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

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- Method For Obtaining A Population Of Stromal Progenitor Cells [Brevetto]
Dominici, Massimo; Cafarelli, Luigi; Veronesi, Elena; Piccinno, MARIA SERENA; Paolucci, Paolo; DE SANTIS, Giorgio; Conte, P. F.


2024 - Combined Double-breasted Full-thickness Abdominal Flap Plication and Acellular Dermal Matrix in Prune-belly Syndrome Reconstruction [Articolo su rivista]
Baccarani, A.; Pappalardo, M.; Ceccarelli, P. L.; Starnoni, M.; De Santis, G.

Background: Reconstruction of the abdominal wall in patients with prune-belly syndrome (PBS) following previous intra-abdominal procedures is a challenging problem with a high incidence of revision due to persistent bulging or herniation. The abdominal wall flaccidity not only produces a severe psychological and aesthetic discomfort for the patient but often determines functional disabilities, including inability to cough properly, impaired bowel and bladder function, and delay in posture and balance. Methods: The authors describe three cases of reconstruction of abdominal wall using a modified double-breasted abdominoplasty fascial plication with additional acellular dermal matrix interposition and review the literature for innovations in the use of abdominal repair for reconstruction of these difficult cases. Results: Three children with PBS at a mean age of 7.3 years achieved successful reconstruction of the abdominal wall, using the modified double-breasted abdominoplasty fascial plication with acellular dermal matrix interposition. Patients underwent previous procedures, including orchiopexy in two patients and bilateral nephrectomy in one patient. No postoperative complications have been found, apart from superficial skin dehiscence along the abdominal incision treated conservatively in one child. At mean follow-up of 42 months (range 28–56 months), no patient presented incisional hernia, persistent or recurrent fascial laxity with abdominal bulging. All patients achieved significant aesthetic and functional improvements, including children’s ability to cough, spontaneous gain of abdominal tonus, balance, and ambulation. Conclusion: Modification of the original vertical, two-layer plications of the deficient abdominal interposing biological mesh has the purpose of improving strength, aesthetics, and function of the abdominal wall in pediatric patients with PBS.

2024 - Delay in cutaneous squamous cell carcinoma diagnosis due to interrupted services is associated with worse prognoses and modified surgical approaches [Articolo su rivista]
Taccioli, Filippo; Blessent, Claudio Gio Francesco; Paganelli, Alessia; Fagioli, Francesca; Chester, JOHANNA MARY; Kaleci, Shaniko; Costantini, Matteo; Barbara, Ferrari; Fiorentini, Chiara; DE SANTIS, Giorgio; Magnoni, Cristina

Background: The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined. Objective: To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018–2019) with the phase following the pandemic’s second wave (2021–2022). Methods: An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data. Results: More cSCC lesions were excised prior to the interruption of services (n = 312 vs. n = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; p = 0.006) and more invasive (52% vs. 89%; p < 0.001), in the period 2021–2022. Surgical reconstructive techniques were significantly different (p = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018–2019 and two in 2021–2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55–8.16, p < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09–3.88, p = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44–7.17, p = 0.004). Conclusions: Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.

2024 - Giant thigh lipomas: from a case report to a guide for the surgical approach [Articolo su rivista]
De Maria, F.; Marra, C.; Blessent, C. G. F.; Starnoni, M.; Pappalardo, M.; De Santis, G.

The issue of international migration and health has received increased attention since its rise due to empirical studies on the immigrant paradox. Less examined has been research focused on countries in the Global South with growing immigrant population share and contentious debates on implications. Using data from the longitudinal National Income Dynamics Study (NIDS) (2008–2017) and panel logistic regression this study focused on evaluating whether reported physical health, mental health, and life satisfaction are all associated with immigrant status in South Africa. Accounting for several sociodemographic factors, results emanating from analysis showed no significant evidence of association between overall immigration status and self-reported health or life satisfaction. This however did not apply to depression as immigrants were found to be significantly less likely to report depressive level scores. Interestingly, preference to migrate was also found to be significantly associated with depression, and life satisfaction. Further evaluation amongst racial groups showed that African immigrants are also significantly more likely to report better health than non-immigrant counterparts. This study argues for the need of contextualisation of the immigrant paradox as evidence thereof varies dependent on specific outcomes and communities. The importance of other associated social determinants of wellbeing is also highlighted since gender, race, age, class, education, relationship status, location, and behavioural factors were found to be significantly associated with wellbeing. Policies should thus be aimed at reducing structural inequalities in broad whilst also introducing social programmes that reduce behavioural or lifestyle activities that have negative implications on wellbeing.

2024 - Technical Refinements and Outcomes Assessment in Prepectoral Pocket Conversion after Postmastectomy Radiotherapy [Articolo su rivista]
Pagliara, D.; Rubino, C.; Grieco, F.; Pili, N.; Serra, P. L.; Schiavone, L.; Lattanzi, M.; Montella, R. A.; Rinaldi, P. M.; Ribuffo, D.; De Santis, G.; Salgarello, M.

Background: Several studies show how submuscular breast reconstruction is linked to animation deformity, shoulder dysfunction, and increased postoperative chest pain, when compared to prepectoral breast reconstruction. In solving all these life-impairing side effects, prepectoral implant pocket conversion has shown encouraging results. Objectives: The aim of this study was to propose a refinement of the prepectoral implant pocket conversion applied to previously irradiated patients. Methods: We conducted a retrospective study on 42 patients who underwent previous nipple- or skin-sparing mastectomy and immediate submuscular reconstruction, followed by radiotherapy. We performed fat grafting sessions as regenerative pretreatment. Six months after the last fat graft, we performed the conversion, with prepectoral placement of micropolyurethane foam-coated implants. We investigated the preconversion and postconversion differences in upper limb range of motion, Upper Extremity Functional Index, and patient satisfaction with the breast and physical well-being of the chest. Results: We reported a resolution of animation deformity in 100% of cases. The range of motion and the Upper Extremity Functional Index scores were statistically improved after prepectoral implant pocket conversion. BREAST-Q scores for satisfaction with the breast and physical well-being of the chest were also improved. Conclusions: The refined prepectoral implant pocket conversion is a reliable technique for solving animation deformity and improving quality of life in patients previously treated with submuscular reconstruction and radiotherapy.

2024 - Two-stage Prepectoral Breast Reconstruction with Expander and Acellular Dermal Matrix: Why and When [Articolo su rivista]
Baccarani, A.; Blessent, C. G. F.; Marra, C.; De Maria, F.; Pappalardo, M.; De Santis, G.

2023 - Adipose-derived stromal vascular fraction (SVF for the treatment of androgenic alopecia (AGA): a systematic review [Articolo su rivista]
Mantovani, G. P.; Marra, C.; De Maria, F.; Pinto, V.; De Santis, G.

Background and aim: Androgenetic alopecia (AGA) is a common chronic, hereditary, cutaneous, and androgen-dependent condition. Low self-esteem and negative impact on quality of life are often conse-quences of AGA. Clinical treatment of AGA using SVF (Stromal Vascular Fraction) has been effective. The hair follicle is affected by various environmental factors and one of the most important factors is the vascular-ity of the scalp which is itself affected by SVF. Methods: In October 2022, we conducted a systematic review to identify all scientific publications discussing hair loss treatment with stromal vascular fraction or adipose stem cells. We selected 140 articles. After a screening process, we kept 9 articles complying with inclusion criteria. Results: No serious adverse events were reported in all studies. Despite a standardized protocol was not found, all studies reported a statistically significant increase in the number (density) of hair after SVF treatment. Two studies found a significant improvement in the pull test. An increase in hair diameter was noticed after treatment. The combination of medical therapy and SVF proved to be advantageous. Conclusions: SVF is nowadays at the center of studies in the field of regenerative medicine due to its potential applications in many branches of medicine and surgery. The initial results are very promising but furthermore, studies are necessary to establish a methodical and systematic research capable of demonstrating its real benefits and the creation of homogenous treatment protocols. (

2023 - An Analysis of Volume, Length and Segmentation of Free Fibula Flap in Reconstruction of the Jaws: Investigation of Their Role on Flap Failure [Articolo su rivista]
Di Bartolomeo, M; Lusetti, Il; Pinelli, M; Negrello, S; Pellacani, A; Angelini, S; Chiarini, L; Nocini, R; De Santis, G; Anesi, A

Reconstruction of defects of the jaws is mainly performed via free fibula flap. An incidence of 2-21% of overall flap failure is still described. We investigated the roles of volume, length and number of fibula flap segments on flap survival using novel three-dimensional segmentation tools. We also analyzed the role of other possible risk factors. Seventy-one consecutive patients with a follow up of at least three months and who underwent free fibula flap reconstruction in a single center between 2002 and 2022 have been evaluated. A total of 166 fibula segments were analyzed. Malignancies were the main reason of resection (45.1%). In 69% of the cases a reconstruction of the mandible was performed. The flaps were mainly divided in two segments (39%) (range 1-4), with a mean length of 2.52 cm and a mean volume was 3.37 cm(3). Total flap failure (TFF) occurred in 12 cases, (16.9%), while partial flap failure (PFF) appeared in 3 patients (4.2%). Volume, length and number of fibula flap segments did not seem to influence flap failure incidence in uni- and multivariate analysis. Reconstruction of the maxilla and use of a recipient vessel different from the facial artery seemed to significantly impact on flap failure. Smoking and previous surgeries showed a higher trend to flap failure, but they did not reach statistical significance. Prospective and multicentric analysis on a wider population should be assessed.

2023 - Efficacy of Vascularized Submental Lymph Node Transfer with Decongestive Therapy and Antibiotics for Early-Stage Lower Limb Filarial Lymphedema [Articolo su rivista]
De Santis, G.; Saxena, B.; Starnoni, M.; Pappalardo, M.; Jacob, V.

Background: Filarial lymphedema (FLE) is the most common cause of secondary lymphedema, with endemic prevalence in developing countries. FLE traditionally has been managed with antibiotics and decongestive therapy (DCT) in the early stage or excisional surgery at the late stage. Results of vascularized lymph node transfer (VLNT) in postoncologic lymphedema have been encouraging, and VLNT is a widely accepted surgical treatment. The authors advocate that the combined treatment of antibiotics, DCT, and vascularized submental lymph node (VSLN) transfer could produce objective and subjective improvement of early-stage lower limb FLE. Methods: Between January of 2019 and January of 2020, patients with early-stage lower-limb FLE who underwent VLNT were retrospectively reviewed. VLNT was harvested from the submental region in all patients. Outcomes were assessed using volume improvement, frequency of cellulitis, and lymphoscintigraphy, along with subjective scoring questionnaire. Results: Three men and one woman with an average age of 27 years (range, 25 to 29 years) were included. Two patients presented bilateral lymphedema. One patient was lost at 3-month follow-up and not included in the analysis. Patients showed an initial decrease in circumferential measurements after antibiotics and DCT of 2074 ± 471 cc (39% ± 9%). At a mean follow-up of 12.3 ± 6.2 months, further improvement of limb volume of 2389 ± 576 cc (45% ± 10%) was achieved following VSLN transfer. Lymphoscintigraphy demonstrated dye uptake by the VLNT with reduced dermal backflow and none of the patients had episodes of postoperative cellulitis. Patients reported excellent outcome on subjective scoring (average score, 9 ± 1) and returned to their daily activities without wearing compression garments. Conclusion: The authors' early experience showed that VSLN transfer may represent an effective treatment option in the multimodal approach to early-stage lower limb FLE.

2023 - Factors influencing final rendering in areola tattoo reconstruction: a statistical analysis [Articolo su rivista]
Lusetti, I. L.; Marra, C.; Pacchioni, L.; de Santis, G.

Background and aim: Reconstruction of the nipple-areola complex announces the end of breast reconstruction process, sometimes difficult to live for the patient, and significantly improves the perception of body image. In literature there are no studies addressing the possible influencing factors of the final rendering of areola reconstruction with tattoo. The aim of the present study was to evaluate all the factors which could influence the yield and the final result of the nipple areola complex pigmentation. Methods: 97 patients who underwent areolar tattooing between January 2018 and February 2020 were retrospectively reviewed. Breast reconstruction timing and personal history, as well as surgical details were recorded. Results: Mean age was 52 years old (range 29-71), almost the totality of cases was women including even 2 men (one with Poland syndrome and one post mastectomy). 27 patients needed bilateral tattooing. 22 had history of adjuvant ra-diotherapy, 16 received neoadjuvant chemotherapy and 4 adjuvant chemotherapy. In the logistic regression analysis, radiotherapy resulted a risk factor for retattooing (p<0.05) while the autologous breast reconstruction resulted a protective factor for retattooing. Neo-and adjuvant chemotherapy were not statistically significant. Conclusions: Tissue thickness, sex, reconstructive technique and history of radiotherapy could influence the final result in areola reconstruction with tattoo, and must be taken into account to obtain the best result, knowing when the pigmentation has to be repeated. (

2023 - Fascio-adipose Intramammary Fold Flap for Full Expander Coverage in Breast Reconstruction [Articolo su rivista]
Baccarani, Alessio; Marra, Caterina; De Maria, Federico; Blessent, Claudio Gio Francesco; De Santis, Giorgio

2023 - Microsurgery courses vs continuous microsurgery laboratory training: an Italian experience [Articolo su rivista]
De Maria, F.; Pinto, V.; Pinelli, M.; Taccioli, F.; Blessent, C. G. F.; Marra, C.; Mantovani, G. P.; De Santis, G.

Background : Microsurgical techniques are an important part of clinical and experimental research. In this paper, we present our survey of Italian microsurgery training and our experience of the importance of a free access microsurgical laboratory. Methods: A cross-sectional observational study was performed by administering a questionnaire regarding the current situation about microsurgical training in Italian Plastic, Reconstructive and Aesthetic Surgery residency programs. A case–control study was performed on 12 residents divided into four groups of attendance to the microlaboratory. Results: Two hundred and seventy-six trainees replied to the questionnaire, representing 94.7% of residents enrolled in the Italian Society of Plastic, Reconstructive-Regenerative and Aesthetic Surgery (SICPRE). Only 25% of Italian residency locations own an environment dedicated to microsurgical training. All residents agreed to the importance of a free access microsurgical laboratory in their resident program. We verify a higher improvement in microsurgical anastomosis in resident who performed a more assiduous attendance to microsurgical laboratory. Conclusions: Microsurgical skills are fundamental in becoming a complete plastic surgery specialist. It is important to invest in a microsurgical training in all residency programs. We consider that our experience could be useful to spur other residency institutions to invest in microsurgical training and maybe to create a microsurgical training network. Level of evidence: Not gradable

2023 - Muscle-only versus chimeric musculocutaneous gastrocnemius pedicled flap in complex orthoplastic reconstructions of the knee region: A retrospective study [Articolo su rivista]
Sapino, G.; Guiller, D.; Osinga, R.; Martineau, J.; De Santis, G.; Steinmetz, S.; di Summa, P. G.

Background: The knee region represents a challenging area of soft tissue reconstruction. Specifically, in the context of total knee arthroplasty (TKA) or following high-energy trauma with fractures and hardware fixation, soft tissue defects can expose critical structures such as joint, bone or tendon, besides the implant/plates themselves, with dramatic consequences in terms of postoperative infection and hardware contamination. Methods: A retrospective study was conducted on a prospectively maintained database from January 2016 to February 2021. Inclusion criteria involved all patients who underwent an implant-associated infection of the knee and upper third of the leg coupled with a soft tissue reconstruction (STR) using the traditional gastrocnemius muscle (GM) pedicled flap or the chimeric GM-MSAP (medial sural artery perforator) flap. Results: Thirty-eight patients were included (group A, GM flap, 22 patients; group B, chimeric GM-MSAP flap, 16 patients). No statistically significant differences were detected in terms of age, comorbidities, defect size, follow-up, and flap complications. A statistically significant difference was seen among the groups in terms of successful flap re-raise (required because of a persistent infection of the implant or in a two-stage procedure setting, including the use of a cemented spacer) in favour of the GM-MSAP group. Conclusion: The chimeric GM-MSAP, being safer to reraise if required, can be a significantly more powerful tool in those cases in which a two-stage procedure is planned or when there is a high probability for secondary intervention need, reducing the need to convert to either free flap coverage or amputation.

2023 - Radial forearm flap versus antero-lateral thigh flap in oral soft tissue reconstruction: Update and statistical analysis on our 77 consecutive cases for an objective selection criteria [Articolo su rivista]
Marra, C.; Pinto, V.; Benanti, E.; De Maria, F.; Pinelli, M.; Spaggiari, A.; De Santis, G.

