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ANDREA LETI ACCIARO
Docente a contratto
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto
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Pubblicazioni
2022
- Modified dome osteotomy and anterior locking plate fixation for distal radius variant of Madelung deformity: a retrospective study
[Articolo su rivista]
Leti Acciaro, Andrea; Garagnani, Lorenzo; Lando, Mario; Lana, Debora; Sartini, Silvana; Adani, Roberto
abstract
Purpose Dome osteotomy of the distal radius with Vickers ligament release is an established method of treatment for Madelung deformity. Many different surgical procedures have been proposed in literature but techniques, patient inclusion and efficacy evaluations are heterogeneous. Materials and methods A retrospective review of children affected by 'distal radius' Madelung deformity and treated with a standardized surgical procedure (modified reverse dome osteotomy of the distal radius and volar fixation with a small locking plate) between 2010 and 2018 at a single center was performed. The technique used in this study, reversing the shape of the classical dome osteotomy, allowed for an improved three-planar correction of the distal radial epiphysis and volar plate fixation allowed for an increased stability and reduced soft tissue morbidity. A structured follow-up including a prompt post-operative rehabilitation program (without wrist immobilization) was established. Pain relief, functional outcome and cosmetic appearance were assessed with a structured clinical assessment, DASH Score and radiographic assessment, accordingly. Results A total of 15 wrists in 13 children (12 females, mean age of 15.6 years, range 11-19) were included. The mean follow-up time was 3.8 years. Bone union and pain relief were obtained in all cases. Improvement in the range of motion was detected in extension, supination and flexion of the wrist. Radial inclination was increased by 15.3 degrees and lunate subsidence by 4.1 mm. Conclusions The use of volar fixation with a small locking plate and immediate post-operative rehabilitation for reverse dome osteotomy of the distal radius in pediatric patients affected by 'distal radius' Madelung's deformity is stable and effective.
2022
- Outpatient paediatric hand surgery: strategy in healthcare implementation and cost-efficient manner
[Articolo su rivista]
Leti Acciaro, Andrea; Ramponi, Laura; Adani, Roberto
abstract
The increasingly cost of health care is a relevant problem as well as prolonged waiting time for admission also in emergencies. Effective cost containment measures and expenditure controls are needed to achieve and maintain clinical and organizational appropriateness. Outpatient management has proven to be the most useful method for lower-cost treatment in less severe pathologies, requiring surgery without hospitalization. The current study provided to evaluate how this model was successfully applied also to the paediatric population in hand surgery. Methods. A retrospective cohort study of 645 patients from 8 to 18 years (mean age 14.9) was performed in children treated in outpatient setting from 2015 to 2019. The direct costs were evaluated as well as the mean waiting time for surgery, comparing the data with the previous five-year period. The mean reduction in waiting time for children emergencies was 57% (from 72 to 31 h) due to the Outpatient setting into a dedicated Day-Surgery Service organizational model. The visual graphed data showed a general clear growing trend towards outpatient surgery in adults and children. The overall effect was a 29.2% of reduction in spending between expected and achieved costs, recovering resources toward the increasing technology and innovation expenditures. Outpatient paediatric hand surgery was an effective and attractive option which leaded to decreased individual and social costs, with increased clinical and organizational appropriateness. Thus, reduced delay in treatment and provided benefits for children and familiars.
2022
- Piezoelectric Bone Surgery. Overview in Applications and Proof of Feasibility in Hand and Plastic Surgery
[Articolo su rivista]
Leti Acciaro, Andrea; Lando, Mario; Starnoni, Marta; Giuca, Giuliano; Adani, Roberto
abstract
Purpose Piezoelectric bone surgery was already extensively used in a number of surgical procedures ranging from dental to maxillofacial surgery. The authors aimed to determine whether piezosurgery was suitable and advantageous for performing osteotomies in Hand and Plastic reconstructive surgery. Methods The authors overviewed a variety of applications for Piezosurgery(R) Device, from Mectron, in bone reconstructive surgery with over the last 8 years. An overall number of 156 bone cutting procedures in adults and children was described at the phalanges, metacarpal bones and distal radius level, as well as in bone graft harvesting and bone remodeling following carpal scaphoid nonunion, scapho-lunate bone-ligament-bone reconstruction and fibula free flap in maxillofacial defects. Results The consolidation rate was 87.5% in scaphoid nonunion grafting and fixation. Bone healing was achieved in all other cases. No intra-operative complications were recorded. Conclusion Piezosurgery(R) allowed high precision in bone cutting as well as custom-made graft and surface roughness were obtained, while preserving nerves, vessels and tendons integrity. The instrument may be handling moved into the surgical space in absence of vibrations, with a clear view onto the bone. The mechanical and biological characteristics of the piezoelectrical effect perfected this technique as an effective and useful instrument in Hand and Plastic surgery. The selective bone cutting properties avoided injuries to the surrounding soft tissues and thermal damage of the bony cells. Best advantages were described in feasibility and flexibility for intra-articular osteotomies, custom-made grafts and reconstructive microsurgical techniques.
