Publications by authors named "Maurizio Cavallini"

23 Publications

  • Page 1 of 1

Mid-face reshaping using threads with bidirectional convergent barbs: A retrospective study.

J Cosmet Dermatol 2021 Feb 28. Epub 2021 Feb 28.

Academy of Aesthetic Sciences, Naples, Italy.

Background: Minimally invasive procedures, such as thread suspension techniques, are a growing trend for facial rejuvenation. However, not enough data are available on the efficacy, outcomes, and morbidity of suture suspension techniques in mid-face reshaping.

Aims: Our goal was to assess treatment outcomes and patient satisfaction following mid-face reshaping using threads with bidirectional convergent barbs (Definisse free floating threads).

Patients/methods: We performed a retrospective analysis of 60 patients who underwent treatment for mid-face reshaping using Definisse free floating threads. Response to treatment was assessed at 6 months using the mid-face-specific Mid-Face Volume Deficit scale (Allergan ), Global Aesthetic Improvement and FACE-QTM scales.

Results: Sixty patients underwent mid-face treatment with the suspension thread technique (mean age 51.3, 90% female). No concomitant procedures were done. A reduction by one point or more in the Mid-Face Volume Deficit Scale (MDFVS) score treatment was seen in all patients after 6 months. Mean overall MFVDS and FACE-Q scores were significantly improved. On the GAIS, most patients were rated as improved or better both by the evaluating investigators and during self-assessment. No major complications were observed, and none of the patients requested the removal of the threads (mean follow-up 9.8 months, range 6-14 months).

Conclusion: Our results suggest that mid-face reshaping with Definisse free floating threads is a safe and reliable procedure characterized by low complication rates and good esthetic results. This minimally invasive procedure is a good alternative for normal or combination skin patients who refuse or want to delay the need for traditional rhytidectomy.
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http://dx.doi.org/10.1111/jocd.14038DOI Listing
February 2021

A Topical Depigmentation Program Against Hyperpigmentation Enhances the Benefits of Previously Performed Chemical Peeling Procedures of the Face.

J Cosmet Sci 2020 Nov-Dec;71(6):385-397

Unit of Dermatology and Dermatosurgery, CDI Hospital, Milan 20124, Italy (M.C., M.P.), Statistics and Data Management Unit, Latis S.r.l., Genova 16121, Italy (F.M.).

Chemical peeling can reduce skin hyperpigmentation; however, once exhausted its thinning action, the depigmentation process does not continue further. We carried out a monocentric, prospective, noncontrolled study aimed at the evaluation of the efficacy, safety, ease of use, pleasantness, and tolerability of a depigmentation topical treatment program in women submitted to a previous chemical peeling. The topical treatment has been administered daily for 30 days to 16 women submitted to a chemical peeling containing a fixed-dose combination of salicylic acid, pyruvic acid, and retinoic acid within 7 days before study inclusion. Target skin areas have been evaluated for melanin concentration and skin texture before peeling and at study visits 1 (after peeling) and 2 (after the 30-day treatment). The topical treatment program induced a decrease in melanin concentration between study visits 1 and 2 (-4.74%; = 0.0008). It reduced melanin concentration even further between the prepeeling period and visit 2 (-7.8%; < 0.0001). Patients rated the depigmentation topical treatment program as "very simple" (87.5%) and "simple" (12.5%) to use and as "pleasant" (56.25%) and "very pleasant" (43.75%). Results support the use of the home-based depigmentation topical treatment program to potentiate the effectiveness of a previous chemical peeling in hyperpigmentation reduction.
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January 2021

Consensus report on the use of PN-HPT™ (polynucleotides highly purified technology) in aesthetic medicine.

J Cosmet Dermatol 2021 Mar 21;20(3):922-928. Epub 2020 Sep 21.

Vice-President, SIMES, Italian Society of Esthetic Medicine, Fatebenefratelli Hospital, Rome, Italy.

Background: Injective procedures using polynucleotides-based products to promote dermal rejuvenation and revitalization are steadily evolving, yet no structured protocols are available that discuss and provide guidance in aesthetic treatments with highly purified polynucleotides. The goal of this document was to provide consensus-based recommendations for the safe and effective use of Polynucleotides Highly Purified Technology™ (PN-HPT™) devices for skin rejuvenation.