Background and aim: The radial forearm free flap (RFFf) and the antero-lateral thigh flap (ALTf) are considered the “key flaps” for oral cavity reconstruction. Nowadays, the literature lacks of an objective and standardized decision-making algorithm for the flap choice. The aim of this study is to describe a decision-making algorithm concerning the more appropriate flap, RFFf or ALTf, in the reconstruction of intra-oral soft tissues based on the volumetric analysis of the defect with a pre-operative Magnetic Resonance Imaging (MRI), updating our previous surgical experience. Methods: We conducted a retrospective observational study including 77 patients who underwent microsurgical reconstruction with RFFf or ALTf after tumor resection of the soft tissues in the oral cavity. During follow-up, patients were evaluated using the UW-QOL questionnaire. Results: Analyzing the scores of the UW-QOL questionnaire based on the size of the tumor on preoperative MRI we found that for tumor volume <50cc and between 50-70cc, the patients reconstructed with RFFf obtained statistically significant better scores compared to the ALTf group, while for tumor volume >70cc, the patients reconstructed with ALTf reported statistically significant better scores. Conclusions: Pre-operative RMI-guided volumetric assessment of oral cancer plays a key role in the planning of adequate soft tissue reconstruction and can objectively help surgeons in the correct choice of the flap (RFFf vs. ALTf) for each case based on preoperative tumor size, suggesting for defects <50cc and between 50 and 70 cc a reconstruction with RFFf, while for defects >70cc a reconstruction with ALTf. (

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.

2023 - The Effect of Adjuvant Radiotherapy on One- and Two-Stage Prosthetic Breast Reconstruction and on Autologous Reconstruction: A Multicenter Italian Study among 18 Senonetwork Breast Centres [Articolo su rivista]
Emanuele Lisa, A. V.; Salgarello, M.; Huscher, A.; Corsi, F.; Piovani, D.; Rubbino, F.; Andreoletti, S.; Papa, G.; Klinger, F.; Tinterri, C.; Testori, A.; Scorsetti, M.; Veronesi, P.; Leonardi, M. C.; Rietjens, M.; Cortinovis, U.; Summo, V.; Rampino Cordaro, E.; Parodi, P. C.; Persichetti, P.; Barone, M.; De Santis, G.; Murolo, M.; Riccio, M.; Aquinati, A.; Cavaliere, F.; Vaia, N.; Pagura, G.; Dalla Venezia, E.; Bassetto, F.; Vindigni, V.; Ciuffreda, L.; Bocchiotti, M. A.; Sciarillo, A.; Renzi, N.; Meneghini, G.; Kraljic, T.; Loreti, A.; Fortunato, L.; Pino, V.; Vinci, V.; Klinger, M.

Purpose. In modern breast cancer treatment, a growing role has been observed for breast reconstruction together with an increase in clinical indications for postmastectomy radiotherapy (PMRT). Choosing the optimum type of reconstructive technique is a clinical challenge. We therefore conducted a national multicenter study to analyze the impact of PMRT on breast reconstruction. Methods. We conducted a retrospective case-control multicenter study on women undergoing breast reconstruction. Data were collected from 18 Italian Breast Centres and stored in a cumulative database which included the following: autologous reconstruction, direct-to-implant (DTI), and tissue expander/immediate (TE/I). For all patients, we described complications and surgical endpoints to complications such as reconstruction failure, explant, change in type of reconstruction, and reintervention. Results. From 2001 to April 2020, 3116 patients were evaluated. The risk for any complication was significantly increased in patients receiving PMRT (aOR, 1.73; 95% CI, 1.33-2.24; p<0.001). PMRT was associated with a significant increase in the risk of capsular contracture in the DTI and TE/I groups (aOR, 2.24; 95% CI, 1.57-3.20; p<0.001). Comparing type of procedures, the risk of failure (aOR, 1.82; 95% CI, 1.06-3.12, p=0.030), explant (aOR, 3.34; 95% CI, 3.85-7.83, p<0.001), and severe complications (aOR, 2.54; 95% CI, 1.88-3.43, p<0.001) were significantly higher in the group undergoing DTI reconstruction as compared to TE/I reconstruction. Conclusion. Our study confirms that autologous reconstruction is the procedure least impacted by PMRT, while DTI appears to be the most impacted by PMRT, when compared with TE/I which shows a lower rate of explant and reconstruction failure. The trial is registered with NCT04783818, and the date of registration is 1 March, 2021, retrospectively registered.

2023 - The Overwhelming Postsplenectomy Sepsis: Role of Plastic Surgeon [Articolo su rivista]
Starnoni, M.; Pappalardo, M.; Marra, C.; Pinelli, M.; De Santis, G.

The overwhelming post-splenectomy infection (OPSI) is a feared late complication of splenectomy, with high morbidity and a mortality rate of up to 50%. Although the management of this syndrome is the duty of clinical physicians, the interest of plastic surgeons in OPSI is related to the injury that can occur in tissues with an end circulation, such as the limb extremities, nasal tip, and lips. In the management of OPSI, surgical techniques are not highlighted. The role of the plastic surgeon can be fundamental for the prevention of further extension of the necrotic tissue, improving as much as possible the vascularization around it. Moreover, a critical role in the management of OPSI is avoiding superinfection of the necrotic areas by combining different techniques and methods, such as surgical debridements, negative pressure wound therapy, and conservative treatment. Last but not least, functional and aesthetic restoration of the injured parts is of paramount importance for the final outcome. In this article, we describe the management of two unvaccinated patients with necrosis of the extremities after OPSI.

2022 - Altered pathways of keratinization, extracellular matrix generation, angiogenesis, and stromal stem cells proliferation in patients with systemic sclerosis [Articolo su rivista]
Spinella, A.; Lo Tartaro, D.; Gibellini, L.; de Pinto, M.; Pinto, V.; Bonetti, E.; Lolli, F.; Lattanzi, M.; Lumetti, F.; Amati, G.; De Santis, G.; Cossarizza, A.; Salvarani, C.; Giuggioli, D.

Objective: Systemic sclerosis is characterized by endothelial dysfunction, autoimmunity abnormalities, and fibrosis of the skin and internal organs. The pathogenetic mechanisms underlying systemic sclerosis vasculopathy are still not clarified. A complex cellular and extracellular network of interactions has been studied, but it is currently unclear what drives the activation of fibroblasts/myofibroblasts and the extracellular matrix deposition. Methods: Using RNA sequencing, the aim of the work was to identify potential functional pathways implied in systemic sclerosis pathogenesis and markers of endothelial dysfunction and fibrosis in systemic sclerosis patients. RNA-sequencing analysis was performed on RNA obtained from biopsies from three systemic sclerosis patients and three healthy controls enrolled in our University Hospital. RNA was used to generate sequencing libraries that were sequenced according to proper transcriptomic analyses. Subsequently, we performed gene set enrichment analysis of differentially expressed genes on the entire list of genes that compose the RNA-sequencing expression matrix. Results: Gene set enrichment analysis revealed that healthy controls were characterized by gene signatures related to stromal stem cells proliferation, cytokine–cytokine receptor interaction, macrophage-enriched metabolic network, whereas systemic sclerosis tissues were enriched in signatures associated with keratinization, cornification, retinoblastoma 1 and tumor suppressor 53 signaling. Conclusion: According to our data, RNA-sequencing and pathway analysis revealed that systemic sclerosis subjects display a discrete pattern of gene expression associated with keratinization, extracellular matrix generation, and negative regulation of angiogenesis and stromal stem cells proliferation. Further analysis on larger numbers of patients is needed; however, our findings provide an interesting framework for the development of biomarkers useful to explore potential future therapeutic approaches.

2022 - Atrophic Maxilla with Fibula Flap and Implant-Supported Prosthesis [Capitolo/Saggio]
De Santis, G.; Starnoni, M.

A 48-year-old man came to plastic surgery department because he suffered from extreme superior jaw atrophy. In order to restore both the vertical and sagittal bone loss, according to prosthetic criteria, a vascularized fibula flap was planned. Neither early nor late complications were detected at the donor site. Clinical and radiologic signs of osteointegration were found at all implant sites at the time of prosthetic loading. The success rate of loaded implants was 100%. Patient was both functionally and aesthetically satisfied with the results.

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

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

2022 - ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe [Articolo su rivista]
Moellhoff, N.; Arnez, T.; Athanasopoulos, E.; Costa, H.; De Santis, G.; De Mortillet, S.; Demirdover, C.; Benedetto, G. D.; Dzonov, B.; Elander, A.; Hansson, E.; Henley, M.; Jecan, C. R.; Kaartinen, I.; Karabeg, R.; Kharkov, A.; Kneafsey, B.; Gjorgova, S. T.; Palencar, D.; Portincasa, A.; Psaras, G.; Rakhorst, H.; Alonso, M. E. R.; Rouif, M.; Saboye, J.; Pompeo, F. S. D.; Spendel, S.; Stepic, N.; Vasar, O.; Zic, R.; Giunta, R. E.

Background Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe. Material and Methods A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country. Results The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination. Conclusion Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe.

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 - 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.

2022 - Human Adipose Mesenchymal Stromal/Stem Cells Improve Fat Transplantation Performance [Articolo su rivista]
Piccinno, M. S.; Petrachi, T.; Pignatti, M.; Murgia, A.; Grisendi, G.; Candini, O.; Resca, E.; Bergamini, V.; Ganzerli, F.; Portone, A.; Mastrolia, I.; Chiavelli, C.; Castelli, I.; Bernabei, D.; Tagliazucchi, M.; Bonetti, E.; Lolli, F.; De Santis, G.; Dominici, M.; Veronesi, E.

The resorption rate of autologous fat transfer (AFT) is 40–60% of the implanted tissue, requiring new surgical strategies for tissue reconstruction. We previously demonstrated in a rabbit model that AFT may be empowered by adipose-derived mesenchymal stromal/stem cells (AD-MSCs), which improve graft persistence by exerting proangiogenic/anti-inflammatory effects. However, their fate after implantation requires more investigation. We report a xenograft model of adipose tissue engineering in which NOD/SCID mice underwent AFT with/without human autologous AD-MSCs and were monitored for 180 days (d). The effect of AD-MSCs on AFT grafting was also monitored by evaluating the expression of CD31 and F4/80 markers. Green fluorescent protein-positive AD-MSCs (AD-MSC-GFP) were detected in fibroblastoid cells 7 days after transplantation and in mature adipocytes at 60 days, indicating both persistence and differentiation of the implanted cells. This evidence also correlated with the persistence of a higher graft weight in AFT-AD-MSC compared to AFT alone treated mice. An observation up to 180 d revealed a lower resorption rate and reduced lipidic cyst formation in the AFT-AD-MSC group, suggesting a long-term action of AD-MSCs in support of AFT performance and an anti-inflammatory/proangiogenic activity. Together, these data indicate the protective role of adipose progenitors in autologous AFT tissue resorption.

2022 - Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults [Articolo su rivista]
Marchioni, Alessandro; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Fermi, Matteo; Trentacosti, Fabiana; Castaniere, Ivana; Fantini, Riccardo; Tabbì, Luca; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Moretti, Antonio; Baroncini, Serena; Samarelli, ANNA VALERIA; Marchioni, Daniele; Pinelli, Massimo; DE SANTIS, Giorgio; Stefani, Alessandro; Mattioli, Francesco; Clini, Enrico

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

2022 - One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study [Articolo su rivista]
Sapino, G.; Lanz, L.; Roesti, A.; Guillier, D.; Deglise, S.; De Santis, G.; Raffoul, W.; Di Summa, P.

Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation.

2022 - Photobiomodulation Therapy: A New Light in the Treatment of Systemic Sclerosis Skin Ulcers [Articolo su rivista]
Spinella, Amelia; de Pinto, Marco; Galluzzo, Claudio; Testoni, Sofia; Macripò, Pierluca; Lumetti, Federica; Parenti, Luca; Magnani, Luca; Sandri, Gilda; Bajocchi, Gianluigi; Starnoni, Marta; De Santis, Giorgio; Salvarani, Carlo; Giuggioli, Dilia

Introduction: Skin ulcers (SU) represent one of the most frequent manifestations of systemic sclerosis (SSc), occurring in almost 50% of scleroderma patients. SSc-SU are often particularly difficult to treat with conventional systemic and local therapies. In this study, a preliminary evaluation of the role and effectiveness of blue light photobiomodulation (PBM) therapy with EmoLED® in the treatment of scleroderma skin ulcers (SSc-SU) was performed. Methods: We retrospectively analyzed 12 consecutive SSc patients with a total of 15 SU on finger hands. All patients were treated with adequate systemic therapy and local treatment for SU; after a standard skin ulcer bed preparation with debridement of all lesions, EmoLED® was performed. All patients were locally treated every week during 2 months of follow-up; SU data were collected after 4 weeks (T4) and 8 weeks (T8). Eight SSc patients with comparable SU were also evaluated as controls. Results: The application of EmoLED® in addition to debridement apparently produced faster healing of SU. Complete healing of SU was recorded in 41.6% cases during EmoLED® treatment. Significant improvements in SU area, length, and width, wound bed, and related pain were observed in EmoLED® patients from T0 to T8. Control subjects treated with standard systemic/local therapies merely showed an amelioration of SU area and width at the end of the follow-up. No procedural or post-procedural adverse events were reported. Conclusions: The positive clinical results and the absence of side effects suggest that EmoLED® could be a promising tool in the management of SSc-SU, with an interesting role to play in the healing process in addition to conventional systemic and local treatments.

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.

2022 - Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study [Articolo su rivista]
Pacchioni, L.; Sapino, G.; Lusetti, I. L.; Zaccaria, G.; Di Summa, P. G.; De Santis, G.

Background: The aim of this paper is to present a preliminary experience of sub-muscular primary direct-to-implant (DTI) breast reconstruction without acellular dermal matrix (ADM), after salvage mastectomy for local recurrence following prior irradiation. Methods: A retrospective investigation was performed on a prospectively maintained database of breast reconstruction cases at our institution between January 2015 and December 2020. We considered only immediate DTI breast reconstructions without ADM following radiotherapy and salvage mastectomy for local recurrence, with at least a 12-month follow-up. Results: The study considered 18 female patients with an average of 68 years. According to the BREAST-Q questionnaire, all patients reported high levels of “satisfaction with outcome” with good “psychosocial wellness” and “physical impact” related to the reconstruction. The aesthetic evaluation showed a significant difference between the VAS score gave by the patient (mean 6.9) and the surgeon (mean 5.4). No implant exposure occurred in this series. In terms of complications, four patients (22%) suffered from wound dehiscence and were managed conservatively. Three patients (17%) required primary closure in day surgery following superficial mastectomy flap necrosis. Late capsular contracture was seen in seven patients (four Baker stage II and three Baker stage III, totally 39%); however, no patient was willing to undergo implant exchange. Conclusions: DTI breast reconstruction following prior irradiation can be considered as an option in patients who are not good candidates for autologous breast reconstruction. Our general outcomes compared favorably with literature data regarding the use of staged procedures, with acceptable complication rates and levels of patient satisfaction.

2021 - Adaptive Proximal Scaphoid Implant stability despite a perilunate dislocation: a case report [Articolo su rivista]
Marcuzzi, Augusto; Vita, Fabio; Sapino, Gianluca; De Santis, Giorgio; Faldini, Cesare; Adani, Roberto

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

2021 - Autologous fat grafting in the treatment of a scleroderma stump-skin ulcer: a case report [Articolo su rivista]
Giuggioli, Dilia; Spinella, Amelia; Cocchiara, Emanuele; de Pinto, Marco; Pinelli, Massimo; Parenti, Luca; Salvarani, Carlo; De Santis, Giorgio

Here we describe the case of a 60-year-old-woman with systemic sclerosis sent to our Scleroderma Unit to treat digital stumps. The stumps were successfully treated with autologous fat grafting (crown-shape infiltration). Our technique of autologous lipotransfer improved wound healing in a scleroderma patient with stump-digital ulcers where all other options failed.

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 - Chronic Knee and Ankle Pain Treatment through Selective Microsurgical Approaches: A Minimally Invasive Option in the Treatment Algorithm for Refractory Lower Limb Pain [Articolo su rivista]
Pietramaggiori, Giorgio; Sapino, Gianluca; De Santis, Giorgio; Bassetto, Franco; Scherer, Saja

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

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

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

2021 - Extended and unusual indications in jaw reconstruction with the fibula flap: An overview based on our 30-year experience [Articolo su rivista]
De Santis, G.; Pinelli, M.; Starnoni, M.

