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Valentina PINTO

Ricercatore t.d. art. 24 c. 3 lett. B
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto
Tutor di tirocinio
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze sede ex-Sc. Biomediche

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Pubblicazioni

2023 - Folded Radial Forearm Free Flap for the Reconstruction of Total Soft Palate Defects: Operative Technique [Articolo su rivista]
Nocini, R.; Favero, V.; Molteni, G.; Pinto, V.; Chiarini, L.; Nocini, P. F.
abstract

Background:The surgical plan to reconstruct the palate must be carefully prepared given the morphological peculiarity of the soft palate forming both the roof of the mouth and the floor of the nasal cavity. This article focuses on the use of folded radial forearm free flaps to manage isolated defects of the soft palate in the absence of tonsillar pillar involvement. Methods:Three patients affected by squamous cell carcinoma of the palate underwent resection of the soft palate and immediate reconstruction with a folded radial forearm free flap. Results:All three patients showed good short-term morphological-functional outcomes as far as swallowing, breathing, and phonation were concerned. Conclusions:The folded radial forearm free flap seems to be an efficacious way to manage localized defects of the soft palate, given the positive outcomes of the three patients treated, and in accordance with other authors. In general, the radial forearm free flap was confirmed to be a versatile solution for those intraoral defects of the soft tissue requiring a limited quantity of volume as in the case of the soft palate.

2022 - Autologous Marrow Mesenchymal Stem Cell Driving Bone Regeneration in a Rabbit Model of Femoral Head Osteonecrosis [Articolo su rivista]
Mastrolia, I.; Giorgini, A.; Murgia, A.; Loschi, P.; Petrachi, T.; Rasini, V.; Pinelli, M.; Pinto, V.; Lolli, F.; Chiavelli, C.; Grisendi, G.; Baschieri, M. C.; Santis, G. D.; Catani, F.; Dominici, M.; Veronesi, E.
abstract

Osteonecrosis of the femoral head (ONFH) is a progressive degenerative disease that ultimately requires a total hip replacement. Mesenchymal stromal/stem cells (MSCs), particularly the ones isolated from bone marrow (BM), could be promising tools to restore bone tissue in ONFH. Here, we established a rabbit model to mimic the pathogenic features of human ONFH and to challenge an autologous MSC-based treatment. ON has been originally induced by the synergic combination of surgery and steroid administration. Autologous BM-MSCs were then implanted in the FH, aiming to restore the damaged tissue. Histological analyses confirmed bone formation in the BM-MSC treated rabbit femurs but not in the controls. In addition, the model also allowed investigations on BM-MSCs isolated before (ON-BM-MSCs) and after (ON+BM-MSCs) ON induction to dissect the impact of ON damage on MSC behavior in an affected microenvironment, accounting for those clinical approaches foreseeing MSCs generally isolated from affected patients. BM-MSCs, isolated before and after ON induction, revealed similar growth rates, immunophenotypic profiles, and differentiation abilities regardless of the ON. Our data support the use of ON+BM-MSCs as a promising autologous therapeutic tool to treat ON, paving the way for a more consolidated use into the clinical settings.

2022 - Defining the Inframammary Fold by Liposuction: An Essential Tool in Aesthetic Shaping of the Reconstructed Breast. Technique and Long-term Results in a Series of Patients [Articolo su rivista]
Pinto, Valentina; Pignatti, Marco; Contu, Luca; Cipriani, Riccardo
abstract

Abstract Background A good inframammary fold (IMF) definition and position is essential to achieve a satisfactory and natural result in breast surgery. This structure can be damaged, especially during mastectomies. Multiple methods are reported in the literature to restore IMF or improve its definition. In this study, we present the results achieved in a series of patients treated with subdermal liposuction. Methods We report on all our patients who underwent IMF liposuction between January 2016 and June 2020. Subdermal liposuction was performed with a blunt 3 mm cannula along the new IMF to promote skin retraction and adherence between skin and fascia. Results were evaluated subjectively by the patients and objectively by 8 individuals not involved with the treatment. Results We performed IMF liposuction in 88 breasts (69 patients), aged 21–74 (mean 52) years for 82 implant-based reconstructions, 2 tuberous breasts, and 4 contralateral breast augmentations. Mean follow-up was 28 months (6–64). Subjective results: the overall result evaluated with the VAS scale reached 86.6/100. All the 22 patients interviewed judged as well defined the new inframammary fold. Objective results: in 83% of cases the definition of the inframammary fold was judged as good or excellent, while symmetry with contralateral IMF, natural appearance, and overall aesthetic outcome were judged as good. Conclusion Based on our long-term satisfactory results, we recommend the technique of subdermal liposuction to improve the definition of IMF in breast reconstruction after mastectomy and other breast procedures. It is effective, easy to perform, minimally invasive, and durable.

2022 - Use of the Spare-Part Strategy to Reconstruct the External Auditory Canal After Subtotal Auriculectomy for Basal Cell Carcinoma [Articolo su rivista]
Pignatti, Marco; Sorbi, Gioia; Pinto, Valentina; Sorrenti, Giovanni; Cipriani, Riccardo
abstract

After removal of an infiltrative BCC of the auditory meatus, a soft tissue defect of the temporal-mastoid area with bone exposure, needed reconstruction. Several options have been taken into account and a simple yet effective solution has been found following the spare-parts principle. The ear lobe, preserved during cancer removal, was split and used as a thin skin flap. Adequate coverage of the bone exposure and resurfacing of the external auditory canal was obtained with minimal donor site morbidity and a short surgery in a fragile patient with several comorbidities. The spare-parts strategy can provide successful solution to difficult reconstructive cases regardless of the anatomical area.

2021 - Autologous platelet-rich fibrin: A novel method for tracheoesophageal puncture site closure: A case report [Articolo su rivista]
Pinto, V.; Morselli, P. G.; Sciarretta, V.; Piccin, O.
abstract

Closure of a tracheoesophageal puncture site performed during voice prosthesis implantation may sometimes be required. Besides local techniques, more elaborate procedures, such as closure by means of free microvascular flaps, have been advocated. In this report, we describe a case of local treatment of a hard-to-heal fistula with local application of autologous platelet-rich fibrin matrix in a 77-year-old male patient. At one-week follow-up, the size of the fistula had decreased dramatically but some leakage remained when drinking. After one month, the patient was able to drink and eat normally without any leakage. There was no recurrence of the leakage at two years' follow-up. In summary, local application of platelet-rich fibrin seems to be a simple, safe and effective procedure for tracheoesophageal fistula closure..

2021 - Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature [Articolo su rivista]
Pignatti, Marco; Pinto, Valentina; Giorgini, Federico A; Lozano Miralles, Maria Elisa; D'Arpa, Salvatore; Cipriani, Riccardo; De Santis, Giorgio
abstract

Background Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV. Methods We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV. Results Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis. Conclusion Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.

2021 - Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study [Articolo su rivista]
Jc, Glasbey; D, Nepogodiev; Jff, Simoes; O, Omar; E, Li; Ml, Venn; Pgdme, ; Chaar MK, Abou; V, Capizzi; D, Chaudhry; A, Desai; Jg, Edwards; Jp, Evans; M, Fiore; Jf, Videria; Sj, Ford; I, Ganly; Ea, Griffiths; Rr, Gujjuri; Ag, Kolias; Hma, Kaafarani; A, Minaya-Bravo; Sc, McKay; Hm, Mohan; Kj, Roberts; C, San Miguel-Méndez; P, Pockney; R, Shaw; Nj, Smart; Gd, Stewart; S, Sundar Mrcog; R, Vidya; Aa, Bhangu; Collaborative, COVIDSurg; Emanuela, Palmerini; Tommaso, Frisoni; Davide, Donati; Belvedere, A; Bernante, P; Bertoglio, P; Boussedra, S; Brunocilla, E; Cipriani, R; Cisternino, G; De Crescenzo, E; De Iaco, P; Dondi, G; Frio, F; Jovine, E; Mineo Bianchi, F; Neri, J; Parlanti, D; M Perrone, A; P Pezzuto, A; Pignatti, M; Pinto, V; Poggioli, G; Ravaioli, M; Rottoli, M; Schiavina, R; Serenari, M; Serra, M; Solli, P; Taffurelli, M; Tanzanu, M; Tesei, M; Violante, T; Zanotti, S; Tonini, V; Cervellera, M; Gori, A; Sartarelli, L
abstract

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway.PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation).RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76).CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

2021 - Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study [Articolo su rivista]
Pignatti, M; Rottoli, M; Cipriani, R; Pinto, V; Covidsurg, Collaborative
abstract

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment.