Patients/methods: A team of eight experts with extensive experience in treatments for skin rejuvenation and revitalization integrated the best available evidence and clinical judgment and devised a series of practical guidance to support dermatologists, plastic surgeons, and aesthetic physician in the use of PN-HPT™ products, alone and in combination, in aesthetic medicine.

Results: For most items, the expert group achieved a majority consensus. "Recommendations" (consensus >80%) were reached for the face, periocular area, décolleté and neck, hands, scalp, and stretch marks. Recommendations include details of techniques, information on dosage, volumes to be injected, and the ideal number of required treatment sessions, as well as time intervals between them for different areas of face and body. A lower agreement level of 60% was reached on but one item related to the initial treatment cycle for the face, leading to a "Consensus statement" for that area instead of a full "Recommendation."

Conclusion: The expert consensus illustrates the value of natural-origin, highly purified polynucleotides (PN-HPT™) as biostimulatory booster strategy for skin priming and revitalization of face and body and provides a detailed guide for the use.
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http://dx.doi.org/10.1111/jocd.13679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984045PMC
March 2021

Expert Consensus on Injection Technique and Area-Specific Recommendations for the Hyaluronic Acid Dermal Filler VYC-12L to Treat Fine Cutaneous Lines.

Clin Cosmet Investig Dermatol 2020 5;13:267-274. Epub 2020 Apr 5.

Diagnostiskt Centrum Hud, Stockholm, Sweden.

Background: VYC-12L is a hyaluronic acid (HA) injectable gel designed to treat fine cutaneous lines and improve skin quality attributes such as hydration and elasticity.

Objective: Expert consensus was sought on VYC-12L injection technique and primary treatment target areas.

Methods: A multinational group of aesthetic medicine clinicians (n = 128) attended product training and each identified ~10 patients for VYC-12L. After treating their first and last patients, the clinicians completed a survey on preferred injection methodology/technique, including injection angle, volume, and spacing. An expert panel (n = 12) discussed survey results and their clinical experiences to obtain consensus on VYC-12L technique and appropriate treatment areas.

Results: Recommendations included micro-depot injections of VYC-12L into the deep dermis with a 32G ½ inch needle inserted at <45º to the skin, spaced 0.5‒1.0 cm apart, with 0.01‒0.05 mL volume per injection (full-face total volume: ~2 mL). Recommended primary treatment areas were the malar, perioral, neck, and décolletage regions. Injection techniques for different treatment areas/demographic characteristics were similar, with some variability in treatment approach. Patient selection criteria, pre- and post-treatment guidelines, and managing patient expectations are important components of treatment.

Conclusion: These consensus recommendations may assist clinicians in optimizing the treatment of fine lines with VYC-12L.
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http://dx.doi.org/10.2147/CCID.S239667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152505PMC
April 2020

VYC-12 Injectable Gel Is Safe And Effective For Improvement Of Facial Skin Topography: A Prospective Study.

Clin Cosmet Investig Dermatol 2019 24;12:791-798. Epub 2019 Oct 24.

Clinical Development, Allergan Plc, Irvine, CA, USA.

Objective: Evaluate safety and effectiveness of VYC-12 (Juvéderm Volite; an injectable crosslinked hyaluronic acid gel designed to improve skin quality attributes such as surface smoothness and hydration) for facial intradermal injection.

Materials And Methods: In a prospective, single-arm study, subjects with moderate/severe cheek skin roughness per Allergan Skin Roughness Scale (ASRS) received VYC-12 in the cheeks and forehead, and/or neck, with touch-up treatment to correct asymmetry 30 days later and optional repeat treatment 9 months after last treatment. The primary effectiveness measure was ASRS responder rate (percentage of cheeks with ≥1-point improvement from baseline) at month 1. Skin hydration was instrument-assessed.

Results: Of 131 subjects treated, 31 (23.7%) received touch-up treatment. ASRS responder rate was 96.2% at month 1, 76.3% at month 4, 34.9% at month 6, and 87.1% after repeat treatment. Responder rate in cheeks with severe baseline roughness was 93.8%, 83.1%, and 52.3% at months 1, 4, and 6, respectively. Skin hydration improved significantly (<0.01) from baseline at all timepoints through month 9. Injection site responses were as expected. All treatment-related adverse events were mild/moderate.

