Nuova ricerca


Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

Home | Curriculum(pdf) | Didattica |


2023 - Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique [Articolo su rivista]
Baccarani, A.; Filosso, P.; Marra, C.; De Maria, F.; Blessent, C. G. F.; Ruggiero, C.; Pappalardo, M.; Pedone, A.; De Santis, G.

Background: Sternal tumors are rare, comprising only 0.94% of all bone tumors, with the majority being sarcomas. An extensive composite defect is often the result of surgical resection. Reconstruction of this anatomical area is a challenge for plastic surgeons. Reconstruction must fulfil two different tasks: restoration of soft tissues and stabilization of the chest wall. Both are well defined, and many techniques have been historically proposed. Methods: We present the case of a 66-year-old man affected by sternal metastasis of lung non-small cell carcinoma with sarcomatoid features. After wide tumor resection, a large defect was created. Results: The patient underwent a complex multilayer reconstruction that combined multiple techniques: Gore DualMesh to reconstruct the pericardial plane and protect the heart muscle, omental flap to facilitate integration of the mesh, titanium bars to recreate chest wall stability, and bilateral pectoralis muscle flaps to cover hardware. This multilayer reconstruction was named the "lasagna technique." Conclusions: Due to the rarity of primary malignancies of the sternum, it is difficult to standardize a therapeutic approach. For this reason, it is necessary to customize the surgical treatment by combining several techniques and materials. Our lasagna technique may be considered a valuable option in treating these complex reconstructive cases.

2022 - Early venous congestion after diep flap breast reconstruction: case report of a successful management [Articolo su rivista]
Baccarani, A.; Starnoni, M.; Pappalardo, M.; Lattanzi, M.; Blessent, C. G. F.; De Maria, F.; De Santis, G.

BACKGROUND AND AIM: More than 250 000 women estimated to be diagnosed with breast cancer in the USA every year. Mastectomy is primary treatment for more than a third of those with early-stage disease. Most of the patients undergoing mastectomy receive breast reconstruction. A number of. Surgical techniques have been described to reconstruct the breast. With autologous tissue breast reconstruction, the plastic surgeon uses patient's own tissues, taken from a different part of the body where there is an excess of fat and skin. Deep inferior epigastric perforator (DIEP) flap is the autologous breast reconstruction technique of choice in our department due to long lasting results, low donor site morbidity and positive patient reported outcomes have been described.   Case Report: We present the case of a 42-year-old woman who underwent neoadjuvant chemotherapy followed by left breast simple mastectomy, axillary lymph-nodes dissection and later adjuvant radiation therapy (RT). After conclusion of RT a DIEP flap breast reconstruction was performed. Nine-hours after the operation, signs of acute venous congestion were noted. The venous congestion was treated by a combined surgical and medical approach based on pedicle discharge and ICU resuscitation protocol. After take back surgery, the patient was tightly monitored in the intensive care unit where intravenous heparin infusion and leech therapy were performed for 2 days. Flap congestion resolved completely, and the patient was discharged.   Conclusions: Venous congestion is very difficult to treat due to its potential multifactorial nature. The most important step is to recognize this kind of emergency because irreversible microvascular damages will develop in 6-8 hours. Because of multiple causes of venous congestion a timely multidisciplinary approach is mandatory, to maximize flap salvage and success rates.

2022 - Secondary Autologous Fat Grafting for the Treatment of Chin Necrosis as a Consequence of Prone Position in COVID-19 Patients [Articolo su rivista]
Pappalardo, M.; Starnoni, M.; De Maria, F.; Lolli, F.; Pedone, A.; Baccarani, A.; De Santis, G.

Summary: Due to the spread of the coronavirus disease 2019 pandemic, an increasing number of ill patients have been admitted to intensive care unit requiring mechanical ventilation. Although prone positioning is considered beneficial, long periods in this position may induce important complications, including pressure ulcers in high-risk and uncommon body areas. We report five cases of pressure ulcer necrosis of the chin in coronavirus disease 2019 patients as a consequence of mechanical ventilation in prone positioning using autologous fat grafting (AFG) as a secondary technique. A series of five patients with secondarily-healed chin necrosis treated by AFG between February and June 2020 were reviewed. All patients had been treated initially with surgical debridement followed by conservative treatment. Secondary AFG was performed to reduce patient's pain, improve chin contour-projection, and minimize cosmetic sequelae and scarring. Patient satisfaction was assessed using a five-point Likert scale (0-4). Vancouver scale was used to evaluate the chin scars clinically. The average amount of fat injected into the chin area was 8.1 ± 2.0 ml. At 6-month follow-up, all patients were mostly satisfied (average Likert-scale 3.2 ± 0.4). Based on the Vancouver scale, improvement of the chin scar from 9.5 ± 0.8 to 4.7 ± 0.8 was found. We report a positive experience with secondary AFG for correction of painful and unaesthetic scarring and contour abnormality following surgical debridement and secondary-intention healing of chin pressure ulcers.

2021 - Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments [Articolo su rivista]
Pappalardo, Marco; Starnoni, Marta; Franceschini, Gianluca; Baccarani, Alessio; De Santis, Giorgio

2021 - Filler-induced complications of the lips: 10 years experience with intralesional laser treatment and refinements [Articolo su rivista]
Zaccaria, G.; Cassuto, D.; Baccarani, A.; Lusetti, I. L.; Santis, G. D.

Background: The number of minimally invasive cosmetic procedures has steadily increased every year. In the last decade, the rates of filler injection reactions have also increased. This study presents our experience in the management and treatment of permanent filler complications to the lips. Undoubtedly, in these adverse reactions, the lips are the hallmark that most stigmatizes an unnatural look of the face. Methods: One hundred and eighty-one patients (168 female and 13 male) with permanent filler complications to the lips were treated from September of 2009 to September of 2019 at the University Hospital of Modena. One hundred and thirty-five patients underwent intralesional laser treatment (ILT). Forty-six patients underwent a stab incision and drainage and 10 of these patients had solid and calcified nodules and therefore underwent a combined technique. Thirty-three patients underwent further cosmetic procedures. Results: In 95% of patients there was a clinical improvement of which complete resolution in 38.7% and partial improvement in 34.2% of cases. Nine patients stopped the treatment because they were not satisfied. No patient was considered to have worsened after the treatment. Thirty-three patients underwent further treatments. Conclusions: A systematic combined approach between antibiotic therapy and treatments (ILT and a stab incision) represents the best therapeutic approach in dealing with permanent fillers complications to the lips. This treatment modality allows both the removal of the foreign material and the inflammatory reaction with low morbidity and little cosmetic disfigurement. Further cosmetic procedures may be applied to improve aesthetic appearance once most of the non-resorbable substance has been removed.

2021 - Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect [Articolo su rivista]
De Santis, G.; Pinelli, M.; Benanti, E.; Baccarani, A.; Starnoni, M.

Background: Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. The minimally invasive intralesional laser treatment can remove foreign substances and the inflammatory reaction, eventually leaving depression and scar tissue in the treated area. Fat grafting can restore volume loss and improve scar tissue. Methods: From March of 2010 to February of 2017, 33 patients were studied. All of them had suffered from inflammatory reactions to permanent facial fillers and had been treated with the 808-nm diode laser at the authors' institution. The evacuation of material had left facial asymmetry and visible depression. To restore facial aesthetic units, fat grafting was performed. The minimum follow-up was 6 months. Results: Volume restoration was recognized (according to the Global Aesthetic Improvement Scale) as significantly improved in 22 patients, moderately improved in eight patients, and slightly improved in three patients. Improvement in atrophic and scarred tissues (with an apparent thickening of the skin or even elimination of scars) was also assessed with the following results: 25 patients were very much improved and eight were moderately improved. Conclusions: This is the first study on filler-induced complications of the face treated by intralesional laser treatment followed by lipofilling. A systematic approach to volume restoration is proposed to patients who had filler removal of the face. There was a high degree of patient satisfaction with this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

2021 - Standardization and selection of high-risk patients for surgical wound infections in plastic surgery [Articolo su rivista]
Starnoni, M.; Pinelli, M.; Porzani, S.; Baccarani, A.; De Santis, G.