2022
- Plate fixation in challenging traumatic carpal scaphoid lesions
[Articolo su rivista]
Leti Acciaro, A.; Lana, D.; Fagetti, A.; Cherubino, M.; Adani, R.
abstract
Background: Complex fractures of the carpal scaphoid with poles fragmentation, edges comminution, bone loss and non-union of fractures previously treated by screw fixation remain challenging for hand surgeons. The authors present the indications, advantages and results of scaphoid plating, underlining the importance of correct plate positioning well shaped onto the bone. Materials and methods: The study includes 11 patients presenting acute fracture with distal pole fragmentation, acute fracture with comminution and non-union after prior failure of screw fixation. All patients were treated with volar locked plate fixation, adding a cortical bone graft in cases of non-union. Results: Bone consolidation was achieved in all cases; excellent outcomes in fracture healing and relevant improvement in symptoms and functions were obtained in non-union group that are consistent with the literature. Only one patient underwent early further surgery (first row carpectomy) with poor results. Conclusion: The treatment of the selected scaphoid lesions with volar locked plate is a surely efficient technique. The plate can be easily adjusted to the shape of the scaphoid and can achieve an adequate correction of bone deformity and high degree of stability both in non-union and fractures.
2022
- Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold
[Articolo su rivista]
Marcuzzi, A.; Colzani, G.; Acciaro, A. L.; Rosa, N. D.; Landi, A.
abstract
Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioabsorbable scaffolds have begun to be proposed to avoid the use of other biological tissues or artificial permanent devices. Methods: In this study, we evaluated the long-term outcomes of poly-ld-lactic acid scaffold in interposition arthroplasty in a series of patients treated in our department. Results: Strength, range of motion, and pain improved after the intervention and lasted over the years; nonetheless, most of the radiographs showed a progressive collapse of the first metacarpal. Conclusions: Despite radiological findings, we believe that poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results.
2022
- Retrospective study in clinical governance and financing system impacts of the COVID-19 pandemic in the hand surgery and microsurgery HUB center
[Articolo su rivista]
Leti Acciaro, A; Montanari, S; Venturelli, M; Starnoni, M; Adani, R
abstract
The authors presented a retrospective study in the surgical activity of the HUB center for Hand Surgery and Microsurgery in Emilia-Romagna comparing the data between March and April 2020, in the peak of Covid pandemic, with the same period in 2019.
2022
- Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung's deformity: long-term follow-up
[Articolo su rivista]
Leti Acciaro, Andrea; Garagnani, Lorenzo; Lando, Mario; Cataldo, Giacomo; Adani, Roberto
abstract
Purpose The emerging role of the locking plate improved the technique also in corrective osteotomies in Madelung's deformity, but there is a lack of analyses between the fixation techniques, as well as little information in functional outcomes and long-term follow-up. The current study compared the outcomes, pitfalls, and advantages of volar plate and screws fixation versus K-wires fixation in a long-term follow-up. Methods Twenty-eight children presenting the "distal radius" variant of Madelung's deformity underwent Vickers ligament release and distal radial dome osteotomy between 2009 and 2015. Twenty-three children (20 females and 3 males, mean age 15 years and 7 months at surgery and 24 years and 8 moths at follow-up), with 26 operatively treated wrists, were available for follow-up. A retrospective two-cohort study, evaluating clinically and radiologically results, has been conducted with a mean eight years and seven months follow-up. Results Bone union and pain relief were obtained in all cases, as well as improvements in wrist motion and radiographic indices. A statistically significant correlation was identified between the volar plate fixation and an improved lunate subsidence on X-ray, and a trend towards an improved DASH score in the cohort with plate and screws, as well as significant improvement in wrist extension and supination always in the plate fixation cohort. Conclusions The long-term follow-up enabled the patients to report on more definitive outcomes in terms of functional and cosmetic improvements. Volar plate fixation is an effective technique allowing for simple post-operative management and earlier rehabilitation program with improved clinical and radiographic outcomes.
2021
- Digital Replantations: Comparison Veins Anastomoses first versus Arteries Anastomoses first
[Articolo su rivista]
Acciaro, Andrea Leti; Colzani, Giulia; Della Rosa, Norman; Starnoni, Marta; Adani, Roberto
abstract
This retrospective study analyses the effect performing veins anastomoses before arteries anastomoses in digital replantation.