Conclusion: VYC-12 safely and effectively improved skin smoothness up to 6 months and hydration lasting 9 months.
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http://dx.doi.org/10.2147/CCID.S216222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817835PMC
October 2019

Improvements in satisfaction with skin after treatment of facial fine lines with VYC-12 injectable gel: Patient-reported outcomes from a prospective study.

J Cosmet Dermatol 2020 May 17;19(5):1065-1070. Epub 2019 Oct 17.

Allergan plc, Irvine, CA, USA.

Background: VYC-12, a hyaluronic acid injectable gel, is designed to treat fine lines and provides improvements in other skin quality attributes. A prospective study demonstrated the safety and effectiveness of VYC-12 for the improvement of fine lines as measured by changes in skin texture.

Aims: To evaluate patient-reported outcomes in subjects treated intradermally with VYC-12 in the cheeks, forehead, and neck (optional) in the prospective study.

Methods: Subjects received an initial treatment of VYC-12 (N = 131), with a touch-up treatment, if deemed necessary, offered 30 days later, and optional repeat treatment 9 months after initial or touch-up treatment. Subjects completed the FACE-Q Satisfaction With Skin scale and assessed willingness to recommend treatment to a friend at baseline, months 1, 4, 6, and 9, and month 1 after repeat treatment. Subjects also evaluated their return to normal daily social activities.

Results: Satisfaction with skin improved from baseline in 90.8% of subjects at month 1, 88.4% at month 4, 83.6% at month 6, 76.4% at month 9, and 91.9% at month 1 after repeat treatment (P < .001, all time points). At least 94% of subjects returned to normal daily social activities one day after treatment (initial, touch-up, or repeat). More than 80% of subjects said they would recommend treatment to a friend at all time points through month 9 (97% at month 1 after repeat treatment).

Conclusion: Treatment with VYC-12 significantly improved satisfaction with skin in the majority of subjects, with most subjects returning to normal activities 1 day after treatment.
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http://dx.doi.org/10.1111/jocd.13129DOI Listing
May 2020

Efficacy, Patient-Reported Outcomes, and Safety in Male Subjects Treated With OnabotulinumtoxinA for Improvement of Moderate to Severe Horizontal Forehead Lines.

Dermatol Surg 2020 02;46(2):229-239

Allergan Plc, Irvine, California.

Background: Men represent a growing segment of the facial aesthetic market.

Objective: To evaluate investigator-assessed efficacy, patient-reported outcomes, and safety after onabotulinumtoxinA treatment of forehead lines (FHL) in men.

Methods: Subjects with moderate to severe FHL received onabotulinumtoxinA (frontalis: 20 U; glabellar complex: 20 U, with/without 24 U in crow's feet regions) or placebo in 6-month, double-blind periods of 2 pivotal trials. Results for men were pooled.

Results: Men comprised 12% (140/1,178) of subjects. Day 30 male responder rates for achieving at least 1-grade Facial Wrinkle Scale (FWS) improvement at maximum eyebrow elevation and at rest were 98.2% and 93.3%, respectively; a significant difference in responder rates was maintained versus placebo (p < .05) through Day 150. Despite men having proportionately more severe FHL at baseline, 81.8% and 79.8% achieved Day 30 FWS ratings of none or mild at maximum eyebrow elevation and at rest, respectively (p < .05); significance versus placebo was maintained through Day 120. Men reported high satisfaction rates and improved psychological impacts. No new safety signals were detected.

Conclusion: Standard dosing and administration of onabotulinumtoxinA significantly improved static and dynamic FHL appearance, despite men having proportionately more severe FHL at baseline. Men reported high satisfaction and appearance-related psychological impact improvements.
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http://dx.doi.org/10.1097/DSS.0000000000002047DOI Listing
February 2020

Skin Quality Improvement With VYC-12, a New Injectable Hyaluronic Acid: Objective Results Using Digital Analysis.

Dermatol Surg 2019 12;45(12):1598-1604

Studio Medico Dott.ssa MgPatalano, Messina, Italy.

Background: VYC-12 is a novel hyaluronic acid-based dermal filler designed to treat fine lines and improve skin quality. A specialist digital camera and proprietary Digital Analysis of the Cutaneous Surface (DACS) software have previously been used to objectively measure changes in skin features.

