0000000000159007

AUTHOR

Francesco Moschella

An Analysis of the Immunomodulatory Properties of Human Spheroids from Adipose-Derived Stem Cells

Aims Current methods to induce tolerance following allotransplantation or in autoimmunity carry significant morbidity, and research is very active in investigating alternative methods which could minimize toxicity. Spheroids from adipose stem cells (SASCs) are increasingly gaining interest, they hold a great proliferative and differentiating potential. An immunomodulatory effect has not been investigated on SASCs yet. In this study, we analysed the immunomodulatory properties of SASCs and compared them to ADSCs. Main methods Adipose stem cells (SASCs and ADSCs) and peripheral blood mononuclear cells (PBMCs) were collected from healthy individuals. We analysed the cytokine production and pro…

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Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap

Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap. Cordova A, D'Arpa S, Pirrello R, Brenner E, Jeschke J, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro, 129-90127, Palermo, Italy. adriana.cordova.unipa@gmail.com Abstract BACKGROUND: Vessels in the supraclavicular area and their contribution to skin vascularization have always been studied for flaps planning in head and neck reconstruction and many pedicled flaps have been des…

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An innervated retroauricular skin flap for total earlobule reconstruction.

In this article, the authors describe a technique for total earlobule reconstruction in a patient who underwent earlobule excision for basal cell carcinoma. The reconstruction was by means of an innervated retroauricular skin flap, folded double. The flap presented preserved skin sensitivity over all the reconstructed area, which is compromised by those techniques using a cranially or medially based flap which lead to the reconstruction of an insensible earlobule. This is a very important aspect of this technique, especially for those who wear pendant earrings, since a non-sensitive lobule would be more vulnerable to traumas causing laceration. In addition, it allows a good aesthetic result…

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Smart hydrogels with Spheroids of Adipose stem cells for minimally invasive bone and cartilage regeneration

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PEDICLED PERFORATOR FLAPS IN NASAL RECONSTRUCTION: A REVIEW

The use of perforator flaps in face reconstruction is becoming increasingly common. They are particularly useful in nose reconstruction, where they can be tailored to match the complex three-dimensional structure of the nasal concave and convex subunits. In this paper, we present a review of the literature on the use of pedicled perforator flaps in nose reconstruction, discussing current indications and outcomes. Literature on this topic is still limited, with only 12 studies reporting data on 129 reconstructions. Reconstruction of nasal defects with pedicled perforator flaps is a novel and expanding field. It allows for the achievement of good aesthetic results, with a single operation and…

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Reply: Time to Reconsider a Gold Standard of Lymph Flow Imaging: Importance of Reliability to Detect Abnormal Lymphodynamics in Lymphedema Screening after Cancer Treatments

Reply to a Letter to Editor

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Cell quality evaluation with gene expression analysis of spheroids (3D) and adherent (2D) adipose stem cells.

Adipose stem cells (ASCs) represent a reliable source of stem cells with a widely demonstrated potential in regenerative medicine and tissue engineering applications. New recent insights suggest that three-dimensional (3D) models may closely mimic the native tissue properties; spheroids from adipose derived stem cells (SASCs) exhibit enhanced regenerative abilities compared with those of 2D models. Stem cell therapy success is determined by “cell-quality”; for this reason, the involvement of stress signals and cellular aging need to be further investigated. Here, we performed a comparative analysis of genes connected with stemness, aging, telomeric length and oxidative stress, in 3D and 2D …

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Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to various causes. Several different classifications have been used to describe the pathophysiological mechanisms leading to the clinical deficit, from simple and reversible compression-induced demyelination, to complete transection of nerve axons. Neurophysiological data localize, quantify, and qualify (demyelination vs . axonal loss) the clinical and subclinical deficits. High-resolution ultrasound can demonstrate the morphological extent of nerve damage, fascicular echotexture (epineurium vs . perineurium, focal alteration of the cross-section of the nerve, any neuromas, etc. ), and the surrounding t…

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Segmental anatomy of the vastus lateralis: guidelines for muscle-sparing flap harvest.

Background: The vastus lateralis muscle is a versatile donor site for pedicled and free flaps that, despite great potential, remains unpopular. Although the muscle is classically described as a single belly, evidence exists for a more complex morphology. The aim of this study was to investigate the segmental anatomy of the vastus lateralis muscle and the feasibility of selective flap harvest. Methods: Ten cadaveric lower limbs were investigated. Muscular partitions were identified according to morphologic architecture, vascular supply, and nerve supply; guidelines for selective flap harvest were described. Twenty-three segmental vastus lateralis (n = 14) or chimeric anterolateral thigh-vast…

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Reply

Reply to a Letter to Editor

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LIfting tradizionale versus lifting omotetico

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Multimodal surgical and medical treatment for extensive rhinocerebral mucormycosis in an elderly diabetic patient: a case report and literature review

Diabetes is a well-known risk factor for invasive mucormycosis with rhinocerebral involvement. Acute necrosis of the maxilla is seldom seen and extensive facial bone involvement is rare in patients with rhino-orbital-cerebral mucormycosis. An aggressive surgical approach combined with antifungal therapy is usually necessary. In this report, we describe the successful, personalized medical and surgical management of extensive periorbital mucormycosis in an elderly diabetic, HIV-negative woman. Mono- or combination therapy with liposomal amphotericin B (L-AmB) and posaconazole (PSO) and withheld debridement is discussed. The role of aesthetic plastic surgery to preserve the patient’s physical…

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"Depressor Flaps" for Large Defects of the Lower Lip and Mental Region

Innervated muscle cutaneous flaps are the result of a long evolution in labial reconstruction techniques. The use of these flaps to reconstruct the lower lip is now common practice thanks to such techniques as the stair case advancement flap, the Karapandzic flap,and the gate flap. In contrast, techniques that make use of depressor muscles of the lower lip are underutilized. In 1995 we published our first results on the reconstruction of full-thickness lateral losses of substance in the lower lip using a depressor anguli oris muscle cutaneous flap.In 1998 we published an article on the use of a platysma muscle cutaneous flap to reconstruct losses of substance in the labial region that exten…

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MicroRNAs in solid organ and vascularized composite allotransplantation: Potential biomarkers for diagnosis and therapeutic use

Abstract Nowadays, solid organ transplantation (SOT) is an established treatment for patients with end-organ dysfunction, which dramatically improves the quality-of-life. Vascularized composite allotransplants (VCAs) including hand and face have been reported worldwide over the last 20 years. However, VCAs, differently to SOT, are life-enhancing instead of life-saving and are not routinely performed due to the risk of immune rejection and the adverse effects of immunosuppression. Over the past decade, although considerable improvements in short-term outcomes after allotransplantation have been registered, these results have not been translated into major progress in long-term allograft acce…

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Re: Correlation between tissue-harvesting method and donor-site with the yield of spheroids from adipose-derived stem cells

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The “Jacobsen Flap” Technique: A Safe, Simple Surgical Procedure to Treat Dupuytren Disease of the Little Finger in Advanced Stage

The "Jacobsen flap" technique: a safe, simple surgical procedure to treat Dupuytren disease of the little finger in advanced stage. Tripoli M, Cordova A, Moschella F. Source Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Italy. matripoli@yahoo.it Abstract The surgery for advanced stages of Dupuytren disease of the little finger is controversial. In the literature, several techniques have been described with variable reported results and postoperative complications. Percutaneous needle fasciotomy, McCash technique, and dermofasciectomy are often performed for surgical treatment but they present significant complic…

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Utilizzazione del lembo muscolo-cutaneo di obliquo esterno nella ricostruzione della parete toracica dopo mastectomia allargata

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A new one-stage method for nose reconstruction: the supratrochlear artery perforator propeller flap.

LETTER TO EDITOR

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EVOLUZIONE DELLE TECNICHE DI RICOSTRUZIONE MORFODINAMICA NEI CARCINOMI DELL'AREA LABIALE

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WSRM 2019 in Bologna: A Great Success beyond Expectations!