2021
- New management and trauma incidence in hand surgery during the phase 1 of COVID-19 pandemic in a referral hand surgery and microsurgery center into the outbreak in North Italy
[Articolo su rivista]
Leti Acciaro, Andrea; Montanari, Sara; Venturelli, Marco; De Santis, Giorgio; Starnoni, Marta; Adani, Roberto
abstract
BACKGROUND: This is a retrospective study of the casuistry occurred at the Hand Surgery and Microsurgery HUB Center of Emilia-Romagna during the months of March and April 2020 in the peak of Phase 1 of COVID-19 pandemic in Italy, comparing the data with the same period in 2019.METHODS: A more relevant reduction of 92.3% in elective surgery and a significantly less relevant reduction of 37.2% in emergencies was recorded. Replantation did not present reduction while cutting lesions of tendons and saw injuries increased such as the injuries during domestic activities.RESULTS: The incidence of hand trauma looks not only at the traditional field of artisanal and industrial injuries, but also to the most recorded accidents in daily life activities. The data evidenced the significantly increase of the injuries occurring in the domestic environment. The 72.8% of emergencies was treated in day-service with significantly reduction in hospitalization, costs and infective risks. Telemedicine implementation has experienced to upgrade the relationship in the emergency network.CONCLUSIONS: Hand injuries remained a major issue also during the lockdown. A functional and skill emergency service and day-service during the phase 1 COVID-19 pandemic played a relevant role in efficacy and efficiency. The utility of telemedicine was greatly limited by liability and risk management issues.
2021
- The Challenges in restoration of extensor tendons function at the hand
[Articolo su rivista]
Leti Acciaro, Andrea; Colzani, Giulia; Starnoni, Marta; Adani, Roberto
abstract
The authors discuss challenges in extensor function restoration at the finger level following distal posterior interosseous or tendon complex injuries, according to the typologies of lesions or the specific patient requirements.
2021
- Upper limb traumatic injuries: A concise overview of reconstructive options
[Articolo su rivista]
Starnoni, M.; Benanti, E.; Acciaro, A. L.; De Santis, G.
abstract
2020
- Soft tissue coverage of the upper limb: A flap reconstruction overview
[Articolo su rivista]
Benanti, Elisa; De Santis, Giorgio; Leti Acciaro, Andrea; Colzani, Giulia; Baccarani, Alessio; Starnoni, Marta
abstract
2020
- Telematic solutions in plastic surgery during COVID-19 pandemic: Liability issues and risk management
[Articolo su rivista]
De Santis, G.; Palladino, T.; Acciaro, A. L.; Starnoni, M.
abstract
During the COVID-19 pandemic, surgical elective procedures were stopped in our plastic surgery unit. Limitations for consultations and for follow-up of previous surgical procedures were imposed in order to minimize the risk of contagion in waiting rooms and outpatient clinics. We have identified telemedicine as an alternative way to follow patients during the lockdown. Nevertheless, we have experienced different difficulties. We have not had the possibility to use a secure teleconferencing software. In our unit we had not technological devices. Surgeons in our department were not able to use remote video technology for patient management. Guidelines for an appropriate selection of patients which could be served via telemedicine had to be created.Telemedicine must be regulated by healthcare organizations for legal, ethical, medico-legal and risk management aspects.Even if we have experienced an important need to use telematic solutions during the COVID-19 lockdown, liability and risk management issues has greatly limited this possibility in our unit. The need of telemedicine in the time of COVID-19 pandemic has encouraged us to implement future virtual encounters in order to reduce unnecessary in-person visits by taking into consideration all legal, ethical and medico-legal aspects.
2019
- Le complicanze dell'osteosintesi interna nelle fratture dell'estremità distali del radio: review della letteratura ed esperienza personale 2006-18
[Articolo su rivista]
Tomarchio, ; LETI ACCIARO, Andrea; Greco; D; et al, A;
abstract
2019
- Management of locked volar radio-ulnar joint dislocation
[Articolo su rivista]
Starnoni, M.; Colzani, G.; De Santis, G.; Acciaro, A. L.
abstract
Isolated volar dislocation of the distal radio-ulnar joint is an extremely rare lesion. Diagnosis is commonly missed. The authors report their experience about a case of an acute locked volar distal radio-ulnar joint dislocation. A correct clinical and radiological diagnosis was done in the Emergency Department, and a closed reduction was achieved only after an axillary block, after a first failed attempt under slight sedation. A K-wire blocking the prono-supination and a short removable forearm cast protected the reduction for 25 days. Two weeks after the removal of the immobilization, the patient presented a complete functional recovery, with full range of motion. The authors highlight the importance of the clinical and radiological findings: a dorsal dimple at the ulnar side leads to a high index of suspicion, and represent the most relevant aid in diagnosis, associated to a proper imaging assessment. Prompt management allows a minimally invasive approach and a rapid functional recovery.
2019
- Median nerve injury caused by screw malpositioning in percutaneous scaphoid fracture fixation
[Articolo su rivista]
Starnoni, M.; Colzani, G.; De Santis, G.; Acciaro, A. L.
abstract
An unusual complication of percutaneous fixation of a schapoid fracture in a 36-year-old man is described. After this surgery, the patient complained of numbness and tingling within the median nerve distribution and thenar weakness. An Electromyography showing moderate CTS had led to carpal tunnel decompression, which resulted unsuccessful. When the patient presented to us, both sensory and motor median nerve impairment were present, interfering with his professional activity. A computed tomography scan performed to assess the scaphoid screw position, showed that the screw had been placed volar to the scaphoid, adjacent to the median nerve. Surgery confirmed median nerve compression by the screw, especially during complete wrist extension. The surgical removal of the screw led to immediate improvement of both the motor and sensory functions of the nerve, with complete clinical restoration of nerve function and resolution of the symptoms 2 months postoperatively.
