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  • 11
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    Online Resource
    IL-10, IL-13, Eotaxin and IL-10/IL-6 ratio distinguish breast implant-associated anaplastic large-cell lymphoma from all types of benign late seromas
    Springer Science and Business Media LLC ; 2021
    In:  Cancer Immunology, Immunotherapy Vol. 70, No. 5 ( 2021-05), p. 1379-1392
    Details
    In: Cancer Immunology, Immunotherapy, Springer Science and Business Media LLC, Vol. 70, No. 5 ( 2021-05), p. 1379-1392
    Abstract: Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is an uncommon peripheral T cell lymphoma usually presenting as a delayed peri-implant effusion. Chronic inflammation elicited by the implant has been implicated in its pathogenesis. Infection or implant rupture may also be responsible for late seromas. Cytomorphological examination coupled with CD30 immunostaining and eventual T-cell clonality assessment are essential for BI-ALCL diagnosis. However, some benign effusions may also contain an oligo/monoclonal expansion of CD30 + cells that can make the diagnosis challenging. Since cytokines are key mediators of inflammation, we applied a multiplexed immuno-based assay to BI-ALCL seromas and to different types of reactive seromas to look for a potential diagnostic BI-ALCL-associated cytokine profile. We found that BI-ALCL is characterized by a Th2-type cytokine milieu associated with significant high levels of IL-10, IL-13 and Eotaxin which discriminate BI-ALCL from all types of reactive seroma. Moreover, we found a cutoff of IL10/IL-6 ratio of 0.104 is associated with specificity of 100% and sensitivity of 83% in recognizing BI-ALCL effusions. This study identifies promising biomarkers for initial screening of late seromas that can facilitate early diagnosis of BI-ALCL.
    Type of Medium: Online Resource
    ISSN: 0340-7004 , 1432-0851
    URL: Article
    DOI: 10.1007/s00262-020-02778-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 12
    Online Resource
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    Response to: What Is Missing From the 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL?
    Oxford University Press (OUP) ; 2023
    In:  Aesthetic Surgery Journal Vol. 43, No. 2 ( 2023-02-03), p. NP138-NP140
    Details
    In: Aesthetic Surgery Journal, Oxford University Press (OUP), Vol. 43, No. 2 ( 2023-02-03), p. NP138-NP140
    Type of Medium: Online Resource
    ISSN: 1090-820X , 1527-330X
    URL: Article
    DOI: 10.1093/asj/sjac305
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2048788-5
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  • 13
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    Saline blow‐assisted vein anastomosis
    Wiley ; 2014
    In:  Microsurgery Vol. 34, No. 7 ( 2014-10), p. 588-588
    Details
    In: Microsurgery, Wiley, Vol. 34, No. 7 ( 2014-10), p. 588-588
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Issue
    URL: Article
    DOI: 10.1002/micr.v34.7
    DOI: 10.1002/micr.22260
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 14
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    Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face
    Wiley ; 2015
    In:  Microsurgery Vol. 35, No. 3 ( 2015-03), p. 177-182
    Details
    In: Microsurgery, Wiley, Vol. 35, No. 3 ( 2015-03), p. 177-182
    Abstract: Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin‐grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin‐grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1‐to‐4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure‐Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21‐month follow‐up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color ( P  = 0.028) and texture ( P  = 0.021) match, shape ( P  = 0.047) and bulkiness ( P  = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed ( P 〉 0.05) between the two groups. Skin‐grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face. © 2014 Wiley Periodicals, Inc. Microsurgery 35:177–182, 2015.