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Vaginal reconstruction with bilateral island "extended" groin flaps: description of a personal technique.

We propose a vaginal reconstruction method using two island "extended" groin flaps designed over the iliac crests and in axis with the superficial circumflex iliac arteries. After a surgical revision of the pelvic organs and dissection of the area between the bladder and the rectum, the two flaps pass, extraperitoneally by way of the abdomen, through an incision made along the lateral margin of the rectus muscle and, from before to behind, through the fibrovascular lamina lateral to the bladder, and finally are placed in the area between the bladder and the rectum, where they are sutured. The technique has been applied to one patient and allowed reconstruction of a vaginal canal with very s…

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Algorithm for clinical evaluation and surgical treatment of gynaecomastia.

Algorithm for clinical evaluation and surgical treatment of gynaecomastia. Cordova A, Moschella F. Source Dipartimento di Discipline Chirurgiche ed Oncologiche, Cattedra di Chirurgia Plastica e Ricostruttiva, Università degli Studi di Palermo, Palermo, Italy. adriana.cordova@excite.com Abstract BACKGROUND: Gynaecomastia can be classified on the basis of the main characterising factors, i.e. pathogenesis, histopathology and morphology. The morphological classifications of gynaecomastia currently made often use subjective parameters and qualifying adjectives. In this paper the authors propose a scheme for morphological classification of gynaecomastia which can serve as a guide for choosing th…

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Propeller Flaps: A Review of Indications, Technique, and Results

In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequate…

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Porcine Model for Deep Superior Epigastric Artery Perforator Flap Harvesting: Anatomy and Technique

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;…

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Exposed Subcutaneous Implantable Devices

Background: Implantable venous and electrical devices are prone to exposure and infection. Indications for management are controversial, but—especially if infected—exposed devices are often removed and an additional operation is needed to replace the device, causing a delay in chemotherapy and prolonging healing time. We present our protocol for device salvage, on which limited literature is available. Methods: Between 2007 and 2013, 17 patients were treated (12 venous access ports, 3 cardiac pacemakers, and 2 subcutaneous neural stimulators). Most patients were operated within 7 days from exposure. All patients received only a single perioperative dose of prophylactic antibiotic. In cases …

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The use of triamcinolone combined with surgery in major ear keloid treatment: a personal two stages approach

Background: Keloid is a fibroproliferative disorder characterized by an abnormal deposition of collagen within a wound. Despite an increased understanding of wound healing and collagen metabolism, the exact cause, the clinical behavior, and gold standard of treatment for keloids remain an enigma. There is no one right way of treatment, the results are variable, and the management of ear keloids can be difficult and frustrating both for patients and physicians. Traditional techniques include intralesional steroids, topical applications of silicone, vitamins, and segmental excision by lasers or surgery. The purposes of this article are to review the literature concerning the current therapies…

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Malattia di Dupuytren

La malattia di Dupuytren ancora oggi rimane avvolta nel mistero: è incerta la paternità della sua prima descrizione, sebbene, e con molte polemiche, da centoottantuno anni è storicamente legata all’illustre chirurgo francese Guillaume Dupuytren. Un enigma per gli studiosi è anche la sua eziopatogenesi, in cui fattori ambientali, comportamentali, genetici, e biomolecolari, in parte ancora sconosciuti, interagiscono a più livelli, generando reazioni biochimiche a cascata che portano alla ben nota iperproliferazione dei fibroblasti e alla conseguente deposizione di collagene. Essa rappresenta inoltre una sfida per il chirurgo che deve districarsi tra tecniche operatorie differenti in relazione…

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"Depressor system flap" for large defects of the lower lip and mental region.

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Prophylactic chimera anterolateral thigh/vastus lateralis flap: preventing complications in high-risk head and neck reconstruction

Purpose In high-risk head and neck cases treated with tumor resection and associated radical neck dissection, orocutaneous fistulas and wound breakdowns in the neck are relatively frequent and can have serious consequences, such as carotid blowout syndrome (CBS), the need for salvage reoperations, and prolonged recovery time. The authors present the application of a prophylactic chimeric anterolateral thigh (ALT) and vastus lateralis (VL) flap to prevent complications. Materials and Methods A retrospective review was performed of a historical group (96 patients) of patients with head and neck cancer treated with tumor resection, radical neck dissection, and microsurgical reconstruction of t…

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A Propeller Flap for Single-Stage Nose Reconstruction in Selected Patients: Supratrochlear Artery Axial Propeller Flap

The paramedian forehead flap is the gold standard technique for nose reconstruction. It requires two different surgical operations which prolonged the postoperative dressing and care. We present our 5-year experience with a propeller flap based on the supratrochlear artery, which allows one-stage transfer of the forehead skin to the nose without the need for pedicle division. This technique is indicated in a selected group of patients who are not suitable for multiple-stage reconstructions because they have concurrent medical conditions, reduced mobility, or live far away from specialized medical centers. We have renamed this procedure as supratrochlear artery axial propeller flap, from the…

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Vascularized dermal flap for abdominal wall reconstruction after bariatric surgery

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Lower eyelid reconstruction by multiple subcutaneous pedicle flaps: a new method.

Abstract In this paper we present an original technique for the reconstruction of the full thickness of the lower eyelid after excision of neoplasms. The method is based on the mobilisation of multiple pedicle subcutaneous flaps outlined in the same eyelid and supported by a chondro-mucosal graft. This technique is used for central and off-central losses which involve the outer rim or up to 75% of the width of the whole eyelid. This method is an alternative to the Hughes (1945), Mustarde´(1981), Tenzel and Stewart (1978) and McGregor (1973) techniques which we have previously used for this type of reconstructive The follow-up is satisfactory in terms of the oncological, functional and aesth…

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Spheroids from adipose-derived stem cells exhibit an miRNA profile of highly undifferentiated cells

Two-dimensional (2D) cell cultures have been extensively used to investigate stem cell biology, but new insights show that the 2D model may not properly represent the potential of the tissue of origin. Conversely, three-dimensional cultures exhibit protein expression patterns and intercellular junctions that are more representative of their in vivo condition. Multiclonal cells that grow in suspension are defined as "spheroids," and we have previously demonstrated that spheroids from adipose-derived stem cells (S-ASCs) displayed enhanced regenerative capability. With the current study, we further characterized S-ASCs to further understand the molecular mechanisms underlying their stemness pr…

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Correlation between tissue-harvesting method and donor-site with the yield of spheroids from adipose-derived stem cells

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Surgical repair of acute Achilles tendon rupture with an end-to-end tendon suture and tendon flap.

Abstract Background Achilles tendon ruptures are becoming more common. Complications after open or minimally invasive surgery are: recurrent rupture (2–8%), wound breakdown, deep infections, granuloma, and fistulas. The authors expose their experience with a personal technique. Materials In 8 patients with acute rupture of Achilles tendon the surgery was performed at least 25 days after trauma. Clinical exam and MR demonstrated in all case a total lesion of tendon. After a posterolateral skin incision the tendon stumps were debrided and suture in end-to-end fashion. A tendon flap was harvested from the proximal part of the tendon, in order to protect and reinforce the suture itself. A plast…

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Platysma Muscle Cutaneous Flap for Large Defects of the Lower Lip and Mental Region

Based on the experience acquired using the depressor anguli oris flap for lateral lower lip reconstruction, the authors in this paper present their own technique to reconstruct large deficits of the lower lateral lip, involving the commissure and the mental region, by means of a platysma muscle cutaneous flap with a triangular skin island. The flap is oriented in the mandibular cheek region. The skin and the platysma muscle fibers, which run vertically, are incised and turned 90 degrees, so the edges of the platysma fibers are sutured to the edge of the residual orbicularis. The mucosal layer and the vermilion are reconstructed with a rotational flap from the cheek mucosa. The motor nerve a…

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Fat Transplantion: Different Clinical Applications to Achieve Symmetry in Face and Body Contouring

Introduction: Fat autograft was first described in 1893 by Neuber for cosmetic and congenital defects. Nowadays its use is becoming widespread for soft tissue augmentation to improve simmetry and contour in all areas of the face and body. The authors present their experience with face and body contouring by fat autograft in post-oncological, post-traumatic and cosmetic settings. Materials and Methods: Between 2005 and 2008 31 patients underwent fat autografting in the plastic surgery unit of the university of palermo. There were 10 cases of breast asimmetry after reduction mammaplasty, breast augmentation and breast recostruction; 3 cases of post-traumatic and 1 congenital deformities in th…

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Sentinel node biopsy for malignant melanoma: a staging procedure only?