2021 - Invited Response on: Letter-to-the-Editor: Defining the Inframammary Fold by Liposuction: An Essential Tool in Aesthetic Shaping of the Reconstructed Breast—Technique and Long-Term Results in a Series of Patients [Articolo su rivista]
Pignatti, M.; Pinto, V.; Contu, L.; Cipriani, R.
abstract

We read with interest the commentary by Atiyeh et al. to our paper ‘‘Defining the Inframammary Fold by Liposuction: An Essential Tool in Aesthetic Shaping of the Reconstructed Breast. Technique and Long-Term results in a Series of Patients’’. We are grateful for their interest in our work and their constructive comments on the important role of a well-defined inframammary fold as a critical visual landmark for breast aesthetics

2021 - Microsurgical Reconstruction of the Nose: The Aesthetic Approach to Total Defects [Articolo su rivista]
Pinto, V.; Antoniazzi, E.; Contedini, F.; Pignatti, M.; Pizzigallo, A.; Marchetti, C.; Cipriani, R.
abstract

Background Reconstruction of complex defects involving nose and close facial units represents an aesthetic and functional challenge. Restoring satisfactory nasal shape, combining aesthetic, nasal function and patent airways is mandatory. In this paper, we describe our approach to total nose defects and we report our 20-year experience in microvascular nose reconstruction.Clinical cases are shown to illustrate different surgical techniques and the evolution of our approach. Methods Nasal reconstruction procedures were performed on 21 patients between 2000 and 2020 using the radial forearm flap (RFF) or anterolateral thigh (ALT) flap. Reported reconstructions included total/subtotal nasal defects, caused by cancer resections. The key point of our approach is the expanded forehead flap for skin coverage. Reconstruction is completed by cartilage grafts to restore nasal framework and to shape nasal tip. Ancillary procedures were needed in some cases to optimize aesthetic outcomes. Results Twenty-one patients completed the multistage nasal reconstruction. The RFF flap was used in 56% of the cases (n = 11), while the ALT flap was used in 44% (n = 10) of our case series. No difference has been detected in the number of reconstructive stages required to achieve the final result comparing RFF and ALT reconstruction (3.3 vs. 3.1 reconstructive steps). Ancillary procedures were performed in 7 patients. Conclusion Microvascular tissue transfer plays a key role in full-thickness nasal defects restoration. Comparing the two groups, both the RFF and ALT are effective and reliable options in lining reconstruction, although with different indications. Expanded forehead flap, combined to free cartilage graft, is our gold standard to provide external skin coverage to rebuild the nasal framework. According to our current approach, accurate preoperative planning, supported by modern technologic tools, multistage reconstruction, and ancillary procedures are useful to accomplish satisfactory functional and aesthetic outcomes.

2021 - Nail-plate dystrophy of the fifth toenail: thinking outside the box [Articolo su rivista]
Dika, E.; Lambertini, M.; Misciali, C.; Fanti, P. A.; Contedini, F.; Pinto, V.; Pignatti, M.; Cipriani, F.; Corti, B.; Piraccini, B. M.
abstract

2021 - Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study [Articolo su rivista]
Cordova, A.; Toia, F.; Salgarello, M.; Pinto, V.; Lucattelli, E.; Sgarzani, R.; Figus, A.; Cherubino, M.; Bassetto, F.; Santanelli di Pompeo, F.; Bonfirraro, P. P.; Maruccia, M.; Faini, G.; Cigna, E.; Starnoni, M.; Baraziol, R.; Riccio, M.; Mazzucco, W.; Rubino, C.; Bonomi, S.
abstract

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.

2021 - Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study [Articolo su rivista]
), ; Alberici, Laura; Antonacci, Filippo; Arena, Alessandro; Belvedere, Angela; Bernagozzi, Fabio; Bernante, Paolo; Bertoglio, Pietro; Bianchi, Lorenzo; Bisulli, Maria; Bonfanti, Barbara; Boussedra, Safia; Brandolini, Jury; Cacciapuoti, Crescenzo; Cardelli, Stefano; Casadei, Riccardo; Cescon, Matteo; Cipolli, Alessandro; Cipriani, Riccardo; Contu, Luca; Costa, Francesco; Daddi, Niccolo’; De Crescenzo, Eugenia; De Iaco, Pierandrea; De Palma, Alessandra; Del Gaudio, Massimo; Nunzia Della Gatta, Anna; Dolci, Giampiero; Dondi, Giulia; Droghetti, Matteo; Nicola Forti Parri, Sergio; Garelli, Elena; Gelati, Chiara; Germinario, Giuliana; Giorgini, Federico A.; Ingaldi, Carlo; Jovine, Elio; Kawamukai, Kenji; Lanci Lanci, Antonio; Lombardi, Raffaele; Lozano Miralles, Maria Elisa; Marchetti, Claudio; Masetti, Michele; Minni, Francesco; Morezzi, Daniele; Parlanti, Daniele; Pellegrini, Alice; Myriam Perrone, Anna; paola Pezzuto, Anna; Pignatti, Marco; Pilu, Gianluigi; Pinto, Valentina; Poggioli, Gilberto; Bernadetta Puglisi, Silvana; Raimondo, Diego; Ravaioli, Matteo; Ricci, Claudio; Ricciardi, Sara; Ricotta, Francesco; Rizzo, Roberta; Romano, Angela; Rottoli, Matteo; Schiavina, Riccardo; Seracchioli, Renato; Serenari, Matteo; Serra, Margherita; Solli, Piergiorgio; Sorbi, Gioia; Taffurelli, Mario; Tanzanu, Marta; Tarsitano, Achille; Tesei, Marco; Vago, Gabriele; Violante, Tommaso; Zanotti, Simone; Frisoni, Tommaso; Solaini, Leonardo; Ercolani, Giorgio
abstract

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9– 2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

2020 - 3D Exoscope-Assisted Microvascular Anastomosis: An Evaluation on Latex Vessel Models [Articolo su rivista]
Pinto, Valentina; Giorgini, Federico A; Lozano Miralles, Maria Elisa; Tarsitano, Achille; Panella, Maria Martina; Cipriani, Riccardo; Pignatti, Marco
abstract

BACKGROUND: Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical field: microsurgical procedures can be performed with the aid of this instrument. Here, we describe our preliminary experience with a high-definition 3D exoscope (VITOM, Karl Storz, Tuttlingen, Germany), evaluating the characteristics of the instrument, and also its use as a magnification device for microanastomosis training.METHODS: Six microsurgeons with various levels of experience were asked to perform three end-to-end anastomoses and two end-to-side anastomoses on latex vessel models, using, as a magnification system, the VITOM 3D 4K exoscope. None of the surgeons involved had previous experience with the exoscope, with robotic surgery, with endoscopic surgery, nor with training simulators.RESULTS: The results of the reported evaluation of the tool's qualities, (VITOM Quality Assessment Tool) included: a good focusing of the surgical field; high image quality; strong luminance; good magnification; clear stereoscopy; and excellent freedom of movement. The exoscope proved to be user-friendly. A constant reduction in the time needed to perform the microsurgical anastomosis at each exercise was recorded. Among other advantages were the easy switching from the magnified image to the macroscopic view, superior ergonomics allowing a relaxed posture while performing the anastomosis, adequate space, and a convenient setting for the assistants to view the operating field.CONCLUSIONS: Our study showed that the exoscope VITOM 3D can be successfully used as a magnification tool for microsurgical anastomosis on synthetic vessels, and that it can also be helpful during training courses in microsurgery.

2020 - A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery [Articolo su rivista]
Pignatti, M.; Tos, P.; Garusi, C.; Schonauer, F.; Cherubino, M.; Tiengo, C.; Ciclamini, D.; Cozzolino, S.; Di Maro, E.; Jiga, L. P.; Ionac, M.; Nistor, A.; Georgescu, A. V.; Pinto, V.; Giorgini, F. A.; De Santis, G.; D'Arpa, S.
abstract

Introduction: The training to learn how to perform perforator flaps requires practice on a living model to optimize dissection and to evaluate outcome. The purpose of this study was to describe a training model that optimizes the use of animals in order to perform the maximum number of exercises per animal. Material and methods: The sequence has been planned and practiced by the first and last author, recorded perfected and implemented in a two-day surgical course. The sequence was then evaluated by the trainers and the trainees by means of a questionnaire. Results: All students were able to complete the sequence of exercises before the end of the second day except two (8/10) who could not complete one exercise each. The students considered the Deep Superior Epigastric Artery Perforator flap the most difficult to perform, being the most technically demanding. The sequence of exercises was judged either easily reproducible or reproducible by all the students. Two students suggested to postpone the DSEAP flap to the second day, after some training, to optimize the experience with the most challenging and rewarding flap. Conclusions: The training sequence proposed offers a wide range of exercises and allows four trainees, divided in two teams, to work and learn on the same animal. They can perform a wide range of flaps and also harvest the internal mammary vessels. The living model allows for evaluation of the quality of the surgical performance, judged by the difficulties and complications encountered during dissection, and finally through the feedback of flap perfusion.