Background: The aim of the present study was to show that the Infection Risk Index (IRI), based on only 3 factors (wound classification, American Society of Anesthesiologists score, and duration of surgery), can be used to standardize selection of infection high-risk patients undergoing different surgical procedures in Plastic Surgery. Methods: In our Division of Plastic Surgery at Modena University Hospital, we studied 3 groups of patients: Group A (122 post-bariatric abdominoplasties), Group B (223 bilateral reduction mammoplasties), and Group C (201 tissue losses with first intention healing). For each group, we compared surgical site infection (SSI) rate and ratio between patients with 0 or 1 risk factors (IRI score 0 or 1) and patients with 2 or 3 risk factors (IRI score 2 or 3). Results: In group A, patients with IRI score 0-1 showed an SSI Ratio of 2.97%, whereas patients with IRI score 2-3 developed an SSI ratio of 27.27%. In group B, patients with IRI score 0-1 showed an SSI ratio of 2.99%, whereas patients with IRI score 2-3 developed an SSI ratio of 18.18%. In group C, patients with IRI score 0-1 showed an SSI ratio of 7.62%, whereas patients with IRI score 2-3 developed an SSI ratio of 30.77%. Conclusions: Existing infection risk calculators are procedure-specific and timeconsuming. IRI score is simple, fast, and unspecific but is able to identify patients at high or low risk of postoperative infections. Our results suggest the utility of IRI score in refining the infection risk stratification profile in Plastic Surgery.

2020 - Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence) [Articolo su rivista]
Baldelli, I.; Baccarani, A.; Barone, C.; Bedeschi, F.; Bianca, S.; Calabrese, O.; Castori, M.; Catena, N.; Corain, M.; Costanzo, S.; Barbato, G. D. P.; De Stefano, S.; Divizia, M. T.; Feletti, F.; Formica, M.; Lando, M.; Lerone, M.; Lorenzetti, F.; Martinoli, C.; Mellini, L.; Nava, M. B.; Porcellini, G.; Puliti, A.; Romanini, M. V.; Rondoni, F.; Santi, P.; Sartini, S.; Senes, F.; Spada, L.; Tarani, L.; Valle, M.; Venturino, C.; Zaottini, F.; Torre, M.; Crimi, M.

Background: Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals. Main body: The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus. Conclusion: Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts.

2020 - Laparoscopically assisted transperineal approach in the management of a giant pelvic lipoma [Articolo su rivista]
Baccarani, A.; Bonetti, E.; Pedone, A.; De Santis, G.; Pappalardo, M.; Romano, A.; Sighinolfi, C.; Rocco, B.

Giant lipomas affecting the retroperitoneum and pelvis are quite rare. The surgical management of these lesions may be technically demanding and controversies exist with respect to diagnosis, competences being involved, type of surgical approach, radicality, and timing. A unique case presentation of a giant lipoma occupying the whole pelvis and the gluteal region is presented. Due to its size, many anatomical areas are involved, requiring the expertise of multiple specialists to treat. After multidisciplinary counseling, the lesion is radically resected in one stage by using a new videolaparoscopically assisted transperineal access to the pelvis. This type of surgical approach may be of interest for resecting pelvic tumors in women and men.

2020 - Management of Personal Protective Equipment in Plastic Surgery in the Era of Coronavirus Disease [Articolo su rivista]
Starnoni, M.; Baccarani, A.; Pappalardo, M.; De Santis, G.

2020 - Necrobiosis Lipoidica Affecting the Leg: What Is the Best Treatment in a Patient with Very High Aesthetic Demand? [Articolo su rivista]
Baccarani, A.; De Maria, F.; Pappalardo, M.; Pedone, A.; De Santis, G.

Summary: Necrobiosis Lipoidica (NL) is a rare necrotising disorder of the skin characterized by collagen degeneration, thickening of blood vessels, and granulomatous inflammatory process. Its main clinical features are brownish-red papules and yellowish plaques with atrophic central areas. NL affects 0.3% -1.2% of the diabetic population, mostly women (female/male ratio is 3:1). Management of NL is challenging, especially for large lesions refractory to medical therapy, thus requiring surgical excision as an alternative option. Due to the rare occurrence of this condition no treatment guidelines exist and individualized treatment mostly depends on the severity of the lesion, location and patient's expectations. A case of a 30-year-old diabetic woman with very high aesthetic expectations was succesfully treated with staged resections of a giant NL to the leg and reconstruction with dermal template and full thickness skin grafts. Grafts were taken from the groin region bilaterally and from the lower abdomen after a cosmetic mini-abdominoplasty procedure. This approach allowed for a stable and very satisfactory aesthetic result with no donor site exposed scars.

2020 - Pectus excavatum correction enhanced by pectoralis muscletransposition: A new approach. [Articolo su rivista]
Aramini, Beatrice; Morandi, Uliano; DE SANTIS, Giorgio; Baccarani, Alessio

BACKGROUND: Indications for the surgical correction of pectus excavatum include func-tional/physiological, cosmetic, and psychosocial reasons. The most popular open technique forpectus excavatum repair was proposed by Ravitch in 1949 as an open approach that requires partialresection of the costal cartilage, xiphoid excision, and osteotomy of the sternum. The goal is to removeabnormal rib cartilage while preserving the perichondrium, allowing regrowth of the rib cartilage tothe sternum in a more anatomic manner. Operative technique. We present a case of bilateral pectoralismuscle flap transposition during a modified Ravitch procedure is presented herein. Conclusion: Thisapproach allows for a significant reduction in late complications and improves both functional andaesthetic outcomes.

2020 - Plastic Surgeons in the middle of the Coronavirus Disease 2019 Pandemic Storm in Italy [Articolo su rivista]
Baccarani, A.; Pappalardo, M.; Starnoni, M.; De Santis, G.

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

2020 - Tattooing of the nipple-areola complex: What not to do. A case series [Articolo su rivista]
Starnoni, M.; Baccarani, A.; Pinelli, M.; Pedone, A.; De Santis, G.

Introduction: Reconstruction of the nipple areola complex (NAC) is the final and easier step of breast reconstruction. However, surgeons, especially if trainees, typically have not developed tattoo skills during their training. The aim of this report is to share advice developed in our clinical practice that would minimize patient complaints and complications while performing NAC tattoos. Methods: From January 2016 to May 2018, reconstruction of NAC was performed in 48 consecutive patients. Nipple reconstruction was performed initially using skin flaps and this was followed three to eight months later by NAC tattooing. We analyzed medical reports at 12 months follow-up where we usually record patient satisfaction (very satisfied, satisfied, dissatisfied) and every patient's complaint or complication. Results: Thirty-two patients (67%) were very satisfied of NAC tattooing, twelve patients (25%) satisfied, while four patients (8%) dissatisfied. Patients complained for not having involved in choosing color, areas without sufficient pigment, extreme darkness of the tattooed NAC and artificial look. Conclusion: Tattooing is a simple and safe procedure, with a high satisfaction rate. Based on our experience, despite some technical aspects have to be considered, it is a procedure that can be safely performed by plastic surgical trainees.

2020 - The Importance of Awareness of Coronavirus Disease 2019 Clinical Syndrome by Plastic Surgeons [Recensione in Rivista]
Baccarani, A.; Lolli, F.; De Santis, G.

2020 - Wound complication after modified Ravitch for pectus excavatum: A case of conservative treatment enhanced by pectoralis muscle transposition [Articolo su rivista]
Aramini, B; Morandi, U; De Santis, G; Brugioni, L; Stefani, A; Ruggiero, C; Baccarani, A

Ravitcha b s t r a c tINTRODUCTION: Multiple surgical debridement sessions are mandatory before wound closure in cases ofinfection after a modified Ravitch procedure for pectus excavatum. Vacuum-assisted closure (VAC) is awell-established technical resource for treating complicated wounds; however, in cases of suspicion ofbone infection, this approach is not enough to prevent bar removal.PRESENTATION OF THE CASE: We present a case of surgical wound dehiscence with hardware exposure in apatient who had undergone chondrosternoplasty for pectus excavatum. Several sessions of debridement(three) and VAC were applied every time. The final result was achieved without the necessity to removethe hardware; however, to avoid the risk of infection, a bilateral pectoralis muscle flap mobilization wasperformed as the final step after the surgical wound revisions, although this approach is suggested tobe used during the modified Ravitch procedure. This approach allows for a significant reduction in latecomplications and improves morphological outcomes.DISCUSSION: In summary, the pectoralis muscle flap transposition is very useful not only for aestheticalresults but also in combination with multiple surgical revisions for conservative management in caseof wound infection during a modified Ravitch procedure. In our case, this technique was adopted afteraccurate care of the wound and before the final closure, which helps to maintain good vascularizationand a very satisfying result.CONCLUSION: It is important to consider this approach during the modified Ravitch procedure, not onlyfor better aesthetical results but also to prevent infections or wound dehiscence at the level of the bar

2019 - Can surgery relieve pain and act as first-line treatment for a large metastasis of the sternum? [Articolo su rivista]
Manfredini, Beatrice; Morandi, U.; De Santis, G.; Catani, F.; Stefani, A.; Pinelli, M.; Baccarani, A.; Starnoni, M.; BELLINI ARTIOLI, Francesco; Aramini, B.