Objective: To assess the effect of facial treatment with VYC-12 on skin texture using the specialist camera.

Materials And Methods: This was a prospective, open-label, 2-center study of 40 women aged 35 to 60 years treated with multiple, microdepot intradermal injections of VYC-12 (2 mL in the face; 1 mL in the neck if required). Eight patients (20.0%) required a touch-up at Day 45. Images were acquired using the specialist camera at baseline and 45 days and 6 months after treatment, and were analyzed by DACS. Clinical improvements were also assessed subjectively using the Global Aesthetic Improvement Scale (GAIS).

Results: VYC-12 improved skin texture from baseline after 45 days (mean improvement: 25.9% ± 9.2%) and 6 months (mean improvement: 30.7% ± 18.2%). Improvements were also evident using the GAIS. There were no major adverse events.

Conclusions: VYC-12 improves skin quality, as measured using an objective, fast, and reproducible measuring tool. VYC-12 represents a valuable addition to the treatment armamentarium.
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http://dx.doi.org/10.1097/DSS.0000000000001932DOI Listing
December 2019

Italian consensus report on the aesthetic use of onabotulinum toxin A.

J Cosmet Dermatol 2018 Oct 9;17(5):719-730. Epub 2018 Aug 9.

Private Practice, Milan, Italy.

Background: The aesthetic treatment of facial and neck wrinkles with botulinum toxin is constantly increasing, thus making it necessary to collect procedures guidelines for the use of botulinum toxin in the treatment of wrinkles and/or cosmetic defects.

Methods: A group of nine Italian doctors, plastic and maxillo-facial surgeons, dermatologists and aesthetic physicians, experts in face and neck aesthetic treatments with onabotulinum toxin A, discussed on procedures used in their clinical practice. From the data collected and discussed by the board, some recommendations on aesthetic treatment with onabotulinum toxin A were developed.

Results: Recommendations have been made on pretreatment, reconstitution of onabotulinum toxin A, as well as on treatment procedures, in terms of injection sites and total dose of onabotulinum toxin A for the following indications: glabellar lines, crown's feet lines, forehead lines, eyebrow shaping, lower orbicularis oculi hypertrophy, bunny lines, sagging nasal tip, gummy smile, masseter hypertrophy, perioral lines, marionette lines, hypertonic mentalis, and platysma bands.

Conclusions: The use of onabotulinum toxin A in the aesthetic field requires careful initial assessment of the patient in its complexity and individuality. Moreover, this treatment needs the use of standardized procedures to achieve the effectiveness and safety of onabotulinum toxin A in clinical practice.
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http://dx.doi.org/10.1111/jocd.12729DOI Listing
October 2018

Gummy Smile Treatment: Proposal for a Novel Corrective Technique and a Review of the Literature.

Aesthet Surg J 2018 11;38(12):1330-1338

Seconda Università Federico II, Napoli, Italy.

Background: A perfect smile is dictated by the balance among 3 parameters: the white (teeth), the pink (gum), and the lips: excessive gingival display while smiling has been a cause of esthetic embarrassment for many patients, thus affecting their psychosocial behavior. With respect to different etiologies, treatment of gummy smile must be properly planned: treatment options include facial surgery, oral surgery, or laser.

Objectives: Given the growing demand for less invasive techniques and observed complications secondary to botulinum toxin injection, we present a novel treatment option aimed at correcting gummy smile using hyaluronic acid injection and review the published techniques and the anatomy of the involved facial muscles.

Methods: The treatment was performed by infiltration in the paranasal area, in the location of the most cranial portion of the nasojugal fold, about 3 mm lateral to the alar cartilage wing, according to a vector perpendicular to the cutaneous plane, to gently compress the lateral fibers of the levator labii superioris alaeque nasi without invading it. A Vycross® technology filler was used for all the treatments.

Results: All patients had an immediate improvement, with a maximum duration ranging from 186 to 240 days (mean, 213 days), according to parameters of the Global Aesthetic Improvement Scale (GAIS 4.06).

Conclusions: This new, less invasive and safer technique to correct dynamic excessive gingival display was shown to be feasible and safe with a long-lasting result. This treatment could be a novel effective option for experienced injectors to treat aesthetic facial flaws.