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

2021 - Invited Response on: Comments on "Autologous Fat Grafting for the Oral and Digital Complications of Systemic Sclerosis: Results of a Prospective Study" [Articolo su rivista]
Pignatti, Marco; Spinella, Amelia; Cocchiara, Emanuele; Boscaini, Giulia; Lusetti, Irene Laura; Citriniti, Giorgia; Lumetti, Federica; Setti, Giacomo; Dominici, Massimo; Salvarani, Carlo; De Santis, Giorgio; Giuggioli, Dilia

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 - Microfragmented adipose tissue is associated with improved ex vivo performance linked to HOXB7 and b-FGF expression [Articolo su rivista]
Casari, G.; Resca, E.; Giorgini, A.; Candini, O.; Petrachi, T.; Piccinno, M. S.; Foppiani, E. M.; Pacchioni, L.; Starnoni, M.; Pinelli, M.; De Santis, G.; Selleri, F.; Catani, F.; Dominici, M.; Veronesi, E.

Introduction: Adipose tissue (AT) has become a source of mesenchymal stromal/stem cells (MSC) for regenerative medicine applications, in particular skeletal disorders. Several enzymatic or mechanical procedures have been proposed to process AT with the aim to isolate cells that can be locally implanted. How AT is processed may impact its properties. Thus, we compared AT processed by centrifugation (C-AT) to microfragmentation (MF-AT). Focusing on MF-AT, we subsequently assessed the impact of synovial fluid (SF) alone on both MF-AT and isolated AT-MSC to better understand their cartilage repair mechanisms. Materials and methods: MF-AT and C-AT from the same donors were compared by histology and qRT-PCR immediately after isolation or as ex vivo cultures using a micro-tissue pellet system. The in vitro impact of SF on MF-AT and AT-MSC was assessed by histological staining and molecular analysis. Results: The main AT histological features (i.e., increased extracellular matrix and cellularity) of the freshly isolated or ex vivo-cultured MF-AT persisted compared to C-AT, which rapidly deteriorated during culture. Based on our previous studies of HOX genes in MSC, we investigated the involvement of Homeobox Protein HOX-B7 (HOXB7) and its target basic Fibroblast Growth Factor (bFGF) in the molecular mechanism underlying the improved performance of MF-AT. Indeed, both these biomarkers were more prominent in freshly isolated MF-AT compared to C-AT. SF alone preserved the AT histological features of MF-AT, together with HOXB7 and bFGF expression. Increased cell performance was also observed in isolated AT-MSC after SF treatment concomitant with enhanced HOXB7 expression, although there was no apparent association with bFGF. Conclusions: Our findings show that MF has a positive effect on the maintenance of AT histology and may trigger the expression of trophic factors that improve tissue repair by processed AT.

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

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 - Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review [Articolo su rivista]
Fermi, Matteo; Bassano, Edoardo; Molinari, Giulia; Alicandri-Ciufelli, Matteo; Scarpa, Alfonso; Presutti, Livio; De Santis, Giorgio; Mattioli, Francesco

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

2021 - Reconstruction of upper limb soft-tissue defects after sarcoma resection with free flaps: A systematic review [Articolo su rivista]
Lucattelli, Elena; Lusetti, Irene Laura; Cipriani, Federico; Innocenti, Alessandro; De Santis, Giorgio; Innocenti, Marco

BACKGROUND AND OBJECTIVES: Upper limb preservation after soft tissue sarcoma (STS) surgical excision is now the accepted gold standard and it often requires reconstruction with free flaps. The purpose of this review is to summarize current literature on upper limb reconstruction with free flaps after STS resection.METHODS: A systematic review was performed in July 2019 in PubMed and MedLine Ovid databases according to the PRISMA guidelines.RESULTS: A total of 17 studies were included in the final analysis, with 132 patients. The most common diagnosis was Malignant Fibrous Histiocytoma. The most frequent timing of flap coverage was immediate. The success rate was almost always 100%. The length of follow-up was reported in 11 studies with a range of 2-187 months. The most commonly reported patient-centered outcome was the MSTS Score. Based on the evidence of the literature collected, we divided the upper limb into four parts (shoulder, elbow and arm, forearm and wrist, and hand) and described the most common and functional free flaps used for reconstruction after STS resection.CONCLUSIONS: Free flaps in the treatment of STS of the upper extremity have a good overall outcome, with a low postoperative complication rate. A wide array of free flaps is available for reconstruction, and the choice of flap is based on defect size, types of tissue required, postoperative functional goal, and surgeon preference. A greater degree of standardization is needed in the reporting of patient-centered outcomes to facilitate future comparative studies.

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.

2021 - Surgical treatment of pressure injuries in children: A multicentre experience [Articolo su rivista]
Pignatti, M.; D'Arpa, S.; Roche, N.; Giorgini, F. A.; Lusetti, I. L.; Lorca-Garcia, C.; De Santis, G.; Berenguer, B.

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

2021 - Systemic sclerosis cutaneous expression: Management of skin fibrosis and digital ulcers [Articolo su rivista]
Starnoni, M.; Pappalardo, M.; Spinella, A.; Testoni, S.; Lattanzi, M.; Femino, R.; De Santis, G.; Salvarani, C.; Giuggioli, D.

Systemic sclerosis is a connective tissue disease with cutaneous involvement. Clinical manifestations result from the balance of inflammations/autoimmunity process and fibrogenesis. Patients suffer from skin ulcers, non-ulcerative lesions including digital pitting scars, telangiectasias, subungual hyperkeratosis, abrasions, fissures, and subcutaneous calcinosis. A review about the pathophysiology of the disease, the physical examination of the patients, the instrumental assessment, and possible treatments is performed.

2021 - Tip of the Tongue Reconstruction with Prelaminated Fasciomucosal Radial Forearm Free Flap [Articolo su rivista]
De Santis, G.; Mattioli, F.; Pinelli, M.; Martone, A.; Starnoni, M.; Fermi, M.; Presutti, L.

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

2021 - Upper limb traumatic injuries: A concise overview of reconstructive options [Articolo su rivista]
Starnoni, M.; Benanti, E.; Acciaro, A. L.; De Santis, G.

2021 - WSRM 2019 in Bologna: A Great Success beyond Expectations! [Articolo su rivista]
Chang, D.; Koshima, I.; De Santis, G.; Moschella, F.

2020 - A regional population-based hereditary breast cancer screening tool in Italy: First 5-year results [Articolo su rivista]
Cortesi, L.; Baldassarri, B.; Ferretti, S.; Razzaboni, E.; Bella, M.; Bucchi, L.; Canuti, D.; De Iaco, P.; De Santis, G.; Falcini, F.; Galli, V.; Godino, L.; Leoni, M.; Perrone, A. M.; Pignatti, M.; Saguatti, G.; Santini, D.; Sassoli de'Bianchi, P.; Sebastiani, F.; Taffurelli, M.; Tazzioli, G.; Turchetti, D.; Zamagni, C.; Naldoni, C.

Background: Up to 10% of individuals with breast cancer (BC) belong to families with hereditary syndromes. The aim of this study was to develop an instrument to identify individuals/families at high-hereditary risk for BC and offer dedicated surveillance programs according to different risks. Methods: The instrument consisted of a primary questionnaire collecting history of BC and ovarian cancer (OC). This questionnaire was applied to women enrolled in the Emilia-Romagna Breast Cancer Screening Program. General practitioners (GPs) and specialists could propose the same questionnaire too. Women with a score of ≥ 2, were invited to complete an oncogenetic counseling. According to the Tyrer-Cuzick evaluation, women considered at high risk were invited to involve the most representative alive individual of the family affected with BC/OC for BRCA1/2 genetic testing. Results: Since January 2012 and December 2016, 660 040 women were evaluated by the regional screening program, of which 22 289 (3.5%) were invited to the Spoke evaluation, but only 5615 accepted (25.2%). Totally, also considering women sent by GPs and specialists, 11 667 were assessed and 5554 were sent to the Hub evaluation. Finally, 2342 (42.8%) women fulfilled the criteria for genetic testing, and 544 (23.2%) resulted BRCA1/2 mutation carriers. Conclusions: To our knowledge, this is the first regional population-based multistep model that is aimed to identify individuals with BRCA1/2 mutations and to offer an intensive surveillance program for hereditary-high risk women. This tool is feasible and effective, even if more efforts must be performed to increase the acceptance of multiple assessments by the study population.

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

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

2020 - Autologous Fat Grafting for the Oral and Digital Complications of Systemic Sclerosis: Results of a Prospective Study [Articolo su rivista]
Pignatti, Marco; Spinella, Amelia; Cocchiara, Emanuele; Boscaini, Giulia; Lusetti, Irene Laura; Citriniti, Giorgia; Lumetti, Federica; Setti, Giacomo; Dominici, Massimo; Salvarani, Carlo; De Santis, Giorgio; Giuggioli, Dilia

Background: Systemic sclerosis is a connective tissue disease. Skin involvement of the mouth and hand may compromise function and quality of life. Autologous fat grafting has been described as a specific treatment of these clinical features. We report the results of our prospective study designed to treat and prevent skin complications in systemic sclerosis. Materials and methods: We treated 25 patients with mouth and/or hand involvement (microstomia, xerostomia, skin sclerosis, Raynaud's phenomenon and long-lasting digital ulcers) with autologous fat grafting, according to the Coleman's technique, around the mouth and/or at the base of each finger. The surgical procedures were repeated in each patient every 6 months for a total of two or three times. Clinical data were collected before the first surgery and again 6 months after each surgical procedure. Pain, skin thickness, saliva production and disability were assessed with validated tests. Results: Overall we performed 63 autologous fat grafting sessions (either on the mouth, on the hands or on both anatomical areas). Results at 6 moths after the last session included improvement of xerostomia evaluated with a sialogram, reduction of the skin tension around the mouth and, in the hands, reduction of the Raynaud phenomenon as well as skin thickness. Pain was reduced while the perception of disability improved. Digital ulcers healed completely in 8/9 patients. Conclusions: Our results confirm the efficacy and safety of autologous fat grafting for the treatment of skin complications and digital ulcers due to systemic sclerosis. In addition, the patients' subjective well-being improved. Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . Keywords: Autologous fat grafting; Digital ulcers; Microstomia; Stem cell transplantation; Systemic sclerosis; Xerostomia.

2020 - Autologous fat grafting efficacy in treating PostMastectomy pain syndrome: A prospective multicenter trial of two Senonetwork Italia breast centers [Articolo su rivista]
Lisa, A. V. E.; Murolo, M.; Maione, L.; Vinci, V.; Battistini, A.; Morenghi, E.; De Santis, G.; Klinger, M.

Postmastectomy pain syndrome (PMPS) represents a common complication following breast surgery defined as a chronic neuropathic pain located in the front of the chest, in the axilla and in the upper arm that for more than 3 months after surgery. Several medications prove to be ineffective while autologous fat grafting revealed to be an innovative solution in the treatment of neuropathic pain syndromes based on retrospective studies. For this reason, we performed a prospective multicenter trial to reduce the memory bias and further increase the evidence of the results. From February 2018 to March 2019, 37 female patients aged between 18 and 80 years, underwent mastectomy or quadrantectomy with pathologic scarring and chronic persistent neuropathic pain, compatible with PMPS, are been included in the study and treated with autologous fat grafting. During the enrollment phase, patients were asked to estimate pain using the Visual Analogue Scale (VAS) and POSAS questionnaire in order to evaluate scar outcomes. The VAS scale, starting from 6.9 (1.3), decreased in the first month by 3.10 (1.59), continuing to fall by 0.83 (1.60) to 3 months and by 0.39 (2.09) at 6 months. Statistical analysis showed a significant reduction after 1 month (P <.0001) and 3 months (P <.005). All POSAS grades documented a statistically significant reduction (P <.0001) of the scores by both observers and patients. We observed that no significant association was found between age, BMI, menopausal status of patients, days from oncologic surgery to autologous fat grafting and reduction of VAS values over time while both smoking and axillary dissection were observed as the main factor significantly associated with a reduced clinical efficacy (respectively, P =.0227 and P =.0066). Our prospective multicenter trial confirms the efficacy of fat grafting in the treatment of PMPS based on the principle of regenerative medicine with a satisfactory response in terms of pain reduction and improvement of the quality of the treated tissues. Clinical questionnaires show that the cicatricial areas improve in terms of color, thickness, skin pliability, and surface irregularities. Regenerative effect is based also on the adoption of needles. The combined effect of fat grafting and needles determines a clinical full response.

2020 - Diagnosis and treatment of upper eyelid lipoma: A case report [Articolo su rivista]
Starnoni, M.; De Santis, G.; Pasini, R.; Pinelli, M.

Purpose: Presentation of a rare lesion: a case of upper eyelid lipoma, Observations: A 76-year-old otherwise healthy woman presented with a right upper eyelid swelling. Her medical history was recorded. On ophthalmologic examination a soft, non-ulcerated and not well-circumscribed mass was evident. An ultrasonography examination was carried out showing a hyperechoic non capsulated mass situated between the superior orbital margin and the orbicularis oculi muscle. Conclusions and Importance: Eyelid lipomas must be differentiated from herniated orbital fat, cystic lesions, tumours, and the lacrimal gland. A pre-operative differential diagnosis of eyelid lipoma can be done through medical history, ophthalmologic, and ultrasonography examinations. Nevertheless, in case of doubt a magnetic resonance imaging (MRI) should be performed to assess a possible orbital involvement and to plan for the right surgical procedure to be performed.

2020 - Factors related to delayed treatment: A case report of a huge cutaneous horn and review of the literature [Articolo su rivista]
Starnoni, M.; De Santis, G.; Lolli, F.; Pinelli, M.

We present a case of a man with a giant cutaneous horn over his frontal region. This case has been presented for the size of the lesion, due to delayed treatment, and to illustrate the reasons why the growth of this lesion has been possible in a western country, in the 21st century. It was a solitary, not painful lesion which caused significant aesthetic problems. The diagnosis was based on an ultrasonographic study and the treatment of choice was a surgical excision. This case is an opportunity to review the literature about the cutaneous horns, to talk about the main causes of delayed diagnosis and treatment of cutaneous lesions and, to define the role of the specialist in the assessment of emotions and patient support.

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

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

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

INTRODUCTION: Venous congestion is the most common vascular complication of the deep inferior epigastric artery perforator (DIEP) flaps. Adding a second venous drainage by anastomosing a flap vein and a recipient vein (super-drainage) is considered the solution of choice. Evidence to support this procedure, had not yet been confirmed by an analysis of the literature. We aimed to provide this evidence.MATERIALS AND METHODS: We searched the literature (MedLine, Scopus, EMBASE, Cochrane Library, and Google Scholar), for studies discussing venous congestion and venous super-drainage in DIEP flap for breast reconstruction. Thirteen of the 35 articles compared results between one or two venous anastomoses. Meta-analysis was performed following PRISMA guidelines. Pooled risk ratio (RRs) for congestion, fat necrosis, partial necrosis, and total necrosis with corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model with the Mantel-Haenszel method. The need to return to surgery (95% CI) was estimated with a random effect model using the DerSimonian and Liard method.RESULTS: We showed a statistically significant advantage of super-drainage to reduce the venous congestion of the flap (RR: 0.12, 95% CI: 0.04-0.34, p-value <.001), partial flap necrosis (RR: 0.50, 95% CI: 0.30-0.84, p-value .008), total flap necrosis (RR: 0.31, 95% CI: 0.11-0.85, p-value .023), and the need to take the patient back to surgery for perfusion-related complications (RR: 0.45, 95% CI: 0.21-0.99, p value .048).CONCLUSIONS: Performing a second venous anastomosis between the SIEV and a recipient vein (venous superdrainage) reduces venous congestion and related complications in DIEP flaps for breast reconstruction.

2020 - Myelomeningocele Repair Combining a Double Cryopreserved Amniotic Membrane Homograft and the Keystone Flap in a 3-Year-Old Child: A Case Report [Articolo su rivista]
Pignatti, Marco; Feletti, Alberto; Sapino, Gianluca; Marotti, Francesca; Pavesi, Giacomo; De Santis, Giorgio

Early repair in patients affected by myelomeningocele (MMC) is of paramount importance in order to prevent infection, minimize neural tissue damage, and reduce mortality. Treatment must include duraplasty and possibly an adequate soft tissue coverage. Delayed surgery in MMC patients can be more tedious due to the less clear borders between the placode and the skin. Moreover, the risks of wound infection and breakdown increase significantly.

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 - Setting of helium plasma device (J-Plasma) in flap elevation [Recensione in Rivista]
Starnoni, M.; Pinelli, 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 - 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.

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.

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 - The Use of Cold Atmospheric Plasma Device in Flap Elevation [Articolo su rivista]
Pinelli, M.; Starnoni, M.; De Santis, G.

2020 - Treatment of Recurrent Tracheocutaneous Fistulas in the Irradiated Neck with a Two Layers-Two Flaps Combined Technique [Articolo su rivista]
Pignatti, M.; Sapino, G.; Alicandri-Ciufelli, M.; Canzano, F.; Presutti, L.; De Santis, G.