BACKGROUND: There are few papers published on sternal metastasis from renal cell carcinoma. The unifying element is the operability of the sternal metastasis if it is the only site of metastasis, on the operability of the primary site of the tumor and on the patient's health conditions. PRESENTATION OF THE CASE: We present a case of a 66-years-old man undergone sternal resection for a large painful metastasis. He was previously undergone left nephrectomy for clear cells carcinoma. En bloc resection of the sternal manubrium and right clavicle was performed, a Gore-Tex mesh was placed. Histology confirmed metastasis of kidney clear cells carcinoma. Patient was discharged with no complications and no pain. Chest CT at six months follow up was negative for recurrence. DISCUSSION AND CONCLUSION: We highlighted the importance of surgery as possible first-line treatment in symptomatic large sternum metastasis. Therefore, prospective studies should be considered to confirm our strategy.

2019 - Lower Lip and Chin Reconstruction with Functional Myocutaneous Gracilis Flap [Articolo su rivista]
Spaggiari, A; Benanti, E; Starnoni, M; Sala, P; Baccarani, A; De Santis, G

Lower lip is an important anatomical unit in daily life activities, and its proper functional and aesthetic reconstruction is crucial. In the literature, both locoregional and microsurgical flaps have been described in lower lip reconstruction. Few authors have reported lower lip reconstruction with gracilis free flap. We describe a case of wide lower lip and chin avulsion caused by human bite reconstructed with an innervated gracilis free flap raised with its overlying skin paddle. The gracilis flap was harvested with a skin paddle of 7 x 5 cm, and vascular and nervous anastomoses were performed. At 9 -month follow-up, an electromyography showed high muscle activities observed in the central part of the flap, and the patient achieved good oral functions reported with daily life activities. Raising the flap with the overlying skin paddle allowed us to avoid morbidity in other donor sites, avoid scar retraction of the skin graft on the gracilis that could limit its movement, and plan aesthetical refinements such as hair transplantation or tattoo of the beard on the skin.

2019 - Obturator nerve split for gracilis free-flap double reinnervation in facial paralysis [Articolo su rivista]
Baccarani, A.; Starnoni, M.; Zaccaria, G.; Anesi, A.; Benanti, E.; Spaggiari, A.; De Santis, G.

The use of a double-powered free muscle transfer for facial reanimation has been reported by several authors with different types of nerve coaptation. A new nerve coaptation strategy is presented herein. We performed a 1-stage double-powered free gracilis muscle flap transfer in a patient with long-standing facial paralysis by splitting the obturator nerve and anastomosing the 2 free ends to the contralateral facial nerve (through a sural graft) and to the masseteric nerve. Voluntary movement of the transferred muscle with teeth clenching was observed at 6 months after the operation and a symmetric smile with bilateral elevation of the mouth angle at 10 months. Our limited experience suggests that in case of a large cross-section of the obturator nerve, the latter can be split and sutured to the ipsilateral masseteric nerve and to the contralateral facial nerve with a sural graft by double end-to-end anastomosis.

2019 - Pectoralis Muscle Transposition in Association with the Ravitch Procedure in the Management of Severe Pectus Excavatum. [Articolo su rivista]
BACCARANI, ALESSIO; Aramini, Beatrice; DELLA CASA, GIOVANNI; BANCHELLI, FEDERICO; D'AMICO, Roberto; RUGGIERO, Ciro; Starnoni, Marta; Pedone, Antonio; STEFANI, Alessandro; MORANDI, Uliano; DE SANTIS, Giorgio

Background: Pectus excavatum (PE) is the most common congenital chest wall deformity. PE is sometimes associated with cardiorespiratory impairment, but is often associated with psychological distress, especially for patients in their teenage years. Surgical repair of pectus deformities has been shown to improve both physical limitations and psychosocial well-being in children. The most common surgical approaches for PE treatment are the modified Ravitch technique and the minimally invasive Nuss technique. A technical modification of the Ravitch procedure, which includes bilateral mobilization and midline transposition of the pectoralis muscle flap, is presented here. Methods: From 2010 to 2016, 12 patients were treated by a modified Ravitch procedure with bilateral mobilization and midline transposition of the pectoralis muscle flap for severe PE. Outcomes, morphological results, and complications were analyzed with respect to this new combined surgical approach. Results: There was a statistically significant difference between pre- and postoperative values (P = 0.0025) of the Haller index at the 18-month follow-up, showing a significant morphological improvement for all treated patients. After surgery, no morbidity and mortality were noted. The mean hospital stay was 7 days, and all patients were discharged without major complications. Conclusion: This technique significantly improved patients’ postoperative morphological outcomes and significantly reduced long-term complications, such as wound dehiscence, skin thinning, and hardware exposure.

2018 - Hosting Center for 2018 American Society for Reconstructive Microsurgery Godina Traveling Fellow [Altro]
Baccarani, Alessio

Professor Yixing Zhang, Jiao Tong University, 9th People Hospital Shanghai. 2018 ASRM Godina Traveling Fellow

2018 - Presidenza Gruppo Triveneto Emiliano Romagnolo per la Chirurgia Plastica (biennio 2019-2020) [Altro]
Baccarani, Alessio

Nomina a Presidente

2018 - Salvage procedure after sternochondroplasty for pectus excavatum. [Articolo su rivista]
Aramini, Beatrice; Morandi, Uliano; DE SANTIS, Giorgio; Baccarani, Alessio

Vacuum-Assisted Closure in association to flap reconstruction is a well-established approach for treating complicated wounds. Case presentation: The authors present a case of soft-tissue breakdown with hardware exposure in a patient treated with strenochondroplasty for pectus excavatum. VAC therapy was applied in association to multiple debridement procedures and final flap closure. This was achieved without the need for hardware removal, thus maintaining adequate skeletal fixation. To our knowledge this approach has not yet been described into the literature after sternochondroplasty procedure. Conclusion Aggressive debridement and VAC therapy before final closure may represent a new, conservative method for managing surgical complications after sternochondroplasty procedures.

2018 - Ultrasonic Cutting and Coagulating Device in Implant-based breast reconstruction [Articolo su rivista]
Baccarani, Alessio; Starnoni, Marta; DE SANTIS, Giorgio


2018 - Vacuum Assisted Closure in the Management of exposed hardware for skeletal fixation: a challenging case [Articolo su rivista]
Baccarani, Alessio; Aramini, Beatrice; Morandi, Uliano; DE SANTIS, Giorgio

No abstract available

2016 - The New Transverse-Facial Artery Musculomucosal Flap for Intraoral Reconstructions [Articolo su rivista]
Pompei, Barbara; Pollastri, Giuseppe; Molteni, Gabriele; DE SANTIS, Giorgio; Baccarani, Alessio

With the bilateral progression of the 2 pedicled flaps, we were able to successfully restore both form and function of the soft palate, with a single-stage straightforward procedure, preserving at the same time the natural course of the facial arteries. Both flaps healed uneventfully. Six days after operation, the patient was placed on a liquid diet with no velopharyngeal insufficiency. This is to our knowledge the first extensive palatal reconstruction carried out with intraoral flaps only

2015 - Mandible reconstruction: a review article [Articolo su rivista]
Baccarani, A; De Santis, G

2014 - Composite scalp replacement and negative pressure therapy for successful graft take and hair regrowth [Articolo su rivista]
Baccarani, Alessio; Pedone, Alfonso; Loschi, P.; Zaccaria, G.; Boscaini, Giulia; Spinzo, G.; Pompei, Barbara; DE SANTIS, Giorgio

Microvascular scalp replantation is the procedure of choice after devastating scalp avulsion injuries. When replantation is not possible, alternative procedures should be considered to provide 1) wound closure and, possibly, 2) acceptable cosmetic results. A number of elective procedures including local and microsurgical flaps have historically been described. None of those procedures allow for obtaining superior cosmetic results in one single stage, as tissues being replaced are not "like with like". The use of spare parts from the avulsed scalp as a non vascularized composite hair bearing graft is reported herein, in association to negative pressure therapy. Despite very low success rate of composite scalp grafts reported into the literature, our patient had a 100% graft take and a favourable cosmetic result in terms of hair re-growth. At 6 months follow-up the graft is stable, pliable, and covered by a considerable amount of hair. The patient is very satisfied with the result. We think negative pressure device as the key factor in enhancing non-vascularized composite tissue survival including follicles. This is to our knowledge the first case of successful non-vascularized scalp replacement associated to negative pressure therapy. We think this approach should be considered when microsurgical replantation is not possible, still being available the use of spare parts, before attempting further elective procedures.