Sentinel node biopsy (SNB) is an established staging tool for malignant melanoma. It allows identification of patients with metastatic disease at a very early stage and to collect accurate and complete prognostic information for these patients. Having noted that in a relevant percentage of patients the sentinel node is the only site of metastases, some authors have postulated a therapeutic role for SNB. In this paper, the possibility of a therapeutic role of SNB is evaluated. Relevant literature on the topic has been analyzed. Several findings suggest that not all patients with a positive SNB have further lymph node involvement. The prognostic indicators currently available do not significa…

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Anatomic basis for the dorsal radial flap of the thumb

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LEMBO LIBERO DI VASTO LATERALE: POTENZIALITA', VERSATILITA' E ANALISI DEL SITO DONATORE

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Introduction to the Current Concepts in Lower Extremity Reconstruction by the Italian Society for Microsurgery

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Reconstruction of full thickness scalp defects after tumour excision in elderly patients: our experience with Integra dermal regeneration template.

Summary Background Scalp reconstruction after wide tumor excision is particularly challenging. Free tissue transfers, local flaps, or skin grafts can be used but present some disadvantages especially with old patients with local advanced cancers, systemic diseases and in patients with a prior history of recurring scalp skin cancers in which the risk of burying a recurring tumor with a flap is likely. The Authors expose their early experience with Integra ® dermal regeneration template for scalp reconstruction after scalp tumor excision. Methods Eight patients with primary or secondary scalp tumor underwent a first surgical procedure under local anaesthesia for tumor removal and Integra ® po…

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Reverse Homodigital Dorsal Radial Flap of the Thumb.

BACKGROUND: Reconstruction of extensive distal defects of the thumb with exposure of bone, tendon, or joint can be a difficult problem because immediate closure is of paramount importance for preserving function and avoiding complications. Surgical treatment includes the use of local, reverse flow, and free flaps. The authors describe a new reverse homodigital flap to repair distal defects of the thumb. This flap is raised from the dorsal radial side of the first metacarpal area. It is pedicled on the dorsal radial collateral artery, which is constant for course, caliber, and communication with the palmar circuit. METHODS: The flap is raised by means of distal to proximal dissection, the sk…

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A new reverse dorsal metacarpal flap for the thumb

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Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy

Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy. Cordova A, Corradino B, Pirrello R, Di Lorenzo S, Dispenza C, Moschella F. Source Dipratimento di Discipline Chirurgiche ed Oncologiche, Divisione di Chirurgia Plastica e Ricostruttiva, Facolta di Medicina, Universita di Palermo, Palermo, Italy. chirplas@unipa.it Abstract CONCLUSION: Our experience confirms that pectoralis major flap is the first-choice technique for repairing recurrent hypopharyngeal fistulae in previously irradiated patients in whom microsurgical techniques are not indicated, and that hyperbaric oxygen therapy helps to solv…

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L'utilizzo di un lembo di derma vascolarizzato per la riparazione della parete addominale dopo chirurgia bariatrica

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Aminobisphosphonates as new weapons for gammadelta T Cell-based immunotherapy of cancer.

BACKGROUND: Activated V gamma 9 V delta 2 T cells are able to kill most tumour cells because of recognition by T cell receptor and natural killer receptors. OBJECTIVE: We discuss the possibility that the intentional activation of gammadelta T cells in vivo by aminobisphosphonates may represent a promising target for the design of novel and highly innovative immunotherapy in cancer patients. METHODS: The antitumoral effects of gammadelta T cells both in vitro and in vivo have been demonstrated suggesting a new therapeutic approach for translation into the clinical setting. RESULTS/CONCLUSION: V gamma 9 V delta 2 T lymphocytes represent a particularly interesting target for immunotherapeutic …

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Reply: vascular anatomy of the supraclavicular area revisited

Reply to Letter to Editor

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An algorithm to improve outcomes of radial forearm flap donor site

Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site compli- cation rates. Methods: The authors analyzed retrospectively 31 patients who underwent free radial fore- arm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was…

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Shaking The Ground You Walk On: Are Adipose-derived Stem Cells (ASCs) True Stem Cells?

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Tecniche chirurgiche di riparazione del nervo ricorrente.

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Innervated Island Flaps in Morphofunctional Vulvar Reconstruction

In this article, the authors present their own experience in vulvar reconstruction following vulvectomy using two different innervated island flaps according to the size and site of the defect. Island-flap mobilization is possible thanks to the rich blood supply of the perineal region. The methods described are a "V-Y amplified sliding flap from the pubis" and a "fasciocutaneous island flap" raised from one or both gluteal folds. The V-Y amplified sliding flap from the pubis is indicated when the defect is symmetric and located anteriorly. This flap is harvested from the pubis and vascularized by the deep arterial network of the pubis. Sensory innervation is provided by branches of the ileo…

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Retroauricular skin: a flaps bank for ear reconstruction.

Retroauricular skin: a flaps bank for ear reconstruction. Cordova A, D'Arpa S, Pirrello R, Giambona C, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro 129, 90127 - Palermo, Italy. adriana.cordova@excite.com Abstract BACKGROUND: The retroauricular skin has always been given much attention by the reconstructive surgeon for ear and face reconstruction because it is richly vascularised, as many anatomical investigations show, it is hidden behind the ear, its skin is very similar to that of ear and face. All these reasons make it an ideal donor site for ear reconstruction.…

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The face-lift smas plication (FLISP) flap for reconstruction of large temporal defect. Reconstructive surgery meets cosmetic surgery

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The “Jacobsen Flap” for the Treatment of Stage III–IV Dupuytren’s Disease at Little Finger: Our Review of 123 Cases

For selective fasciectomy in patients with Dupuytren’s disease at Tubiana Stage I–II, midline longitudinal incisions with serial Z-plasties, Bruner zigzag incisions, and V-Y plasties over the palm and most severely affected fingers are accepted methods. Advantages of these approaches are good intraoperative visualization of the fibrous tissue, rapid dissection, minor tissue trauma, and usually the possibility of a tension-free wound closure (Brenner and Rayan 2003). In cases of Dupuytren’s disease at Stage III and IV, with severe digital flexion, inelastic overlying skin, and expected skin shortage after contracture release, these incisions may sometimes be useful, but in our experience, qu…

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Update on the role of molecular factors and fibroblasts in the pathogenesis of Dupuytren’s disease

The mechanism by which the fibroblast is able to trigger palmar fibromatosis is still not yet fully understood. It would appear certain that the “abnormal” fibroblasts continuously synthesise profibrotic cytokines which are able to determine the activation to myofibroblasts, to stimulate them to the further proliferation and synthesis of other cytokines, to modify the cells’ differentiation and ultrastructural characteristics, as well as the production of matrix and other proteins. Several fibroblast growth factors have been suggested to be responsible of an abnormal cell activation with an aberrantly elevated collagen synthesis and extracellular deposition in Dupuytren’s disease, as TGF-Be…

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Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases.