2019
- Osteotomia cupuliforme del radio modificata nel trattamento della deformità di Madelung; Studio Retrospettivo
[Articolo su rivista]
Leti Acciaro, A; Lana, D; Sartini, S; Landi, A; Adani, R.
abstract
2018
- A mini-invasive tenolysis of the flexor tendons following hand fractures: case series
[Articolo su rivista]
Leti Acciaro, A.; Lando, M.; Russomando, A.; Colzani, G.
abstract
Introduction: The treatment of the flexor tendon adhesions following phalanx and metacarpal fractures, in closed or open injuries, is a great challenge for the hand surgeon. The outcomes are often poor, because of the severity of the lesion and the aggressiveness of the surgical procedure of the secondary tenolysis. Materials and methods: The authors describe the technical findings and the results of a new mini-invasive tenolysis in order to treat the adhesions in zone 1 and 2 of the fingers, following phalangeal and metacarpal fractures. With an atraumatic Allis or Duval surgical forceps, the flexor tendons are separately and gently tracted making a twisting movement on themselves until the adhesions were torn and the tendons appeared released. Results: The relevant outcomes achieved show this technique is very useful to treat tendon adhesions, without adding trauma and scare to the tendinous canal and surrounding soft tissues.
2018
- A new sign allowing diagnosis in the pathologies of the extensor tendons of the hand
[Articolo su rivista]
Leti Acciaro, A.; Pilla, F.; Colzani, G.; Corradi, N.
abstract
Introduction: The thorough knowledge of the anatomy of the extensor tendon system of the hand is crucial for clinical examination and detection of tendon injuries. The Juncturae between the EDCII and other extensor tendons presents different incidences, shapes (“r” or “y”) and morphologies (Type I, II, III). The EIP does not receive connection. These characteristics may result in variable effects on extensor tendons during active finger movements. The purpose of this study is to investigate and describe a new sign helping diagnosis for injuries or pathologies of EIP and EDC index finger (EDC II), based on a cadaveric dissection and clinical observation. Materials and methods: The authors performed a clinical observational study in 520 patients in order to distinctly evaluate by means of inspection and palpation the EIP and EDC II tendons and an anatomical analysis of extensor tendon apparatus of long fingers was then performed in 89 cadaver hands focusing the investigation on the juncturae system. Results: The observational studies showed that during the flexion of the III, IV and V fingers, associated to the active extension of the I and II fingers, the EDC of the III, IV and V fingers moved the EDC II in ulnar direction by means of juncturae action. The EIP remained in its position becoming visible and isolated from the migrated EDC II. Conclusions: This feature allows the distinct clinical evaluation by observation and palpation of both EDC II and EIP tendons and may be helpful in clinical conditions such as diagnosis of tendon lesions, pre-operative planning of EIP transfer and extensor tendon tenolysis associated to soft tissue scar at the second MPj.
2018
- The carpal tunnel syndrome in children
[Articolo su rivista]
Leti Acciaro, A.; Pilla, F.; Faldini, C.; Adani, R.
abstract
Introduction: Carpal tunnel syndrome (CTS) in children represents a complex challenge for the hand surgeon because of its rarity, poor patient cooperation, frequently associated malformation syndromes and mental retard, atypical symptoms and nuanced and poor sensitivity of instrumental tests. The most frequently associated causes with the CTS in children are rare congenital malformations and diseases, requiring an overall assessment of the young patient and a high degree of suspicion for the potentially associated canalicular syndrome. On the other hand, the associated syndromes may be the main ally for a diagnosis that starts from the knowledge of the literature and the surgeon's suspicion by observing the child wailing. Early diagnosis and decompression treatment is mandatory. Materials and methods: The authors report a case series of 26 children and analyze the etiology and diagnostic algorithms. Patient assessment was based on complete clinical examination and medical history collection of these young patients with the involvement of the family and educators. Results: In all 26 patients treated, along an average period of 23 months (minimum 12, maximum 30), no signs of recurrence or persistence of median nerve disturbances were recorded. Conclusions: In conclusion, we believe that anamnesis, a careful physical examination and analysis of instrumental examinations, should be accompanied by a thorough knowledge of rare diseases in the context of congenital malformations. The carpal tunnel syndrome, while well known and treated by each orthopedic surgeon, reveals a mysterious aspect in the context of the "fabulous" world of childhood illnesses, even more difficult than rare congenital diseases.