2014 - Ecthyma gangrenosum in a newborn causing external otitis with complete facial nerve palsy [Articolo su rivista]
Gioacchini, FEDERICO MARIA; Baccarani, Alessio; Villari, Domenico; Postacchini, Valentina; ALICANDRI CIUFELLI, Matteo

Ecthyma gangrenosum (EG) involving the external ear canal is an unusual presentation.

2014 - NF1 truncating mutations associated to aggressive clinical phenotype with elephantiasis neuromatosa and solid malignancies [Articolo su rivista]
Ponti, Giovanni; Martorana, Davide; Pellacani, Giovanni; Ruini, Cristel; Loschi, Pietro; Baccarani, Alessio; DE SANTIS, Giorgio; Pollio, Annamaria; Tauro, Maria Neri; Mandel, Victor Desmond; Maiorana, Antonio; Maccio, Livia; Maccaferri, Monia; Tomasi, Aldo

Background/aim: Von Recklinghausen disease is a syndrome characterized by a wide phenotypic variability giving rise to both, cutaneous and visceral benign and malignant neoplasms. The first include cutaneous neurofibromas, subcutaneous and plexiform neurofibromas. The latter can undergo malignant transformation and/or determine elephantiasis neuromatosa. Visceral tumors may include malignant peripheral nerve sheet tumors, gastrointestinal stromal tumors, cerebral gliomas and abdominal neurofibromas. In the present study, the authors discuss the clinical and biomolecular characterization of a cohort of 20 families with a diagnosis of type 1 neurofibromatosis. Patients and methods: Clinically, the cohort includes three probands with elephantiasis neuromatosa and a peculiarly high incidence of breast and gastrointestinal cancer. Results: Among the 14 NF1 mutations documented, 10 encoding for a truncated protein have been associated to particularly aggressive clinical phenotypes including elephantiasis neuromatosa, malignant peripheral nerve sheet tumors, breast cancer, gastrointestinal stromal tumors. Conclusion: This effect on protein synthesis, rather than the type of NF1 mutation, is the key to the explanation of the genotype-phenotype correlations in the context of neurofibromatosis type 1.

2013 - Facetransplantation surgical options and open problems in cadaveric models: a review article [Articolo su rivista]
Baccarani, A; Follmar, Ke; Erdmann, D; Levin, Ls

2013 - Merkel cell carcinoma of the upper eyelid: Presentation and management [Articolo su rivista]
Baccarani, A.; Pompei, B.; Pedone, A.; Brombin, A.

Merkel cell carcinoma (MCC) is a rare and potentially aggressive neuroendocrine tumour. The authors describe a unique presentation of a 4.5 cm wide MCC of the upper lid in a 73-year-old female. After total upper lid resection, immediate reconstruction was achieved by a full-thickness lower-lid transposition flap based on the lower lateral palpebral artery. At the 3 year follow-up the patient is free from disease and the reconstructive result is satisfactory both functionally and aesthetically. © 2012 International Association of Oral and Maxillofacial Surgeons.

2012 - High-density hyaluronic acid for the treatment of HIV-related facial lipoatrophy [Articolo su rivista]
Pignatti, Marco; Pedone, A.; Baccarani, A.; Guaraldi, Giovanni; Lombardi, M.; DE SANTIS, Giorgio; Orlando, Gabriella

Facial lipoatrophy is a stigmatizing hallmark of HIV. The injection of facial fillers has an essential role in the treatment of this condition. The objective of our study was to verify the safety and efficacy of a new formulation of high-density hyaluronic acid for the injectable treatment of HIV-related facial lipoatrophy.We treated with high-density hyaluronic acid injections HIV patients affected by moderate to severe facial lipoatrophy and evaluated them at last follow-up, at a minimum of 36 weeks. Physician-related outcomes included pre-and post-treatment ultrasound measurement of the soft-tissue thickness of the cheeks and qualitative assessment of aesthetic results by means of the Global Aesthetic Improvement Scale using pre- and post-treatment photos of the patients. Patient satisfaction outcomes were evaluated with the VAS-face scale and Freiburg test.Fifty-four patients were studied. The median number of treatment sessions was 3 and the median length of treatment was 5.5 months. The thickness of the soft tissues of the cheek increased significantly from 9.45 to 13.12 mm (p<0.0001). On the basis of the Global Aesthetic Improvement Scale, 87.5% of the patients were judged as "much improved" or "improved." Patient satisfaction at 1 year from the end of treatment was proven (VAS-face: 77.9; Freiburg questionnaire: 93.6% of patients were satisfied or very satisfied). Complications were limited to mild redness and swelling in the early postoperative period.Long-term improvement of facial contour and excellent patient satisfaction, in the absence of severe side effects, were obtained by the injection of high-density hyaluronic acid (STYLAGE® XL) in HIV patients with facial lipoatrophy.

2012 - Long-term efficacy and safety of polyacrylamide hydrogel injection in the treatment of human immunodeficiency virus-related facial lipoatrophy: a 5-year follow-up. [Articolo su rivista]
DE SANTIS, Giorgio; Pignatti, M.; Baccarani, A.; Pedone, A.; Spaggiari, A.; Orlando, Gabriella; Guaraldi, Giovanni

BACKGROUND: Facial lipoatrophy, a human immunodeficiency virus-related wasting of the facial soft tissues, can compromise patients' quality of life. Injection of different materials in the cheeks can improve this condition. Concern regarding potential long-term complications of nonbiodegradable fillers remains. The authors investigated the long-term efficacy and safety of polyacrylamide gel injections.METHODS: Human immunodeficiency virus-infected patients treated with polyacrylamide gel for moderate to severe facial lipoatrophy with a minimum of 5 years' follow-up were included. Aquamid (1 ml) was injected monthly into each cheek until adequate correction was obtained. Outcome measures were ultrasound measurement of cheek soft-tissues thickness, evaluation of aesthetic improvement, and self-evaluation of satisfaction and psychological consequences of treatment (visual analogue scale for the face, Assessment of Body Change and Distress questionnaire, and Beck Depression Inventory score). Adverse events were classified as acute (<1 week), early (1 week to 1 month), midterm (1 month to 1 year), or late (>1 year).RESULTS: One hundred forty-one patients completed the treatment as of June of 2005; 38 (32 men; mean age, 42 years) were available for follow-up of more than 5 years (mean, 62 months). The mean number of treatment sessions was seven over a mean period of 8 months. Significant improvement of cheek thickness and aesthetic result and highly significant satisfaction and psychological improvement were obtained. No serious adverse events occurred during the follow-up period.CONCLUSION:The long-term efficacy and safety of polyacrylamide gel injection for the treatment of human immunodeficiency virus-related facial lipoatrophy were shown over a period of 5 years. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

2010 - A New Approach in the Management of Triangular Fossa Auricular Defects: The Posterior Auricular Artery Perforator Antihelix-Conchal Flap (PAAP Flap). [Articolo su rivista]
Baccarani, Alessio; Antonio, Pedone; Giovanna, Petrella; Pietro, Loschi; Barbara, Pompei; DE SANTIS, Giorgio

Background: The reconstruction of extensive scapha or triangular fossa defects to the ear still represents a challenge considering the lack of local simple surgical procedures. Objective: To present a new perforator flap which is a modification of the Elsahy and Ladocsi chondrocutaneous rotation flaps. Patients and Methods: Ten patients, in whom the oncological resection to the triangular fossa did not include cartilage, but skin and perichondrium. Defects no larger than 3 cm in diameter were treated. The dissection of the flap was carried out from lateral to medial on the anterior subperichondral plane. The flap was thus raised without the cartilage component but with the anterior perichondrium branched with the perforating vessels. Results: All flaps survived and treated patients presented good aesthetic results. Conclusions: We think that this procedure represents a valuable option to be considered in reconstructing well selected composite defects to upper ear.