Background: Despite the widespread use of free perforator flaps, pedicled perforator flaps seem not to be as widely accepted, probably because of the fear of vascular complications caused by transfer of a flap attached only by its vascular pedicle, prone to shearing, kinking, and trauma. In this article, the authors report on their experience with 85 consecutive cases, focusing on incidence, prevention, and management of complications. Methods: Eighty-five consecutive cases were treated over 6 years at the Plastic and Reconstructive Surgery Department of the University of Palermo for defects of different causes that were reconstructed with a freestyle pedicled perforator flap, in every regi…

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Adipose tissue, angiogenesis and angio-MIR under physiological and pathological conditions.

Angiogenesis is a crucial process for the maintenance of normal tissue physiology and it is involved in tissue remodeling and regeneration. This process is essential for adipose tissue maintenance. The adipose tissue is composed by different cell types including stromal vascular cells as well as adipose stem cells (ASCs). In particular, ASCs are multipotent somatic stem cells that are able to differentiate and secrete several growth factors; they are recently emerging as a new cell reservoir for novel therapies and strategies in many diseases. Several studies suggest that ASCs have peculiar properties and participate in different disease-related processes such as angiogenesis. Furthermore, …

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Vascular Anatomy of the Supraclavicular Area Revisited: Feasibility of the Free Supraclavicular Perforator Flap

Vascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap. Cordova A, Pirrello R, D'Arpa S, Jeschke J, Brenner E, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. adriana.cordova.unipa@gmail.com Abstract BACKGROUND: The supraclavicular skin has been studied extensively and used as a pedicled flap for face and neck reconstruction. Its use as a free flap has not paralleled its use as a pedicled flap. The authors performed an anatomical investigation to assess the possibility of harvesting a free supraclavicular flap …

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Composite graft: a simple option for nasal lining.

Background  We present our experience in the reconstruction of full-thickness losses of the substance of the nose using a forehead flap and a composite graft (taken from the anterior surface of the concha and adequately shaped) as both support and endonasal lining. This technique has never been described for the reconstruction of large full-thickness losses of the substance of the nose. The donor site of the composite graft in the concha is repaired by a Masson retroauricular flap. Methods  This technique was used on 14 patients (age range, 52–92 years) after full-thickness excision of tumors of the distal third of the nose. Follow-up was from 1 to 4 years. All the composite grafts were rev…

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Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls

Background Current research on the upper limb lymphatic system mainly studies breast cancer patients with unilateral lymphedema. Without preoperative lymphoscintigraphy, the contralateral limb is used as a control, assuming that it is functionally intact. Few lymphoscintigraphic studies investigate patients before any axillary surgery. The purpose of this study was to evaluate, through lymphoscintigraphy, the preoperative condition of the upper limb lymphatic system in melanoma patients and healthy controls. Methods Two groups were studied: the study group (16 patients with trunk/upper limb melanoma candidates for axillary sentinel lymph node biopsy) and the control group (10 healthy volunt…

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Free style facial artery perforator flap for one stage reconstruction of the nasal ala.

Summary The nasolabial skin is the ideal donor site for nasal ala reconstruction. The classic techniques involve a two-stage procedure to reconstruct an aesthetically pleasing nasal ala. A one-stage technique for reconstruction of the nasal ala with a free style nasolabial perforator flap is presented in this article. Patients and methods The technique has been used in eight patients between November 2004 and June 2007. In most of the cases (seven out of eight) the whole alar subunit was reconstructed. Results Besides a small distal 2mm necrosis in one flap – which healed without further treatment – all the flaps healed uneventfully with aesthetically pleasing results using the one-stage te…

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Pharmacological thrombolysis: one more weapon for free-flap salvage.

Despite the high success rate of free-tissue transfer, thrombosis still complicates 5-30% of cases. Meticoulous technique, careful vessel selection, and pharmacological prophylaxis are not always enough to avoid thrombosis. Early diagnosis and reintervention provide the only way to salvage a thrombosed free flap, in case of either arterial or venous thrombosis. When kinking, torsion, or external compression of the pedicle are ruled out, and thrombectomy and redo of the anastomosis are unsuccessful, the last resort to save the flap is thrombolytic therapy. The authors present their experience with the salvage of two otherwise lost flaps by means of urokinase thrombolysis through direct intra…

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Correction of Constricted Ear

We present a case of moderate constricted ear corrected using a modified Tanzer's technique for the helical deformity and lengthening the lower third of the pinna with a cutaneous transposition flap from the retroauricular area. The operation begins with a rapid intraoperative expansion of the retroauricular skin. Then an incision is made on the posteromedial ear aspect and the ear is degloved using a subperichondral plane. The upper pole of the cartilage is expanded and rearranged by an anteriorly pedicled helical flap and a cartilaginous graft is taken from the constricted part of the concha. The lower third of the pinna is lengthened by a cutaneous transposition flap from the retroauricu…

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Porcine Model for Internal Mammary Vessels Harvesting

Recipient vessels selection is crucial for successful microsurgical breast reconstruction. The internal mammary vessels (IMVs) have gained great popularity, and they are often selected as first choice recipient vessels. The IMVs can be exposed for microvascular anastomosis through a rib-removing (trans-costal) or a rib-sparing (intercostal) approach.1–3 Because the vessels are located between the rib cage and the parietal pleura, adequate training is needed to avoid and eventually manage bleedings and pleural perforation. This training is better performed in a nonhuman model. Our aim was to investigate the pig as a surgical model for IMVs harvesting to be used in training.

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Molecular analysis of Spheroids from Adipose-derived Stem Cells (S-ASCs) during in vitro long-term culture.

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Re: Technique of internal mammary dissection using pectoralis major flap to prevent contour deformities

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Non-adherent progenitors from Adipose-derived Stem Cells (napASCs): a new prospective for tissue engineering?

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One-stage reconstruction of the nasal ala: the free-style nasolabial perforator flap.

no abstract

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Posterior compartment of the lower leg reconstruction with free functional rectus femoris transfer after sarcoma resection.

A 72-year-old man with the third recurrence of a low-grade liposarcoma of the right lower leg came to our attention seeking limb-salvage surgery. The tumour was removed en bloc with all the superficial posterior compartment of the leg. Appropriate foot flexion was restored by means of a free-functional rectus femoris musculocutaneous flap harvested from the ipsilateral thigh. The patient was kept on a postoperative splint for 6 weeks. Three months after the operation, clinical and elecromyographic signs of reinnervation were observed. The patient was able to walk, run and climb stairs and no donor-site morbidity was observed. Thigh extension was rated M4, comparable to the contralateral thi…

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Botulinum Toxin A for Oral Cavity Cancer Patients: In Microsurgical Patients BTX Injections in Major Salivary Glands Temporarily Reduce Salivary Production and the Risk of Local Complications Related to Saliva Stagnation

Abstract: In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid b…

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"Downward steps technique" with CO2 ultrapulsed laser for the treatment of rhinophyma: our protocol.

Abstract BACKGROUND: The rhinophyma is an important soft-tissue hypertrophy of the nose. In literature a wide range of surgical approaches to rhinophyma has been described such as dermoabrasion, scalpel shave, cryosurgery, electrocautery, near total excision with skin grafting, and laser excision. PATIENTS AND METHODS: The authors describe their experience with CO(2) ultrapulsed laser in 14 elderly male patients, using their personal approach, the Downward steps technique. With this technique they removed the pathological hypertrophic tissue using a progressive reduction of the laser power during the treatment. They obtained good results from morphological and aesthetic point of view, in a …

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Anatomic basis for the dorsal radial flap of the thumb: clinical applications

The pattern of the dorsal arterial supply of the thumb was studied by the dissection of 25 thumbs of fresh cadavers. A constant vascular axis was found, originating at the radial a. and communicating at the level of the middle third of the proximal phalanx with the arterial palmar circuit. The constant presence of this vascular axis and its connection with the palmar circuit permits the mobilisation of a dorsal metacarpal skin flap, with a distal pedicle and a reversed flow, that can be used for covering dorsal and palmar losses of substance in the thumb.