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Issue
    URL: Article
    DOI: 10.1002/micr.v35.3
    DOI: 10.1002/micr.22305
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 15
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    Double‐barrel vascularized dual fibula transfer with epiphyseal growth plate for hip reconstruction: A case report
    Wiley ; 2018
    In:  Microsurgery Vol. 38, No. 5 ( 2018-07), p. 572-575
    Details
    In: Microsurgery, Wiley, Vol. 38, No. 5 ( 2018-07), p. 572-575
    Abstract: We present a case report of a 10‐year‐old girl diagnosed with Ewing sarcoma treated with intra‐articular wide resection of the right femur and reconstruction with a series‐connected double‐barrel bilateral vascularized fibula graft (db‐BVFG), including fibular head for articulation with the acetabulum of the pelvic bone and preservation of the epiphyseal growth plates for eventual limb growth. No postoperative complications were observed and bone union was achieved with fibular graft hypertrophy, allowing for full weight bearing. Neither local recurrence nor metastasis was observed at 17‐year follow‐up. Range of motion degrees at last follow up: hip flexion 90 degree, extension 12 degree, abduction 31 degree, rotation 25 degree. Right versus left limb discrepancy was 60 mm. Db‐BVFG may be an option for reconstruction of long femoral defects and hip joint restoration following tumor resection and inclusion of epiphysis within the graft is a viable option in pediatric patients to restore longitudinal growth of the reconstructed long bone.
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Issue
    URL: Article
    DOI: 10.1002/micr.v38.5
    DOI: 10.1002/micr.30303
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 16
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    Diep flap sentinel skin paddle positioning algorithm
    Wiley ; 2015
    In:  Microsurgery Vol. 35, No. 2 ( 2015-02), p. 91-100
    Details
    In: Microsurgery, Wiley, Vol. 35, No. 2 ( 2015-02), p. 91-100
    Abstract: Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free‐tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand‐held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward. Skin paddle (SP) position was preoperatively drawn following mastectomy type incisions; in skin‐sparing mastectomies types I–III a small SP (sSP) replaces nipple–areola complex; in skin‐sparing mastectomy type IV, SSP is positioned between wise‐pattern branches while in type V between medial/lateral branches. In case of nipple‐sparing mastectomy SSP is positioned at inframammary fold or in lateral/medial branches of omega/inverted omega incision if used. Three hundred forty‐seven DIEP flap breast reconstructions were reviewed and stratified according to SP type into group A including 216 flaps with large SP and group B including 131 flaps with SSP and sSP. Sixteen flaps (4.6%) were taken back for pedicle compromise, 13 of which were salvaged (81.25%), 11 among 13 from group A and 2 among 3 from group B. There was no statistical difference between the groups concerning microvascular complication rate ( P  = 0.108), and time until take‐back ( P  = 0.521) and flap salvage rate ( P  = 0.473) resulted independent of SP type. Our results suggest that early detection of perfusion impairment and successful flaps salvage could be achieved using SSP for buried DIEP flap monitoring, without adjunctive expensive monitoring tests. © 2014 Wiley Periodicals, Inc. Microsurgery 35:91–100, 2015.
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Issue
    URL: Article
    DOI: 10.1002/micr.v35.2
    DOI: 10.1002/micr.22269
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 17
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    Evaluation of peripheral microcirculation improvement of foot after tarsal tunnel release in diabetic patients by transcutaneous oximetry
    Wiley ; 2016
    In:  Microsurgery Vol. 36, No. 1 ( 2016-01), p. 37-41
    Details
    In: Microsurgery, Wiley, Vol. 36, No. 1 ( 2016-01), p. 37-41
    Abstract: According to recent studies, peripheral nerve decompression in diabetic patients seems to not only improve nerve function, but also to increase microcirculation; thus decreasing the incidence of diabetic foot wounds and amputations. However, while the postoperative improvement of nerve function is demonstrated, the changes in peripheral microcirculation have not been demonstrated yet. The aim of this study is to assess the degree of microcirculation improvement of foot after the tarsal tunnel release in the diabetic patients by using transcutaneous oximetry. Patients and methods Twenty diabetic male patients aged between 43 and 72 years old (mean age 61.2 years old) suffering from diabetic peripheral neuropathy with superimposed nerve compression underwent transcutaneous oximetry (PtcO2) before and after tarsal tunnel release by placing an electrode on the skin at the level of the dorsum of the foot. Eight lower extremities presented diabetic foot wound preoperatively. Thirty‐six lower extremities underwent surgical release of the tibialis posterior nerve only, whereas four lower extremities underwent the combined release of common peroneal nerve, anterior tibialis nerve, and posterior tibialis nerve. Results Preoperative values of transcutaneous oximetry were below the critical threshold, that is, lower than 40 mmHg (29.1 ± 5.4 mmHg). PtcO2 values at one month after surgery (45.8 ± 6.4 mmHg) were significantly higher than the preoperative ones (P = 0.01). Conclusions The results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients. © 2015 Wiley Periodicals, Inc. Microsurgery 36:37–41, 2016.