Level Of Evidence 4:
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http://dx.doi.org/10.1093/asj/sjy174DOI Listing
November 2018

Preliminary Report on an Objective, Fast, and Reproducible Method to Measure the Effectiveness of Botulinum Toxin Type A.

Aesthet Surg J 2015 Aug 12;35(6):715-20. Epub 2015 May 12.

Dr Cavallini is a plastic surgeon in private practice in Milano, Italy.

Background: The injection of botulinum toxin type A for cosmetic proposes is a popular procedure, although the interpretation of its effectiveness still poses a challenge. In fact, although the methods that evaluate the efficacy of the treatment are validated and reliable, they are usually based on subjective scales, while an objective and quantitative scale is still needed.

Objectives: I propose an objective, fast, and reproducible method to evaluate the severity of wrinkles with a three-dimensional imaging and texture analysis.

Methods: Digital Analysis of the Cutaneous Surface (DACS) is employed to analyze cutaneous texture. Measures are performed in the glabellar area before and one month after infiltration of 15 units of onabotulinumtoxin-A.

Results: Eight women were included in this study. DACS was able to detect improvements in all cases. On average, static lines decreased by 12.4% and dynamic lines by 41.2%.

Conclusions: DACS provides an objective, direct, fast, and reproducible method to measure the results of botulinum toxin type A usage. It avoids the use of subjective scores, gives a direct measure of the wrinkles, is simple to perform, and allows the operator to analyze only the desired area.

Level Of Evidence: 4 Therapeutic.
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http://dx.doi.org/10.1093/asj/sju104DOI Listing
August 2015

The setting of a botulinum toxin treatment service.

Neurol Sci 2014 May;35 Suppl 1:49-50

Neurology Department, Ospedale Cardinal Massaia, Via Conte Verde 125, 14100, Asti, Italy,

The administration of botulinum toxin is an activity performed mostly by a specialist service for the management of a wide range of neurological conditions. For therapeutic purposes botulinum toxin type A is used, although in selected patients who develop antibodies specific for the serotype A botulinum toxin B can be used for the treatment. Hereby, we describe the organizational arrangements for the botulinum toxin treatment service at the Department of Neurology of Hospital Cardinal Massaia based in Asti. The diseases most frequently treated are movement disorders (primary and secondary focal dystonia, blepharospasm, facial emispasmo) spasticity and, more recently, chronic migraine. In particular, the latter application is one of the most promising expansions of the use of this drug in the few past years, although a larger number of patients are required to determine its efficacy and the related tolerability profile.
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http://dx.doi.org/10.1007/s10072-014-1742-4DOI Listing
May 2014

Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies.

Dermatol Surg 2014 May 28;40(5):525-36. Epub 2014 Feb 28.

Unit of Plastic Surgery, Centro Diagnostico Italiano, Milan, Italy.

Background: The use of botulinum toxin A (BoNT-A) for aesthetic treatments is growing steadily, and new safety data have been reported in recently published studies.

Objective: To investigate the safety data on the use of the three BoNT-A formulations approved for facial aesthetics from recent studies and to confirm their safety profiles.

Methods: The literature search was conducted using three online databases restricted to the timeframe from January 2000 to June 2012. Only clinical trials, randomized or open label, with safety as the primary or secondary endpoint, were included.

Results: Thirty-five papers were selected, with a total of subjects 8,787 studied. OnabotulinumtoxinA was used in 60.0% of the studies, abobotulinumtoxinA in 37.1%, and incobotulinumtoxinA in 2.8%. The glabella was the most investigated area (51.4%), followed by the upper face (25.7%), crow's feet (11.4%), and lower face (11.4%). Treatment-related adverse events were blepharoptosis (2.5%), brow ptosis (3.1%), and eye sensory disorders (3%) in the upper face and lip asymmetries and imbalances in the lower face (6.9%). All of these events resolved spontaneously.

Conclusion: The short-term safety profile of BoNT-A in cosmetic nonsurgical procedures was confirmed for all the three commercial formulations.
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http://dx.doi.org/10.1111/dsu.12463DOI Listing
May 2014

The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers.

Aesthet Surg J 2013 Nov 6;33(8):1167-74. Epub 2013 Nov 6.

Dr Cavallini is a plastic surgeon in private practice in Milano, Italy.