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Management of large dorsal diffuse plexiform neurofibroma

Abstract Neurofibromas are considered one of the hallmark signs of neurofibromatosis type 1(NF1). Diffuse plexiform neurofibroma is a congenital NF1-associated tumor, characterized by overgrowth and interference with function of the affected area. The rich vascular plexus associated with neurofibromas, together with their infiltrative pattern, makes them difficult to eradicate. Complications of neurofibromas are rare but include malignant transformation and potentially lifethreatening hemorrhages. The use of the term “giant” to define a neurofibroma is controversial because there is no clear consensus and descriptions are limited to few case reports. We report a case of a large dorsal diffu…

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Gracilis free muscle transfer for morpho-functional reconstruction of the lower lip.

Background. Large full-thickness defects of the lower lip need free tissue transfer. The free forearm flap is the more widespread technique for free flap lower lip reconstruction, but it results in a static lip. The authors describe a technique of morphodynamic sensate reconstruction of the lower lip with a free gracilis flap and a musculomucosal flap. Methods. Three patients underwent reconstruction with an innervated free muscular gracilis flap, an innervated musculo-mucosal flap for the vermillion (2 cases), and a full-thickness skin graft. Results. No significant complications were observed. Static function and vermillion sensitivity were immediately restored. The skin color match was e…

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Treatment of stages IIIIV of the Dupuytrens Disease using a personal approach: percutaneous needle fasciotomy (PNF) and minimal invasive selective aponeurectomy.

Abstract The authors present their experience in treating 23 fingers on 20 patients affected by Dupuytrens Disease in stages III and IV of the Tubiana classification with their personal technique that involves the percutaneous needle fasciotomy followed 40 days after by a selective open aponeurectomy on the previously treated cord, by making a small cutaneous incision. The treatment requires careful selection of the patients. In fact, patients suffering from the disease for more than 5 years and all the cases with a suspicion of joint rigidity are excluded from the study. The average follow up period was approximately 48 months. 18 out of the 20 patients had excellent functional recovery. S…

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Botulinum toxin in preparation of oral cavity for microsurgical reconstruction.

CONCLUSIONS: Infiltration of botulinum toxin in the major salivary glands allows a temporary reduction of salivation that begins 8 days afterwards and returns to normal within 2 months. The inhibition of salivary secretion, carried out before the oral cavity reconstructive surgery, could allow a reduction of the incidence of oro-cutaneous fistulas and local complications. OBJECTIVES: Saliva stagnation is a risk factor for patients who have to undergo reconstructive microsurgery of the oral cavity, because of fistula formation and local complications in the oral cavity. The authors suggest infiltration of botulinum toxin in the major salivary glands to reduce salivation temporarily during th…

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Experimental study of peripheral nerve rigeneration

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Linee guida al trattamento chirurgico della ginecomastia.

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Laser treatment of giant xanthelasma palpebrarum

Xanthelasma palpebrarum is the most common cutaneous xanthoma. It typically presents in middle-aged and older adults, most often around the eyelids. The diagnosis is made clinically. Giant xanthelasmas palpebrarum are xanthelasmas that extensively affect the superior and inferior bilateral eyelids. Many techniques have been put forward for treating these lesions (surgical, laser, and chemical techniques), but we describe our experience in the treatment of giant xanthelasmas by ultrapulsed CO2 laser. Between 2009 and 2012, in the Division of Plastic and Reconstructive Surgery at the University of Palermo, 12 patients with giant xanthelasmas were treated using a CO2 laser. The laser parameter…

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Porcine Model for Internal Mammary Vessels Harvesting

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Perioperative antibiotic prophylaxis in plastic surgery: A prospective study of 1100 adult patients.

Summary Background Although guidelines for antibiotic prophylaxis to prevent surgical site infections (SSIs) exist, specific guidelines for plastic surgery are missing and there is a tendency towards excessive administration of antibiotics. A total of 1100 patients were prospectively studied according to an evidence-based protocol to investigate if limiting antibiotic prophylaxis to high-risk cases does increase the infection rate. Methods Between April 2009 and April 2010, 1100 consecutive patients undergoing elective reconstructive or cosmetic procedures were enrolled. Procedures were classified into four groups, and prophylactic antibiotics were only administered perioperatively in 23.4%…

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Bleeding prophylaxis in a child with cleft palate and factor VII deficiency: a case report.

Bleeding prophylaxis in a child with cleft palate and factor VII deficiency: a case report. Pirrello R, Siragusa S, Giambona C, D'Arpa S, Cordova A, Moschella F. Source Dipartimento di Discipline Chirurgiche ed Oncologiche, Sezione di Chirurgia Plastica e Ricostruttiva, Università di Palermo, Palermo, Italy. Abstract The association between factor VII deficiency and cleft palate has never been described. The case of a child with cleft palate and factor VII deficiency who successfully underwent palatoplasty is described in this article. To allow surgical treatment, through maintenance of a normal prothrombin time, the patient was given 15 microg/kg of recombinant factor VIIa every 12 hours, …

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A new mucosal propeller flap (Deep Lingual Artery Axial Propeller): The renaissance of lingual flaps

BACKGROUND: Lingual flaps provide ideal mucosal coverage for intraoral defects but traditionally require two surgical stages. The authors present an axial mucosal propeller flap for single-stage intraoral reconstruction. The flap includes the mucosa of the lateral side of the tongue, islanded on the deep lingual vessels. METHODS: Between 2011 and 2013, 23 patients underwent intraoral mucosal reconstruction with a deep lingual artery axial propeller flap after cancer resection in the cheek (n = 16), floor of the mouth (n = 2), retromolar trigone (n = 2), hard palate (n = 2), and soft palate (n = 1). Mean defect size was 19.5 cm. Preoperative and postoperative intraoral function was evaluated…

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Adipose-derived stem cells

SPECIAL EDITORIAL

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The face lift SMAS plication flap for reconstruction of large temporofrontal defects: reconstructive surgery meets cosmetic surgery.

Background: Reconstruction of large defects in the temporal region can be performed with skin grafts or pedicled or free flaps. Results are often not optimal because of the patch of a skin graft, lack of availability of local flaps, and distant skin from free flaps. A technique for reconstruction of these defects with local tissue is presented in this article that uses superficial musculoaponeurotic system (SMAS) plication to allow wide advancement of a cervicofacial flap. Methods: Once the defect is outlined, a face-lift–like skin incision is used to raise the flap. The SMAS is plicated with two purse-string sutures that relieve tension on the flap and allow maximal advancement. Thirteen f…

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κ-Carrageenan and PVA blends as bioinks to 3D print scaffolds for cartilage reconstruction.

3D printing of polymeric scaffolds and autologous stem cells is a promising tool for damaged facial cartilage reconstruction surgeries. To this end, suitable bioinks are needed to generate scaffolds with the required morphological and functional features. We formulated hydrogel bioinks using k-Carrageen (kC) and poly(vinyl alcohol) (PVA) in three different weight ratios. The kC gives the systems the ability to undergo rapid sol-to-gel transitions upon cooling from 60 °C and above to body temperature, while the PVA is used as rheology modifier and porogen. The latter is crosslinked after molding or printing by freeze-thaw cycling for 1 day (FT1) or 5 days (FT5). To select the most suitable f…

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18Fluoro2deoxy-Dglucose-Positron Emission Tomography (FDG-PET) Imaging versus sentinel lymph node biopsy (SLNB) in the staging of cutaneous melanoma in AJCC stage i and II.