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Issue
    URL: Article
    DOI: 10.1002/micr.v36.1
    DOI: 10.1002/micr.22378
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 18
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    Tips and tricks for DIEP flap breast reconstruction in patients with previous abdominal scar
    Wiley ; 2017
    In:  Microsurgery Vol. 37, No. 4 ( 2017-05), p. 282-292
    Details
    In: Microsurgery, Wiley, Vol. 37, No. 4 ( 2017-05), p. 282-292
    Abstract: The aim of this study was to analyze outcomes of patients who had prior abdominal operations and underwent DIEP flap breast reconstruction and to describe technical strategies to insure well‐vascularized flap‐harvest minimizing abdominal donor‐site complications. All patients who underwent DIEP flap breast reconstruction between 2004 and 2014 were reviewed and divided into a control group (CG) and a scar group (SG). Patient demographics, operative details, flap and donor‐site complications were analyzed and compared. For all of the scars, DIEP flap design was not modified, but a standardized approach was developed according to the type and location of the scar, available vascular pedicle, perforator locations, and the required flap tissue for breast reconstruction. Two hundred and eighty patients underwent 292 flaps in CG and 107 underwent 111 flaps in SG. Pfannenstiel, McBurney, laparoscopic, midline and subcostal were the most common previous incisions. There were no significant differences between groups regarding demographics, flap and mastectomy weight, active smoking, or radiation status ( P   〉  0.05). No significant differences were observed in DIEP flap loss ( P  = 0.909), partial flap loss ( P =0.799), or fat necrosis ( P =0.871) and in the rate of abdominal donor‐site complications between groups ( P   〉  0.05). SG had a significantly higher mean operative time than CG ( P =0.034). Medial raw was a negative risk‐factor for flap complications, while BMI ( 〉 25.1 kg/m 2 ) and smoking‐history were significant predictors for donor‐site complications. With careful preoperative planning and appropriate technical strategies, successfully DIEP flap breast reconstruction can be performed without increased flap and donor‐site complications in patients with preexisting abdominal scars. © 2015 Wiley Periodicals, Inc. Microsurgery 37:282–292, 2017.
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Issue
    URL: Article
    DOI: 10.1002/micr.v37.4
    DOI: 10.1002/micr.22457
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 19
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    Time‐dependent factors in DIEP flap breast reconstruction
    Wiley ; 2017
    In:  Microsurgery Vol. 37, No. 7 ( 2017-10), p. 793-799
    Details
    In: Microsurgery, Wiley, Vol. 37, No. 7 ( 2017-10), p. 793-799
    Abstract: The process of harvesting and performing microsurgical anastomosis may lengthen deep inferior epigastric artery perforator (DIEP) flap breast reconstruction affecting results and patient safety. The aim of the study was to investigate the associations between predictors and operative time (OT). Methods Between 2004 and 2016, 336 immediate and 68 delayed unilateral reconstructions were performed in 404 patients. Age, weight, height, body mass index (BMI), nulliparity, or pluriparity condition were collected to determine the impact of patient characteristics on OT. Flap weight, mastectomy type, flap zone, perforator number, venous anastomoses, recipient vessels selection, reconstruction timing, contralateral symmetrization, and a dedicated anesthesiologist were analyzed as possible predictors. Results Mean OT was 289 min (range, 150–550 min). Using univariate analysis, for each increment of BMI value and patient weight OT increased, respectively, 3.5‐ and 1.4 min (97.5% CI: 1.768–5.145, 97.5% CI: 0.739–1.949; P   〈  0.001). Skin‐sparing mastectomy (SSM) (97.5% CI: 2.487–36.637; P  = 0.025), perforator number, and venous anastomoses (97.5% CI: 24.468–43.690, 97.5% CI: 24.843–50.492; P   