The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap.

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 - A Rare Case of Nipple-Areolar Complex Partial Necrosis following Micropigmentation: What to Learn? [Articolo su rivista]
Starnoni, M.; Pinelli, M.; Franceschini, G.; De Santis, G.

Summary: A 52-year-old woman, without any comorbidity, presented at our institution for reconstruction of nipple-areolar complex (NAC). Nipple reconstruction was obtained through local skin flaps. After 2 months, a tattoo of the NAC was performed. Follow-up was planned at 6 months. Nevertheless, the patient came to our attention 2 days after tattooing for partial necrosis of the epidermal-dermal layer of the tattooed area with partial muscular layer exposition. Empirical antibiotic treatment was immediately started to avoid infection. Daily medications were performed for 3 weeks. Complete healing was obtained within 3 weeks without the necessity of a skin graft. We think that the partial necrosis of the NAC occured because of vascular impairment of the dermal and subdermal vascular plexus during micropigmentation. From this experience, we developed some advice to improve our clinical practice by allowing surgeons, especially if trainees, to avoid complications in performing NAC micropigmentation.

2019 - A Simplified and Practical Surgical Treatment for Medial Ectropion: A Case Report [Articolo su rivista]
Pinelli, Massimo; Starnoni, Marta; De Santis, Giorgio

We present the case of a 81-year-old patient with right facial palsy suffering from recurrent medial ectropion with lower lateral dislocation of the lacrimal punctum causing epiphora and photophobia. The patient was first treated for ectropion with lateral tarsal strip procedure. Unfortunately, this surgical procedure did not get the expected result. This was the reason we used the Mitek anchor system to fix the lower lateral dislocation of the punctum. We had no recurrence of symptoms during a follow-up period of 18 months.

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 - Dermal matrix fixation: A good adhesion to wound edges without vascularization impairment [Articolo su rivista]
Starnoni, M.; De Santis, G.; Pinelli, M.

2019 - Fibula Free Flap Elevation without Tourniquet: Are Harmonic Scalpel Shears Useful? [Articolo su rivista]
Starnoni, Marta; De Santis, Giorgio; Pinelli, Massimo

2019 - Impact of HOXB7 overexpression on human adipose-derived mesenchymal progenitors [Articolo su rivista]
Foppiani, E. M.; Candini, O.; Mastrolia, I.; Murgia, A.; Grisendi, G.; Samarelli, A. V.; Boscaini, G.; Pacchioni, L.; Pinelli, M.; De Santis, G.; Horwitz, E. M.; Veronesi, E.; Dominici, M.

Background: The ex vivo expansion potential of mesenchymal stromal/stem cells (MSC) together with their differentiation and secretion properties makes these cells an attractive tool for transplantation and tissue engineering. Although the use of MSC is currently being tested in a growing number of clinical trials, it is still desirable to identify molecular markers that may help improve their performance both in vitro and after transplantation. Methods: Recently, HOXB7 was identified as a master player driving the proliferation and differentiation of bone marrow mesenchymal progenitors. In this study, we investigated the effect of HOXB7 overexpression on the ex vivo features of adipose mesenchymal progenitors (AD-MSC). Results: HOXB7 increased AD-MSC proliferation potential, reduced senescence, and improved chondrogenesis together with a significant increase of basic fibroblast growth factor (bFGF) secretion. Conclusion: While further investigations and in vivo models shall be applied for better understanding, these data suggest that modulation of HOXB7 may be a strategy for innovative tissue regeneration applications.

2019 - Integra in Scalp Reconstruction After Tumor Excision: Recommendations From a Multidisciplinary Advisory Board [Articolo su rivista]
Magnoni, Cristina; De Santis, Giorgio; Fraccalvieri, Marco; Bellini, Pietrantonio; Portincasa, Aurelio; Giacomelli, Luca; Papa, Giovanni

Integra is a dermal regeneration template used in the reconstruction of burns, traumatic injuries, or excision lesions in patients who present particular risk factors for traditional surgical procedures. A multidisciplinary advisory board of expert dermatologists and plastic surgeons have discussed the use of Integra in the reconstruction of scalp defects after tumor excision, focusing on the evidence derived from literature and on their experience in the treatment of approximately 400 patients. In this position paper, the authors summarize the main evidence discussed during the board, and the common practice guidelines proposed by the experts. The use of Integra is recommended in elderly patients with multiple comorbidities who have a higher risk for potential complications in traditional surgery; these patients may in fact benefit from a lower anesthetic risk, a less complicated postsurgical care and limited morbidity at the donor site obtained with the dermal template. Integra should also be used in the reconstruction of large and complex wounds and in case of bone exposure, as it helps to overcome the challenges related to wound healing in difficult areas. Notably, Integra has proven to be effective in patients who have undergone previous surgical procedures or adjuvant radiation therapy, in which previous incisions, scarring and radiation damages may hamper the effectiveness of traditional procedures. Finally, Integra is recommended in patients with recurrent and aggressive tumors who need closer tumor surveillance, as it gives easy access to the tumor site for oncologic follow-up examination.

2019 - Laminin 332-Dependent YAP Dysregulation Depletes Epidermal Stem Cells in Junctional Epidermolysis Bullosa [Articolo su rivista]
De Rosa, L.; Secone Seconetti, A.; De Santis, G.; Pellacani, G.; Hirsch, T.; Rothoeft, T.; Teig, N.; Pellegrini, G.; Bauer, J. W.; De Luca, M.

Laminin 332-deficient junctional epidermolysis bullosa (JEB) is a severe genetic skin disease. JEB is marked by epidermal stem cell depletion, the origin of which is unknown. We show that dysregulation of the YAP and TAZ pathway underpins such stem cell depletion. Laminin 332-mediated YAP activity sustains human epidermal stem cells, detected as holoclones. Ablation of YAP selectively depletes holoclones, while enforced YAP blocks conversion of stem cells into progenitors and indefinitely extends the keratinocyte lifespan. YAP is dramatically decreased in JEB keratinocytes, which contain only phosphorylated, inactive YAP. In normal keratinocytes, laminin 332 and alpha 6 beta 4 ablation abolish YAP activity and recapitulate the JEB phenotype. In JEB keratinocytes, laminin 332-gene therapy rescues YAP activity and epidermal stem cells in vitro and in vivo. In JEB cells, enforced YAP recapitulates laminin 332-gene therapy, thus uncoupling adhesion from proliferation in epidermal stem cells. This work has important clinical implication for ex vivo gene therapy of JEB.

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 - Management of locked volar radio-ulnar joint dislocation [Articolo su rivista]
Starnoni, M.; Colzani, G.; De Santis, G.; Acciaro, A. L.

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.

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 - Objective Selection Criteria between ALT and Radial Forearm Flap in Oral Soft Tissues Reconstruction [Articolo su rivista]
Benanti, E.; Starnoni, M.; Spaggiari, A.; Pinelli, M.; De Santis, G.

Different locoregional and free flaps were described for oral soft tissues reconstruction after oncological resections; however, free flaps remain the first choice. Among free flaps, the radial forearm flap (RFF) and the anterolateral thigh perforator flap (ALT) are preferred the most. The lack of standardization of the flap choice leaves the selection to the surgeon's experience. The purpose of our observational study is to provide an algorithm to support the flap choice for the reconstruction of oral soft tissues. Sixty patients with squamous cell carcinoma of oral soft tissues were enrolled in our study. All the patients underwent preoperative magnetic resonance imaging (MRI) to measure the three-dimensional size of the tumor. During the follow-up, the patients were evaluated by using the University of Washington-Quality of Life Questionnaire. The questionnaire score was better for small tumors and worse for large tumors in both functional and relational fields. We observed that most of the overlapping results were obtained for small defects and the choice of RFF, as well as for large defects and the use of ALT. We observed that in the preoperative time, it is possible to select which flap between radial forearm and ALT is more appropriate for oral soft tissues defects reconstruction, according to the size of the tumor evaluated by MRI. We propose a decisional algorithm that suggests the type of flap to use between ALT and RFF.

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.

2019 - Reconstruction of complex soft tissue defects including tendons with anterolateral thigh flap extended to fascia lata: Long term recovery and functional outcomes [Articolo su rivista]
di Summa, P. G.; Sapino, G.; Cherubino, M.; De Santis, G.; Durand, S.; Zaugg, P.; Bauquis, O.; Raffoul, W.

Background: We evaluated composite anterolateral thigh (ALT) flaps including vascularized fascia lata (FL), for stable soft tissue coverage and tendons restoration at various joint levels in a one-stage procedure. Methods: We performed a retrospective investigation including 21 “functional” ALT flaps between November 2006 and December 2016. In all patients included, FL was shaped to anatomical reproduce a tendon structure. Functional analysis included range of motion and force assessment. Functional scores were established according to Chen classification, DASH, and LEFS score. Defects resulted from tumor excision, trauma, burn, or infection-debridement and were distributed in four main anatomical districts: knee (seven cases), ankle (six cases), forearm-elbow (four cases), and hand-wrist level (three cases). Results: Nineteen flaps were raised as free flaps, while two as distally-based propeller flaps. Average follow-up was 38 months. Major complication requiring the harvest of a second flap was seen in two patients, whereas three flaps presented superficial necrosis and was treated in an outpatient regimen. We observed 81% of total ROM recovery compared to contralateral sides with 89% recovered articular stability. Best articulation outcomes were present in elbow reconstruction, while ankle reconstructions showed less articularity. Hospital stay was significantly reduced in hand and wrist functional reconstruction when compared with reconstruction at the ankle level (P < 0.05). Conclusion: The ALT flap extended to vascularized FL provides a particularly effective and resistant tissue that can be folded to reconstruct and support tendinous structures. This can restore functional and structural integrity after complex defects in a single stage procedure.

2019 - Surgical Wound Infections in Plastic Surgery: Simplified, Practical, and Standardized Selection of High-risk Patients [Articolo su rivista]
Starnoni, M.; Pinelli, M.; De Santis, G.

2019 - The “Bat Flap”: A flap for reconstruction of large skull skin defects [Articolo su rivista]
Reggiani, C.; Bellini, P.; Salgarelli, A. C.; Setti, G.; Ferrari, B.; De Santis, G.; Starnoni, M.; Magnoni, C.

2019 - Thu0349 autologous fat grafting in the treatment of patients with systemic sclerosis: current experience and future prospects [Abstract in Rivista]
Spinella, Amelia; Pignatti, Marco; Citriniti, Giorgia; Lumetti, Federica; Cocchiara, Emanuele; Palermo, Adalgisa; Sighinolfi, Gianluca; Pacchioni, Lucrezia; Zaccaria, Giovanna; Lusetti, Irene Laura; DE SANTIS, Giorgio; Salvarani, Carlo; Giuggioli, Dilia

2018 - Approccio del Fisioterapista nella presa in carico del paziente con lombalgia cronica: indagine esplorativa presso l'AziendA USL di Reggio Emilia [Articolo su rivista]
Santis, De; Costi, Stefania; Bassi, Sandra; Lombardi, Francesco; Rancati, JACOPO MATTEO

Background: Chronic Low Back Pain (CLBP) is currently considered a biopsychosocial syndrome, where individual, physical, occupational, psychological and social risk factors coexist. The available research indicates that physiotherapists (PTs) theoretically endorse the proposed biopsychosocial approach to treatment, yet very few are adopting this approach in clinical practice. Aim: The purpose of this exploratory survey is to obtain a detailed view of physiotherapists’ perceptions in their local setting, with specific reference to the operators’ kind of approach and professional skills in the treatment of CLBP. Methods: The survey tool was a focus group, based on a simulated clinical case conducted with expert operators selected on a voluntary basis. The results of the interview were analyzed using a qualitative-inductive method. Results: The analysis shows results related to three interconnected macro areas: the physiotherapists’ professional skills/training, evaluation tools, and organizational structure. Physiotherapists’ skills should be reinforced with training dedicated to communication-relational aspects and supported by assessment tools necessary to screen and evaluate psychosocial factors. As regards organizational structure, it takes the opportunity to design a clinical path or structure specialized in outpatient services for patients with chronic low back pain (CLBP). Conclusion: Some results are aligned with the literature. In particular, the need to reinforce physiotherapists’ inter-relational skills and to support them with the intervention of other specialists (multidisciplinary team) in the case of problems not strictly of their competence. The role of management is to identify organizational solutions to creating clinical pathways to reduce dispersion and to reinforce the professionals’ expertise.

2018 - Porcine model for deep superior epigastric artery perforator flap harvesting: Anatomy and technique [Articolo su rivista]
Roggio, T.; Pignatti, M.; Cajozzo, M.; Tos, P.; De Santis, G.; Garusi, C.; Schonauer, F.; Moschella, F.; Cordova, A.; D'Arpa, S.

BACKGROUND Microsurgical training on rats before starting with clinical practice is a well-established routine. Animal model training is less widespread for perforator flaps, although these flaps represent a technical challenge. Unlike other flaps, they require specific technical skills that need to be adequately trained on a living model 1 : a cadaver is not enough because no bleeding, vessel damage, or vasospasm can be simulated. 2 The purpose of this study was to assess the suitability of the porcine abdomen as a training model for the deep inferior epigastric artery perforator (DIEAP) flap, commonly used in human breast reconstruction. METHODS A female swine (Sus scrofa domesticus, ssp; weight 25kg) was used. The procedure was performed with the pig under general anesthesia and in the supine position. A deep superior epigastric artery perforator (DSEAP) flap was harvested on the left side of the abdomen, including the 3 cranial nipples and stopping in the midline to spare the contralateral flap for another dissection (as in bilateral breast reconstructions in humans; Fig. 1). All steps of a DIEAP harvest were simulated: superficial vein harvest, suprafascial perforator dissection, intramuscular perforator harvest with preservation of the nerves, and flap isolation. Observation of capillary refill was used to confirm flap viability at the end of the dissection. The procedure was recorded by means of a GoPro camera and simultaneously with a head mounted (4× magnification) Loupecam system. Photographs were taken using 2 cameras during surgery at relevant time points. RESULTS At the end of the dissection, the flap was viable. The subcutaneous adipose tissue of the pig is less represented than in human and pigs have an additional muscular layer, the panniculus carnosus, which is the analogue of the human Scarpa's fascia. The rectus fascia is thinner. The perforators are lined in 2 rows: 1 lateral and 1 medial, as in the DIEAP, and the intercostal nerves cross the vessels, as happens in humans. The porcine rectus abdominis muscle is thinner than the human one, but vessels' branching faithfully reproduces the human model. 1 We identified 5 perforating vessels of more than 1mm in diameter (2 lateral and 3 medial). We isolated a lateral perforator first and a medial one last: the latter was eventually used to nourish the flap (Fig. 2). CONCLUSIONS The DSEAP flap allows one to closely reproduce all the steps of DIEAP flap harvesting and also to carry out the intramuscular dissection of 2 perforators for each side (up to 4 for each animal), confirming the adequacy of this pig model for microsurgical training. The deep superior epigastric artery is dominant in pigs. 3 Despite this anatomical difference, the DSEAP allows one to reproduce the main steps of DIEAP flap harvesting, providing an excellent training model. Moreover, the presence of double perforating rows allows simulating the dissection twice on each side.

2018 - Porcine model for gluteal artery perforator flap: Anatomy and technique [Articolo su rivista]
Favuzza, N.; D'Arpa, S.; Cajozzo, M.; Roggio, T.; Tos, P.; De Santis, G.; Cherubino, M.; Moschella, F.; Cordova, A.; Pignatti, M.

Although flap anatomy is well studied on cadavers and microsurgical techniques are well practiced on rats, still there are few training models for learning the techniques of perforator flap harvesting. The cadaver has no bloodstream, so accuracy of dissection cannot be evaluated and flap viability cannot be verified. Training on humans carries a high risk of flap damage. A living model for perforator flap harvest is needed to learn the technique before starting with its clinical application.

2018 - Porcine model for internal mammary vessels harvesting: Anatomy and technique [Articolo su rivista]
Cajozzo, M.; D'Arpa, S.; Roggio, T.; Tos, P.; De Santis, G.; Ciclamini, D.; Moschella, F.; Cordova, A.; Pignatti, M.

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

2017 - Closed incision negative pressure therapy: international multidisciplinary consensus recommendations [Articolo su rivista]
Willy, C.; Agarwal, A.; Andersen, C. A.; De Santis, G.; Gabriel, A.; Grauhan, O.; Guerra, O. M.; Lipsky, B. A.; Malas, M. B.; Mathiesen, L. L.; Singh, D. P.; Reddy, V. S.

Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words ‘prevention’, ‘negative pressure wound therapy (NPWT)’, ‘active incisional management’, ‘incisional vacuum therapy’, ‘incisional NPWT’, ‘incisional wound VAC’, ‘closed incisional NPWT’, ‘wound infection’, and ‘SSIs’ identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m2); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.

2017 - La Tecnologia CAD / CAM applicata alla Chirurgia Ricostruttiva della Mandibola [Relazione in Atti di Convegno]
Anesi, Alexandre; Ragoni, Matteo; Chiarini, Luigi; DE SANTIS, Giorgio

L’intento è quello di condividere le prime impressioni relative alla messa in pratica della cosiddetta «Computer Aided Surgery», (CAS) ossia della chirurgia assistita da computer, nelle ricostruzioni mandibolari con lembo libero di perone. Molti chirurghi considerano la modellazione del perone, il suo adattamento e la sintesi ai monconi mandibolari, come la fase chirurgica più impegnativa della ricostruzione, dalla cui accuratezza dipendono gli esiti chirurgici ed a cui si associa un dispendio di tempo non indifferente, capace di incidere sulla durata totale dell’intervento e, di conseguenza, sui costi associati a questo tipo di chirurgia. La svolta nella pianificazione di trattamento si è avuta con lo sviluppo della tecnologia CAD/CAM e conseguenti applicazioni in campo medico & chirurgico. CAD stà a significare «disegno assistito da computer», CAM «produzione assistita da computer». I software CAD, nati negli anni 60’, permettono di progettare, sul monitor bidimensionale di un computer, modelli tridimensionali di oggetti reali o meno. I software CAM invece sono in grado di tradurre le informazioni provenienti da un progetto CAD in istruzioni per macchinari capaci di materializzare il progetto virtuale stesso, le così dette stampanti 3D. Dime chirurgiche di taglio del perone e per l'osteotomia oncologica sono pianificate digitalmente

2016 - Breast amyloidosis: a case report [Articolo su rivista]
Boscaini, Giulia; Pignatti, Marco; Tazzioli, Giovanni; DE SANTIS, Giorgio

Amyloidosis is an uncommon disorder characterized by extracellular deposition of abnormal proteins. Breast involvement has rarely been reported and can clinically be misdiagnosed as breast cancer. A 60-year-old woman presented with a 3-mm diameter mass in the right breast close to a silicon implant positioned 20 years before. A core biopsy, performed to rule out breast cancer, showed amyloid deposit. Further exams confirmed a systemic amyloid light chain amyloidosis. After few months the mass increased causing breast volume and shape distortion. Since breast cancer may be the cause of amyloid deposits or be hidden by it, the patient underwent a bilateral skin sparing mastectomy and expander and fat grafting breast reconstruction. The resection specimens showed amyloid deposits only, no evidence of cancer. At 2 years follow-up, no breast amyloidosis recurrence was shown. Breast amyloidosis is rare but can occur in a plastic surgeon’s practice. It is mandatory to rule out a comitant breast cancer or systemic amyloidosis.

2016 - Composite orbital reconstruction using the vascularized segmentalized osteo-fascio-cutaneous fibula flap [Articolo su rivista]
Lundgren, T. Kalle; Pignatti, Marco; Martin, Halle; Boscaini, Giulia; Ann Charlotte, Docherty Skogh; Chiarini, Luigi; DE SANTIS, Giorgio

Reconstruction of composite orbital defects must address the orbit and an exposed skull base and/or maxillary region. The orbit should not only be covered but also reshaped to accommodate the orbital contents or an epithesis when warranted. This study presents a rationale for a near-anatomical reconstruction of the orbit, together with adjacent dead space obliteration, using the segmentalized osteo-fascia-cutaneous fibula flap. Before the flap transfer, a cutting template for the fibula is made according to the measures and requirements of the facial defect. The segmentalized bone is then osteosynthesized to the facial skeleton and revascularized. Thus, an orbital depth is created by the bony fibula, whereas the fascio-cutaneous part of the flap may be used for lining the orbit and obliteration of the skull base or the maxillary region, or resurface the palate and/or the nasal cavity.

2016 - Management of complications caused by permanent fillers in the face: A treatment algorithm [Articolo su rivista]
Cassuto, Daniel; Pignatti, Marco; Pacchioni, Lucrezia; Boscaini, Giulia; Spaggiari, Antonio; DE SANTIS, Giorgio

Background: Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. Inflammatory reactions (often termed granulomas) to these materials can be functionally and socially disabling. Most therapeutic options used until now are nonspecific antiinflammatory treatments, targeting an ill-defined immune reaction of undefined cause. The minimally invasive intralesional laser treatment can remove the foreign substance and the inflammatory reaction with an 808-nm diode laser. Methods: Two hundred nineteen consecutive patients referred from September of 2006 until June of 2013 for inflammatory reactions to permanent facial fillers and treated with this technique at the authors' institution with a minimum 6-month follow-up were studied. All patients were screened with an ultrasound soft-tissue examination and the lesions were classified as either cystic (implants inserted by bolus injections) or infiltrating (as in microdeposit injection). The authors' therapeutic approach is summarized in an algorithm: infiltrating patterns were treated with intralesional laser treatment alone, whereas cystic distribution cases were also drained through stab wound incisions. The mean patient age was 49 years (range, 23 to 72 years); 204 patients were women. Results: Partial improvement was obtained in 30 percent of patients, whereas 8 percent discontinued the treatment because of a lack of satisfaction. Lesions disappeared completely in 62 percent. Complications included transient swelling in all cases, hematoma in 2 percent, secondary sterile abscess in 9.5 percent, and minimal scarring in 10 percent. Conclusion: A problem-oriented systematic approach to inflammatory complications from permanent fillers is proposed, based on the comprehensive work from the past 7 years, with an overall improvement rate of 92 percent.

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 - Histology-directed and imaging mass spectrometry: An emerging technology in ectopic calcification [Articolo su rivista]
Taverna, Domenico; Boraldi, Federica; De Santis, Giorgio; Caprioli, Richard M.; Quaglino, Daniela

The present study was designed to demonstrate the potential of an optimized histology directed protein identification combined with imaging mass spectrometry technology to reveal and identify molecules associated to ectopic calcification in human tissue. As a proof of concept, mineralized and non-mineralized areas were compared within the same dermal tissue obtained from a patient affected by Pseudoxanthoma elasticum, a genetic disorder characterized by calcification only at specific sites of soft connective tissues. Data have been technically validated on a contralateral dermal tissue from the same subject and compared with those from control healthy skin. Results demonstrate that this approach 1) significantly reduces the effects generated by techniques that, disrupting tissue organization, blend data from affected and unaffected areas; 2) demonstrates that, abolishing differences due to inter-individual variability, mineralized and non-mineralized areas within the same sample have a specific protein profile and have a different distribution of molecules; and 3) avoiding the bias of focusing on already known molecules, reveals a number of proteins that have been never related to the disease nor to the calcification process, thus paving the way for the selection of new molecules to be validated as pathogenic or as potential pharmacological targets.

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

2014 - A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive italian women [Articolo su rivista]
Cortesi, Laura; Razzaboni, Elisabetta; Toss, Angela; DE MATTEIS, Elisabetta; Marchi, I.; Medici, Veronica; Tazzioli, Giovanni; Andreotti, Alberto; DE SANTIS, Giorgio; Pignatti, Marco; Federico, Massimo

BACKGROUND: Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. PATIENTS AND METHODS: This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. RESULTS: In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. CONCLUSIONS: Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization. KEYWORDS: BRCA1/2 mutation carriers; acceptability; genetic counselling; risk-reducing mastectomy

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 - Long-term stability and safety of transgenic cultured epidermal stem cells in gene therapy of junctional epidermolysis bullosa. [Articolo su rivista]
DE ROSA, Laura; Carulli, S; Cocchiarella, Fabienne; Quaglino, Daniela; Enzo, Elena; Franchini, Eleonora; Giannetti, A; DE SANTIS, Giorgio; Recchia, Alessandra; Pellegrini, Graziella; DE LUCA, Michele

We report a long-term follow-up (6.5 years) of a phase I/II clinical trial envisaging the use of autologous genetically modified cultured epidermal stem cells for gene therapy of junctional epidermolysis bullosa, a devastating genetic skin disease. The critical goals of the trial were to evaluate the safety and long-term persistence of genetically modified epidermis. A normal epidermal-dermal junction was restored and the regenerated transgenic epidermis was found to be fully functional and virtually indistinguishable from a normal control. The epidermis was sustained by a discrete number of long-lasting, self-renewing transgenic epidermal stem cells that maintained the memory of the donor site, whereas the vast majority of transduced transit-amplifying progenitors were lost within the first few months after grafting. These data pave the way for the safe use of epidermal stem cells in combined cell and gene therapy for genetic skin diseases.

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.

2014 - Osteomielite ed osteonecrosi della parete toracica anteriore con radiodermite consensuale: risultati di due casi trattati con parietectomia toracica anteriore e ricostruzione della parete con lembo peduncolato di grande omento. [Abstract in Atti di Convegno]
Nesci, Jessica; Pignatti, Marco; Stefani, Alessandro; Loschi, Pietro; Deruvo, Nicola; DE SANTIS, Giorgio; Morandi, Uliano

Una complicanza relativamente rara, ma debilitante descritta nelle pazienti che hanno subito una mastectomia con successiva radioterapia per neoplasia della mammella può essere la formazione di ulcere radionecrotiche infette della parete toracica. In questi casi, in assenza di recidiva neoplastica l’indicazione terapeutica di scelta è l’asportazione chirurgica di tutti i tessuti infetti con successiva ricostruzione del difetto creato con tessuti altamente vascolarizzati. Presenteremo due casi di pazienti donne, entrambe sottoposte da più di 20 anni a mastectomia radicale destra, successivamente radiotrattate e che hanno entrambe sviluppato un’ ulcera radionecrotica infetta della parete toracica anteriore destra. Le pazienti sono state trattate chirurgicamente dopo il fallimento di medicazioni ripetute e della terapia antibiotica mirata. In entrambi i casi abbiamo eseguito un ampio debridement parietale con rimozione di tutti i tessuti macroscopicamente infetti o necrotici, mantenendo adeguati margini di resezione. In entrambi i casi è stato necessario asportare dalla terza alla sesta cartilagine costale insieme ai relativi spazi inetrcostali e l’emisterno destro nella porzione di corpo compresa tra il secondo e il quinto spazio intercostale. Nel primo caso l’area totale del difetto era di 108 cm2, mentre nel secondo caso era più ampia e misurava 160 cm2. La ricostruzione della parete toracica è stata fatta in tutti e due i casi con un lembo peduncolato di grande omento e il lembo è stato successivamente coperto con un innesto cutaneo prelevato dalla coscia sinistra. Nella prima paziente abbiamo osservato una necrosi post operatoria parziale del lembo che è stata trattata con successo grazie a VAAC (vacuum-assisted closure) therapy e con un successivo nuovo innesto cutaneo. Il decorso post operatorio della seconda paziente è stato privo di complicanze. Le possibilità ricostruttive dei difetti di parete della prete toracica anteriore prevedono l’utilizzo del muscolo grande dorsale, del muscolo retto dell’addome o del grande omento. In questi casi il muscolo grande pettorale e il retto dell’addome non erano utilizzabili a causa del pregresso irradiamento, mentre il gran dorsale non era sufficientemente trofico. Lembi liberi non peduncolati non rappresentano una buona alternativa a causa della insufficiente vascolarizzazione. In letteratura sono presenti pochi casi di ulcere radionecrotiche infette trattate con questa tecnica. La nostra esperienza conferma che l’ampia resezione dell’area di parete toracica patologica, la successiva ricostruzione con un lembo peduncolato di grande omento e la copertura del lembo con un innesto cutaneo rappresenta un trattamento valido delle ulcere radionecrotiche infette della parte toracica anteriore in pazienti precedentemente radiotrattati.

2014 - Thalassaemia intermedia: The role of erythroexchange in the treatment of an indolent wound [Articolo su rivista]
Pignatti, Marco; Govoni, Maurizio; Graldi, Giuseppe; Pacchioni, Lucrezia; DE SANTIS, Giorgio; Borgna, Caterina

Thalassaemia intermedia: the role of erythroexchange in the treatment of an indolent wound.

2013 - Adipose stromal/stem cells assist fat transplantation reducing necrosis and increasing graft performance. [Articolo su rivista]
PICCINNO, MARIA SERENA; VERONESI, Elena; LOSCHI, Pietro; M., Pignatti; MURGIA, ALBA; GRISENDI, Giulia; I., Castelli; D., Bernabei; CANDINI, Olivia; P., Conte; PAOLUCCI, Paolo; E. M., Horwitz; DE SANTIS, Giorgio; IUGHETTI, Lorenzo; DOMINICI, Massimo

Autologous fat transfer (AFT) is a procedure for adipose tissue (AT) repair after trauma, burns, post-tumor resections and lipodystrophies still negatively impacted by the lack of graft persistence. The reasons behind this poor outcome are unclear and seem to involve damages in either harvested/transplanted mature adipocytes or on their mesenchymal progenitors, namely adipose stromal/stem cells (ASC), and due to post-transplant AT apoptosis and involution. A rabbit subcutaneous AT regeneration model was here developed to first evaluate graft quality at different times after implant focusing on related parameters, such as necrosis and vasculogenesis. Standard AFT was compared with a strategy where purified autologous ASC, combined with hyaluronic acid (HA), assisted AFT. Five million of autologous ex vivo isolated CD29+, CD90+, CD49e+ ASC, loaded into HA, enriched 1 ml of AT generating an early significant protective effect in reducing AFT necrosis and increasing vasculogenesis with a preservation of transplanted AT architecture. This beneficial impact of ASC assisted AFT was then confirmed at three months with a robust lipopreservation and no signs of cellular transformation. By a novel ASC assisted AFT approach we ensure a reduction in early cell death favoring an enduring graft performance possibly for a more stable benefit in patients.

2013 - Effects of silicone expanders and implants on echocardiographic image quality after breast reconstruction. [Articolo su rivista]
M., Pignatti; F., Mantovani; L., Bertelli; A., Barbieri; L., Pacchioni; P., Loschi; DE SANTIS, Giorgio

Use of silicone expanders and implants is the most common breast reconstruction technique after mastectomy. Postmastectomy patients often need echocardiographic monitoring of potential cardiotoxicity induced by cancer chemotherapy. The impairment of the echocardiographic acoustic window caused by silicone implants for breast augmentation has been reported. This study investigates whether the echocardiographic image quality was impaired in women reconstructed with silicone expanders and implants.The records of 44 consecutive women who underwent echocardiographic follow-up after breast reconstruction with expanders and implants at the authors' institution from January of 2000 to August of 2012 were reviewed. The population was divided into a study group (left or bilateral breast expanders/implants, n=30) and a control group (right breast expanders/implants, n=14). The impact of breast expanders/implants on echocardiographic image quality was tested (analysis of covariance model).Patients with a breast expander/implant (left or bilateral and right breast expanders/implants) were included. The mean volume of the breast devices was 353.2±125.5 cc. The quality of the echocardiographic images was good or sufficient in the control group; in the study group, it was judged as adequate in only 50 percent of cases (15 patients) and inadequate in the remaining 15 patients (p<0.001). At multivariable analysis, a persistent relationship between device position (left versus right) and image quality (p=0.001) was shown, independent from other factors.Silicone expanders and implants in postmastectomy left breast reconstruction considerably reduce the image quality of echocardiography. This may have important clinical implications, given the need for periodic echocardiographic surveillance before and during chemotherapy.Therapeutic, III.

2013 - Prelamination of radial forearm free flap with buccal mucosa. [Articolo su rivista]
G. G., Kim; E. G., Halvorson; A. X., Hang; W. C., Pederson; DE SANTIS, Giorgio; T. G., Hackman

Reconstruction of extripative defects in the head and neck with vascularized free tissue transfer has become the standard of care. In order to overcome disadvantages of the traditional radial forearm free flap (RFFF), e.g., color and texture difference, bulk, and donor site morbidity, the concept of prelamination of the RFFF with mucosa was developed. The term prelamination, introduced in 1994, is a process in which tissue is implanted into a vascular flap prior to transfer [1]. Prelamination with oral mucosa has been implemented in the reconstruction of a variety of intraoral and facial defects [2–4]. With their high cell renewal rate, morcelized buccal mucosal grafts can spread over a vascularized fascial bed and become functional in 3 weeks [2]. The resultant mucosa resembles the native oral mucosa both macroscopically and histologically [5], providing lubrication. Fasicomucosal flaps are thinner than fasciocutanous flaps since no subcutaneous tissue is included. This allows for better tongue mobility and rehabilitation. We studied patients who underwent reconstruction with a prelaminated radial forearm fasciomucosal flap (RFFMF) to describe surgical technique and report multi-institutional outcomes.