2009 - Composite Lower Back and Buttock Reconstruction with Gluteal Myocutaneous Flap in the Just Born [Articolo su rivista]
Baccarani, A.; Jacob, V.; Pedone, A.; Pinelli, M.; DE SANTIS, Giorgio; Bianchini, M. A.; Cacciari, Alfredo

Review of the literature has not revealed a younger patient in plastic surgery than the one described in this article. Instances have been reported where newborns are operated on before 24 hours of age for cardiovascular or respiratory compromise.Major vascular shunting in a girl born at 36 weeks' gestation (weight, 3400 g; length, 50 cm) with a massive (1530 g, 21 cm) sacrococcygeal cystic teratoma compelled the medical and surgical pediatric teams to undertake an immediate postnatal bulk reduction surgery at 12 hours of age. The issue was compounded further by hemorrhage from the teratoma at cesarean section.

2009 - Increased signs of acute rejection with ischemic time in a rat musculocutaneous allotransplant model [Articolo su rivista]
Pradka, Sp; Ong, Ys; Zhang, Y; Davis, Sj; Baccarani, A; Messmer, T; Fields, Ta; Erdmann, D; Klitzmann, B; Levin, Ls

2008 - Aesthetic and functional innovations in jaw reconstruction with free fibula flap [Capitolo/Saggio]
DE SANTIS, Giorgio; Pinelli, Massimo; Gargano, Francesco; Baccarani, Alessio

No abstract available

2008 - Facial allograft transplantation: fiction or reality? Surgical techniques in a fresh human cadaver model [Articolo su rivista]
Messmer, C; Baccarani, A; Follmar, Ke; Mukundan, S; Levin, Ls; Marcus, Jr; Erdmann, D

The aim of this study was to describe two methods of face-harvesting techniques - a skin and soft tissue flap and a combined osteocutaneous flap - and to demonstrate the compatibility between donor and recipient in a human fresh cadaver model. In fresh human cadavers the skin and soft tissue of the face (type 1) and a combined osteocutaneous flap (including a le Fort III segment, type 2) were harvested. The faces were subsequently exchanged among the donor crania, simulating full-face transplantation. Both flaps are based on the external blood supply of the faciotemporal vessels and the external jugular vein. The end branches of the trigeminal nerve could potentially be used for restoration of sensation (type 1 flap). With type 2 flaps the facial expression may be restored with the inclusion of the facial nerve. Four morphological parameters determine the donor/recipient compatibility: skin color and texture, anthropometric head dimensions, specific soft tissue components (nose, lip, cheek, and eyebrow), and gender. Apart from ethical considerations, long-term immunosuppression will remain the limiting factor of full facial transplantation in the near future. © 2007 Springer Medizin Verlag.

2008 - Free fibula flap for humerus segmental reconstruction: report on 13 cases [Articolo su rivista]
Adani, Roberto; Delcroix, Luca; Innocenti, Marco; Tarallo, Luigi; Baccarani, Alessio

In the period between 1994 and 2004, 13 patients (10 male, 3 female) presenting with post-traumatic defects to the humerus were treated with vascularised fibula graft. Age ranged from 21 to 62 (mean 37) years. Length of the bony defect ranged from 6 to 16 cm. Graft fixation was performed with plates in 12 cases, and in one case only screws were used. All patients were clinically reviewed between 120 days and 14 months after surgery. In one patient the flap was lost and a second free fibula flap was performed to achieve the reconstructive goal. Mean time for segmental bony union was 6 months (range from 3 to 13 months). Vascularised fibula graft allows for a successful humerus reconstruction when traditional techniques provide unsatisfactory results.

2008 - Osteocutaneous face transplantation [Articolo su rivista]
Follmar, K. E.; Baccarani, A.; Das, R. R.; Mukundan, S.; Levin, L. S.; Erdmann, D.; Marcus, J. R.

Background: Facial transplantation has the potential to become a viable option in the treatment of acquired and congenital facial deformities. Transplantation of the bony maxillofacial skeleton with the soft tissues (osteocutaneous face transplantation) has not been performed clinically nor has it been described experimentally in a human cadaver model. Methods: A mock osteocutaneous face transplant procedure was carried out on a cadaver model. The face was harvested in the subperiosteal plane and included the Le Fort III osseous segment. The allograft was inset by rigid internal fixation and soft tissue approximation. Results: The face transplant procedure was technically feasible. On the basis of this experiment, review of prior investigations, and our experience in craniofacial surgery, the authors have identified 10 topics that present technical challenges specific to osteocutaneous transplantation of the face: customisation of the bony segment, sensory and motor innervation, extra-ocular movements, dentition, mastication, speech and swallowing, airway, vascular considerations, immunologic considerations, and identity issues. Conclusions: Once further advances in immunomodulatory therapy are made, face transplantation will likely still be reserved for only the most severe facial defects. Defects of such severity will likely include a substantial bony component in need of reconstruction. In addition to the challenges associated with facial allo-transplantation in general, there are many technical challenges associated specifically with osteocutaneous face transplantation. It is necessary to consider and discuss these challenges in anticipation of future advances that may allow composite face transplantation to become safe and clinically efficacious. This modality of transplantation has the potential to provide substantial benefit compared with autologous reconstruction. © 2008.

2008 - Polyacrylamide hydrogel injection in the management of human immunodeficiency virus-related facial lipoatrophy: a 2-year clinical experience. [Articolo su rivista]
DE SANTIS, Giorgio; Jacob, V.; Baccarani, A.; Pedone, A.; Pinelli, M.; Spaggiari, A.; Guaraldi, Giovanni

BACKGROUND: Facial lipoatrophy is defined as the reduction in buccal and orbital fat pads along with a more global loss of fat within the subcutaneous tissue. It is the most common and distressing sign of human immunodeficiency virus-associated lipodystrophy. Injectable polyacrylamide hydrogel (Aquamid) is a synthetic nonbiodegradable polymer consisting of a minor backbone of 2.5 percent cross-linked polyacrylamide and 97.5 percent nonpyrogenic water and is used for cosmetic facial contour correction. Favorable results with maximum aesthetic gains with the use of polyacrylamide hydrogel for reconstruction of facial lipoatrophy on the face in significantly immunocompromised individuals are being reported. These results are attributable to its use in limited volume injected at multiple sites and in multiple sittings. METHODS: Aquamid has been used for the correction of severe nasolabial folds and mid and lower facial volume loss in patients affected by human immunodeficiency virus-associated lipodystrophy. Fifty patients were enrolled and treated, with a mean follow-up of 13.1 months. Results were evaluated clinically, by standardized ultrasonography, and by psychological tests (visual analogue scale, Beck Depression Inventory, and Assessment of Body Change and Distress questionnaire) to quantify patient satisfaction. RESULTS: No significant side effects or issues such as swelling, infections, allergies, or nodule formation were noted over the follow-up period. CONCLUSION: Aquamid has provided a minimally invasive, effective, long-lasting facial contour correction that significantly improves the quality of life in human immunodeficiency virus-infected patients.

2008 - Reconstruction of posttraumatic bone defects of the humerus with vascularized fibular graft [Articolo su rivista]
Adani, Roberto; Delcroix, Luca; Tarallo, Luigi; Baccarani, Alessio; Innocenti, Marco

Humeral nonunions still present a challenge to the orthopedic surgeon. Many methods of treating recalcitrant, posttraumatic humeral shaft nonunions have been described, with varying degrees of success. The present report reviews our experience with the use of vascularized fibular grafting for the treatment of large humeral defects. We treated 13 patients, with an average length of the humeral defect of 10.5 cm. Nine patients healed primarily, 3 required additional bone grafting, and 1 had a second fibular transplant. The mean period to radiographic bone union was 6 months. Only 5 patients regained full range of motion of the shoulder and elbow. The vascularized fibular graft is a reliable reconstructive procedure for recalcitrant pseudoarthrosis of the humerus in which the bony gap is greater than 6 to 7 cm, especially when traditional procedures have not provided the expected result. © 2008 Journal of Shoulder and Elbow Surgery Board of Trustees.