2018
- Utilizzo del joint scaffold nel trattamento della rizoartrosi mediante artroplastica di interposizione: risultati a lungo termine
[Articolo su rivista]
Verdecchia, C; Leti Acciaro, A; Marcuzzi, A; Della Rosa, N; Landi, A.
abstract
2017
- Lo pseudotumore fibro-osseo alla mano: casistica
[Articolo su rivista]
Leti Acciaro, A; Cerocchi, I; Pilla, F; Petrella, G; Landi, A; Adani, R.
abstract
2016
- 3D printed replica of distal radius fracture: why?
[Articolo su rivista]
Bizzotto, N; Corain, M; Leti Acciaro, A; Et, Al.
abstract
2016
- Iatrophatic and post-infective loss of tissue
[Capitolo/Saggio]
Landi, A; Darin, F; Leti Acciaro, A; Marcelli, S; Et, Al
abstract
2016
- Il morso di vipera nel bambino: case report
[Articolo su rivista]
Leti Acciaro, A; Russomando, A.
abstract
2016
- La rete di chirurgia della mano e microchirurgia integrata nei sistemi sanitari regionali dell'Emergenza-urgenza
[Articolo su rivista]
Pfanner, S; Leti Acciaro, A.
abstract
2015
- External bone remodeling after injectable calcium-phosphate cement in benign bone tumor: 2 cases in the hand
[Articolo su rivista]
Ichihara, S.; Vaiss, L.; Acciaro, A. L.; Facca, S.; Liverneaux, P.
abstract
2015
- External bone remodeling after injectable calcium-phosphate cement in benign bone tumor: Two cases in the hand
[Articolo su rivista]
Ichihara, S.; Vaiss, L.; Acciaro, A. L.; Facca, S.; Liverneaux, P.
abstract
Bone remodeling commonly occurred after fracture and curettage benign bone tumor. A lot of previous articles reported "internal" trabecular bone remodeling. There were no previous clinical reports about "external" cortical bone remodeling. We present here 2 clinical cases of "external" bone remodeling after injectable calcium-phosphate in benign bone tumor in the hand. In two cases of benign bone tumor, we performed complete removal of the tumor and immediate filling of the metacarpal bone with injectable calcium-phosphate cement Arexbone® from the mechanical viewpoint. With respect to the shape of the calcium-phosphate, by using an injection-type, calcium-phosphate is adhered uniformly to the bone cortex by injecting, remodeling has been promoted. After 5 and 8years, both cases were no recurrences, and the shape of the metacarpal looked close to the contralateral side. These findings supposed to be concerned with potential self-healing and self-protection mechanism in human body.
2015
- Incidence estimates of hand and upper extremity injuries in Italy
[Articolo su rivista]
Giustini, Marco; de Leo, Anna; Leti Acciaro, Andrea; Pajardi, Giorgio; Mamo, Carlo; Voller, Fabio; Fadda, Francesco; Fondi, Gianni; Pitidis, Alessio
abstract
Objective. The purpose of this investigation is to estimate the incidence rates of upper extremity injuries and to give an overview of the most frequent diagnoses.Materials and methods. Two population databases were queried for all injuries in the upper extremities, the SINIACA-IDB (S-IDB: Emergency Department Injury Database in Italy) and the Hospital Discharge Register (HDR). The diagnoses codes of hand trauma were selected from both databases in order to estimate the national incidence rate.Results. According to the S-IDB data of year 2011, total 1 479 510 ED attendances per year in Italy were estimated with an upper extremity injury (incidence rate: 2491 per 100 000 persons/year). About 880 816 Emergency Department (ED) attendances per year are due to hand injuries, while over 653 336 attendances per year concern arm injuries. The incidence rates are 1483 and 1100 per 100 000 person/year respectively. About 201 940 hospitalizations are observed in the HDR because of upper extremity injuries (incidence rate: 340 per 100 000 persons/year). Males have higher incidence rate (387 vs 280 per 100 000 persons per year). The trend in the incidence rates for the age group of inpatients shows two peaks: at age 12 (400 cases per 100 000 persons/year), and in the older age groups (700 cases per 100 000 persons/year).
2015
- La sindrome del tunnel carpale nel bambino
[Articolo su rivista]
Leti Acciaro, A; Banfi, A; Lando, M; Landi, A.
abstract
2015
- La tenolisi mini-invasiva dei tendini flessori negli esiti delle fratture alle dita della mano. Preliminary report
[Articolo su rivista]
Leti Acciaro, A; Chiarelli, N; Lando, M; Russomando, A; Landi, A.
abstract
2014
- Hyaluronic acid scaffold for skin defects in congenital syndactyly release surgery: A novel technique based on the regenerative model
[Articolo su rivista]
Landi, A.; Garagnani, L.; Leti Acciaro, A.; Lando, M.; Ozben, H.; Gagliano, M. C.
abstract
Syndactyly release may require skin grafting to fill the skin defects, which might lead to complications or poor cosmetic outcomes. A simple graftless technique for syndactyly release with a hyaluronic acid (HA) scaffold used to cover the bare areas is described. Between 2008 and 2011, release of 26 webs in 23 patients was performed. All skin defects were covered with Hyalomatrix® PA. One patient was excluded due to early post-operative infection that required HA scaffold removal before its integration. Web creep, secondary deformities, scar quality, and patient and parental satisfaction were assessed. Mean follow-up of the group of 22 patients was 24 months. There were no secondary deformities and minimal degree of web creep. All patients had close to normal pigmentation and good pliability at the sites of scaffold application. The results confirm the use of a HA scaffold as a promising alternative to skin grafting in syndactyly release surgery.