2013 - Treatment of wounds colonized by multidrug resistant organisms in immune-compromised patients: a retrospective case series. [Articolo su rivista]
Pignatti, Marco; Gerunda, Giorgio Enrico; G., Rompianesi; N. D., Ruvo; DI BENEDETTO, Fabrizio; M., Codeluppi; D., Bonucchi; L., Pacchioni; P., Loschi; C., Malaventura; DE SANTIS, Giorgio

Immune-compromised patients incur a high risk of surgical wound dehiscence and colonization by multidrug resistant organisms. Common treatment has been debridement and spontaneous secondary healing.All immune-compromised patients referred to our Institution between March 1, 2010 and November 30, 2011 for dehiscent abdominal wounds growing multidrug resistant organisms were treated by serial wound debridements and negative pressure dressing. They were primarily closed, despite positive microbiological cultures, when clinical appearance was satisfactory.Nine patients were treated by direct wound closure, five had been treated previously by secondary intention healing.According to our results, fast healing can be safely obtained by closure of a clinically healthy wound, despite growth of multidrug resistant organisms, even in immune-compromised patients.

2012 - Esperienza di un centro ospedaliero universitario di riferimento nella terapia combinata laser assistita nel trattamento delle complicanze da filler del volto [Articolo su rivista]
DE SANTIS, Giorgio; M., Pignatti; A., Spaggiari; L., Pacchioni; G., Boscaini; P., Loschi; G., Spinzo; D., Cassuto

scopo: una complicanza dell’iniezione di filler permanenti è rappresentata dai granulomi. I trattamenti medici sono raramente efficaci. L’escissione chirurgica causa cicatrici spesso inaccettabili. Materiali e metodi: dal gennaio 2010 all’aprile 2012 sono stati trattati 202 pazienti per granulomi da filler utilizzando un laser diodo con lunghezza d’onda di 808 nm (LAsEmAR 800, EuFOtON, Italia). una sonda ottica di 200-μm viene introdotta attraverso la cute nel granuloma. Il materiale liquefatto viene evacuato mediante digitopressione dai fori di ingresso della sonda. Risultati: 84 pazienti con un follow-up minimo di 6 mesi sono entrati nello studio. Numero medio di trattamenti per ogni granuloma: 1,7 (1-8). una riduzione del volume del granuloma >75% si è avuta in 19 (22,6%) pazienti; una «riduzione 25-75%» in 35 (41,6%) pazienti; «riduzione <25%» in 26 (30,9%) pazienti; «nessun cambiamento» in 4 (4,7%). tra gli eventi avversi: edema e rossore in 37 pazienti (75,8%), ustione al foro di ingresso della sonda in 13 pazienti (26,5%), aree di retrazione in 2 pazienti (4,1%). Conclusioni: la tecnica laser intralesionale (Intra Lesional therapy, ILt) nel trattamento dei granulomi da filler non riassorbibili si è dimostrata sicura ed efficace. Il trattamento richiede una o più sedute che permettono una riduzione del volume del granuloma e della sintomatologia correlata. I risultati cosmetici e funzionali appaiono buoni, soprattutto considerando le poche ed invasive altre opzioni di trattamento.

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&lt;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.

2012 - Reply: long-term efficacy and safety of polyacrylamide hydrogel injection in the treatment of human immunodeficiency virus-related facial lipoatrophy. [Articolo su rivista]
Pignatti, M; DE SANTIS, Giorgio

No abstract available

2011 - Mesenchymal Stromal/Stem Cells from Tissue Repair to Destruction of Tumor Cells [Capitolo/Saggio]
Bussolari, Rita; Grisendi, Giulia; L., Cafarelli; Loschi, Pietro; L., Scarabelli; A., Frassoldati; M., Maur; DE SANTIS, Giorgio; Paolucci, Paolo; P. F., Conte; Dominici, Massimo

A tumor is a complex framework composed of tumor cells (TC) and stroma where the extracellular matrix (ECM) and cellular components such as immune cells, vessels cells and fibroblasts interact closely together. Here these complex interactions are addressed in the light of the possible use of mesenchymal stomal cells to target tumors.

2011 - Surgical correction of HIV-associated facial lipoatrophy. [Articolo su rivista]
Guaraldi, Giovanni; J., Fontdevila; L. H., Christensen; Orlando, Gabriella; C., Stentarelli; Carli, Federica; Zona, Stefano; DE SANTIS, Giorgio; A., Pedone; D., De Fazio; P., Bonucci; E., Martínez

not available

2011 - Understanding Tumor-Stroma Interplays for Targeted Therapies by Armed Mesenchymal Stromal Progenitors: The Mesenkillers. [Articolo su rivista]
Grisendi, Giulia; Bussolari, Rita; Veronesi, Elena; Piccinno, MARIA SERENA; Burns, J. S.; DE SANTIS, Giorgio; Loschi, Pietro; Pignatti, M.; DI BENEDETTO, Fabrizio; Ballarin, Roberto; C., Di Gregorio; V., Guarneri; Piccinini, Lino; Em, Horwitz; Paolucci, Paolo; P., Conte; Dominici, Massimo

Tumor represents a complex structure containing malignant cells strictly coupled with a large variety of surroundingcells constituting the tumor stroma (TS). In recent years, the importance of TS for cancer initiation, development,local invasion and metastases became increasingly clear allowing the identification of TS as one of the possibleways to indirectly target tumors. Inside the heterogeneous stromal cell population, tumor associated fibroblasts(TAF) play a crucial role providing both functional and supportive environments. During both tumor and stroma development,several findings suggest that TAF could be recruited from different sources such as locally derived host fibroblasts,via epithelial/endothelial mesenchymal transitions or from circulating pools of fibroblasts deriving form mesenchymalprogenitors, namely mesenchymal stem/stromal cells (MSC). These insights prompted scientists to identifymultimodal approaches to target TS by biomolecules, monoclonal antibodies and, more recently, via cell basedstrategies. These latter appear extremely promising, although associated with still debated and unclear findings. Thisreview discusses on crosstalk between cancers and their stroma, dissecting specific tumor types, such as sarcoma,pancreatic and breast carcinoma where stroma plays distinct paradigmatic roles. The recognition of these distinctstromal functions may help in planning effective and safer approaches aimed either to eradicate or to substitute TSby novel compounds and/or MSC having specific killing activities

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.

2010 - Adipose-derived mesenchymal stem cells as stable source of tumor necrosis factor-related apoptosis-inducing ligand delivery for cancer therapy [Articolo su rivista]
Grisendi, Giulia; Bussolari, Rita; Cafarelli, Luigi; Petak, I.; Rasini, Valeria; Veronesi, Elena; DE SANTIS, Giorgio; Spano, Maria Carlotta; Tagliazzucchi, M.; Barti Juhasz, H.; Scarabelli, Laura; Bambi, F.; Frassoldati, A.; Rossi, G.; Casali, Christian; Morandi, Uliano; Horwitz, E. M.; Paolucci, Paolo; Conte, P.; Dominici, Massimo

Adipose-derived mesenchymal stromal/stem cells (AD-MSC) may offer efficient tools for cell-based gene therapy approaches. In this study, we evaluated whether AD-MSC could deliver proapoptotic molecules for cancer treatment. Human AD-MSCs were isolated and transduced with a retroviral vector encoding full-length human tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), a proapoptotic ligand that induces apoptosis in a variety of human cancers but not normal tissues. Although several studies have documented the antitumor activity of recombinant human TRAIL, its use in vivo is limited by a short half-life in plasma due to a rapid clearance by the kidney. We found that these limitations can be overcome using stably transduced AD-MSC, which could serve as a constant source of TRAIL production. AD-MSC armed with TRAIL targeted a variety of tumor cell lines in vitro, including human cervical carcinoma, pancreatic cancer, colon cancer, and, in combination with bortezomib, TRAIL-resistant breast cancer cells. Killing activity was associated with activation of caspase-8 as expected. When injected i.v. or s.c. into mice, AD-MSC armed with TRAIL localized into tumors and mediated apoptosis without significant apparent toxicities to normal tissues. Collectively, our results provide preclinical support for a model of TRAIL-based cancer therapy relying on the use of adipose-derived mesenchymal progenitors as cellular vectors.

2009 - Advanced laser techniques for filler-induced complications. [Articolo su rivista]
D., Cassuto; O., Marangoni; DE SANTIS, Giorgio; L., Christensen

The increasing use of injectable fillers has been increasing the occurrence of disfiguring anaerobic infection or granulomas. This study presents two types of laser-assisted evacuation of filler material and inflammatory and necrotic tissue that were used to treat disfiguring facial nodules after different types of gel fillers.Infectious lesions after hydrogels were drained using a lithium triborate laser at 532 nm, with subsequent removal of infected gel and pus (laser assisted evacuation). Granuloma after gels containing microparticles were treated using an 808-nm diode laser using intralesional laser technique. The latter melted and liquefied the organic and synthetic components of the granulomas, facilitating subsequent evacuation. Both lasers had an easily controllable thin laser beam, which enabled the physician to control tissue damage and minimize discomfort and pain.All 20 patients experienced reduction or complete resolution, the latter increasing with repeated treatments.Laser-assisted treatment offers a successful solution for patients who have been suffering from disfiguring nodules from injected fillers-often for many years. The procedure broadens the range of treatment options in cases of untoward reactions to fillers, in line with surgical removal but with lower morbidity and less cosmetic disfigurement.

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 - Fibroblast protein profile analysis highlights the role of oxidative stress and vitamin K recycling in the pathogenesis of pseudoxanthoma elasticum [Articolo su rivista]
Boraldi, Federica; Annovi, Giulia; Guerra, Deanna; Paolinelli Devincenzi, Chiara; Maria Inmaculada Garcia, Fernandez; Panico, Fulvio; De Santis, Giorgio; Tiozzo, Roberta; Ronchetti, Ivonne; Quaglino, Daniela

Pseudoxanthoma elasticum (PXE) is a genetic disorder associated to mutations in the ABCC6 gene, however the pathogenetic mechanisms leading to elastic fibre calcification and to clinical manifestations are still unknown. Dermal fibroblasts, directly involved in the production of the extracellular milieu, have been isolated from healthy subjects and from patients affected by PXE, cultured in vitro and characterized for their ability to produce reactive oxygen species, for structural and functional properties of their cell membranes, for changes in their protein profile. Data demonstrate that oxidative stress has profound and endurable consequences on PXE fibroblast phenotype being responsible for: reduced levels of global DNA methylation, increased amount of carbonylated proteins and of lipid peroxidation products, altered structural properties of cell membranes, modified protein expression. In conclusion, these data shed new light on pathogenetic pathways in PXE, by identifying a network of proteins affecting elastic fibre calcification through inefficient vitamin K recycling, and highlighting the role of several differentially expressed proteins that could be regarded as targets for validating the efficacy of future therapeutic strategies aiming to delay and/or revert the pathologic phenotype of PXE fibroblasts. Moreover, these data open new perspectives for investigating PXE-like phenotypes in the absence of ABCC6 mutations.

2009 - Salvage of exposed breast implant using capsular flaps. [Articolo su rivista]
Gargano, Francesco; Ciminello, Frank; Podda, Silvio; DE SANTIS, Giorgio

Extrusion represents potential complications associated with the use of breast implants. Attempts to salvage the exposed implants are rarely successful when poor tissue coverage or radiotherpy is present and therefore removal of implant and wound healing are mandatory. In these refractory complicated cases the use of capsular flaps can represent a useful tool to save the implant and achieve definitive healing.Capsular flaps have been performed on 6 patients with implant extrusion and 11 patients with breast contour deformities over the last 6 years. The authors describe an innovative technique using capsular flaps which are harvested from thicker viable tissues and inset in multiple layers into the fistula tract to reinforce the breast envelope and prevent recurrence of implant extrusion.Complete healing and implant salvage were achieved in all patients treated. No major complications occurred and only minor contour deformities, that regressed spontaneously after surgery, were observed for 2 weeks.Although capsular flaps have been previously described to correct breast shape deformities, no previous report has yet suggested its utility in breast implant salvage in case of extrusion. The authors advocate the use of capsular flap to save the exposed breast implant especially when poor tissue coverage is present and other surgical options to save the implant have already failed.

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 - New insights into Pseudoxanthoma elasticum pathogenesis by proteome analysis. [Abstract in Rivista]
Quaglino, Daniela; Boraldi, Federica; Annovi, Giulia; Guerra, Deanna; Panico, Fulvio; Spaggiari, Antonio; DE SANTIS, Giorgio; Tiozzo, Roberta; Ronchetti, Ivonne

Proteome analysis on fibroblasts from PXE patients allowed to investigate on pathways involved in the pathogenesis of the disorder, thus highlighting the importance of oxidative stress and vitamin K recycling.

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 - The neck-liver axis. Madelung disease as further evidence for an impact of body fat distribution on hepatic histology [Articolo su rivista]
Ballestri, Stefano; Amedeo, Lonardo; Carulli, Lucia; Matteo, Ricchi; Lorena, Bertozzi; DE SANTIS, Giorgio; Mario, Bondi; Loria, Paola

tissue.A 49-year-old alcoholic man withMD(Fig. 1) fulfilling ATP IIIcriteria6 for arterial hypertension, waist girth and HDL cholesterol,and showing bull-like neck due to subcutaneuos lipoma in DCA,quit drinking alcohol when first observed in 2001. Subsequently,the patient was subjected to anthropometric laboratory evaluationand paired liver biopsy. Owing to neurological and respiratorycomplications, surgical removal of 5kg adipose tissue from the neck area was performed at 2 times (2005-2007). Follow-up of this patient (June 2001– June 2007) disclosed increasing body weight (90-148 kg) coupled with decreasing triglyceride serum levels (90-38mg/dL), as if the expanded adipose tissue were avidly absorbingcirculating triglycerides, thus removing them from the bloodstream.Paired liver biopsy showedalcoholic steatohepatitis in advanced fibrotic stage (2001) and precirrhoticchanges without steatosis (2006), as seen in NAFLD.studies support,therefore, hepatic steatosis to be a protective mechanism against freefatty acid toxicity in the liver. Conversely, selective accumulation offateb in the neck-DCA could be a risk factor for inflammatoryfibrotichepatic changes.

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.

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 - Expression and function of neurotrophins and their receptors in human melanocytes. [Articolo su rivista]
Marconi, Alessandra; Panza, Mc; Bonnet Duquennoy, M; Lazou, K; Kurfurst, R; Truzzi, Francesca; Lotti, Roberta; DE SANTIS, Giorgio; Dumas, M; Bonté, F; Pincelli, Carlo

Melanocytes and cells of the nervous system are of common ectodermal origin and neurotrophins (NT) have been shown to be released by human keratinocytes. We investigated the expression and function of NT [nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), NT-3, NT-4/-5] and their receptors in human melanocytes. Human melanocytes produce all NT in different amounts, whereas they only release NT-4. NT-4 release is downregulated, whereas NT-3 is upregulated by ultraviolet (UVB) irradiation. Melanocytes treated with phorbol 12-myristate 13-acetate (PMA) express TrkA and TrkB, but not TrkC. NT fail to stimulate melanocyte proliferation, whereas they stimulate the synthesis of tyrosinase and tyrosinase-related protein-1 (TRP-1). Finally, NT-3, NT-4 and NGF increase melanin production. Taken together, these results demonstrate an intriguing interaction between melanocytes and the nervous system. We speculate that NT could be considered the target of therapy for disorders of skin pigmentation.

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 - Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy [Articolo su rivista]
Guaraldi, Giovanni; G., Orlando; N., Squillace; DE SANTIS, Giorgio; A., Pedone; A., Spaggiari; D., De Fazio; Vandelli, Maria Angela; M., De Paola; C., Bertucelli; C., Aldrovandi; Nardini, Giulia; Beghetto, Barbara; V., Borghi; Bertolotti, Marco; Bagni, Bruno; M. G., Amorico; A., Roverato; Esposito, Roberto

Background: Treatment for metabolic and morphologic alterations in HIV-related lipodystrophy include medical therapy, physical exercise, and surgical interventions. Method: We assessed the efficacy and safety of a comprehensive multidisciplinary approach for treating morphological and metabolic alterations of the lipodystrophy syndrome in consecutive patients attending the Metabolic Clinic (MC) of the University of Modena and Reggio Emilia who had at least 2 evaluations over a 48-week period. 245 patients were evaluated: 143 (62.4%) were men, 74 (36.1%) presented with lipoatrophy, 10 (4.9%) with fat accumulation, 93 (45%) with mixed forms, 24 (11.3%) had hypercholesterolemia (LDL >1 60 mg/dL), 87 (38%) had hypertriglyceridemia (TG >1 50 mg/dL), 13 (5.7%) had diabetes (glucose >1 26 mg/ dL), and 78 (44%) had insulin resistance (HOMA-IR >4). Results: At follow-up, a significant improvement was observed in both objective and subjective variables. Anthropometric improvement was observed in waist to hip ratio, waist circumference, and right and left cheek dermal thickness measurements. A nonsignificant improvement was observed in fat and lean regional mass by DEXA; CT showed improvement in visceral and subcutaneous adipose tissue. Glucose, HOMA-IR, total cholesterol, and APO B improved. Subjective variables improved in aesthetic satisfaction. Conclusion: We conclude that the medical and surgical interventions proposed in this multidisciplinary therapeutic approach are efficacious and safe in the management of lipodystrophy.