〈  0.001) negatively influenced OT while nipple‐sparing mastectomy (NSM) reduced OT of 22.7‐min (97.5% CI: −40.333 to −5.098; P  = 0.012). The use of circumflex scapular vessels as recipients reduced OT of 75.4‐min while internal mammary vessels (IMV) increased OT of 55.8‐min (97.5% CI: −88.631 to −62.209, 97.5% CI: 22.918–88.642; P   〈  0.001). A dedicated anesthesiologist and the learning curve (LC) reduced OT, respectively, of 39.63‐min and of 13‐min for every year (97.5% CI: −57.119 to −22.137, 97.5% CI: −14.666 to −11.898; P   〈  0.001). Using multivariate regression, LC was a negative predictor while SSM, perforators number, superficial epigastric vein, IMV, and flap weight were positive predictors ( P   〈  0.001). Conclusions The increase of flap weight, related perforators number, and venous drainage negatively influence OT. LC meaning systematic approach for surgery can optimize DIEP flap surgery efficiency.
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Issue
    URL: Article
    DOI: 10.1002/micr.v37.7
    DOI: 10.1002/micr.30203
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 20
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    Free‐style technique versus computed tomographic angiography ‐guided perforator selection in deep inferior epigastric perforator flap harvest: A prospective clinical study
    Wiley ; 2023
    In:  Microsurgery
    Details
    In: Microsurgery, Wiley
    Abstract: Computed tomographic angiography (CTA) is the preferred diagnostic tool in preoperative deep inferior epigastric perforator (DIEP) flap assessment, though some surgeons prefer approaching perforator selection with intraoperative findings alone. Methods This prospective observational study conducted between 2015 and 2020 assessed our intraoperative decision‐making “free‐style” technique for DIEP flap harvest. Any patient with indication for immediate or delayed breast reconstruction using abdominally based flaps and who received preoperative CTA was enrolled. Only unilateral cases performed by the same surgeon were considered. Allergy to iodine‐based contrast media, renal impairment and claustrophobia were other exclusion criteria. Primary endpoint consisted in comparing operative times and complication rates between free‐style technique and CTA‐guided approach. Secondary endpoints included evaluation of agreement rate between intraoperative findings and CTA, and identification of variables affecting operative time and complication rate. Demographics, surgical information, agreement versus non‐agreement and complications were collected. Results Starting from 206 patients, 100 were enrolled. Fifty were assigned to Group A, receiving DIEP flap with free‐style technique . The other 50 were assigned to Group B, receiving DIEP flap with CTA‐guided perforators selection. Study groups' demographics were homogenous. Operative time was statistically lower ( p  = .036) in free‐style group (252.4 ± 44.77 min vs. 265.6 ± 31.67 min). Complication rates were higher in CTA‐guided group (10% vs. 2%) though this was not significant ( p  = .092). Overall agreement rate in dominant perforator selection between intraoperatively and CTA‐based assessment was 81%. Multiple regression analysis showed no variable increased complication rate, though CTA‐guided approach, BMI  〉  30 and harvesting more than one perforator were respectively associated with B‐coefficient of 17.391 (2.430–32.351, 95% CI) [ p  = .023], 3.50 (0.640–6.379, 95% CI) [ p  = .017] and 18.887 (6.232–31.542, 95% CI) [ p  = .004], predicting increased operative time. Conclusions The free‐style technique proved to be a useful tool for guiding DIEP flap harvest with good sensibility in detecting the dominant perforator suggested by CTA without statistically increasing surgery duration and complications.
    Type of Medium: Online Resource
    ISSN: 0738-1085 , 1098-2752
    URL: Article
    DOI: 10.1002/micr.31031
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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