Aim. In the present study, 18Fluoro-2-deoxy-D-Glucose-Positron Emission Tomography (FDG-PET) findings were compared with histopathological results of sentinel lymph-node biopsy (SNLB). The purpose was to determine the value of FDG-PET in predicting regional lymph-node involvement in patients with primary melanoma stage I and II. Methods. Twenty five consecutive patients with primary cutaneous melanoma, stage I and II, underwent FDG-PET scans, preoperative lymphoscintigraphy, and SNLB. The sentinel node detection was sistematically performed within the week following the PET scanning. Results. The FDG-PET and SNLB results were interpreted independently of each other and then compared. Conclu…

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STATIC TREATMENT OF PARALYTIC LAGOPHTALMOS WITH AUTOGENOUS TISSUES

Static treatment of paralytic lagophthalmos with autogenous tissues. Pirrello R, D'Arpa S, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Universitá di Palermo, Via del Vespro, 129, 90138 Palermo, Italy. Abstract BACKGROUND: Long-standing facial paralysis is frequently seen in patients who have undergone surgical procedures with sacrifice of the facial nerve and have never been counseled about limiting its consequences. Lagophthalmos must always be treated in these patients to protect vision. The authors describe their techniques of static treatment for lagophthalmos using autologous tissues and their classification…

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THE ROLE OF GAMMA-DELTA (γδ) T LYMPHOCYTES IN MELANOMA: BASIC SCIENCE FINDINGS AND CLINICAL CORRELATIONS

INTRODUCTION: Advanced melanoma is associated with a poor prognosis. Numerous clinical trials have focused on the potential of tumor-infiltrating lymphocytes (TILs) for immunotherapy in stage III and IV melanoma, but its treatment remains challenging. Gamma-delta (γδ) T cells are the most represented subpopulation of TILs and have shown therapeutic potentials in many solid tumors, although their role against melanoma has not been fully investigated. MATERIALS AND METHODS: Seventy-four patients with cutaneous melanoma underwent peritumoral skin biopsies and blood sample collection. TILs and circulating lymphocytes phenotype and effector functions were analzyed using immunohistochemistry and …

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A systematic review on external ear melanoma

Summary Background External ear melanoma accounts for only 1% of all cutaneous melanomas, and data on its optimal management and prognosis are limited. Aim We aim to review the literature on external ear melanoma to guide surgeons in the treatment of this uncommon and peculiar pathology. Materials and methods A systematic review of English language studies on ear melanoma published from 1993 to 2013 was performed using the PubMed electronic database. Data on epidemiology, oncological treatment (tumor resection and regional lymph nodes management), and reconstruction were extrapolated from selected papers. Results The total number of patients was 858 (30 studies). The helix was the most comm…

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Irreversible changes occurring in long-term denervated Schwann cells affect delayed nerve repair.

OBJECTIVEMultiple factors may affect functional recovery after peripheral nerve injury, among them the lesion site and the interval between the injury and the surgical repair. When the nerve segment distal to the lesion site undergoes chronic degeneration, the ensuing regeneration (when allowed) is often poor. The aims of the current study were as follows: 1) to examine the expression changes of the neuregulin 1/ErbB system during long-term nerve degeneration; and 2) to investigate whether a chronically denervated distal nerve stump can sustain nerve regeneration of freshly axotomized axons.METHODSThis study used a rat surgical model of delayed nerve repair consisting of a cross suture betw…

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In-situ gelling xyloglucan formulations as 3D artificial niche for adipose stem cell spheroids.

Abstract Three-dimensional spheroidal cell aggregates of adipose stem cells (SASCs) are a distinct upstream population of stem cells present in adipose tissue, with enhanced regeneration properties in vivo. The preservation of the 3D structure of the cells, from extraction to administration, can be a promising strategy to ensure optimal conditions for cell viability and maintenance of stemness potential. With this aim, an artificial niche was created by incorporating the spheroids into an injectable, in-situ gelling solution of partially degalactosylated xyloglucan (dXG) and an ad hoc formulated culture medium for the preservation of stem cell spheroid features. The evolution of the mechani…

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Human Spheroids from Adipose-Derived Stem Cells Induce Calvarial Bone Production in a Xenogeneic Rabbit Model

ABSTRACT: Calvarial defects can result from several causes. Tissue engineering hold the potential to restore native form and protective function. We have recently shown that stemness and differentiation ability of spheroids from adipose-derived stem cells (S-ASCs) promotes osteoblasts growth within Integra in a small vertebral lesion. In our study, we aimed to test osteogenic potential of S-ASCs in aiding regeneration of a calvarial defect. Groups containing Integra showed increased bone regeneration at the calvarial defect-Integra interface compared with the control group. In particular, S-ASC-derived osteoblasts group showed a superior calvarial remodeling than undifferentiated S-ASCs gro…

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Surgical Treatment of Extravasation Injuries

The authors present their experience of treating anti-cancer drug extravasation by means of a composite surgical technique that consists of infiltration with physiological solution and hyaluronidase and subsequent manual aspiration of solutes alternated with profuse irrigation of the infiltrated area. In the immediate post-op we carry out a medical therapy that consists of calciparine and topic antibiotic and/or steroid creams. Since the year 2000 this technique has been used on 25 patients. We have had neither complications nor scars. Copyright 2005 Wiley-Liss, Inc Surgical treatment of extravasation injuries. Napoli P, Corradino B, Badalamenti G, Tripoli M, Vieni S, Furfaro MF, Cordova A,…

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Characterization of Human γδ T Lymphocytes Infiltrating Primary Malignant Melanomas

T lymphocytes are often induced naturally in melanoma patients and infiltrate tumors. Given that gamma delta T cells mediate antigen-specific killing of tumor cells, we studied the representation and the in vitro cytokine production and cytotoxic activity of tumor infiltrating gamma delta T cells from 74 patients with primary melanoma. We found that gamma delta T cells represent the major lymphocyte population infiltrating melanoma, and both V delta 1(+) and V delta 2(+) cells are involved. The majority of melanoma-infiltrating gamma delta cells showed effector memory and terminally-differentiated phenotypes and, accordingly, polyclonal gamma delta T cell lines obtained from tumor-infiltrat…

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Dupuytren's contracture: an update of biomolecular aspects and therapeutic perspectives.

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren’s contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren’s disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.

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Studying nerve transfers: Searching for a consensus in nerve axons count

Axonal count is the base for efficient nerve transfer; despite its capital importance, few studies have been published on human material, most research approaches being performed on experimental animal models of nerve injury. Thus, standard analysis methods are still lacking. Quantitative data obtained have to be reproducible and comparable with published data by other research groups. To share results with the scientific community, the standardization of quantitative analysis is a fundamental step. For this purpose, the experiences of the Italian, Austrian, German, Greek, and Iberian-Latin American groups have been compared with each other and with the existing literature to reach a consen…

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THe role of autologous nerve fragments implantation in enhancing peripheral nerve regeneration

ntroduction: The aim of this study was to assess the effect of seeding a nerve suture with autologous nerve fragments. Our hypothesis is that the fragments could improve axonal regeneration. Back to Top | Article Outline Material and Methods: On 20 Sprague-Dawley rats a 15mm sciatic nerve defect was created and grafted. In the study group (n=10) a 1mm nerve segment was minced and seeded around the distal suture. In the control group (n=10) no fragments were seeded. Rats were sacrificed at 4 (n= 10) and 12 weeks (n= 10) and number of regenerated fibers, fiber area and density, Soleus and Gastrocnemius muscles mass indexes, and walking track analysis in the 12 weeks group were evaluated. The …

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Perforator mapping in the trunk: a guide for freestyle flap surgery and an introduction to the sustainable anatomical study

Introduction: Freestyle Perforator flaps minimize flap harvest morbidity and can be harvested anywhere in the body if perforators anatomy is well known. A study of trunk perforator vessels has been performed on recycled CT scans avoiding cadaver investigations or unnecessary radiation exposure. Materials and Methods: 200 CT scans, performed for the study of liver or pancreatic disease, were examined. No unnecessary radiation was administered. Previous abdominal surgery was reason of exclusion. The trunk between the xyphoid process and Downloaded by: Biomedische Bibliotheek 193.191.170.2 - 10/8/2014 8:35:28 AM Abstracts Eur Surg Res 2012;49:130–216 215 the umbilicus was studied. On axial sca…