2008 - Schwannomas of the upper extremity: diagnosis and treatment [Articolo su rivista]
Adani, Roberto; Baccarani, Alessio; Guidi, Enrico; Tarallo, Luigi

Schwannomas are the most common benign tumors developing in peripheral nerves. They account for 5% of all tumors in upper extremity. They usually present as a slow-growing mass, sometimes associated to pain and paresthesia. Preoperative evaluation is based on US and MRI, but final diagnosis requires histopathology. The aim of this study is to define clinical findings and MRI characteristics in identification, localization, and possible differential diagnosis of schwannomas.

2007 - A clinically applicable reporting system for the diagnosis of facial fractures [Articolo su rivista]
Follmar, K. E.; Baccarani, A.; Das, R. R.; Erdmann, D.; Marcus, J. R.; Mukundan, S.

A clinically applicable, comprehensive reporting system for the diagnosis of facial fractures was developed with three guiding principles: (1) preservation of classical anatomical terminology and nomenclature, (2) facilitation of uniform interpretation of radiographs between radiologists and (3) non-redundant diagnostic descriptions of complex fractures, in a manner that correlates with treatment modality. Twenty-two fracture types (17 simple fracture types and 5 complex fracture types) are included in the system. Each patient's fracture pattern is described by listing the component fractures present. A short narrative (modifying description) is provided after each fracture listed. Simple fractures that help to comprise more complex fractures are not listed separately, but are described within the modifying description of the complex fracture they help to comprise. When components of multiple complex fractures are present, a hierarchy of complex fractures dictates which fracture is described first. Additional complex fractures are only described separately when they do not share common components. In all other cases, the second (lower order) complex fracture is best described by simply listing the component (simple or complex) fractures that are not accounted for in the higher order complex fracture. Adoption of this reporting system should improve communication between emergency medicine physicians, radiologists and surgeons. © 2007 International Association of Oral and Maxillofacial Surgeons.

2007 - A pilot study in sub-SMAS face transplantation: Defining donor compatibility and assessing outcomes in a cadaver model [Articolo su rivista]
Baccarani, A.; Follmar, K. E.; Das, R. R.; Mukundan, S.; Marcus, J. R.; Levin, L. S.; Erdmann, D.

BACKGROUND: Face transplantation may become a viable alternative in the treatment of patients with severe acquired facial deformity. In this study, the authors investigate morphological compatibility between donor and recipient by assessing chimeric outcomes in a human cadaver model. METHODS: Four faces were harvested from fresh human cadaver specimens in a surgical plane deep to the galea, to the superficial musculoaponeurotic system, and to the platysma. The faces were subsequently exchanged among the four donor crania, simulating full-face transplantations. Eight cranium-face chimera complexes were created and analyzed with standardized photography and with volumetric computed tomographic radiography. RESULTS: Four morphological parameters to consider in determining donor/recipient compatibility were defined: (1) skin color and texture, (2) head size, (3) soft-tissue features, and (4) gender. CONCLUSION: Careful selection of face donors based on compatibility criteria will aid in ensuring that the posttransplant outcome is morphologically similar to the recipient's native face. ©2007American Society of Plastic Surgeons.

2007 - Concomitant injuries in patient with panfacial fractures [Articolo su rivista]
Follmar, Ke; De Bruijn, M; Baccarani, A; Bruno, Ad; Mukundan, S; Erdmann, D; Marcus, Jr

BACKGROUND:: Patients with panfacial fractures comprise a small portion of the overall facial fracture patient population. Because of the forces necessary to cause panfacial injury, these patients often have other concomitant injuries. The timing of operative facial fracture management remains controversial. METHODS:: A 3-year review of all patients with facial fractures was conducted at Duke University Medical Center (2003-2005, 437 total patients). All patients with panfacial fractures, defined as fractures involving at least three of the four facial segments (frontal, upper midface, lower midface, and mandible), were analyzed. RESULTS:: Panfacial fractures were present in 38 patients (9% of overall facial fracture population). Twenty (53%) of these patients suffered concomitant injuries. The most common mechanism of trauma was motor vehicle collision, and the most common category of concomitant injury was intracranial injury or hemorrhage. Other commonly occurring categories of injury included abdominal organ injury, pneumothorax, pulmonary contusion, spine fracture, rib or sternum fracture, extremity fracture, and pelvic fractures. There was no significant difference in day of operation for the management of facial fractures between those with isolated facial injuries and those with other concomitant injuries (hospital day 2.1 vs. hospital day 2.9, not significant). CONCLUSIONS:: Concomitant injuries to all parts of the body are found in patients with panfacial trauma. In our experience, these injuries do not significantly delay or have an adverse effect on the treatment of facial fractures. A treatment strategy for consistent timely management of facial fractures is described. © 2007 Lippincott Williams &amp; Wilkins, Inc.

2007 - Efficacy of Ethyl Nitrite in reversing surgical vasospasm [Articolo su rivista]
Baccarani, A; Yasui, K; Olbrich, Kc; El-Sabbagh, A; Kovach, S; Follmar, Ke; Erdmann, D; Levin, Ls; Stamler, Js; Klitzman, B; Zenn, Rm

2007 - Flap coverage of the foot [Capitolo/Saggio]
Levin, Ls; Baccarani, A

2007 - Free vascularized tissue transfer to preserve upper extremity amputation levels [Articolo su rivista]
Baccarani, A; Follmar, Ke; DE SANTIS, Giorgio; Adani, R; Pinelli, M; Innocenti, M; Baumeister, S; VON GREGORY, H; Germann, G; Erdmann, D; Levin, Ls

BACKGROUND: Free vascularized tissue transfer to preserve upper extremity amputation level is an uncommon procedure. The authors investigate the role of free tissue transfer in preserving both morphology and function of the amputated upper extremity, with the goal of facilitating prosthetic rehabilitation.METHODS: Thirteen patients who underwent microsurgical free tissue transfer to preserve upper extremity amputation level were reviewed retrospectively. These cases were selected from four centers: Duke University Medical Center (Durham, N.C.) University Hospital of Modena (Modena, Italy), Careggi University Hospital (Florence, Italy), and the University of Heidelberg (Heidelberg, Germany). Parameters that were evaluated included age, sex, cause of the defect, reconstructive procedure, structures to be salvaged, and functional outcome, among others.RESULTS: The cause of amputation was trauma in 92 percent of patients. Mean age was 32 years. In 31 percent of the cases, an emergency free fillet flap was used, and in the remaining 69 percent, a traditional free flap was performed. Structures/function to be preserved included pinch function to the hand, function of the elbow and shoulder joints, and skeletal length greater than 7 cm. Complications occurred in 38 percent of the cases, but the final goal of the procedure was achieved in all cases. A treatment algorithm for the management of the amputated upper extremity is presented.CONCLUSION: Use of free vascularized tissue transfer for preservation of upper extremity amputation level in well-selected cases facilitates prosthetic rehabilitation and improves residual limb function

2007 - Long-term psychometric outcomes of facial lipoatrophy therapy: forty-eight-week observational, nonrandomized study. [Articolo su rivista]
Orlando, G.; Guaraldi, Giovanni; De Fazio, D.; Rottino, A.; Grisotti, A.; Blini, M.; Pedone, A.; Spaggiari, A.; Baccarani, A.; Vandelli, M.; De Paola, M.; Comelli, D.; Nardini, Giulia; Beghetto, Barbara; Squillace, N.; Esposito, Roberto; DE SANTIS, Giorgio