2013
- Bedeutung des FESSH Hand Trauma Komitees in Europa
[Articolo su rivista]
Battiston, B.; Leti Acciaro, A.; Deleo, A.
abstract
In Europe the need for clear definitions of hand surgery facilities regarding trauma is becoming really important to guarantee a correct and up-dated treatment of lesions more and more frequent and complex. The goal for European patients should be to have similar treatment based on appropriate referral and assistance in centres officially accredited for hand surgery. The target for the European countries, giving the correct support to the centres and surgeons treating these problems, should also be to save the costs of residual invalidities. These are some of the reasons for the European Federation of Societies for Surgery of the Hand (FESSH) decided to form a committee (Hand Trauma Committee) devoted to study this problem, trying to give common guidelines and forming an European net of accredited centres. The first step was to collect data through a network of national representatives. Covering a 487 millions population, 309 centres were recorded, including 1 797 surgeons and 20 363 patients treated during January 2006, then having a clear situation of hand trauma treatment through Europe. Next, the HTC worked on 3 definitions: hand trauma, hand trauma surgeons and hand trauma centres and started to accredit centres applying to these well defined criteria. The HTC is now working on scientific consensus on some traumatic lesions but also on the important topic of prevention of hand traumas. This work is expected to improve an homogenous situation throughout Europe focusing on the better use of the given resources for the prevention and the treatment of these traumatic lesions. © Georg Thieme Verlag KG Stuttgart · New York.
2013
- Trattamento delle malunion di polso
[Articolo su rivista]
Leti Acciaro, A; Della Rosa, N; Marcuzzi, A.
abstract
2012
- Un nuovo segno clinico nella semeiotica degli estensori delle dita della mano
[Articolo su rivista]
Leti Acciaro, A.
abstract
2011
- Antibiotico profilassi in chirurgia della mano: l'orientamento attuale in Italia
[Articolo su rivista]
Brambullo, T; Pfanner, S; Leti Acciaro, A; Et, Al.
abstract
2011
- Le fratture di polso - Osteotomie correttive e Malunion extra-articolari
[Monografia/Trattato scientifico]
Corradi, M; Luchetti, R; Leti Acciaro, A; Et, Al.
abstract
2011
- Sindrome compressiva del nervo ulnare al gomito e al polso
[Articolo su rivista]
Leti Acciaro, A; Russomando, A; Pegoli, L; Et, Al.
abstract
2010
- A rare case of acral myxoinflammatory fibroblastic sarcoma at the hand
[Articolo su rivista]
Leti Acciaro, A.; Gabrieli, R.; Landi, A.
abstract
One case of acral myxoinflammatory fibroblastic sarcoma is presented. Most of the soft tissue tumefactions of the distal extremities are benign. Sarcomas are rare and usually high grade. Acral myxoinflammatory fibroblastic sarcoma is a unique low-grade tumor described by Kindblom in 1998. This neoplasm has a propensity for digits, presents a low rate of metastasis and is characterized by a high rate of local multiple and aggressive recurrence. The clinical presentation, the frequent association with tenosynovitis and the extensive inflammatory infiltrate can lead to misdiagnosis by both the surgeon and the pathologist. Correct and early diagnosis depends on a good knowledge of histological and immunohistochemical findings. It is important to avoid recurrences recurring to an immediate wide excision of the tumor. © Springer-Verlag 2009.
2010
- Efficiency of hyaloglide ® in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: A randomized, controlled, multicentre clinical trial
[Articolo su rivista]
Riccio, M.; Battiston, B.; Pajardi, G.; Corradi, M.; Passaretti, U.; Atzei, A.; Altissimi, M.; Vaienti, L.; Catalano, F.; Del Bene, M.; Fasolo, P.; Ceruso, M.; Luchetti, R.; Landi, A.; Bertani, A.; Campodonico, A.; Pangrazi, P. P.; Marchesini, A.; Leti Acciaro, A.; Castagnetti, G. C.; Kantunakis, G.; Cugola, L.; Pivato, G.; De Cristofaro, V.; Breda, B.; Conforti, L.; Fusco, M.; Nigi, M.; Pfanner, S.; Azzara, A.; Verdano, M. A.; Frattini, M.; Rocchi, L.