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Vinorelbine, cisplatin, and 5-fluorouracil as initial treatment for previously untreated, unresectable squamous cell carcinoma of the head and neck

BACKGROUND The combination of vinorelbine (VNR), cisplatin (CDDP), and 5-fluorouracil (5-FU) has previously been shown to be active in recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCHNC). This multicenter Phase II study was carried out with the aim of evaluating the effectiveness of this combination in patients with previously untreated, unresectable locally advanced SCHNC. METHODS Sixty patients with previously untreated, unresectable SCHNC were treated with CDDP 80 mg/m2 on Days 1, 5-FU 600 mg/m2 as a 4-hour infusion on Days 2-5, and VNR 25 mg/m2 iv bolus on Days 2 and 8. There were 15 patients with laryngeal carcinoma, 19 patients with oropharyngeal carcinoma…

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Gigantomastia

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Squamous Cell Tumors Recruit γδ T Cells Producing either IL17 or IFNγ Depending on the Tumor Stage

Abstract The identification of reciprocal interactions between tumor-infiltrating immune cells and the microenviroment may help us understand mechanisms of tumor growth inhibition or progression. We have assessed the frequencies of tumor-infiltrating and circulating γδ T cells and regulatory T cells (Treg) from 47 patients with squamous cell carcinoma (SCC), to determine if they correlated with progression or survival. Vδ1 T cells infiltrated SSC tissue to a greater extent than normal skin, but SCC patients and healthy subjects had similar amounts circulating. However, Vδ2 T cells were present at higher frequencies in circulation than in the tissue of either cancer patients or healthy donor…

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Analysis of MSCs' secretome and EVs cargo: Evaluation of functions and applications

Mesenchymal stem cells (MSCs) can exert different functions and can be used in several medical fields. In the last years, MSC properties have been attributed to their secreted factors such as soluble proteins, cytokines and growth factors. Moreover, a key role is played by the extracellular vesicles (EVs) which lead a heterogeneous cargo of proteins, lipids and small and long non-coding RNAs that interfere with the pathways of the recipient cells. Due to the safeness and easiness in obtaining the secretome, its use is becoming a turning point for the application in physiological and pathological fields. This review summarizes the most recent studies on the use of MSCs secretome, focusing on…

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Porcine Model for Gluteal Artery Perforator Flap: Anatomy and Technique

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.

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Spheroids of adipose derived stem cells show their potential in differentiating towards the angiogenic lineage

Introduction: Adipose derived stem cells (ASCs) are a mesenchymal stem cell population of great scientific interest due to their abundance and easiness in obtaining them from adipose tissue. Recently, several techniques for three dimensional (3D) ASCs cultivation have been developed to obtain spheroids of adipose stem cells (SASCs). It was already proved that ASCs are able to differentiate towards the endothelial lineage thus, for the first time, we investigated the ability of our 3D SASCs to differentiate endothelially and the effects of not differentiated SASC secreted factors on specific cultured cells. Materials and methods: SASCs were differentiated with a specific medium towards endot…

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Aminobisphosphonates as New Weapons for γ δ T Cell-Based Immunotherapy of Cancer

Several observations in mice and in humans have collectively laid the foundation for examining the potential of γ δ T cells to exert tumor immunotherapy. Human γ δ T cells can be activated in a non-MHC dependent fashion either by low molecular mass phosphoantigens, or by agents that provoke the accumulation of endogenous pyrophosphates such as isopentenylpyrophosphate. Among the latter, aminobisphosphonates are well-established in the clinic, and extensive data are available on the compounds antiangiogenic, antiosteolytic and pro-apoptotic properties. In this review we discuss on the possibility that the intentional activation of γ δ T cells in vivo by aminobisphosphonates may represent a p…

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Expanded forehead (Fricke) flap for large defect of lateral canthal area

The use of an expanded forehead (Fricke) flap to repair large full thickness defects of the lateral canthus and/or of the upper eyelid is presented. The reconstruction is performed in two stages. In the first stage, a rectangular, 25 ml tissue expander (6 cm in width and 2 cm in length) is inserted under the skin lateral to and above the eyebrow; expansion is completed in about three weeks. At the second stage, the lesion is excised, and the laterally based expanded flap is elevated. Using the expanded Fricke flap, thinner, abundant skin is obtained, and the donor site is directly closed, without grafting and without distorting the eyebrow. If there is a shortage of conjunctiva, this can be…

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Solitary Fibrous Tumor of the Lower Leg: A Rare and Difficult Diagnosis

Summary: Solitary fibrous tumor (SFT) is a rare neoplasm that commonly originates in the pleura. Extrapleural locations are rare and for this reason sometimes difficult to diagnose. Malignant forms with local recurrence or distant metastases have been reported, also as a consequence of inappropriate treatment. In this article, we report the case of an SFT of the lower leg in a 37-year-old man. Leg SFT is a rare occurrence, and differential diagnosis may be difficult because they can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin, and Bcl-2 is necessary. Misdiagnosis carries a significant risk of inadequate removal with subse…

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Seeding nerve sutures with minced nerve-graft (MINE-G): a simple method to improve nerve regeneration in rats

Background: The aim of this study was to assess the effect of seeding the distal nerve suture with nerve fragments in rats. Methods: On 20 rats, a 15 mm sciatic nerve defect was reconstructed with a nerve autograft. In the Study Group (10 rats), a minced 1 mm nerve segment was seeded around the nerve suture. In the Control Group (10 rats), a nerve graft alone was used. At 4 and 12 weeks, a walking track analysis with open field test (WTA), hystomorphometry (number of myelinated fibers (n), fiber density (FD) and fiber area (FA) and soleus and gastrocnemius muscle weight ratios (MWR) were evaluated. The Student t-test was used for statistical analysis. Results: At 4 and 12 weeks the Study Gr…

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Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series.

Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series. Cordova A, Pirrello R, D'Arpa S, Moschella F. Source Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. adriana.cordova@excite.com Abstract BACKGROUND: On the basis of a previously published anatomic study on the superior auricular artery (SAA) and on a series of 52 consecutive cases, the authors propose a new superior pedicle retroauricular island flap (SP-RIF) for defects of the upper half of the ear and for temporal region or superficial helical defects. ME…

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Different Surgical Approaches to Treat Chronic Tophaceous Gout in the Hand: Our Experience

Chronic tophaceous gout is a disabling erosive arthritis characterized by an elevated serum urate concentration, recurrent attacks of arthritis, and deposits of monosodium urate crystals in synovial fluids. Tophi, ulcerations of the overlying skin, and fissures of the interarticular cartilage may occur in advanced stages, combined with deformities of the joints and decreased active joint flexion and extension. Although the timely use of allopurinol is associated with a decrease in the frequency of deposits of the tophaceous substance, however, surgical management is necessary to restore and improve the cosmesis and joint function, to alleviate symptomatic discomfort, and to reduce the risk …

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Advancement Perforator Cheek Flap for Aesthetic One-Stage Reconstruction of Postoncological Extended Split-Thickness Defects of the Nasal Sidewall

Aesthetic reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. The unique character of this subunit and the complex relationships with a number of different facial or nasal subunits make the excision of large tumors difficult to manage. Numerous techniques are described in the literature, but a primary reconstruction with a final good result is not often possible. The authors develop an advancement cheek flap for an aesthetic one-stage reconstruction of postoncological extended nasal sidewall defects. Between January 2009 and July 2012, 16 patients (mean age, 63.3 yr) underwent excision of skin tumors of nasal sidewall and immediate rec…

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Safe pedicle tunnelling in maxillary reconstruction.