Hyaluronidases, a family of enzymes that are able to degrade hyaluronic acid (HA), are employed in medicine to increase drug diffusion and reverse the effects of HA filler injections. Hyaluronidases are able to dissolve subcutaneous nodules or to correct excessive quantities of injected filler. Knowledge of the use, methods of application, and adverse effects of hyaluronidases is essential for the aesthetic practitioner. Therefore, we performed an extensive review of the available literature from 1928 to 2011 and compared the different enzymes available, recording each author's indications regarding usage and side effects.
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http://dx.doi.org/10.1177/1090820X13511970DOI Listing
November 2013

Radiometric infrared temperature detection in skin expansion.

Plast Reconstr Surg 2012 Nov;130(5):762e-764e

Dipartimento di Scienze Medico Chirurgiche, Università degli Studi di Milano, IRCCS Policlinico San Donato, Milan, Italy (Gazzola) Servizio di Chirurgia Plastica, Centro Diagnostico Italiano, Milan, Italy (Cavallini) Plastic Surgery Department, Azienda Ospedaliera "Santa Maria della Misericordia", Università di Udine, Gemona del Friuli, Italy (Parodi) Dipartimento di Scienze Medico Chirurgiche, Università degli Studi di Milano, IRCCS Policlinico San Donato, Milan, Italy (Benanti, Vaienti).

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http://dx.doi.org/10.1097/PRS.0b013e318267d9c0DOI Listing
November 2012

Effects of adhesive dressings on stratum corneum conductance.

Skin Res Technol 2012 May 21;18(2):241-4. Epub 2011 Aug 21.

Servizio di Chirurgia Plastica, Centro Diagnostico Italiano, Milano, Italy.

Background: Stratum corneum is a fundamental layer of epidermis. It acts as a barrier, with antimicrobial features, regulating skin permeability and integrity as well. Adhesive dressings and their removal could alter this layer, affecting cutaneous water balance and lipid composition of stratum corneum. These changes could be monitored by measurement of cutaneous hydration.

Methods: Ninety-two patients affected by wounds dressed with adhesive tapes or plasters have been studied. Measurement of skin conductance under tape/plaster and in the surrounding healthy skin, immediately after removal of dressing has been performed. Dressing age, wound localization, and characteristics were also considered.

Results: Adhesive dressings alter significantly stratum corneum conductance. Although healthy skin hydration has significant variations throughout the body, cutaneous conductance under adhesive dressing in different areas displays no significative changes. Moreover, the increase in hydration due to adhesive tapes/plasters showed no association with wound dehiscence.

Discussion: Adhesive dressings cause a significative increase in stratum corneum conductance, acting as a barrier to apocrine secretions. Although different hydration levels have been observed in healthy skin throughout the body, no difference exists under adhesive dressing among different regions, suggesting no contraindications in their employment throughout the body.

Conclusion: Increase in cutaneous hydration showed no correlations with wound dehiscence, thus confirming safety and practicality of these dressings.
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http://dx.doi.org/10.1111/j.1600-0846.2011.00561.xDOI Listing
May 2012

Post operative delirium with hyponatriemia after transurethral resection of the prostate: a case of transurethral resection syndrome?

Acta Neurol Belg 2011 Jun;111(2):152-4

Neurological Department, Ospedale Cardinal Massaia, Asti, Italy.

Postoperative delirium is one of the most spectacular, frightening and misdiagnosed postoperative complications of surgery. We describe the case of a caucasian 77-year-old male patient, who developed a severe postoperative delirium after combined transurethral resection of the prostate and cystolithotripsy. This systemic and unpredictable complication of endoscopic surgery is caused by excessive absorption of electrolyte-free irrigation fluids, leading to brain edema and metabolic encephalopathy. The clinical spectrum ranges from asymptomatic hyponatraemia, to electrocardiographic (ECG) changes, nausea, vomiting, convulsions, coma, pulmonary edema, cardiovascular compromise and death. Because of the heterogeneous clinical presentation diagnosis can be difficult. In a patient who develops alterations of consciousness with evidence of hypervolemia and hyponatremia after endoscopic surgery, transurethral resection syndrome must be considered.
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June 2011

Safety of dermal diphoterine application: an active decontamination solution for chemical splash injuries.