The aim of this observational, prospective, nonrandomized study was to assess long-term psychometric outcomes of surgical treatment of HIV-related facial lipoatrophy. Two hundred ninety-nine participants (70.8% male) consecutively attending the Metabolic Clinic of Modena and Reggio Emilia University from November 2005 to July 2006, undergoing surgical interventions for HIV-related facial lipoatrophy were enrolled. Fifty-four (18.1%) underwent facial lipofilling, which consists of the harvesting of a small, intact parcel of fatty tissue with processing that removes the nonviable components and of the transport of fatty parcels through a small cannula to implant the graft in a manner that provides nutrition and anchors the fat to the host tissue. After an initial lipofilling, 24 (8%) needed polylactic acid injections to correct cheek asymmetry, 91 (30.4%) received only polylactic acid infiltrations, and 130 (43.5%) polyacrylamide infiltrations only. Subjective outcome measures were face aesthetic satisfaction, body image perception, depression evaluated by a visual analogue scale (VAS), the Assessment of Body Change and Distress questionnaire (ABCD), and by the Beck Depression Inventory questionnaire, respectively. Objective measure was cheek thickness evaluated by a 7.5-MHz frequency ultrasound probe perpendicular to the skin surface at the nasolabial fold, the corner of the mouth, the zygomatic arch, and centrally between these points in the buccal fat pad area. Both subjective and objective variables were evaluated at baseline and 48 weeks after end of surgical treatment. All 299 participants had significant improvement of the aesthetic satisfaction for the face (VAS from 2.9 +/- 2.1 to 6.2 +/- 2.1, p &lt; 0.0001), of body image satisfaction (ABCD question 7 from 3.8 +/- 1 to 3.1 +/- 1 p &lt; 0.0001 and ABCD question 8 from 70.7 +/- 16.7 to 77.2 +/- 17.2 p &lt; 0.0001), of depression score (Beck score from 11.4 +/- 8.3 to 9.4 +/- 7.8 p = 0.001). Participants experienced a significant augmentation of both cheeks' thickness (right cheek from 4.3 +/- 1.9 mm to 9.5 +/- 3 mm p &lt; 0.0001, left cheek from 4.4 +/- 2 mm to 9.6 +/- 3.1 mm, p &lt; 0.0001). Our data suggest that facial surgery is an important option in the treatment of HIV-related lipoatrophy as an integral part of the management of HIV infection, because of the important and lasting psychological benefits.

2007 - The distally based Sural Flap [Articolo su rivista]
Follmar, K; Baccarani, A; Baumeister, Sp; Levin, Sl; Erdmann, D

2007 - The distally based sural flap for foot and ankle reconstruction [Articolo su rivista]
Levinson, H; Follmar, Ke; Baccarani, A; Baumeister, S; Erdmann, D; Levin, Sl

2007 - Tissue expansion of free and pedicled flaps after transfer: Possibilities and indications [Articolo su rivista]
Baumeister, Sp; Follmar, Ke; Erdmann, D; Baccarani, A; Levin, Ls

Tissue expansion in combination with flap transfer has been widely reported as preexpansion of flaps, but only once as expansion of a free flap after transfer. Three free flaps and one pedicled flap were expanded after transfer. Indication, timing of expander implantation and explantation, technical aspects, and complications are reviewed. Indications for expander implantation after flap coverage were adjacent scar contracture, a secondary ulcer, or correction of contour deformity. The expander was placed as early as 4.5 months after free flap transfer. Low grade infection and seroma were complications necessitating early expander removal in two cases. The outcome was satisfactory in all four patients. Tissue expansion after flap transfer has been shown to be a reliable reconstructive option in selected cases. Indications are rare and include hypertrophic scar formation, scar contracture, secondary ulceration, or reconstructive procedures. In early free flap expansion, it is critical to avoid mechanical pressure of the pedicle. In musculocutaneous flaps, this can be accomplished by placing the expander subcutaneously. If more than 6 months have passed since transfer of the flap, the randomized blood supply is sufficient to place the expander anywhere under the flap. Copyright © 2007 by Thieme Medical Publishers, Inc.

2007 - Vascularized Composite Auricular Graft in the management of Nasal Subunit Defects [Articolo su rivista]
Zhang, Y; Baccarani, A; Quian, Y; Yang, J; Wang, D; Erdmannd, ; Levin, Ls

2006 - A severe case of Madelung syndrome [Articolo su rivista]
Baccarani, Alessio; Chiarini, Luigi; Antonio, Spaggiari; Follmar, Keith E.; DE SANTIS, Giorgio

We were very interested in reading the brief communicationby Dr. B. Civelek et al. entitled “AnUnusual Entity for a Plastic Surgeon: Madelung Syndrome”(Plast. Reconstr. Surg. 117: 693, 2006).1During the past 3 years, we have treated four cases ofMadelung syndrome. Two patients had upper extremitylocalizations that were treated by liposuction only;one patient had upper trunk and neck involvement thatwas treated by combined liposuction and lipectomy.One patient had major involvement of the neck thatwas managed with an open approach, and which wepresent herein. In all three cases treated by liposuction,we encountered disease recurrence to various degrees.Our experience strongly supports Civelek et al.’s conclusionthat open excision is the best approach to avoidrecurrence in these cases.

2006 - Clinical and instrumental evaluation of implant stability after free fibula flaps for jaw reconstruction [Articolo su rivista]
DE SANTIS, Giorgio; Pinelli, M.; Baccarani, A.; Pedone, A.; Spaggiari, A.; Jacob, V.

Osseointegration is a direct union between bone and an allograft with no soft tissue interposition. It represents the morphological basis of secondary stability. Introduction of Resonance Frequency Analysis (RFA) as a commercially available technique has made it possible to measure implant stability as an Implant Stability Quotient (ISQ) unit at any time during the course of implant treatment and loading. The study aims to clinically and objectively analyze the stability of implants loaded upon revascularized free fibula flaps on patients who underwent maxilla or mandible reconstruction following trauma, oncological resection or class V–VI Cawood's atrophy treatment. Of the 105 patients that underwent jaw bone reconstruction with free fibula flaps in our division between 1993 and 2003, 37 were eligible for implant-supported dental rehabilitation. Of these, the last 12 were selected and included in the study. Primary and secondary implant stability assessments involved a clinical evaluation, radiograms and RFA measurements using the Osstell (Integration Diagnostics, Savedalen, Sweden) at the time of implant insertion, at 6 months and at 1 year of functional loading. 76 implants were loaded in 12 patients. All of them were clinically stable at each evaluation. Radiograms showed modest bone resorption after 1 year of functional load in 16 implants (21%). Implant stability levels ranged from 48 to 74 ISQ (mean 59.9±7.8 ISQ) at 6 months. At 1 year, the mean ISQ level was higher (62.6±7.2) but still coherent according to the radiographic evidence. Implant-supported dental rehabilitation of the reconstructed jawbone is not always possible. Free fibula flap represents a good substrate for implant osseointegration being a bicortical bone capable of structural remodelling after masticatory load enhancement. When possible, instrumental evaluation of implant stability with RFA and supported by radiograms represent the best objective way to assess osseointegration as a clinical evidence alone is unable to offer a definitive assessment

2006 - Fascio-subcutaneous extension of a free radial forearm flap for frontonasal duct obliteration [Articolo su rivista]
Baccarani, A.; Follmar, K. E.; Marcus, J. R.; Levin, L. S.; Erdmann, D.

Frontonasal duct injury is a critical factor in the treatment of frontal sinus fractures. We present the case of a 43-year-old man who sustained multiple comminuted fractures of the anterior table of the frontal sinus and of the orbital roof as the result of a gunshot. After adequate debridement, the combined bone and soft tissue defect was reconstructed with a titanium mesh and a free radial forearm flap. The frontonasal duct injury was treated by surgical obliteration with a custom designed fascio-subcutaneous extension of the free radial forearm flap. The postoperative course was uneventful with good functional and aesthetic results. No early or late complications have occurred. ©2006Muntaz B. Habal, MD.

2006 - Long lasting psycho-social benefits of polyacrylamide injections for the treatment of facial lipoatrophy [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; Squillace, N.; Vandelli, M.; De Paola, M.; Cardinali, L.; Comelli, D.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto

Polyacrylamide (PAL) injections are an effective surgical option for the treatment of HIV-related face lipoatrophy. The aim of this study was to analyse the psycho-social benefits of thissurgical intervention one year after the end of the treatment.

