize the risk of contagion in waiting rooms and outpatient clinics. We have identified telemedicine as an alternative way to follow patients during the lockdown. Nevertheless, we have experienced different difficulties. We have not had the possibility to use a secure teleconferencing software. In our unit we had not technological devices. Surgeons in our department were not able to use remote video technology for patient management. Guidelines for an appropriate selection of patients which could be served via telemedicine had to be created. Telemedicine must be regulated by healthcare organizations for legal, ethical, medico-legal and risk management aspects. Even if we have experienced an important need to use telematic solutions during the COVID-19 lockdown, liability and risk management issues has greatly limited this possibility in our unit. The need of telemedicine in the time of COVID-19 pandemic has encouraged us to implement future virtual encounters in order to reduce unnecessary in-person visits by taking into consideration all legal, ethical and medico-legal aspects.
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http://dx.doi.org/10.23750/abm.v91i3.10291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716977PMC
July 2020

Setting of helium plasma device (J-Plasma) in flap elevation.

J Vasc Surg Cases Innov Tech 2020 Sep 15;6(3):446. Epub 2020 Jul 15.

Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy.

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http://dx.doi.org/10.1016/j.jvscit.2020.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451687PMC
September 2020
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