2006 - Preliminary observations on transplants of vascularized bone scaffolds: an experimental and morphological study. [Abstract in Rivista]
Ferretti, Marzia; Palumbo, Carla; Bertoni, Laura; Cavani, Francesco; Carbonara, A.; DE SANTIS, Giorgio; Marotti, Gastone

Bone formation occurring inside and around dead bone implanted scaffolds seems to follow the same sequence of events that are observed during normal intramembranous ossification.

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.

2005 - Tecnica chirurgica di prelievo osseo dalla metafisi tibiale per finalità ricostruttive maxillofacciali [Articolo su rivista]
Consolo, Ugo; Bencivenni, D.; Bellini, Pierantonio; DE SANTIS, Giorgio

Vedasi l'allegato

2005 - Trattato di chirurgia preprotesica e ingegneria tissutale [Monografia/Trattato scientifico]
Nocini, Pier Francesco; Chiarini, Luigi; DE SANTIS, Giorgio


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 - Functional rehabilitation of the atrophic mandible and maxilla with fibula flaps and implant-supported prosthesis. [Articolo su rivista]
DE SANTIS, Giorgio; P. F., Nocini; Chiarini, Luigi; A., Bedogni

Historically, nonvascularized bone grafts have been the standard treatment for severe mandibular and maxillary atrophy, followed by immediate or delayed implant placement. Extreme atrophy is an unfavorable biological and mechanical location for nonvascularized autologous bone transplants. The authors present the results of a multidisciplinary treatment protocol for rehabilitation of extreme mandibular and maxillary atrophy by use of the vascularized fibular flap. This protocol includes bone augmentation, implant surgery, soft-tissue management, and prosthetic restoration. Since 1993, 18 patients with a mean age of 47.5 years presented with extreme mandibular and/or maxillary atrophy and underwent alveolar crest augmentation with vascularized fibular flaps. Bone healing was achieved in 17 of the 18 patients. Seventy-three osteointegrated implants were inserted in 12 of 17 fibular flaps. Altogether, 62 implants were loaded and 11 dental prostheses were made. Average follow-up of the loaded implants was 41 months. The success rate of loaded implants was 100 percent. The authors strongly recommend the use of the fibular bone flap when dealing with extreme atrophy of the mandible and maxilla and suggest the protocol outlined in this review.

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

2004 - Tecnica di prelievo di osso autologo dalla tibia [Abstract in Rivista]
Bellini, Pierantonio; Consolo, Ugo; Cannizzaro, G.; M., Pinelli; DE SANTIS, Giorgio

Tecnica di prelievo di osso autologo dalla tibia

2003 - La clinica metabolica per il trattamento della lipodistrofia [Abstract in Rivista]
Guaraldi, Giovanni; Orlando, G.; DE SANTIS, Giorgio; De fazio, D.; Giuricin, F.; Vandeli, M.; Bertolotti, Marco; Galetti, G.; Sartini, S.; Murri, R.; Covezzi, R.; Esposito, Roberto; Wu, A.

La presa in carico del paziente con lipodistrofia trascende le competenze infettivologiche e necessita di una rete di specialisti competenti per la diagnosi, il monitoraggio, e il trattamento delle alterazioni metaboliche e morfologiche ad essa associate. L'obiettivo della ricerca è di illustrare la metodologia di lavoro e i risultati di questo approccio multidisciplinare integrato denominato "Clinica Metabolica"

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.

2002 - Lining the mouth floor with prelaminated fascio-mucosal free flaps: clinical experience. [Articolo su rivista]
Chiarini, Luigi; DE SANTIS, Giorgio; Bedogni, A; Nocini, P. F.

Soft-tissue defects of the mouth floor need thin, foldable, and pliable tissues able to preserve local anatomy as well as chewing, phonation, and deglutition. The oral mucosa is made of a stratified, nonkeratinized, epithelium-secreting mucus, which lubricates the oral cavity and facilitates tongue movements. No flap exists that can reproduce the physiology of the oral mucosa better than the oral mucosa itself. Prefabrication of mucosal flaps may represent the best solution. Therefore, 10 consecutive cases of mouth floor cancer were treated with prelamination of the fascia antibrachialis with mucosal grafts obtained from the healthy cheek, and with subsequent transplantation 3 weeks later. A significant increase in mucosal graft surface was seen in all cases, with a mean size twice the original. All flaps healed uneventfully. Follow-up time ranged between 2-60 months (average, 26.6 months). Morphological and functional results were excellent. Tongue motility, speech intelligibility, and swallowing were reestablished in all treated cases. Mucosal prelamination of the forearm fascia is feasible and allows physiological reconstruction of oral cavity defects up to 6 x 4 cm.

2002 - Simultaneus bimaxillary alveolar ridge augmentation by a single free fibular transfer : a case report [Articolo su rivista]
Nocini, P. F.; DE SANCTIS, G.; Bedogni, A.; Chiarini, Luigi

Class VI atrophy according to Cawood still represents a major challenge in pre-prosthetic surgery.Reconstruction of mandibular and maxillary bony defects using microvascular techniques is safe and reliable. Thefibula, due to its morphological properties, is ideal for alveolar ridge augmentation and its donor site morbidity isthe lowest among vascularized bone flaps. In this paper, we report the first case, to our knowledge, of extremeatrophy of both jaws, successfully treated by simultaneous bony augmentation of the maxillary and mandibularalveolar ridges with just one free fibula flap. Pre-operative planning, surgical technique and prosthetic restorationare discussed in detail.

2000 - Applicazione preoperatoria dello studio TC spirale per la valutazione morfologico-dimensionale della fibula a scopo implanto-protesico in microchirurgia ricostruttiva cervico-facciale. [Abstract in Atti di Convegno]
Bedogni, A.; Testoni, M.; Nocini, P. F.; Morana, G.; Chiarini, Luigi; DE SANTIS, Giorgio

Atti del 49° Congresso Nazionale SICPRE

2000 - Correzione delle atrofie estreme delle creste alveolari mediante perone vascolarizzato. [Abstract in Atti di Convegno]
DE SANTIS, Giorgio; Pinelli, M.; Chiarini, Luigi; Richeldi, G.; Nocini, P. F.

No abstract

2000 - Finalizzazione implanto-protesica del lembo osseo rivascolarizzato di fibula per la ricostruzione del distretto cranio-maxillo-facciale :10 anni di esperienza. [Abstract in Atti di Convegno]
Nocini, P. F.; Bedogni, A.; DE SANTIS, Giorgio; Chiarini, Luigi; Avesani, F.; Fior, A.

No abstract

2000 - Free prelaminated fasciomucosal flaps in oral cavity floor reconstruction [Lembi liberi prelaminati fascio-mucosi per la ricostruzione del pavimento del cavo orale] [Articolo su rivista]
DE SANTIS, Giorgio; Chiarini, Luigi; Bedogni, A.; D'Agostino, A.; Consolo, Ugo; Nocini, P. F.

The Chinese fasciocutaneous flap is the most versatile method for repairing soft tissue defects of the oral cavity. Its slenderness and pliability make it preferable to other free flaps in the reconstruction of mobile structures. Its chief limitations are, however, its unfavourable skin characteristics, which are void of mucosecretory activity, and the presence of cutaneous appendages. The consequent reduction in oral cavity lubrication is responsible for the dry feeling which hinders rehabilitation, irrespective of reconstructive outcome. The softness of the donor region is cosmetically and functionally consistent. Clinical application of tissue prefabrication techniques in reconstructive microsurgery enables the problem to be solved by raising tailored flaps with the same characteristics as the region under repair, affording excellent long-term results. Between February 1997 and February 1999 we produced 6 prefabricated fasciomucosal radial flaps in 6 patients affected by squamous cell carcinoma of the oral cavity floor. Surgery was performed in two separate stages. The first phase consisted of prelamination of the fascia antebrachii by a mucosal graft raised from the cheek. The prelaminated flap was then transferred in the second stage. Complete integration of the mucosal graft took three weeks. On reopening after three weeks, initial dimensions were found in all cases to have increased approximately two-fold. The post-operative period was free of complications in all treated cases. Healing by first intention was achieved in the forearm from which the graft was raised. Patients were followed up for between 12 and 34 months. In 5 cases, morphological outcome was excellent, with preservation of tongue motility and restoration of lateral excavations. In all cases, speech, mastication and deglutition were preserved. To date, all patients are free from illness.

2000 - Functional rehabilitation of jaw bone defects with vascularized free fibula flap and implant-supported prsthesis: 10- year experience. [Abstract in Rivista]
Pf, Nocini; DE SANTIS, Giorgio; Chiarini, Luigi; Consolo, Ugo; A., Bedogni; D., Bertossi

No abstract available

2000 - La versatilità del lembo osseo rivascolarizzato di perone nella ricostruzione dei mascellari resecati per neoplasie. Fibula flap versatility in the reconstruction in resected jawbone [Articolo su rivista]
DE SANTIS, Giorgio; Bedogni, Alberto; Chiarini, Luigi; Pinelli, Massimo; Nocini,

No abstract available

2000 - a comparison between radial forearm flap and preliminated fasciomucosal free flap in oral recostruction [Abstract in Rivista]
Chiarini, Luigi; Nocini, P. F.; Bedogni, A.; Giannetti, Luca; DE SANTIS, Giorgio; Consolo, Ugo

1999 - jaw reconstruction by free fibular transfer: emphasis on osteointegrated implants, TMJ and maxillary reconstruction [Articolo su rivista]
DE SANTIS, Giorgio; Chiarini, Luigi; A., Bedogni; P. F., Nocini

From December 1989 to September 1997 21 patients were treated for mandible reconstruction and 10 for maxilla reconstruction using the fibular flap. The age of patients ranged from 25 to 64, the length of the bone grafts from 7 to 25 cm. In 16 cases osseointegrated implants were used for denture rehabilitation; in 3 cases the reconstruction involved the TM joint. In the maxilla the fibula flap was used to reconstruct extreme atrophy of the alveolar process in 4 cases; to reconstruct a previous hemimaxillectomy in 3 cases and post-traumatic bone loss in 3 cases. Bone fixation was obtained by K-wires in 4 cases and miniplates in the remaining 27. The TM joint was reconstructed with an osteochondral graft from the second metatarsal head or an ear cartilage graft sutured on top of the fibula. In one case the homologous condyle conserved after tumor resection was used. The flaps were bone only (12 cases), bone plus muscle (15 cases) and osteocutaneous (4 cases). Average follow-up was 3–4 years. Twenty-eight flaps had no complications, with good functional and morphological results. One flap was lost because of infection, 1 flap was lost after 3 years due to a recurrence of malignancy; 1 flap had a segmental bone necrosis because partial devascularization occurred after hemostasis to stem major bleeding. Seventy-nine fixtures were placed, 47 into the new mandibles and 32 into the reconstructed maxillae. All implants have been well osseointegrated, except 1 removed at the time of surgery because of poor primary stability. Sixteen patients have had an implant-supported prosthesis. In our experience fibula is one of the most versatile flaps for jaw reconstruction, especially when osseointegration is planned or the TMJ and the maxilla need to be reconstructed.

1996 - Prelievo d'osso dall'olecrano: proposta d'utilizzo in campo oro-maxillo-facciale." [Relazione in Atti di Convegno]
Chiarini, Luigi; DE SANTIS, Giorgio; Bertoldi, Carlo

Nonostante la sempre più massiccia presenza commerciale di materiali alloplastici ed eterologhi per la chirurgia oro-maxillo-facciale, l'impiego di osso autologo è, comunque, universalmente ritenuto il più affidabile, sicuro e quello che offre i migliori risultati. L'unico inconveniente legato all'uso di quest'ultimo materiale è il costo biologico (necessità, quasi costante, di prelievo in sedi secondarie rispetto a quella d'intervento) e sociale (legato all'allungarsi dei tempi di intervento). Da queste considerazioni sono scaturite le proposte più diverse di zone donatrici. Gli autori hanno studiato la tecnica di prelievo osseo dall'olecrano applicata in campo Oro-Maxillo-Facciale per fini eminentemente pre-protesici. Il prelievo dall'olecrano, infatti, è comunemente utilizzato in campo ortopedico ed otorinolaringologico, ma non è stato mai proposto nel nostro settore di ricerca. Gli autori studiano le caratteristiche dell'accesso alla zona olecranica con tassello osseo corticale che può arrivare a dimensioni di 25x10 mm e con un volume di osso spongioso prelevabile che varia tra i 2 e i 4 CC. Lo studio è stato condotto in 9 casi di rialzo del pavimento del seno mascellare ed in 3 casi per riempimenti di difetti ossei di varia natura. Secondo le valutazioni degli autori il prelievo osseo olecranico può rappresentare, in una tale tipologia di interventi e nei casi in cui la carenza ossea sia compatibile, un metodo di elezione. Codice: IT\ICCU\AQ1\0020032

1995 - Il lembo libero di tensore della fascia lata nella variante fasciale: a proposito di due casi [Articolo su rivista]
Vaienti, L.; DE SANTIS, Giorgio; Azzolini, C.

No abstract

1995 - La ricostruzione tegumentaria della gamba: tecniche a confronto. [Articolo su rivista]
DE SANTIS, Giorgio; De Fazio, D.; Pinelli, M.; Bedeschi, P.

No abstract

1994 - microsurgical model of ischemia reperfusion in rat muscle: evidence of free radical formation by spin trapping [Articolo su rivista]
DE SANTIS, Giorgio; M., Pinelli

The purpose of developing the experimental model described in this study was to verify the hypothesis that free radicals are formed during ischemia- reperfusion of skeletal muscle. Spin trapping technique, along with electron spin resonance spectroscopy (ESR), directly indicates the presence of reactive radicals, which are widely considered to be important in tissue injury. The experimental model was a rat pedicled rectus femoris muscle flap. The femoral artery and vein were cannulated to inject the 'spin trap' and collect the effluent flow. The spin trap agent was phenyl-t-butyl nitrone (PBN) and Hank's balanced salt solution. Three injections and collections were made: a) before ischemia; b) after ischemia of 15, 30, 60, 120, and 180 minutes, but before blood flow had been restored; and c) after blood flow had been restored. No ESR signal was detected either before the ischemic period or after only 15 minutes of ischemia. PBN radical adducts were detected after 30, 60, 120, and 180 minutes of ischemia. A similar signal was detected when PBN was injected during reperfusion 10 minutes after the ischemic periods. The study demonstrated the presence of free radicals in an in vivo intact skeletal muscle ischemia-reperfusion model.

1993 - Local fascial flaps in soft tissue Reconstruction of the hand [Capitolo/Saggio]
DE SANTIS, Giorgio; Lucchetti, R.; Pinelli, M.

No abstract

1992 - Hemimandibular reconstruction via an autologous transplant of vascularized fibula. A report of a clinical case. (Ricostruzione di un emicorpo mandibolare mediante trapianto autologo di perone vascolarizzato. Presentazione di un caso clinico. [Articolo su rivista]
DE SANTIS, Giorgio; Chiarini, Luigi; Cantoni, Luca; Riccio, M.

The authors illustrate the advantage of vascularised as opposed to conventional edges in the reconstruction of the jaw, focusing in particular on the use of a fibular autologous transplant. After a rapid description of the surgical technique used to remove the graft, they report a case of mandibular reconstruction in a young patient who had been involved in a shooting accident which had led to the loss of the left of this jaw.

1992 - Impianti osteointegrati su innesto vascolarizzato [Relazione in Atti di Convegno]
Chiarini, Luigi; DE SANTIS, Giorgio; Cantoni, E.; Tanza, D.; Bertoldi, Carlo; Tassinari, M.