2006 - Technical Aspects of face transplantation: two options for total face harvesting [Articolo su rivista]
Baccarani, A; Follmar, Ke; Marcus, Jr; Erdmann, D; Levin, Ls

2006 - Technical and anatomical considerations of face harvest in face transplantation [Articolo su rivista]
Baccarani, A; Follmar, Ke; Baumeister, Sp; Marcus, Jr; Erdmann, D; Levin, Sl

2006 - Tenofovir treatment in HIV-related lipodystrophy syndrome. Retrospective observational forty-eight weeks follow-up study [Articolo su rivista]
Guaraldi, Giovanni; Orlando, Gabriella; Roverato, A.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; De Fazio, D.; Vandelli, M.; Bertucelli, C.; Beghetto, Barbara; Nardini, Giulia; Borghi, V.; Grisendi, C.; Bertolotti, Marco; Carubbi, Francesca; Zini, I.; Esposito, Roberto

Efficacy and safety of morphological and metabolic alterations treatment in HIV related lipodystrophy syndrome have never been evaluated outside clinical trials and progression of lipodystrophy remains uncertain. This is a 48 weeks follow up observational retrospective study over consecutive patients attending the Metabolic Clinic of the University of Modena and Reggio Emilia in whom a biochemical, antropometric with DEXA and psychometric evaluation was available. The aim of this research was to assess efficacy and safety of switching to tenofovir (TDF) in the context of the multidisciplinary interventions offered in the Metabolic Clinic comprehensive of: dietary counseling, physical activities, surgical treatment for facial lipoatrophy or fat hypertrophy and psychological support. In a cohort of 189 people with lipodystrophy, TDF was part of the antiretroviral regimen in 125 individuals (82 males e 43 females). TDF-control group was made of 64 individuals (38 males e 26 females). The two study groups were homogeneous for metabolic, morphologic and psychometric profile at baseline. In the follow up period a significant improvement was observed in TDF+ group with regard of blood glucose, insuline, triglyceride. Non significant change in morphologic alterations evaluated with DEXA was observed in the two study groups. With regards of psychometric evaluations, a striking improvement was observed in aesthetic satisfaction of the face, of the body, of body image and depression. In the cohort, no progressions of HIV disease nor serious adverse events were observed. We conclude that switching to tenofovir in the context of the multidisciplinary interventions offered in the Metabolic Clinic is efficacious and safe in the management of LD

2005 - Comparison of three different interventions for the correction of HIV-associated facial lipoatrophy: a prospective study [Articolo su rivista]
Guaraldi, Giovanni; Orlando, G.; De Fazio, D.; De Lorenzi, I.; Rottino, A.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; Borghi, V.; Esposito, Roberto

Objective: To compare autologous fat transfer (AFT), injections of reabsorbable [polylactic acid (PLA)] and non-reabsorbable [polyacrylamide hydrogel (PAAG)] filler materials for the treatment of HIV-related facial lipoatrophy. Design and methods: Eligible individuals with enough residual subcutaneous fat in the abdomen or in the dorso-cervical region were offered AFT surgery. Other individuals were blindly assigned to two different surgical teams, who administered a set of PLA or PAAG injections every 4 weeks. The primary endpoint was the measurement of Bichat's fat pad region, determined by the result of dermal plus subcutaneous thickness. Secondary endpoints included body image evaluation (determined by ABCD questionnaire), facial aesthetic satisfaction (determined by Visual Analogue Scale), and aesthetic pre- and post-picture comparisons by independent reviewers. All variables were measured at baseline and at 24 weeks after the last treatment session. Results: Twenty-four individuals received AFT and 35 were selectively randomized to PLA (20) or PAAG (15) infiltrations. PLA and Ill groups received a mean of 5 and 6 injections respectively (P=NS). The mean change in dermal and subcutaneous thickness was 3.3 +/- 4.1 mm, 3.5 +/- 4.0 mm; 2.1 +/- 3.0 mm (P=0.687), respectively. The mean change in ABCD score result was poorer in the AFT arm, but there were no other differences in other measured factors. Four serious adverse events were documented in the AFT arm only. Conclusions: All three interventional techniques were highly effective in improving the aesthetic satisfaction of the patients. Longer follow-up is necessary to determine the most durable and suitable treatment.

2005 - Effectiveness and durability of polyacrylamide hydrogel injections for treating HIV-related facial lipoatrophy [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; Pedone, A.; Spaggiari, A.; Baccarani, A.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Cappi, C.; DE SANTIS, Giorgio

Polyacrylamide hydrogel injections implant (PHI) is stable, pH neutral, insoluble, non toxic injectable implant used for facial and body contour correction and reconstruction. The aim of our study was to assess objective and subjective effectiveness and durability of PHI in HIV-infected individuals with facial lipoatrophy.

2005 - Osteoma cutis of the foot: a case report [Articolo su rivista]
Baccarani, A.; Pinelli, M.; Pedone, A.; Spaggiari, A.; DE SANTIS, Giorgio; Seidenari, S

No abstract

2005 - Psychometric evaluation in patients undergoing fillers injections for the treatment of HIV-related facial lipoatrophy: polylactic acid versus polyacrylamide [Abstract in Rivista]
Guaraldi, Giovanni; Orlando, G.; Vandelli, M.; De Paola, M.; Comelli, D.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; De Fazio, D.; Blini, M.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto

Filler injections can represent an effective treatment for HIV-related face lipoatrophy. The aim of this study was to analyse quality of life (QoL), depression and body image perception in a cohort of patients udergoing polylactic acid or polyacrylamide injections for face lipoatrophy using a set of questionnaires.

2004 - Correzione della lipodistrofia facciale HIV correlata: esperienza con l’uso di poliacrilammide nell’ambito di uno studio multicentrico comparativo [Abstract in Atti di Convegno]
Pinelli, M.; Baccarani, A.; Pedone, A.; Spaggiari, A.; Guaraldi, Giovanni; DE SANTIS, Giorgio

Il trattamento dell'infezione da HIV negli ultimi anni è stato profondamente modificato a seguito del miglioramento delle conoscenze teoriche sulla patogenesi dell'infezione e grazie alla disponibilità di nuovi agenti antiretrovirali. La comunità scientifica ha tuttavia recentemente messo in luce pesanti effetti collaterali a lungo termine associate all'uso di questi farmaci, fra questi la lipodistrofia.

2004 - Prospective, partially randomized, 24-week study to compare the efficacy and durability of different surgical techniques and interventions for the treatment of HIV-related facial lipoatrophy [Abstract in Rivista]
Guaraldi, Giovanni; Orlando, G.; De Fazio, D.; Callegari, M.; DE SANTIS, Giorgio; Pedone, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto

Autologous fat transfer (AFT) surgery and injection of reabsorbable or non-reabsorbable material into the lipoatrophic areas of the face are the only availabletreatment for HIV-related facial lipoatrophy. Comparisons between treatment approacheshave been limited.

2004 - Psychometric evaluation of patients undergoing surgical treatment of HIV-related facial lipoatrophy [Abstract in Rivista]
Orlando, G.; Guaraldi, Giovanni; Vandelli, M.; De Palma, M.; Comelli, D.; DE SANTIS, Giorgio; Pedoni, A.; Spaggiari, A.; Baccarani, A.; Pinelli, M.; De Fazio, D.; Borghi, V.; Nardini, Giulia; Beghetto, Barbara; Esposito, Roberto

Surgery seems to be the only effective treatment for HIV-related face lipoatrophy. The aim of this study was to analyse the role of available psychometric questionnaires to valuate quality of life, depression and body image perception in a cohort of patients undergoing surgical treatment for face lipoatrophy.

2004 - Rectus abdominis muscolocutaneous flap in the management of sacrogluteal, flank and iliac crest region defects: a case report. [Articolo su rivista]
Baccarani, Alessio; Pedone, A.; Pinelli, M.; Spaggiari, A.; DE SANTIS, Giorgio

No abstract

2003 - Double V-Y advancement flap in the management of lower lip reconstruction [Articolo su rivista]
Bocchi, A; Baccarani, A; Bianco, G; Castagnetti, F; Papadia, F

2003 - Maxilla reconstruction with free fibula flap: Twelve-year experience [Articolo su rivista]
DE SANTIS, Giorgio; Pinelli, M.; Baccarani, A.; Spaggiari, A.; Chiarini, Luigi; Pedone, A.

Since 1997 maxilla reconstruction with free fibula flaps has become the gold standard after wide resection of malignancy. A few years later also Cawood's class VI atrophy became an indication for fibula microvascular transplantation. We present our 12-year experience in maxilla reconstruction in the management of post-oncological surgery defects and in the correction of severe alveolar ridge atrophy. Since 1989 27 patients have been treated in our division. Of them 17 were post-oncological and ten had severe bone atrophies. Age ranged from 45 to 60. In all cases except one the flap successfully healed. We had one flap necrosis after vascular pedicle trombosis. Ninety-eight osseo-integrated implants were inserted, with a success rate of 93.8%. Follow-up ranged from 14 to 86 months of functional load. Results turned out to be satisfactory from a functional and aesthetic standpoint.