2020 - Delaying surgery for patients with a previous SARS-CoV-2 infection [Articolo su rivista]
Glasbey, J. C.; Nepogodiev, D.; Omar, O.; Simoes, J. F. F.; Ademuyiwa, A.; Fiore, M.; Minaya-Bravo, A.; Shaw, R.; Vidya, R.; Bhangu, A.; Bhangu, A. A.; Siaw-Acheampong, K.; Benson, R.; Bywater, E.; Chaudhry, D.; Dawson, B. E.; Evans, J. P.; Gujjuri, R. R.; Heritage, E.; Jones, C. S.; Kamarajah, S. K.; Khatri, C.; Khaw, R. A.; Keatley, J. M.; Knight, A.; Lawday, S.; Li, E.; Mann, H. S.; Marson, E. J.; Mclean, K. A.; Mckay, S. C.; Mills, E. C.; Pellino, G.; Picciochi, M.; Taylor, E. H.; Tiwari, A.; Simoes, J. F. F.; Trout, I. M.; Venn, M. L.; Wilkin, R. J. W.; Moug, S.; Vimalchandran, D.; Vallance, A.; Pockney, P.; Griffiths, E. A.; Townend, P.; Roberts, K.; Mckay, S.; Isaac, J.; Satoi, S.; Edwards, J.; Coonar, A. S.; Marchbank, A.; Caruana, E. J.; Layton, G. R.; Patel, A.; Brunelli, A.; Ford, S.; Desai, A.; Gronchi, A.; Almond, M.; Tirotta, F.; Dumitra, S.; Kolias, A.; Price, S. J.; Fountain, D. M.; Jenkinson, M. D.; Hutchinson, P.; Marcus, H. J.; Piper, R. J.; Lippa, L.; Servadei, F.; Esene, I.; Freyschlag, C.; Neville, I.; Rosseau, G.; Schaller, K.; Demetriades, A. K.; Robertson, F.; Alamri, A.; Schache, A. G.; Winter, S. C.; Ho, M.; Nankivell, P.; Biel, J. R.; Batstone, M.; Ganly, I.; Wilkins, A.; Singh, J. K.; Thekinkattil, D.; Sundar, S.; Fotopoulou, C.; Leung, E.; Khan, T.; Chiva, L.; Sehouli, J.; Fagotti, A.; Cohen, P.; Gutelkin, M.; Ghebre, R.; Konney, T.; Pareja, R.; Bristow, R.; Dowdy, S.; Rajkumar, S. T. S.; Ng, J.; Fujiwara, K.; Stewart, G. D.; Lamb, B.; Narahari, K.; Mcneill, A.; Colquhoun, A.; Mcgrath, J.; Bromage, S.; Barod, R.; Kasivisvanathan, V.; Klatte, T.; Committee, D.; Adamina, M.; Ademuyiwa, A. O.; Agarwal, A.; Alameer, E.; Alderson, D.; Alakaloko, F.; Albertsmeiers, M.; Alser, O.; Alshaar, M.; Alshryda, S.; Arnaud, A. P.; Augestad, K. M.; Ayasra, F.; Azevedo, J.; Bankhead-Kendall, B. K.; Barlow, E.; Benson, R. A.; Blanco-Colino, R.; Brar, A.; Breen, K. A.; Buarque, I. L.; Chaar, M.; Chakrabortee, S.; Christensen, P.; Cox, D.; Cukier, M.; Cunha, M. F.; Davidson, G. H.; Di Saverio, S.; Drake, T. M.; Edwards, J. G.; Elhadi, M.; Farik, S.; Fitzgerald, J. E.; Garmanova, T.; Gallo, G.; Ghosh, D.; Gomes, G. M. A.; Grecinos, G.; Grundl, M.; Halkias, C.; Harrison, E. M.; Hisham, I.; Hutchinson, P. J.; Hwang, S.; Isik, A.; Jonker, P.; Lawani, I.; Lederhuber, H.; Leventoglu, S.; Litvin, A.; Loehrer, A.; Loffler, M. W.; Lorena, M. A.; Madolo, M. M.; Major, P.; Martin, J.; Mashbari, H. N.; Mazingi, D.; Metallidis, S.; Mohan, H. M.; Moore, R.; Moszkowicz, D.; Ng-Kamstra, J. S.; Maimbo, M.; Niquen, M.; Ntirenganya, F.; Olivos, M.; Oussama, K.; Outani, O.; Parreno-Sacdalanm, M. D.; Pata, F.; Rivera, C. J. P.; Pinkney, T. D.; Qureshi, A.; Radenkovic, D.; la Medina, A. R. -D.; Roslani, A. C.; Rutegard, M.; Santos, I.; Sayyed, R.; Schache, A.; Schnitzbauer, A. A.; Sharma, N.; Shu, S.; Soreide, K.; Spinelli, A.; Sund, M.; Tabiri, S.; Tsoulfas, G.; van Ramshorst, G. H.; Vimalachandran, D.; Warren, O. J.; Wedderburn, D.; Wright, N.; Allemand, C.; Boccalatte, L.; Figari, M.; Lamm, M.; Larranaga, J.; Marchitelli, C.; Noll, F.; Odetto, D.; Perrotta, M.; Saadi, J.; Zamora, L.; Alurralde, C.; Caram, E. L.; Eskinazi, D.; Mendoza, J. P.; Usandivaras, M.; Badra, R.; Esteban, A.; Garcia, J. S.; Garcia, P. M.; Gerchunoff, J. I.; Lucchini, S. M.; Vargas, L.; Hovhannisyan, T.; Stepanyan, A.; Gould, T.; Gourlay, R.; Griffiths, B.; Gananadha, S.; Cecire, J.; Joshi, N.; Salindera, S.; Sutherland, A.; Ahn, J. H.; Charlton, G.; Chen, S.; Gauri, N.; Hayhurst, R.; Jang, S.; Jia, F.; Mulligan, C.; Yang, W.; Ye, G.; Zhang, H.; Ballal, M.; Gibson, D.; Hayne, D.; Moss, J.; Richards, T.; Viswambaram, P.; Vo, U. G.; Bennetts, J.; Bright, T.; Brooke-Smith, M.; Fong, R.; Gricks, B.; Lam, Y. H.; Szpytma, M.; Watson, D.; Bagraith, K.; Caird, S.; Chan, E.; Dawson, C.; Ho, D.; Jeyarajan, E.; Jordan, S.; Lim, A.; Nolan, G. J.; Oar, A.; Parker, D.; Puhalla, H.; Quennell, A.; Rutherford, L.; Townend, P.; Von Papen, M.; Wullschleger, M.; Blatt, A.; Cope, D.; E
abstract

no abstract available

2020 - How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northen Italy [Articolo su rivista]
Pignatti, Marco; Pinto, Valentina; Miralles, Maria Elisa Lozano; Giorgini, Federico A.; Giacomo, Cannamela; Cipriani, Riccardo
abstract

The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon’s evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.

2020 - How to Design and Harvest a Propeller Flap [Articolo su rivista]
Pignatti, Marco; Pinto, Valentina; Docherty Skogh, Ann-Charlott; Giorgini, Federico Armando; Cipriani, Riccardo; De Santis, Giorgio; Hallock, Geoffrey G
abstract

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.

2020 - Meta-analysis of the effects of venous super-drainage in deep inferior epigastric artery perforator flaps for breast reconstruction [Articolo su rivista]
Pignatti, Marco; Pinto, Valentina; Giorgini, Federico A; Lozano Miralles, Maria Elisa; Cannamela, Giacomo; D'Arpa, Salvatore; Cipriani, Riccardo; De Santis, Giorgio
abstract

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.

2020 - Our Definition of Propeller Flaps and Their Classification [Articolo su rivista]
Pignatti, M; Ogawa, R; Mateev, M; Georgescu, Av; Balakrishnan, G; Ono, S; Cubison, T; Pinto, V; D'Arpa, S; Koshima, I; Hyakusoku, H; Hallock, Gg
abstract

The term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isolated perforator, and the terms propeller and perforator flap were used together. Thereafter, the surgical technique of propeller flaps evolved and new applications developed. With the "Tokyo consensus," we proposed a definition and a classification schema for propeller flaps. A propeller flap was defined as an "island flap that reaches the recipient site through an axial rotation." The classification included the SPP (SPP) flap, the perforator pedicled propeller (PPP) flap, and the supercharged PPP (SCP) flap. A recent update added a new category, the axial pedicled propeller (APP) flap. Here we propose our updated and comprehensive classification of propeller flaps, taking into account the previous classification and subsequent publications. Based on their vascular pedicle, we consider the following five types of propellers: (1) SPP flap, 2.PPP flap, its subtype (2a) SCP flap, (3) APP flap, (4) muscle propeller flap, and (5) chimeric propeller flap. The variables that can be taken into account in the classification are as follows: type of nourishing pedicle, degrees of skin island rotation, position of the nourishing pedicle, artery of origin of the pedicle, and flap shape.