abstract
Hyaloglide® is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to reduce postsurgical adhesions. Its efficacy was assessed in a multicentred randomized controlled trial comparing the results of flexor tenolysis in zone 2 following failed flexor tendon repairs. In the control group a standard release was performed. In the treated group, Hyaloglide® was applied into the flexor sheath and around the site of tenolysis. Forty-five patients, 19 controls and 26 treated with Hyaloglide®, were enrolled in 13 centres. All the patients were evaluated at 30, 60, 90 and 180 days after surgery by testing Total Active Motion, Quick-DASH questionnaire and number of working days lost after surgery. Patients in the Hyaloglide® group had a statistically better recovery of finger motion at all time intervals and returned earlier to work and daily activities. The use of Hyaloglide® did not appear to increase the complication rate. © 2010 The British Society for Surgery of the Hand.
2010
- Le infezioni dell'arto superiore ad elevato rischio di vita
[Articolo su rivista]
Leti Acciaro, A; Colombo, S; Sgrambiglia, R; Et, Al.
abstract
2009
- La Chirurgia Funzionale dell'Arto Superiore
[Capitolo/Saggio]
Caserta, G; Leti Acciaro, A; Pellacani, A; Landi, A.
abstract
2009
- The total anterior tenoarthrolysis in the treatment of the stiffness in flexion of the fingers
[Articolo su rivista]
Leti Acciaro, A.; Gabrieli, R.; Landi, A.
abstract
The total anterior tenoarthrolysis (TATA) allows tenolysis, arthrolysis and skin repair in the same operation, avoiding combined different surgical procedures. The authors present a series of personal and original indications and propose a partial anterior tenoarthrolysis (PATA) for the treatment of isolated stiffness of the proximal interphalangeal joint or in the presence of less severe flexion contractures. The etiology was wide various, and the TATA revealed to be extremely useful also in tetraplegia or spasticity, permitting respectively the following tendon transfer and the hygienic improvement, and in the presence of global stiffness following complex lesions, reflex sympathetic algodystrophy or psychotic contracture. The performed additional procedures, at the skin and tendon level, further expanded the inclusion criteria. In the presence of appropriate indications, the TATA is a very useful tool with excellent outcome and represents a salvage procedure in the more severe deformities, avoiding joint fusion, with shortage of the digit, or amputation.
2008
- Le Sindromi Compartimentali acute e gli esiti stabilizzati a livello dell'arto inferiore
[Capitolo/Saggio]
Barca, F; Leti Acciaro, A.
abstract
2007
- Carpal tunnel syndrome: Rare causes
[Capitolo/Saggio]
Landi, A.; Leti Acciaro, A.; Della Rosa, N.; Pellacani, A.
abstract
Carpal tunnel syndrome (CTS), in its idiopathic form, is an extremely frequent entrapment neuropathy in the clinical practice. © 2007 Springer-Verlag Berlin Heidelberg.
2007
- Reimpianto del Pollice
[Capitolo/Saggio]
Abatre, M; Leti Acciaro, A; Landi, A.
abstract
2007
- Spasticità
[Capitolo/Saggio]
LETI ACCIARO, Andrea; Della Rosa, Norman; Landi, Antonio
abstract
2007
- Storia del Logo della SICM
[Capitolo/Saggio]
Landi, A; Rippa Bonatti, M; Leti Acciaro, A; Martinelli Braglia, G; Pellacani, A.
abstract
2007
- The life-threatening infections of the upper limb
[Capitolo/Saggio]
Landi, A; Leti Acciaro, A; Codeluppi, M; Nasole, E; Gagliano, Mc.
abstract
2006
- Ligamentous reconstruction of scapholunate dislocation through a double dorsal and palmar approach
[Articolo su rivista]
Marcuzzi, A.; Leti Acciaro, A.; Caserta, G.; Landi, A.
abstract
Six patients, were treated for scapholunate dissociation by reconstruction of both the palmar and dorsal parts of the scapholunate interosseous ligament through a combined palmar and dorsal approach. The mean active range of motion of the wrist at final follow-up was 44° of flexion and 58° of extension and the mean hand grip strengths was 88% of that of the contralateral hand. The average time to return to work was 105 days and the mean DASH score at a mean follow-up of 32 months was 18. At follow-up, radiographs showed maintenance of the anatomical reduction of the scapholunate articulation in all cases and the scapholunate angle was normal in five patients. © 2006 The British Society for Surgery of the Hand.