La ricostruzione dei settori ossei del distretto Maxillo-Facciale, dopo resezioni per patologie tumorali o displastiche o dopo perdite di sostanza per gravi traumatismi, ha sempre rappresentato un settore operativo di notevole importanza, difficoltà e frequenza.Nei casi in cui, poi, la regione interessata si riveli particolarmente estesa, comprendendo una parte od anche un'intera arcata alveolare, oltre a tutti i problemi comuni a tutti i tipi di innesto ( dimensioni, modellabilità, vitalità, ecc.), subentra la problematica inerente la riabilitazione delle potenzialità fisiologiche orali.In questo lavoro gli autori studiano l'impiego dell'innesto rivascolarizzato di perone nella riabilitazione globale di soggetti con carenze di ampi settori ossei mandibolari.Il perone rivascolarizzato nelle ricostruzioni mandibolari si è dimostrato un lembo altamente versatile, trofico, con caratteristiche morfologiche che si prestano perfettamente alla sostituzione della mandibola mancante.In particolare, per quanto concerne la riabilitazione con impianto finale di fixture edossee, l'aspetto strutturale (bicorticale con canale midollare interno) offre un substrato particolarmente adatto permettendo il posizionamento degli impianti in bicorticalismo.Codice: IT\ICCU\UFI\0353309

1992 - The use of the fascial flaps in the reconstruction of the hand [Relazione in Atti di Convegno]
Riccio, M.; DE SANTIS, Giorgio; Sacchetti, G. L.

The authors suggest the use of the island or free fascial flaps for the treatment of serious hand traumas characterized by wide loss of cover skin. In their experience, the fascial flaps, give better functional and aesthetic results than corresponding fascio-cutaneous flaps both at the recipient site and the donor site

1992 - Use of fibula free flap in mandible reconstruction: Cases reports (L’impiego del perone vascolarizzato nella ricostruzione della mandibola: presentazione dei casi clinici) [Relazione in Atti di Convegno]
DE SANTIS, Giorgio; Chiarini, Luigi; Riccio, M.

From January 1990 to December 1991, 4 patients were treated by the authors with fibula free flap for mandible reconstruction. Two cases were oncological, 1 posttraumatic and 1 infected pseudoarthrosis. The age of the patients ranged from 25 to 54, the average lenght of the mandible defect was 12.25 cm. In 1 case the anterior arch of the mandible was reconstructed and in the other 3 cases the reconstruction involved the hemimandible including the T-M joint (1 case). No early general, local or microsurgical complications were observed. We had only 1 late complication due to the recurrence of the infection in a case of recurrent infected pseudoarthrosis. Bone fixation was obtained with K. wires (2 cases) and with miniplates (2 cases). In 1 case together with the bone flap a fair amount of F.A.L. muscle was taken to better contour the soft tissue loss. All microsurgical anastomoses were performed on the facial artery and homonymous veins. All osteotomies sites healed primarily, in 1 case osteointegrated implants have been positioned in the graft to be fitted with conventional dentures. Simmetry and contour of the mandible were judged to be good and excellent in all patients as well as mandible range of motion. Fibula free flap has the advantage of bicortical shape, ample lenght, possibility of segmentation and contour, distant location of donor site (to allow a team approach) and low donor site morbidity. For these reasons we consider it the flap of choice in mandible reconstruction expecially when the bony defect is prevalent and soft tissue loss is limited.

1991 - Migration of a osteosynthesis pin from the femoral neck into the urinary bladder (MIGRAZIONE DI UN CHIODO PER OSTEOSINTESI DAL COLLO FEMORALE IN VESCICA) [Articolo su rivista]
DE SANTIS, Giorgio; Manenti, Antonio; Caserta, G.; Pollastri, C.; Cavana, R.


1991 - Mr of benign peripheral nerve sheath tumors [Articolo su rivista]
Cerofolini, Emilio; Landi, Antonio; DE SANTIS, Giorgio; Maiorana, Antonino; Canossi, Giancarlo; Renato, R.

Seventeen benign peripheral nerve sheath tumors were studied using MR. In all cases T2 relaxation time, signal intensity on Tl-weighted images (lesion/muscle ratio), detectability of nerve of origin, nerve-lesion relationship, and presence of a capsule were assessed. Sixteen tumors showed marked hyperintensity on T2-weighted images with T2 relaxation times values >95 ms. One schwannoma was almost isointense with fat (T2 60 ms). All lesions were isointense with muscle on Tl-weighted images. In schwannomas the nerve was usually situated at the periphery of the lesion and only in one case was it obliterated by the mass. In neurofibromas the nerve was either visible in a central position within the mass (two cases) or no longer visible (five cases). A capsule could be detected in 70% of the schwannomas and in 30% of the neurofibromas. In patients with soft tissue masses, MR may contribute to recognition of nerve sheath tumors by showing the nerve of origin and typical signal hyperintensity on T2-weighted images. It can also be helpful in distinguishing between schwannomas and neurofibromas by the location of the nerve of origin and the presence of a capsule. © 1991 Raven Press, Ltd., New York.

1991 - The distally based posterior interosseous island flap for the coverage of skin loss of the hand. [Articolo su rivista]
A., Landi; R., Luchetti; O., Soragni; DE SANTIS, Giorgio; G. L., Sacchetti

Eight patients with skin coverage of the hand by the distally based posterior interosseous island flap (DBPIIF) are presented. The first web was reconstructed in 6 and the volar and dorsal aspect of the hand in 2 patients. Primary closure of the donor sites has always been possible. An echo Doppler examination is indicated to verify the presence and size of the vessel and the direction of its flow. The dissection of the vascular pedicle, however, is frequently quite complex and time consuming. To better appreciate the cosmetic aspect of the DBPIIF and its donor site, a random study has been undertaken to compare this flap with the radial forearm and the groin flap and their corresponding donor sites. Females have more often preferred the groin flap, whereas doctors preferred the DBPIIF. Reliability, a good aesthetic result at the donor site, and the preservation of the main vessels of the hand are the specific merits of the DBPIIF.

1990 - Effect of postoperative radiation on the incorporation of tibial bone grafts in the rabbit. [Articolo su rivista]
DE SANTIS, Giorgio; J. F., Williams; E., Dvir; B. M., O'Brien; J. V., Hurley; I., Goldberg

A dose of 48 Gy of X-irradiation given over two to five weeks after grafting caused no significant delay in the rate of healing and only a small and statistically non-significant decrease in the torsional strength of the graft-bone junction of either vascularised or non-vascularised bone grafts of the tibiae of rabbits. Healing was faster and the union between the graft and adjacent bone developed torsional strength significantly more rapidly with vascularised than with non-vascularised grafts. These findings suggest that postoperative radiotherapy is unlikely to have a significantly deleterious effect on the healing of bone grafts used to repair defects produced by excision of malignant bone tumours.

1990 - Particular aspect of lesions in continuity of peripheral nerves [Relazione in Atti di Convegno]
Landi, Andrea; DE LUCA, Stefania; Luchetti, Roberto; DE SANTIS, Giorgio; Soragni, O.; Sacchetti, G. L.


1990 - Vascularized nerve graft: a clinical contribution. [Articolo su rivista]
R., Luchetti; DE SANTIS, Giorgio; O., Soragni; S., Deluca; L., Pederzini; M., Alfarano; A., Landi

The authors present 4 cases of vascularized nerve graft. The results were better than those obtained with traditional grafting. The indication is a rare one, and the experimental results are contradictory. Indications are limited to Volkmann ischemic syndromes, post-actinic lesions of the brachial plexus, infections and finally, post-burning scarring. Nevertheless, traditional nerve grafts remain the treatment of choice for peripheral nerve lesions which cannot undergo direct suturing.

1989 - CT in established Volkmann's contracture in forearm muscles. [Articolo su rivista]
Landi, Antonio; DE SANTIS, Giorgio; Torricelli, Pietro; A., Colombo; P., Bedeschi

Differential diagnosis between true and pseudo-Volkmann's contracture should not be based on clinical grounds alone, because clinical data are often insufficient in determining the severity and the extent of muscle damage. CT has been utilised in 11 cases where a flexion contracture of the forearm muscles was present and corresponded closely with the surgical findings. True and pseudo-Volkmann's contracture can thus be distinguished and the severity and extent of the muscle damage determined.

1989 - Free and axial flaps in the tratmente of malignant tumours of the limbs. Report of 16 cases. (Lembi liberi e ad isola nel trattamento di tumori dei tessuti molli degli arti) [Articolo su rivista]
DE SANTIS, Giorgio; Mc Leod, A.; Soragni, O.

No abstract

1989 - From the roman age to the renaissance [Capitolo/Saggio]
DE SANTIS, Giorgio; De Luca, S.; Bernabeo, R.

No abstract

1989 - Interventi microchirurgici nella ricostruzione del 1° raggio nel bambino. [Articolo su rivista]
DE SANTIS, Giorgio; Luchetti, R.; Sacchetti, G. L.

No abstract

1989 - Le lesioni nervose in continuità nel bambino [Articolo su rivista]
Landi, A.; Soragni, O.; Sacchetti, G. L.; DE SANTIS, Giorgio

No abstract

1989 - The deleterious effect of arteriovenous flow reversal during experimental free muscle transfer. [Articolo su rivista]
M. F., Angel; M. J., Hickey; DE SANTIS, Giorgio; B. M., O'Brien

Arteriovenous flow reversal (AVR) has been used experimentally to salvage ischemic limbs and to create novel skin flaps with some success. The clinical applicability of AVR in muscle by way of two arteriovenous anastomoses in the rabbit was investigated. Twenty-four rabbits were divided into two groups. In Group 1 (control), the rectus femoris muscle was harvested and transplanted in the opposite thigh, anastomosing the donor femoral artery to the recipient femoral artery, and the donor rectus femoris vein to the recipient femoral vein. In Group 2 (flow reversal), the same procedure was done except the donor artery was anastomosed to the recipient vein and vice versa. Six and 24 hr postoperatively, specimens were compared macroscopically and by weight and histology. Reversed flow muscles were significantly heavier than control muscles at 6 hr and at 24 hr. Histologically, 6 hr of AVR caused edema, intramuscular hemorrhage, neutrophil infiltration, and thrombosis of most vessels. By 24 hr muscle cell degeneration was well advanced. All control muscles were viable, with only mild edema and slight peripheral necrosis. Possible reasons for the failure of AVR in muscle are discussed. On the basis of these results, AVR in free muscle transfer is not advocated.

1989 - The use of CT scan in evaluating Volkmann's syndrome in the limbs. [Articolo su rivista]
A., Landi; DE SANTIS, Giorgio; G. L., Sacchetti; C., Ciuccarelli; R., Luchetti; P., Bedeschi

Between January 1980 and October 1986 26 cases of Volkmann's syndrome were submitted to preoperative CT scan. Thirteen were localised in the upper limb, 11 in the lower limb, and 2 were cases of pseudo-Volkmann's disease. CT scan allowed us to confirm the densitometric features and distribution of muscle infarction in the various muscle planes. Thus, two groups were distinguished, each with different densitometric features: a first group with diffuse hypodensity of the muscular sheaths with unclear borders, and a coefficient of attenuation at approximately 30-40 H.U., which at operation corresponded to diffuse fibrosis; a second group with defined hypodensity of the various muscle groups equal to 10-20 H.U., which at operation gave a macroscopic picture of infarction. CT scan provides a detailed preoperative topographical and morphological evaluation of the infarction area, and therefore a treatment plan based on a more accurate knowledge of the anatomical and pathological lesions.

1989 - Utilità della TAC nella valutazione della sindrome di Volkmann degli arti [Articolo su rivista]
Landi, A.; DE SANTIS, Giorgio; Sacchetti, G. L.

No abstract

1989 - the effect of immunosoppression on vascularised allograft: a preliminary report [Articolo su rivista]
K., Doi; DE SANTIS, Giorgio; J. V., Hurley

Five vascularised allografts of the knee joint were performed in dogs immunosuppressed with cyclosporin A and azathioprine. Three survived with normal function for 3 to 4 months after operation. One of the unsuccessful grafts had a failed vascular anastomosis, the other an inadequate blood level of cyclosporin A. All three successful grafts healed well. In two, bone scans, radiographs and biopsies were indistinguishable from successful autografts; in the third the blood supply to the graft failed despite patent anastomoses but the graft healed well with good function. All three grafts were rejected within 2 to 3 weeks of withdrawal of cyclosporin A and azathioprine. In non-immunosuppressed dogs, allografts of the knee, both vascularised and non-vascularised, were rejected within a few days of operation. In two non-vascularised allografts, administration of cyclosporin and azathioprine had no apparent effect on the rate of rejection of the graft.

1987 - Accesso alla interfalangea prossimale delle dita lunghe per via volare [Articolo su rivista]
Landi, A.; Luchetti, R.; De Luca, S.; Soragni, O.; Pederzini, L.; Alfarano, M.; DE SANTIS, Giorgio

No abstract

Luchetti, R.; DE SANTIS, Giorgio; Soragni, O.; Deluca, S.; Pederzini, L.; Alfarano, M.; Landi, Andrea


1987 - Il lembo assiale di Mc Gregor nella ricostruzione della prima commissura [Articolo su rivista]
DE SANTIS, Giorgio; Pederzini, L.; De Luca, S.

No abstract

1986 - 2 cases of mucoid pseudocysts of the peripheral nerves (Due casi di pseudocisti mucoidi dei nervi periferici). [Articolo su rivista]
DE SANTIS, Giorgio; M., Villani; L., Pederzini; S. D., Luca; O., Soragni; R., Luchetti

No abstract available

1986 - Computerized tomography in the assessment of soft-tissue neoplasms. Observations in 124 cases (La tomografia computerizzata nella valutazione delle neoplasie delle parti molli. Osservazioni in 124 casi). [Articolo su rivista]
Torricelli, Pietro; Calò, M; Boriani, S; DE SANTIS, Giorgio

In order to evaluate the role of Computed Tomography (CT) in prediction of nature, staging and follow-up of soft-tissue tumors, the authors examined by CT 124 patients with soft tissue neoplasms who later underwent surgery (116 cases) or fine needle biopsy (8 cases). Comparison between CT and surgical or anatomical results showed that CT was able to correctly predict the benignancy or malignancy of the masses in 76% of cases but it was very seldom able to allow an histological prediction. On the contrary CT was found to be a very useful tool for pre-therapeutic staging and follow-up of the tumors, because it gave many diagnostic information which influenced therapeutic choices and strategies.

1986 - Tumori maligni dei nervi periferici [Capitolo/Saggio]
Landi, Antonio; Brooks, ; DE SANTIS, Giorgio

No abstract available

1985 - I reimpianti pluridigitali di mano [Articolo su rivista]
Landi, A.; Cugola, L.; Luchetti, R.; Soragni, O.; DE SANTIS, Giorgio

No abstract

1985 - Il trapianto del 2° dito del piede ed il lembo composito dell’alluce pro pollice [Articolo su rivista]
Landi, A.; Soragni, O.; DE SANTIS, Giorgio

No abstract

1985 - Lembi muscolari e miocutanei liberi [Articolo su rivista]
8. Cugola, L.; Landi, A.; Soragni, O.; DE SANTIS, Giorgio

No abstract

1985 - Revisione dei casidi ricostruzione del pollice trattati secondo Morrison nella Clinica Ortopedica e Traumatologica di Modena. [Articolo su rivista]
Landi, A.; Soragni, O.; Luchetti, R.; DE SANTIS, Giorgio


1984 - Nocturnal prolactin secretion in carpal tunnel syndrome. [Articolo su rivista]
E., Rossi; E., Sighinolfi; P., Bortolotti; DE SANTIS, Giorgio; R., Schoenhuber; M., Grandi; A., Landi

The correlation between plasma PRL levels and CTS was investigated in 21 patients in whom a specific causal agent of CTS could not be identified. No correlation between plasma PRL levels and other clinical and neurophysiological data was detected.

1983 - Sarcoidosis of the hand--report of two cases. [Articolo su rivista]
A., Landi; D., Brooks; DE SANTIS, Giorgio

Sarcoidosis occurring as an isolated manifestation in the hand can pose a diagnostic problem. Skin, muscle, tendon sheath, and bone may be affected. The unusual clinical picture and operative findings are often misleading and malignancy may be suspected. Two cases of isolated involvement of bone and muscle are described.

1981 - Gli insuccessi nel trattamento delle lesioni nervose in continuità. [Articolo su rivista]
3. Landi, A.; Soragni, O.; DE SANTIS, Giorgio

No abstract

1981 - Il dolore negli esiti del trattamento chirurgico delle lesioni dei nervi periferici [Articolo su rivista]
2. Bedeschi, P.; Mingione, A.; Luchetti, R.; DE SANTIS, Giorgio

No abstract

1980 - Tumori e condizioni similtumorali della mano: casistica della Clinica Ortopedica e Traumatologica dell’Università di Modena [Articolo su rivista]
DE SANTIS, Giorgio; Cavazzuti, A.; Camporesi, C.

No abstract