2020 - Preliminary Study on the Echo-Assisted Intersphincteric Autologous Microfragmented Adipose Tissue Injection to Control Fecal Incontinence in Children Operated for Anorectal Malformations [Articolo su rivista]
Parente, Giovanni; Pinto, Valentina; Di Salvo, Neil; D’Antonio, Simone; Libri, Michele; Gargano, Tommaso; Catania, Vincenzo Davide; Ruggeri, Giovanni; Lima, Mario
abstract

Abstract: Aim of the study: To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called “anal-lipofilling”) in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs). Methods: Following ethical committee approval (CHPED-MAR-18-02), anal-lipofilling was proposed to patients with fecal incontinence not responsive to medications or bowel management (bowel enema and/or transanal irrigation automatic systems), then a prospective study was conducted. Anal-lipofilling consisted of three phases: lipoaspiration from the abdominal wall, processing of the lipoaspirate with a Lipogems system and intersphincteric injection of the processed fat tissue via endosonographic assistance. A questionnaire based on Krickenbeck’s scale (KS) was administered to the patients to evaluate the clinical outcome. Main Results: Four male patients (three recto-urethral fistula, and one recto-perineal fistula) underwent the anal-lipofilling procedure at a mean age of 13.0 ± 4.2 yrs. There were no complications during or after the procedure. From an initial assessment of the patients there was an improvement in the bowel function at a median follow up of 6 months, with better scores at KS (100% Soiling grade three pre-treatment vs. 75% grade one post-treatment). Conclusions: Even if our Study is preliminary, echo-assisted anal-lipofilling could be considered as a feasible and safe alternative technique in the management of the fecal incontinence in non-responding ARMs patients. More studies are still necessary to support the validity of the implant of autologous adipose tissue in the anal sphincter as a therapy for fecal incontinence in children born with ARMs.

2019 - Chest Wall Masculinization in Female-to-Male Transsexuals: Our Treatment Algorithm and Life Satisfaction Questionnaire [Articolo su rivista]
Morselli, P. G.; Summo, V.; Pinto, V.; Fabbri, E.; Meriggiola, M. C.
abstract

Esthetic masculinization of the chest wall is one of the first surgical steps in female-to-male transsexual (FTMTS) reassignment.This surgical procedure is not a simple mastectomy: it is required for removal of breast tissue with glandular resection and skin excess revision, to reduce and replace the nipple-areola complex in the right location, minimizing chest wall scars. The creation of an esthetically pleasing male chest allows the patient to live at ease in the male gender role.In this article, we present our series of 68 FTMTSs who underwent bilateral mastectomies for surgical sexual reassignment (a total of 136 mastectomies) according to our algorithm, in the period between January 2010 and December 2017. We selected 4 different operative procedures, classified as subcutaneous ("pull-through" and "concentric circular" techniques) and skin extended ("ultrathin vertical bipedicle" and free nipple graft).We achieved a total complication rate of 6.6%, less than that reported in the literature; additional procedures for esthetic improvements were performed in 14.7% of cases. The mean patient satisfaction was approximately 4.57% of a maximal value of 5 (excellent).To help surgeons in choosing the most appropriate FTMTS surgical technique and to reduce unfavorable results, we propose the use of our treatment algorithm in preoperative evaluation of the chest wall according to the breast volume, degree of glandular ptosis, and skin elasticity.

2019 - Informed consent in plastic surgery, evaluation of its effectiveness for mutual satisfaction of patient and doctor: Comparison of methods [Articolo su rivista]
Morselli, P. G.; Lippi, A.; Giorgini, F. A.; Fabbri, E.; Pinto, V.
abstract

Background: The acquisition of signed informed consent is not always enough to ensure adequate medical protection. Particularly, in plastic surgery, improving the doctor–patient relationship by understanding the patient's emotions and expectations becomes a determining factor when choosing the best therapeutic strategy for the subject in question, which may also include nonsurgical eligibility. Methods: Ninety patients with various plastic surgery disabilities were recruited and randomly divided into three groups: Patients in the first group underwent the ``traditional'' clinical interview, those in the second underwent the clinical approach called Shared Decision Making (SDM), and those in the third group received both the SDM and a questionnaire evaluating patient expectations (Expectation Questionnaire-Pgm). At the end of each interview, a specialist physician in Plastic, Reconstructive and Aesthetic Surgery was asked to fill in a questionnaire regarding his/her satisfaction with the method used. Likewise, the patient filled in a questionnaire on his/her satisfaction with the interview. Results: For the doctors, the third method was superior in investigating patient expectations, emotions, and personal preferences. For the patients, the third method scored significantly higher than the first one for overall satisfaction and ability to evaluate personal preferences and needs and higher than the first and second methods in assessing expectations. Conclusions: For doctors, the SDM coupled with the Expectation Questionnaire-Pgm proved to be the most useful tool to understand patient expectations and emotions and thus improve the medical-patient relationship through shared decision-making. The third method therefore aims for better patient coverage and improved informed consent, thereby reducing the likelihood of litigation and better assessing nonfitness for operation.

2019 - Single stage reconstruction of complex head and neck defects involving the skin with a single ALT flap: A ten year review [Articolo su rivista]
Caliceti, U.; Sgarzani, R.; Cipriani, R.; Cantore, S.; Contedini, F.; Pinto, V.; Gelati, C.; Piccin, O.
abstract

Background: Multicomponent defects of the head and neck involving the cervical skin pose a reconstructive challenge for microsurgeons and usually requires two flaps. However, many patients who undergo such surgical treatment had prior treatment with radiotherapy and the availability of recipient vessels for free flap reconstruction may be limited. The purpose of this study was to review our experience in the reconstruction of these extensive head and neck defects using a single ALT free flap. Methods: A total of 21 patients with complex defects of the head and neck involving multiple anatomical subunits, including the overlying cervical skin, underwent reconstruction with a single ALT flap. The clinical, functional, and aesthetic outcomes of these patients were reviewed. Results: The mean hospital stay was 24 days. There was one total flap loss due to pedicle thrombosis. The patient underwent a further ALT reconstruction with no postoperative complications. Cervical fistulas occurred in three patients, and all fistulas were healed by simple wound packing. Three patients with tracheal defect had a functional tracheostoma with adequate stomal patency. A modified barium swallowing study was performed on each patient, and all of them achieved total oral intake. Among them, two patients tolerated only a pureed diet. Conclusions: Complex neck reconstruction can be accomplished with a single ALT flap with good clinical and functional results, minimal morbidity and quick recovery.

2018 - Effect of early correction of nasal septal deformity in unilateral cleft lip and palate on inferior turbinate hypertrophy and nasal patency [Articolo su rivista]
Pinto, V; Piccin, O; Burgio, Luca; Summo, V; Antoniazzi, E; Morselli, Pg.
abstract

Abstract OBJECTIVES: A relatively neglected aspect of cleft lip nasal deformity is the effect of septal deviation and inferior turbinate hypertrophy (ITH) on the functional airway. In particular, ITH in the noncleft side can be especially problematic, because it reduces the healthy nasal area, creating bilateral nasal obstruction that might affect the growth of the maxillofacial skeleton. Although these anatomic and functional changes are documented, few recommendations have been developed regarding the proper approach to ITH. The aim of the present study was to asses the ITH severity and determine the degree of nasal airway patency in patients who have undergone primary correction of the nasal septum during lip repair compared to patients operated on without primary septal correction. METHODS: The study population included two groups. One group consisted of twenty unilateral cleft lip palate UCLP patients who have previously undergone primary rhinoseptoplasty as part of their treatment plan. The control group consisted of twenty UCLP patients operated on without rhinoseptal correction. The Nasal Obstructive Symptom Evaluation (NOSE) scale and nasal endoscopy were used to assess nasal obstruction. RESULTS: The overall untreated group reported severe symptoms across all NOSE scale dimensions more frequently than children who have undergone primary rhinoseptoplasty. The difference was statistically significant for each dimensions (p < 0.05). The mean NOSE score for group A and group B was 21.4 ± 9.4 and 70.8 ± 17.2 respectively (p < 0.0001). In group A turbinate size decreased significantly (p < 0.05) compared to pre-operative data. Comparing the two groups a statistically significant difference in turbinate size was observed (p < 0.0001). CONCLUSION: The results of the present study confirm that there is a significant degree of ITH and nasal airway dysfunction in patients with UCLP. Early septal repositioning during primary cleft lip repair results in a statistically significant reduction in IT size and improvement of nasal patency.

2018 - Long Term Cosmetic and Functional Results of One Stage Reconstruction for Lower Eyelid Malignant Melanoma: A Single Centre Experience of Eleven Patients [Articolo su rivista]
Pinto, V; Zannetti, G; Villani, R; Tassone, D; Cipriani, R; Piccin, O
abstract

Abstract Introduction Eyelid malignant melanoma represents less than 1 % of all skin melanomas and approximately 1 % of all malignant neoplasms of the eyelid skin. Because of its relative rarity, there is a paucity of descriptive papers reporting only small series of reconstructed patients. The repair of eyelid defects represents a reconstructive challenge. Ideally, the reconstruction of the defect must guarantee function with tissue of the same color, texture, and thickness of that of the removed skin and at the same time avoid complications such as ectropion and lagophthalmos. Materials and Methods We describe a consecutive series of 11 patients affected by cutaneous melanoma of the lower lid who underwent full-thickness excision of the neoplasm and subsequent wide excision. All the patients were treated in one-stage reconstruction modality with a modified monopedicle myocutaneous flap, harvested from omolateral upper eyelid, tunneled under the lateral canthus skin and armed with a conchal auricular cartilage framework. Four patients underwent the sentinel lymph node biopsy during reconstructive procedure. No major complications were reported. In our experience, the proposed myocutaneous flap allows to obtain excellent results, both aesthetically and functionally. Conclusions This technique has the advantage of avoiding multi-staged procedures, with respect for the oncological excision indication for head and neck melanoma, decreasing the incidence of associated major complications.