Cutan Ocul Toxicol 2009 ;28(4):149-56

Toxicology Consulting and Medical Translating Services, Inc., Laramie, Wyoming 82072, USA.

Diphoterine (Laboratoire Prevor, Valmondois, France) is an active, amphoteric, polyvalent, chelating, slightly hypertonic decontamination solution for chemical splashes to the skin and eyes. It chemically binds a large number of chemical substances present on the skin surface without causing a significant release of heat (exothermic reactions). Because of its amphoteric properties, it can bind chemically opposite substances such as acids and bases or oxidizers and reducing agents. No adverse effects have been observed in an ongoing postmarketing surveillance program during many years of use in European industrial facilities. Diphoterine has more recently been used in hospitals for delayed management of chemical burns to the skin and eyes. There is interest in having protocols for both immediate and delayed diphoterine use for skin decontamination. Whereas studies of diphoterine efficacy, clinical and in vitro or ex vivo, have been published or are in the process of being prepared for publication, no review has yet been published focusing solely on the safety of this decontamination solution. Therefore, all available studies on the safety of diphoterine are described here, including recent studies demonstrating no harmful effects on the skin. Diphoterine can be used, even on damaged skin, without toxic, irritant, allergenic, or sensitizing effects.
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http://dx.doi.org/10.3109/15569520903269122DOI Listing
January 2010

The supratip triangle.

Plast Reconstr Surg 2008 Jul;122(1):19e-20e

Istituto Ortopedico Galeazzi; University of Milan; Milan, Italy.

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http://dx.doi.org/10.1097/PRS.0b013e31817746eaDOI Listing
July 2008

Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery.

Plast Reconstr Surg 2005 Jul;116(1):316-21; discussion 322-3

Unit of Plastic Surgery, Galeazzi Hospital, Milan, Italy.

Background: The aim of this prospective, controlled study was to evaluate the effects on coagulation function of active patient warming during elective plastic surgery.

Methods: Seventy-six patients undergoing elective plastic surgery (additive and reductive mastoplasty, rhinoplasty, and liposuction) were either covered with standard sterile drapes (control group, n = 38) or actively warmed during surgery with countercurrent fluid warming and forced-air skin warming (treatment group, n = 38). Complete evaluation of the coagulation activity was performed 1 hour before general anesthesia was induced and then at the end of surgery.

Results: Although no differences in preoperative core temperature were observed (36.0 +/- 0.5 degrees C in the control group and 36.1 +/- 0.4 degrees C in the treatment group; p = 0.12), core temperature was lower at the end of surgery in the control group (34 +/- 1.0 degrees C) than in the treatment group (36 +/- 0.6 degrees C) (p = 0.0005). No differences in prothrombin time and fibrinogen plasma concentrations were observed between the two groups. At the end of surgery, control group patients showed significantly larger activated partial thromboplastin times (36.8 +/- 3.5 seconds) and bleeding times (8.1 +/- 1.6 minutes) as compared with patients maintained normothermic during surgery (34.0 +/- 2.9 seconds and 4.3 +/- 1.1 minutes; p = 0.0005 and p = 0.0005, respectively).

Conclusion: Actively maintaining intraoperative normothermia allows patients to maintain normal coagulation function during elective plastic surgery lasting longer than 2 hours, potentially reducing the occurrence of bleeding-related complications after plastic surgery.
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http://dx.doi.org/10.1097/01.prs.0000170798.45679.7aDOI Listing
July 2005

Surgical approach in a rare case of coloboma-choristoma.

Br J Plast Surg 2005 Jul;58(5):732-5

Department of Plastic and Reconstructive Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.

Embryogenic eyelid defects can be isolated or associated with malformative diseases, such as Tessier craniofacial clefts. We describe the exceptional coexistence of upper eyelid coloboma and lower eyelid dermolipoma in a 45-day-old infant with a Tessier no. 0-1 cleft. The surgical intervention carried out on this patient, which used a flap of subconjunctival choristoma and grafting of reshaped cutaneous and tarsal portions of a preauricular anlage, is presented as a technique for correcting congenital palpebral coloboma. Adoption of this technique allowed virtually complete repair of the defect and gave an acceptable functional and cosmetic result.
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http://dx.doi.org/10.1016/j.bjps.2005.03.005DOI Listing
July 2005