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Characteristics, Management Techniques, and Outcomes of the Most Common Soft-Tissue Hand Tumors: A Literature Review and Our Experience

INTRODUCTION Diagnosis of the hand's soft-tissue tumors is often difficult because of the different anatomic structures present in this region and yet clinicians must be able to distinguish typical benign entities from life-threatening or limb-threatening malignant diseases. MATERIALS AND METHODS At the Department of Plastic and Reconstructive Surgery at the University of Palermo, 629 patients with hand tumors were studied. Treatment was surgical for all of them; also radiotherapy and chemotherapy were necessary based on the histological diagnosis. CONCLUSIONS Our retrospective study with a literature review aims to present the most commonly observed soft-tissue hand lesions, analyzing thei…

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Technique of Internal Mammary Dissection Using Pectoralis Major Flap to Prevent Contour Deformities

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Systematic review on spheroids from adipose‐derived stem cells: Spontaneous or artefact state?

Three-dimensional (3D) cell cultures represent the spontaneous state of stem cells with specific gene and protein molecular expression that are more alike the in vivo condition. In vitro two-dimensional (2D) cell adhesion cultures are still commonly employed for various cellular studies such as movement, proliferation and differentiation phenomena; this procedure is standardized and amply used in laboratories, however their representing the original tissue has recently been subject to questioning. Cell cultures in 2D require a support/substrate (flasks, multiwells, etc.) and use of fetal bovine serum as an adjuvant that stimulates adhesion that most likely leads to cellular aging. A 3D envi…

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Paralytic Lagophthalmos:grading sistem and surgical management

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Further application of the bilobed flap: the split bilobed flap for reconstruction of composite posterior auricular and mastoid defects

In this article a modified bilobed flap from mastoid and lateral neck skin for reconstruction of complex defects of the posteromedial surface of the auricle and mastoid skin, with the preservation of the retroauricular sulcus, is described. Reconstruction of the postero-medial auricular surface has almost never been a concern for reconstructive surgeons. It is in fact a shaded area with little aesthetic relevance and direct closure, skin grafting and even secondary healing are used for skin cancer defects repair. Also mastoid skin defects can be repaired with simple techniques such as skin grafts or transposition flaps from the remaining mastoid skin or from the neck. On the other hand, can…

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INTRODUCING NON-ADHERENT PROGENITORS FROM ADIPOSE-DERIVED STEM CELLS (NAPADSCS): PROOF OF STEMNESS AND POSSIBLE FUTURE APPLICATIONS IN REGENERATIVE SURGERY

Introduction: Mesenchymal Stromal Cells (MSCs) can be isolated from adipose tissue and are currently used in vitro for experimental studies. MSCs are often mislabeled as Adipose-derived Stem Cells (ADSCs) despite presenting a more differentiated phenotype. The isolation and expansion of non-adherent progenitors from adipose-derived stem cells (napADSCs), has been achieved in our laboratory and is currently under investigation. In this study we investigate: a) the proof of stemness of such progenitors, and b) the feasibility of napADSCs adhesion over Integra® for cell colonization and for future differentiation and engineering of semi-synthetic tissues. Material and Methods: Adipose tissue (…

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Evaluation of nodal patterns for melanoma of the ear

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ADVANCEMENT CHEEK FLAP FOR A SINGLE STAGE RECONSTRUCTION OF POST-ONCOLOGICAL NASAL SIDEWALL LARGE DEFECTS 

Objective: Reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. Numerous techniques are described in the literature but a primary reconstruction with a final good result is not often possible. The authors present an advancement cheek flap for a single-stage reconstruction of post-oncological nasal sidewall large defects. Methods: Between January 2009 and July 2012, sixteen patients with age ranged between 54 and 74 years underwent excision of skin tumors of the nasal sidewall and immediate reconstruction with an advancement cheek flap nourished by perforators from the facial branch of the superficial temporal artery. The defects size ra…

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A Difficult Case of Necrotizing Fasciitis Caused By Acinetobacter baumannii

This study reports the case of a 55-year-old woman with diabetes with a necrotizing fasciitis of the right lower limb and the perineum, first admitted at the emergency department for septic shock with cardiac arrest, and later transferred to the department of surgery. Microbiological and histopathological examination confirmed the diagnosis of necrotizing fasciitis caused by Acinetobacter baumanii. A broad-spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture. Intensive hemodynamic support was required. Wounds were dressed daily with a 3 percent boric acid solution and a silver sulfadiazine-impregnated dressing. An extensive s…

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Tecniche chirurgiche di riparazione del nervo ricorrente. CAP 35, pp. 403-406

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ADHESION AND OSTEOGENIC DIFFERENTIATION OF NON-ADHERENT PROGENITORS FROM ADIPOSE-DERIVED STEM CELLS (napASCs) OVER INTEGRA DERMAL REGENERATION TEMPLATE

INTRODUCTION: Non-adherent progenitors from adipose-derived stem cells (n.a.p.ASCs) represent an upstream lineage of multipotent stem cell progenitors capable of clonal expansion and asymmetric divisions comparable to stem cell spheres observed in breast, thyroid and colon, and, as such, confirm the stemness of cells extracted from lipoaspirate. The identification of napASCs confirms the stem-cell origin of the more differentiated and commonly used adherent mesenchymal stromal cells (MSCs). NapASCs adhesion for differentiation purposes may be useful in tissue engineering. In this study we investigate the feasibility of napASCs adhesion over Integra® dermal regeneration template for cell col…

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Linfodenectomia laterocervicale.

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Reconstruction of Nasal Alar Defects with Freestyle Facial Artery Perforator Flaps

In 2009, we have described the use of freestyle facial artery perforator flaps for one-stage nose reconstruction. Since then, several articles have reported the use of facial artery perforator flaps for nose reconstruction. The purpose of this article is to provide an update of the published technique after 10 years of experience. Since 2004, 21 patients have been treated with a freestyle facial artery perforator flap for one-stage reconstruction of the nasal ala. The flaps were 16 propellers, 4 V-Y, and 1 island transposition. A single venous congestion leading to a minor flap tip necrosis and a wound dehiscence was observed. All other flaps healed uneventfully. The V-Y design and multiple…

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Injectable xyloglucan hydrogels incorporating spheroids of adipose stem cells for bone and cartilage regeneration

Abstract Cartilage or bone regeneration approaches based on the direct injection of mesenchymal stem cells (MSCs) at the lesion site encounter several challenges, related to uncontrolled cell spreading and differentiation, reduced cell viability and poor engrafting. This work presents a simple and versatile strategy based on the synergic combination of in-situ forming hydrogels and spheroids of adipose stem cells (SASCs) with great potential for minimally invasive regenerative interventions aimed to threat bone and cartilage defects. Aqueous dispersions of partially degalactosylated xyloglucan (dXG) are mixed with SASCs derived from liposuction and either a chondroinductive or an osteoinduc…

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Immunomodulation in vascularized composite allotransplantation: What is the role for adipose-derived stem cells?

Hand and face transplants are becoming increasingly common, recording progressively more penile, uterus, abdominal wall, and allotransplantation cases reported worldwide. Despite current protocols allow long-term survival of the allografts, the ultimate goal of donor-specific tolerance has not been achieved yet. In fact, the harmful adverse effects related to the lifelong administration of immunosuppressive agents are the main drawbacks for vascularized composite allotransplantations. Research is very active in investigating alternative methods to induce greater tolerance while minimizing toxicity. Adipose-derived stem cells (ASCs) represent promising cell therapies for immunomodulation in …

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Sentinel node biopsy. A staging procedure only?

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Variability and reliability of the vastus lateralis muscle anatomy.

The aims of this study are to investigate the variability of the morphological and neurovascular anatomy of the vastus lateralis (VL) muscle and to describe the relationships among its intramuscular partitions and with the other muscles of the quadriceps femoris. Clinical implications in its reliability as a flap donor are also discussed.In 2012, the extra- and intramuscular neurovascular anatomy of the VL was investigated in 10 cadaveric lower limbs. In three specimens, the segmental arterial pedicles were injected with latex of different colors to point out their anastomotic connections. The morphological anatomy was investigated with regard to the mutual relationship of the three muscula…

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