2018 - Making pharyngoplasty simple and safe: When plastic surgery meets sleep surgery [Articolo su rivista]
Pinto, V.; Piccin, O.
abstract

2018 - Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome [Articolo su rivista]
Pinto, V; Piccin, O; Morselli, Pg
abstract

No abstract

2017 - A case of severe obstructive sleep apnoea in Madelung's disease treated by lateral pharyngoplasty [Articolo su rivista]
Pinto, Valentina; Morselli, Paolo; Tassone, Daniela; Piccin, Ottavio
abstract

Background: Madelung's disease is a rare disorder characterised by the presence of multiple, symmetric, non-capsulated fat masses in the face, neck and other areas of upper extremities. In some cases, severe clinical complications such as upper airway compression can occur. Case report: A 56-year-old man affected by Madelung's disease complained of snoring and severe daytime sleepiness. Polysomnography revealed severe obstructive sleep apnoea. An attempt to treat sleep apnoea by continuous positive airway pressure failed because of poor compliance. Functional expansion pharyngoplasty was carried out as an initial treatment. Marked improvement of neck movements and normalisation of somnographic parameters were observed at six months' follow up. Conclusion: Patients with Madelung's disease should be examined carefully for potential obstructive sleep apnoea. Although continuous positive airway pressure remains the treatment of choice, specific surgery can be used in those patients who cannot tolerate continuous positive airway pressure therapy.

2017 - Obstructive Sleep Apnea in Adults: The Role of Upper Airway and Facial Skeletal Surgery [Articolo su rivista]
Pinto, Valentina; Sorrenti, Giovanni; Morselli, Paolo; Piccin, Ottavio
abstract

Not present

2016 - Non-syndromic cleft lip with or without cleft palate in Asian populations: Association analysis on three gene polymorphisms of the folate pathway [Articolo su rivista]
Martinelli, Marcella; Girardi, Ambra; Cura, Francesca; Nouri, Nayereh; Pinto, Valentina; Carinci, Francesco; Morselli, Paolo; Salehi, Mansoor; Scapoli, Luca
abstract

Objective Orofacial clefts (OFCs) are one of the most common birth defects in humans. They are the subject of a number of investigations aimed at elucidating the bases of their complex mode of inheritance involving both genetic and environmental factors. Genes belonging to the folate pathway have been among the most studied. The aim of the investigation was to replicate previous studies reporting evidence of association between polymorphisms of folate related genes and the occurrence of non-syndromic cleft lip with or without cleft palate (NSCL/P), using three independent samples of different ancestry: from Tibet, Bangladesh and Iran, respectively. Design Specifically, the polymorphisms rs1801133 of MTHFR, rs1801198 of TCN2, and rs4920037 of CBS, were tested. Results A decreased risk of NSCL/P was observed in patients presenting the C677T variant at MTHFR gene (relative risk for heterozygotes = 0.53; 95% confidence interval [C.I.] = 0.32-0.87). The investigated polymorphisms mapping at TCN2 and CBS genes did not provide any evidence of association. Conclusion Overall, these results indicate that NSCL/P risk factors differ among populations and confirm the importance of testing putative susceptibility variants in different genetic backgrounds.

2015 - Abdominal Wall Transplantation and Technique [Capitolo/Saggio]
Cipriani, Riccardo; Negosanti, Luca; Pinto, Valentina; Sgarzani, Rossella; Gelati, Chiara; Contedini, F.
abstract

Many patients undergoing intestinal or multivisceral transplantation have a past history of complete midgut removal with the loss of the domain of the abdominal compartment or have severely damaged abdominal walls from repeated laparotomies or enterocutaneous fistulae. These patients may encounter severe abdominal wall closure problems at the end of transplantation, resulting in increased morbidity and mortality. It is, therefore, of paramount importance to properly cover transplanted organs in order to reduce postoperative complications. Abdominal wall transplantation was proposed for closure of patients undergoing both small bowel and multivisceral transplantation. We present our experience in abdominal wall transplantation in which, by taking advantage of microsurgical experience, we were able to re-vascularize the composite tissue allograft anastomosing the deep inferior epigastric vessels of the graft to those of the recipient. This technique allows to preserve donor’s vascular pedicle that can be used as grafts for vascular procedures.

2015 - Reconstruction of a complex pelvic perineal defect with pedicled anterolateral thigh flap combined with bilateral lotus petal flap: A case report [Articolo su rivista]
Contedini, Federico; Luca, Negosanti; Pinto, Valentina; Maria Oranges, Carlo; Rossella, Sgarzani; Ferdinando, Lecce; Bruno, Cola; Riccardo, Cipriani
abstract

Reconstructing extensive perineal defects represents a challenge, and reconstructive choice requires a careful physical assessment of previous radiotherapy, pre-existing scars, the presence of stomas, and the availability of donor sites. We report a case of a patient affected by an anal carcinoma who underwent a pelvic exenteration and bilateral inguinal iliac obturator lymph node dissection. We performed a pedicled anterolateral thigh flap (ALT) combined with bilateral lotus petal flaps (LPF) to reconstruct the pelvic-perineal area. The result was good, and no major post-operative complications were reported. Bilateral LPF, combined with a pedicled ALT, may represent a valid option in pelvic-perineal reconstruction following a wide oncological resection. © 2014 Wiley Periodicals, Inc. Microsurgery 35:154-157, 2015.

2015 - Surgical correction of lateral pharyngeal wall collapse in sleep related disordered breathing: functional expansion pharyngoplasty [Articolo su rivista]
Piccin, O; Pinto, V; Sorrenti, G.
abstract

The recent evolution regarding the techniques of pharyngoplasty has been focused on the concept of obtaining the expansion and stabilization of the pharyngeal airspace through the treatment of lateral pharyngeal wall (LPW) collapse rather than through ablation of the redundant pharyngeal soft tissue. The role of LPW in the pathogenesis of obstructive sleep apnea syndrome has been demonstrated by radiologic and sleep endoscopy studies and the narrowing of the LPW appears to be the sole independent risk factor for obstructive sleep apnea syndrome. The functional expansion pharyngoplasty represents a conservative modification of expansion sphincter pharyngoplasty and can be used in patients with obstruction of the upper airway due to the LPWs collapse without altering physiological functions of the upper airway, including smell, taste, swallowing, and speech.

2014 - Modified bilobed flap for one-stage earlobe reconstruction: A case report [Articolo su rivista]
Pinto, Valentina; Luca, Negosanti; Ottavio, Piccin; Riccardo, Cipriani; Guido, Zannetti
abstract

Many techniques have been described in the literature for the reconstruction of congenital or acquired defects of the earlobe. Most techniques for earlobe reconstruction use adjacent tissue to compose a pedicled or bilobed flap, but usually require a two-stage procedure, or need a skin graft; more rarely reconstructive methods that led to a satisfactory result and a pleasant appearance in one-stage procedure have been described. We describe a personal and geometrical modification of the double-lobed flap according to Gavello's original technique, which allows to shape the anatomical curvature of the earlobe and to reduce the skin retraction without adding any scars or skin graft. In our opinion, the revisited reconstructive technique provides lots of advantages, improves aesthetical results and provides more natural appearance.

2014 - Photodynamic therapy with topical aminolevulinic acid [Articolo su rivista]
Negosanti, Luca; Pinto, Valentina; Sgarzani, Rossella; Negosanti, Francesca; Zannetti, Guido; Cipriani, Riccardo
abstract

Photodynamic therapy (PDT) is a relatively new therapy in dermatology that uses the topical application of a porphyrin derivative to selectively destroy a cutaneous target. The action is implemented by the application of a specific light frequency. The ability of porphyrin to selectively target tumor tissue has been known since the 1960s. In the late 1970s, the underlying mechanism was defined, and Dougherty’s discovery of the first chromophore led to the production and commercialization of Photofrin®. Many other chromophores that can act as photosensitizers have been studied since then, with aminolevulinic acid currently the most commonly used chromophore in clinical practice. PDT is simple, minimally invasive and can be administered on an outpatient basis. The efficacy of PDT has been proven for actinic keratosis, Bowen’s disease and basal cell carcinoma; another of its well-known applications is the treatment of photoaging. Indications for its use are continuously increasing, and promising results are reported for various skin diseases. In this paper we report the mechanism of action of PDT with aminolevulinic acid, the literature concerning the most common diseases treated with PDT and the subsequent level of evidence.