2005
- Patologia del piede. Vol. 1: Tecniche chirurgiche
[Monografia/Trattato scientifico]
Barca, Francesco; Ronconi, Paolo; Giannini, Sandro; Zecchini, F; Magnan, B; Viladot, A; Leti Acciaro, A; Maleti, O.
abstract
2005
- The Historical Odyssey of the Mutilated Hand
[Capitolo/Saggio]
Landi, A.; Acciaro, A. L.; Rosa, N. D.
abstract
2005
- Valutazione RX - Alluce Valgo
[Capitolo/Saggio]
Leti Acciaro, A; Barca, Francesco
abstract
2004
- Surgical correction of crossover deformity of the second toe: A technique for tenodesis
[Articolo su rivista]
Barca, F.; Acciaro, A. L.
abstract
Twenty-seven patients with 30 crossover toe (COT) deformities of the second toe were evaluated. This deformity in the transverse and sagittal planes at the second metatarsophalangeal joint may be caused by hindfoot pronation. Compression of the lateral plantar nerve may produce incompetence of the second dorsal interosseous muscle and an increased extension-adduction pull by the lumbrical and first dorsal interosseous muscles. A surgical procedure for tenodesis is described to correct these deformities and restore the extrinsic-intrinsic musculotendinous balance at the second MTP joint. Our results are encouraging, with 83% good or excellent results. There was one recurrence.
2003
- Conventional tendon grafting
[Capitolo/Saggio]
Landi, Antonio; Caserta, Giuseppe; Della Rosa, Norman; Acciaro, Andrea
abstract
2003
- Emergency reconstruction of the thumb in traumatic amputations in adults
[Capitolo/Saggio]
Landi, A; Busa, R; Leti Acciaro, A; Esposito, M.
abstract
2003
- The upper limb in cerebral palsy: Surgical management of shoulder and elbow deformities
[Articolo su rivista]
Landi, A.; Cavazza, S.; Caserta, G.; Leti Acciaro, A.; Sartini, S.; Gagliano, M. C.; Manca, M.
abstract
The authors report a simple chart that offers a comprehensive picture of spasticity of the upper limb and provides a more objective method of recording data. Distinction is made between fixed postures and the residual active range of motion at the shoulder and elbow. The presence and function of the muscles can be identified easily on dynamic EMG studies, which are essential for understanding the degree of spasticity and dyssynergy related to a single muscle. When spasticity of the upper arm is managed with a global approach and objectives are defined clearly in advance with the patient and caregivers, treatment of shoulder and elbow deformities can achieve important results for personal hygiene or functional targets.
2002
- Consensus Issues on Replantation within the Upper Limb
[Monografia/Trattato scientifico]
Landi, A; Elliot, D; Leti Acciaro, A; Della Rosa, N.
abstract
2002
- Intra-articular osteoid osteoma of the lower extremity: Diagnostic problems
[Articolo su rivista]
Francesco, B.; LETI ACCIARO, Andrea; Vincenzo, S.
abstract
We report five cases of intra-articular osteoid osteoma. Physical findings of osteoid osteoma vary with the site of the tumor. Juxta- and intra-articular osteoid osteomas present various atypical and nonspecific features. They are recorded both for their rarity and for the unusual clinical and roentgenographic findings that may delay diagnosis or induce misdiagnosis. Specialized imaging techniques may hasten diagnosis, but only an accurate clinical history, with a high index of suspicion, can allow for a proper diagnosis. When the diagnosis is suspected, we suggest that the most sensitive test is a "three-phase" technetium-99m bone-scan followed by computerized tomographic-scanning. Detailed evaluation of the suspected area, using thin sections is required to prevent misinterpretation, especially in a diagnosis involving first sprain of an ankle. The following cases of intra-articular osteoid osteoma illustrate the problems encountered in their diagnosis.
2002
- Osteoid osteoma of the hand and wrist
[Articolo su rivista]
Marcuzzi, A.; Leti Acciaro, A.; Landi, A.
abstract
Eighteen cases of osteoid osteoma of the hand and wrist were treated between 1985 and 1999. The diagnosis was confirmed pre-operatively with X-rays, bone scintigraphy, CT, and MRI, and all the diagnoses were later confirmed by histological examination. The authors highlight the difficulties in the diagnosis of the osteoid osteoma of the hand and wrist. An accurate clinical history and a high index of suspicion are required. Three phase bones scans are highly sensitive for osteoid osteoma and should be used in conjunction with CT examination to facilitate diagnosis and pre-operative planning. All the patients were treated surgically, by removal of the tumour, with complete resolution of all symptoms.
1998
- Osteoid osteoma of the phalanx: Enlargement of the toe-two case reports
[Articolo su rivista]
Barca, F.; Acciaro, A. L.; Recchioni, M. D.
abstract
After a review of the literature, two cases of osteoid osteoma involving phalanges of the toes are reported. Physical findings of osteoid osteoma very with the site of the tumor; in the foot, particularly the toes, it presents various atypical and characteristic features. Its more frequent cancellous and subperiosteal localization in the small bones of hand and foot, showing atypical roentgenographic findings, poses particular problems in diagnosis. In the osteoid osteoma of the phalanges, characteristic enlargement of the toe or finger seems to be frequent and with a typical clinical history may be considered a reliable sign of suspected osteoid osteoma. Specialized imaging techniques may hasten diagnosis, but only an accurate clinical history and the characteristic findings with a high index of suspicion can allow for a proper diagnosis.