2013 - Comparison between stem cells harvested from wet and dry lipoaspirates [Articolo su rivista]
Muscari, Claudio; Bonafè, Francesca; Fiumana, Emanuela; Oranges, C. M.; Pinto, Valentina; Caldarera, Claudio Marcello; Guarnieri, Carlo; Morselli, Paolo
abstract

Adipose-derived stem cells (ASC) are usually isolated from lipoaspirates, but it is not known if the anesthetic solution injected into adipose tissue affects cell yield and functions. Two different samples were drawn from the abdominal region of female subjects. In the first, a physiological solution containing lidocaine/adrenaline was injected (wet liposuction, WL), while in the contralateral area, the sample was collected without injecting any solution (dry liposuction, DL). The aspirates were processed to investigate the yield of the stromal-vascular fraction (SVF) cells and ASC frequency, growth rate, apoptosis, and differentiation potential. The solid dried mass of fresh WL isolates was lower than that of DL isolates (p<0.01) due to the presence, in the former, of a liquid solution. As a consequence, the amount of WL-SVF cells was 18.7% lower than those obtained from DL (p < 0.01); this difference was also observed under culture conditions. In addition, the number of colony-forming unit-fibroblasts (CFU-Fs) obtained from 1 × 10(3) SVF cells was 25.5% lower in WL-aspirates than DL-aspirates (p < 0.05) owing, at least in part, to the observed presence of ASC in the liquid solution of the WL isolates. After WL and DL, no differences were observed in ASC growth rate, apoptosis, or differentiation potential toward adipogenic, osteogenic, and endothelial cell lineages. In conclusion, WL yields about 40% fewer ASC than DL due to the combined effect of tissue dilution and the reduced frequency of ASC in the SVF. The main biological features of ASC are suitable for cell-based therapies.

2013 - Functional expansion pharyngoplasty in the treatment of obstructive sleep apnea [Articolo su rivista]
Sorrenti, G; Piccin, O; Pinto, V
abstract

NO ABSTRACT

2013 - Tensor fascia latae perforator flap: an alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available [Articolo su rivista]
Contedini, F; Negosanti, Luca; Pinto, Valentina; Tavaniello, Beatrice; Fabbri, E; Sgarzani, Rossella; Tassone, Daniela; Cipriani, Riccardo
abstract

Introduction: The anterolateral thigh flap (ALT) is a versatile flap and very useful for the reconstruction of different anatomical districts. The main disadvantage of this flap is the anatomical variability in number and location of perforators. In general, absence of perforators is extremely rare. In literature, it is reported to be from 0.89% to 5.4%. If no sizable perforators are found, an alternative reconstructive strategy must be considered. Tensor fascia lata (TFL) perforator flap can be a good alternative in these cases: Perforator vessels are always present, the anatomy is more constant and it is possible to harvest it through the same surgical access. The skin island of the flap can be very large and can be thinned removing a large part of the muscle allowing its use for almost the same indications of the ALT flap. Materials and Methods: We report 11 cases of reconstruction firstly planned with the ALT flap, then converted into TFL perforator flap. Results and Conclusion: The result was always satisfactory in terms of the donor site morbidity and reconstructive outcome.

2012 - ABDOMINOPLASTY SURGERY: A RETROSPECTIVE ANALYSIS ON 186 PATIENTS [Articolo su rivista]
C., Riberti; I., Pezzini; P., Carcoforo; F., Carinci; I., Zollino; V., Candotto; Pinto, Valentina; Morselli, Paolo
abstract

Massive weight loss for high percentage of patients means cutaneous skin folds that cause important functional and hygienic problems. In these patients body contouring with removal of the excessive skin fold becomes necessary to improve their new quality of life. One hundred and eighty six patients during the period between September 2005 and December 2010 underwent to abdominoplasty surgery at the Plastic Surgery Unit, S. Anna Hospital, Ferrara. Surgery performed was lipectomy for 99 patients, fascial plastic in 75 cases, scars review for 5 patients and lipectomy with fascial plastic in 7 cases. There had been 3 cases of bleeding and 18 cases of keloids. Chi square text was used to detect the variables (i.e. surgeon, type of surgery and diagnosis) potentially associated with failures. However, despite of possible methodological dificulties and the limited complications in our series, abdominoplasty can be considered essential option for post-bariatric patients and for all those patients that have loss massive weight, because it can improve lifestyle and even psychological status.

2012 - BRANCHIAL ANOMALIES [Articolo su rivista]
Franchella, A.; Pellegrinelli, S.; Carinci, F.; Zollino, I.; Carnevali, G.; Candotto, V.; Franchella, S.; Pinto, V.; Morselli, G. P.
abstract

Branchial anomalies are masses located in children’ neck. They are composed of an heterogeneous group of congenital malformations mainly fistulae, cysts, sinus tracts and cartilaginous remnants. Females and males are affected equally and many lesions are diagnosed before child reaches adulthood. Aim of this retrospective study is to asses the clinical outcome in a series of patients affected by branchial anomalies and discuss the pertinent literature. In the period between January 2001 and December 2010, 31 patients underwent to surgical correction of branchial anomalies at the Pediatric Surgery Unit, S Anna Hospital, Ferrara, Italy. Patients included 15 (48.4%) females and 16 (51.6%) males. Age ranged from 5 months to 15.6 years with a mean value of 5.1 years at the time of admission. There were 16 fistulae 5 cysts and 10 branchial remnants All cases were surgically corrected under general anesthesia. Cervical cysts occur in children and adolescents as a mass situated anterior to the sterno-cleid muscle and near the angle of the mandible. Cervical symptoms may consist of drainage from a pit –like depression at the angle of mandible. The definitive treatment of all branchial anomalies is the surgical for a complete excision. Complete surgical resection through a wide transverse cervicotomy results in good prognosis. Identification during operation, of the internal and external carotid arteries and of the vagus, hypoglossal, glossopharingeal and superior laryngeal nerves will avoid injury of these structures.

2012 - Breast reduction: a retrospective analysis on 139 patiens [Articolo su rivista]
C., Riberti; I., Pezzini; P., Carcoforo; F., Carinci; I., Zollino; V., Candotto; Pinto, Valentina; Morselli, Paolo
abstract

Gigantomastia represents a disabling condition characterized by excessive breast growth. Breast reduction can be performed with some techniques such as inferior pedicle reduction and superior pedicle reduction. Aim of this retrospective study is to assess the clinical outcome of a series of 139 patients underwent to breast reduction and discuss the pertinent literature. One hundred and thirty nine patients underwent to breast reduction during the period between September 2005 and December 2010. Treatments were grouped into three classes: 1 - inferior pedicle breast reduction, 2 - superior pedicle breast reduction and 3 - scars corrections. Eight out of 139 cases had failures such as keloids and poor aesthetics results. Chi square text was used to detect those variables (i.e. surgeon, type of surgery) potentially associated with failures. None of studied variables correlated with failures. Breast reduction is a worldwide use to correct gigantomastia and several surgical techniques are available. Proper diagnosis is of paramount importance to avoid potential complications such as hematomas or sieromas. In addition the patient’ psychological habitus has to be evaluated at admission. Since very few cases failed in our series, breast reductions are considered reliable surgical techniques to cure gigantomastia.

2012 - CLEFT LIP AND PALATE: A CASE SERIES ANALYSIS [Articolo su rivista]
A., Franchella; S., Pellegrinelli; F., Carinci; I., Zollino; G., Carnevali; V., Candotto; S., Franchella; Pinto, Valentina; Morselli, Paolo
abstract

Orofacial clefts (OFC) are common birth defects of complex aetiology resulting in disruptions of normal facial structure. They represent one of the most usual birth defects and occur in 1 per 500 to 2,500 births depending on ancestry, geographic residential location, maternal age and prenatal exposures, and socioeconomic status. Aim of this retrospective study is to assess the clinical outcome in a series of patients affected cleft lip and palate and discuss the pertinent literature. In the period between January 2001 and December 2010, 56 patients underwent to cleft lip and/ or palate correction at the Pediatric Surgery Unit, S. Anna Hospital, Ferrara, Italy. Patients included 25 females and 23 males. There were 7 cleft lip, 24 cleft palate and 17 cleft lip and palate. All patients were surgically corrected under general anesthesia. Millard and Skoog techniques were used for cleft lip anomalies, whereas Langebeck, Vidmayer- Perko and Furlow techniques were used for cleft palate defects. In our series a multidisciplinary approach was used and several surgical techniques were performed. Functional and aesthetic results were satisfactory in most cases. The need of a specific dedicated team is mandatory for treating this group of patients.

2012 - CONGENITAL MALFORMATIONS OF THE EAR [Articolo su rivista]
Franchella, A.; Pellegrinelli, S.; Carinci, F.; Zollino, I.; Carnevali, G.; Candotto, V.; Franchella, S.; Pinto, V.; Morselli, G. P.
abstract

Malformations of the external ear can involve orientation, position, size and relief pattern of the pinna, anotia may also occur. To make a classification of ear malformations must be considered: size of auricle, shape of the ear and position of the ear. Aim of this retrospective study is to assess the clinical outcome in a series of patients affected by ear defects and discusses the pertinent literature. In the period between January 2001 and December 2010, 35 patients underwent to surgical correction of external ear malformations at the Pediatric Surgery Unit, S Anna Hospital, Ferrara, Italy. Patients included 23 (66%) females and 12 (34%) males. Age ranged from 1 months to 14.5 years with a mean value of 2.6 years at the time of admission. All cases were surgically corrected under general anesthesia. Successful correction of prominent ears and of all others kind of ear malformations requires a precise understanding of the normal anatomy and relationships of the external ear with the face. The surgeon should be familiar with the normal anatomy of the cartilaginous skeleton and the soft tissue features of the external ear. Abnormalities in ear dimensions will reveal themselves at an early age. The rapid development of the ear to approximately 90% of adult dimensions by age 3 years allows for early surgical intervention for auricular anomalies. Many surgeons recommend performing surgical correction of prominent ears when children are aged 3 to 6 years, before the start of school. The goal is to minimize the malformation before the period of socialization to avoid ridicule by other children.

2012 - CONGENITAL MELANOCYTIC NEVI: A CASE SERIES [Articolo su rivista]
A., Franchella; S., Pellegrinelli; F., Carinci; I., Zollino; G., Carnevali; V., Candotto; S., Franchella; Pinto, Valentina; Morselli, Paolo
abstract

Nevi represent benign melanocytic neoplasms that have importance as facultative precursors and predictors of cutaneous melanoma. In daily clinical practice high nevus counts help to identify person at risk. In the period between January 2008 and December 2010, 141 patients underwent to nevi excision at the Pediatric Surgery Unit, S Anna Hospital, Ferrara, Italy. Patients included 64 (45.4%) females and 77 (54,6%) males. Age ranged from 1.5 to 18 years with a mean value of 12.4 years at the time of admission. 29, 46, 75 and 19 nevi where located in arms, legs, trunk and head and neck, respectively. 19, 121 and 29 nevi were junctional, compound and dermal nevi, respectively. Nevi were treated with surgical excision: 35 under general anesthesia, 4 under sedation and the remaining under local anesthesia. Melanocytic nevi during the past have been treated with several techniques such as cauterization with carbon dioxide, snow, a heated platinum loop and even by x-ray. Most of these treatments result unsatisfactory because these cause scars whereas leaving few intact melanocytes in the derma. Surgical excision is the method of choice. If the lesion has been injured or infected antibiotic treatment could facilitate healing.

2012 - Clinical evidences, personal experiences, recent applications [Articolo su rivista]
Negosanti, Luca; Pinto, Valentina; Sgarzani, Rossella
abstract

Management of difficult wounds can be a complex, challenging and expensive task, especially for wounds showing a slow healing process. Topical negative pressure (TNP) therapy has greatly improved difficult wounds treatment. It allows to treat patient on an outpatient management, to reduce the complication rate with shorter hospital stay, to avoid frequent dressings with expensive advanced materials and allow a lower commitment of health professionals. Vacuum Assisted Closure® (VAC®) system is a therapeutic device based on the administration of a controlled TNP introduced by Morykwas and Argenta in 1997. It is indicated in different kinds of wound, but clinical evidences are present only for few of them. In this work we summarize indications and recommendations for VAC® therapy and we analyze the actual better choice of treatment based on evidences and personal experience in order to stimulate further studies. Finally we introduce recent applications of VAC® system such as Prevena®, VAC Instill® and VAC Via®. Prevena® is a system based on TNP indicated in the management of closed wounds that present risk factors for dehiscence. VAC Instill® is a system that allows to associate TNP and topical administration of solutions, such as antibiotics or disinfectants, to treat specific type of wounds. VAC Via® is a device based on TNP, characterized by little dimension and a preset system that allow the treatment of little wounds for 7 d, with no impairment for the patient. The aim of our paper is to describe a report of VAC® therapy use in order to stimulate further studies and to define the level of evidence of VAC® therapy.

2012 - Cross-leg as salvage procedure after free flaps transfer failure: a case report [Articolo su rivista]
Contedini, F; Negosanti, Luca; Fabbri, E; Pinto, Valentina; Tavaniello, Beatrice; Sgarzani, Rossella; Cipriani, Riccardo
abstract

Abstract: Posttraumatic wounds of the lower leg with soft tissue defects and exposed fractures are a reconstructive challenge due to the scarce availability of local tissues and recipient vessels. Even when a free tissue transfer can be performed the risk of failure remains considerable. When a free flap is contraindicated or after a free flap failure, the cross-leg flap is still nowadays a possible option. We report a case of a male with a severe posttraumatic wound of the lower leg with exposed tibia fracture firstly treated with two consecutive latissimus dorsi muscular free flaps, failed for vascular thrombosis; the coverage was then achieved with a cross-leg flap with acceptable results.

2012 - Early Correction of Septum JJ Deformity in Unilateral Cleft Lip–Cleft Palate [Articolo su rivista]
Morselli, Paolo; Pinto, Valentina; Negosanti, Luca; Firinu, A.; Fabbri, E.
abstract

Background: The treatment of patients affected by unilateral cleft lip–cleft palate is based on a multistage procedure of surgical and nonsurgical treatments in accordance with the different types of deformity. Over time, the surgical approach for the correction of a nasal deformity in a cleft lip–cleft palate has changed notably and the protocol of treatment has evolved continuously. Not touching the cleft lip nose in the primary repair was dogmatic in the past, even though this meant severe functional, aesthetic, and psychological problems for the child. McComb reported a new technique for placement of the alar cartilage during lip repair. The positive results of this new approach proved that the early correction of the alar cartilage anomaly is essential for harmonious facial growth with stable results and without discomfort for the child. Methods: The authors applied the same principles used for the treatment of the alar cartilage for correction of the septum deformity, introducing a primary rhinoseptoplasty during the cheiloplasty. The authors compared two groups: group A, which underwent septoplasty during cleft lip repair; and group B, which did not. Results: After the anthropometric evaluation of the two groups, the authors observed better symmetry regarding nasal shape, correct growth of the nose, and a strong reduction of the nasal deformity in the patients who underwent primary JJ septum deformity correction. Conclusion: The authors can assume that, similar to the alar cartilage, the septum can be repositioned during the primary surgery, without causing growth anomaly, improving the morphologic/functional results.

2012 - Lop ears: a retrospective study [Articolo su rivista]
Franchella, A; Pellegrinelli, S.; Carinci, F.; Zollino, I.; Canervali, G.; Candotto, V.; Franchella, S.; Pinto, V.; Morselli, P. G.
abstract

Congenital “lop ears” are a deformity include varying degrees of turning down (lidding) of the helix, reduction in the fossa triangularis, scapha compression, reduction of the superior crus of the antihelix and an associated reduction in vertical height of the external ear. Aim of this retrospective study is to assess the clinical outcome in a series of patients affected lop ears and discuss the pertinent literature. In the period between January 2003 and December 2009, 32 patients underwent to lop ears correction at the Pediatric Surgery Unit, S Anna Hospital, Ferrara, Italy. Patients included 4 (33.3%) females and 8 (66.6%) males. Age ranged from 5.6 to 18 years with a mean value of 11 at the time of admission. Lop ears were treated with Mustarde’ surgical technique under general anesthesia. No complications were detected in the follow-up period. The goal standard of surgery treatment for prominent ears is to obtain symmetrical and natural ears with not sign of being operated. More than 200 surgical techniques have been described for its correction indicating the lack of an ideal technique. These techniques can be classiied into two categories: with conservation of cartilage and with cartilage section. Section methods attend to eliminate the inherent memory of the cartilage so that the shape of the ear can be modiied. These techniques may leave signiicant asymmetries. In contrast, methods which shape the cartilage are based on the Mustardé technique, which consists of placing 3 or 4 horizontal mattress sutures with permanent suture material along the ridge of the helix, to create an antihelix fold. Our clinical results are similar to those reported in the English literature.

2012 - MUCOCELE IN PEDIATRIC PATIENTS: CASE SERIES ANALYSIS [Articolo su rivista]
A., Franchella; S., Pellegrinelli; F., Carinci; I., Zollino; G., Carnevali; V., Candotto; S., Franchella; Pinto, Valentina; Morselli, Paolo
abstract

The mucocele, a mucus accumulation from the salivary gland, represents a common lesion of the oral cavity. From 44 % to 79 % of mucoceles occur on the lower lip. There is no gender predilection and it can arise at any age. Mucoceles do not cause direct obstruction of salivary flow, and the amount of secretion that can be extravasated is limited by the elasticity of the surround tissues. In the period between January 2001 December 2010, 21 patients underwent to ulcer treatments at the Pediatric Surgery Unit, S Anna Hospital, Ferrara, Italy. Patients included 9 females and 12 males. Age ranged from 5 months to 13 years with a mean value of 7 years. All were located in the lower lip. Mucocele were treated with surgical excision, 13 under general anesthesia and the remaining under local anesthesia. Several techniques have been proposed: initial cryosurgical approach, CO2 laser, marsupialization and complete resection: this last is in most cases the best option.

2012 - VAC® therapy for wound management in patients with contraindications to surgical treatment [Articolo su rivista]
Negosanti, Luca; Sgarzani, Rossella; P., Nejad; Pinto, Valentina; Tavaniello, Beatrice; Palo, Stefano; C. M., Oranges; Fabbri, Erich; VIETTI MICHELINA, Veronica; Zannetti, Guido; Morselli, Paolo; Cipriani, Riccardo
abstract

The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient’s general conditions contraindicate surgical procedures, topical negative pressure with Vacuum Assisted Closure (VAC®) device can achieve wound healing with reduction of healing time and simpler manage- ment. We treated with VAC® device four patients with complex wounds and important contraindica- tions to surgery. In all the patients, we used VAC® device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC® when surgical procedures are contraindicated.

2010 - A Rare Case of Squamous Cell Carcinoma Arising in Chronic Perineal Hidradenitis Suppurativa [Abstract in Rivista]
Tassone, D.; Negosanti, L.; Pinto, V.; Nejad, P.; Tavaniello, B.; Gelati, C.; Cipriani, R.
abstract

2010 - Electrochemotherapy for Primary or Metastatic Skin Tumours: A Single Institution Experience [Abstract in Rivista]
Tavaniello, Beatrice; A., Ceccone; S., Palo; Tassone, Daniela; Negosanti, Luca; P., Nejad; Pinto, Valentina; Zannetti, Guido
abstract

2010 - Madelung’s Disease: A Case Report [Abstract in Rivista]
Pinto, V.; Tassone, D; Negosanti, L.; Tavaniello, B.; Palo, S.; Nejad, P.; Zavalloni, F.; Oranges, C. M.; Morselli, P. G.
abstract

2009 - Chirurgia plastica e cellule staminali: il tessuto adiposo come risorsa per la medicina rigenerativa [Articolo su rivista]
Morselli, P. G.; Oranges, C. M.; Pinto, V.; Sgarzani, R.; Negosanti, L.; Tavaniello, B.
abstract

Current developments in medicine have come to identify strategies that allow the regeneration of tissues affected by pathological phenomena. In this context we find the research on stem cells, which are equipped with the capacity to continue over time and, similarly, to give rise at least to an offspring of completely differentiated and highly specialized cells. In support of the latest advances in regenerative medicine, plastic surgery is playing an ever increasing role. Through the procedures of liposuction, the plastic surgeon provides biologist and clinician with a considerable amount of fat tissue, which is proving an extraordinary source of stem cells, useful both for plastic surgery and other fields of medicine. Adipose-derived stem cells have shown a very considerable differentiation potential. Furthermore, their easiness of taking and their abundance in the human body, makes them a potential tool with extraordinary effectiveness in tissue repairing. We already have experiences documenting that these cells have been successfully used in otorhinolaryngology, for the reconstruction of the vocal cords, in orthopedic surgery for bone defects filling, in neurosurgery, for the repair of cerebrospinal fluid loss, in colo-rectal surgery, which used the graft of adipose tissue for the treatment of sphincterial incompetence. In plastic surgery the most significant results were achieved in the treatment of radiodermatitis lesions, ulcers and for the breast reconstruction and augmentation. The purpose of this review is to examine the literature about the usefulness of adipose tissue as a source of stem cells and evaluate the studies which have already tried their use in regenerative medicine, with particular reference to plastic surgery.

2009 - Evaluation of Clinical Prognostic factors in T1NOMO Head and Neck Basal Cell Carcinoma [Articolo su rivista]
Morselli, P.; Zollino, I.; Pinto, V.; Brunelli, G.; Carinci., F.
abstract

2009 - Reverse Pedicled and Disepithelized Forearm Flap for Hand Reconstruction [Abstract in Rivista]
Gelati, Chiara; Sgarzani, Rossella; Fabbri, E.; Contedini, F.; Pinto, Valentina; Nejad, P.; Negosanti, Luca; Cipriani, Riccardo
abstract

2009 - Sentinel node biopsy: indications and controversies [Abstract in Rivista]
Masciotra, L.; Tavaniello, B.; Negosanti, L.; Pinto, V.; Palo, S.; Sgarzani, R.; Santoli, M.; Zannetti, G.; Cipriani, R.
abstract

2009 - Treatment of alveolar cleft performing a pyramidal pocket and an autologous bone grafting [Articolo su rivista]
Morselli, Paolo; Giuliani, Renzo; Pinto, Valentina; Oranges, Cm; Negosanti, Luca; Tavaniello, Beatrice; Morellini, A.
abstract

2008 - Clinical prognostic factors in stage I head and neck squamous cell carcinoma [Articolo su rivista]
Morselli, Paolo; I., Zollino; Pinto, Valentina; G., Brunelli; F., Carinci
abstract

2008 - Rinocheilognatoschisi monolaterale: approccio globale alla dismorfia della punta nasale [Articolo su rivista]
Morselli, P. G.; Pinto, V.; Morellini, A.; Sgarzani, R.; Negosanti, L.; Tavaniello, B.; Faenza, M.; Oranges, C. M.
abstract

The correction of nasal tip deformities, always combined with cleft lip, so that some authors the prefere the term rynocheilognatoschisis, is one of the most difficult and controversial issues in plastic surgery procedures for face malformation.The nose is a crucial feature in the harmony of the face and there is a vast literature on the numerous surgical corrective techniques, concerning both methodologies and timing. As a regards the time of correction we divide rhinoplasty into: primary rhinoplasty, performed at the time of primary lip surgery repair, intermediate rhinoplasty, performed between first and second childhood and final rhinoplasty, performed after completion of the development of the face. The purpose of this paper is to describe the pathological anatomy of nasal deformities in unilateral rinocheilognatoschisis and to illustrate the global methodology implemented by the Bologna school, made up of three distinct phases of treatment: pre-surgical modeling, surgery and post-surgical shaping.It aims to describe how the treatment of nasal deformities combined with cleft lip has been developed in the Bologna school over the last twenty years, through the analysis of functional and aesthetic results achieved in the treatment of 70 clinical cases, from 1988 to data, in the Center for Dismorphopaties Plastic Surgery/Center for the Treatment of Malformations.The main objective of the article is to compare the results achieved through the global technique with those obtained through the merely surgical traditional procedure used in the past.On the basis of the data obtained we can conclude that an early use of pre-surgical procedures and of their surgical variant currently applied in the Bologna school has allowed to achieve very good both on functional and aesthetic level. These procedures have actually resulted in a series of short and long term benefits, which mainly concern the correction of nose/lip/ labial deformities, and have significantly reduced complexity and invasiveness of secondary corrective surgery, which can thus be performed on a more stable and symmetric background. Finally they have also reduced the price to be paid in terms of residual scars, length of stay in hospital and surgery morbidity. These results are optimized by Psychological Assistance that influence in determining the future life in terms of adaptation and social interaction, appearance, self-esteem, emotional conditioning, behavioural and even cognitive, conditioning therefore, in a positive way, the quality of life of young patients and their families.

2007 - Clinical Parameters in T1NOMO Lower Lip Squamous Cell Carcinoma [Articolo su rivista]
Morselli, Paolo; Masciotra, Loredana; Pinto, Valentina; I., Zolino; G., Brunelli; F., Carinci
abstract

2007 - Comparison Among Clark’s, Breslow’s, and TNM Classifications for Cutaneous Head and Neck Malignant Melanoma [Articolo su rivista]
Morselli, Paolo; L., Masciotra; Pinto, Valentina; I., Zollino; G., Brunelli; F., Carinci
abstract

This retrospective study was carried out to assess the prognostic value of three classification systems used for staging cutaneous head and neck malig- nant melanoma (CHNME). Fifty-three patients with histologically proven CHNME were analyzed. Thirty patients were never treated before admis- sion, whereas 23 (43.4%) had a second radical re- section of the primary tumor location, 9 (17%) had neck nodes, none had distant metastasis, and all had a minimum of 5 years of follow-up. Results show that T-stage is the most important clinical prognostic parameter, whereas Clark’s and Breslow’s classifications have lower impact in defining prog- nosis. Sites of primary tumor determines different clinical outcomes, but this does not reach statistically significant values. A second surgery on the primary tumor location is possible and is effective toward survival. No statistical differences were noted be- tween the previously untreated and treated groups. Neck nodes have to be removed with neck dissection, and this regimen can improve the clinical outcome; however, only 40% of neck positive patients survive more than 5 years.

2006 - Chirurgia plastica delle schisi del processo alveolare: La scuola di Bologna [Articolo su rivista]
Morselli, Paolo; Giuliani, Renzo; Morellini, A; Sgarzani, Rossella; Pinto, Valentina; Masciotra, Loredana; Cavina, Carlo
abstract

Alveolar cleft repair is a debate topic in Cleft Lip and Palate treatment. Many surgical techniques have been described in the past, but there are different opinions on witch therapy is the best one for this malformation. There are different opinions also on with material is the best for grafting. The repair can be achieve by inserting different material in the cleft or without any grafting, as in the periostioplasty technique so said "boneless bone graft". The material can be autologous, allogenical or alloplastical. Also operative times are a debate topic and the discussion is not focus on of a few days or months of difference, but regard many years. In fact some authors treat alveolar cleft at neonatal age but some others prefer to operate at the age of 8-10 years. The article analyze the evolution in the treatment of this pathology in the last 50 years and to expose the methodology of the School of Bologna. During the period between 1981 and 2006, 460 patients with alveolar clefts have been treated in our unit with autologous bone grafting. Our protocol is to repair alveolar cleft with an autologous bone graft at an average age of 10. The operation is carried out after the growth of maxillary bone is completed for 80%, before the eruption of canine teeth. Autologous bone was taken in the 45% of patients from the skull, 35% from the iliac crest, and the 20% from the chin. The surgical technique of realizing a pocket to home the bone graft, key point to get a good result, and the surgical technique to get bone graft from the donor sites are described. We analyzed the experience of the School of Bologna, we describe the methodology and we evaluated the results and we can conclude that our method let us achieve satisfactory results.