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Rochira D.,Casa di Cura Villa Valeria | Ottaviani A.,Casa di Cura Villa Valeria | Tambasco D.,Catholic University of Sacro Cuore
Annals of Plastic Surgery | Year: 2016

Background Silicone gel-filled implants as opposed to saline-filled breast implants are the most commonly used breast implants in Europe, and this has recently also become the case in the United States. Modern implants have a multiple layer silicone shell and high to very high levels of cohesive silicone gel inside. Although breast magnetic resonance imaging is at present considered the gold standard imaging method for breast implant rupture detection, breast ultrasound (US) imaging is still the first-step investigation in Europe. The aim of this study was to verify whether or not the stepladder sign at US is still associated to intracapsular rupture among the last generation silicone breast implant. Materials and Methods In this study, 156 patients presenting for breast augmentation, mastopexy with implants and breast reconstruction for a total number of 303 breast implants inserted were enrolled. A preoperative breast ultrasonography was performed, and patients underwent a routine US scan every 6 months for 24 months to evaluate the implant status. A final US evaluation 6 years after implantation was also performed. Results Stepladder signs were seen at 6 years in 170 implants (56%) of the examined implants at US scan, and only 2 implants showed signs of possible rupture because of severe distortion of the implant profile with or without external silicone collection. A third ruptured implant was detected at magnetic resonance imaging by the presence of breach of the shell at the posterior surface of the implant with small external silicon collection and was eventually confirmed at surgery. Therefore, the overall rupture rate found at the United States at 6 years was about 1% (3 of 303 implants). According to our findings, the stepladder sign at the United States is no longer associated to intracapsular rupture. Conclusions Plastic surgeons, patients, and financial departments of hospitals would also be delighted to know that surgeons should not take patients back to theater for implant explantation when aging signs are not associated with a visible breach of the implant shell or external silicone collections. © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source

Panni A.S.,University of Molise | Vasso M.,University of Molise | Cerciello S.,University of Molise | Salgarello M.,Catholic University of Sacro Cuore
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011

Purpose: The aim of our review paper is to present a possible algorithm of treatment of knee periprosthetic soft tissue defects, relative to their extent and depth. Different management of exposed total joints is also proposed, depending on the presence or loss of deep infection and on the timing of infection itself. Methods: In accordance with literature and the experience of senior knee surgeon, the incidence and risk factors, and possible treatment options of wound complications following total knee arthroplasty have been throughly analyzed. Results: There is much controversy regarding the optimal management of wound necrosis around a total knee. Local wound care, debridement, and fasciocutaneous, muscle and perforator flaps have been differently used. Muscle coverage remains the standard to which all other flaps should be compared, especially in infected wounds. Perforator flaps have recently represented a true revolution in the soft tissue reconstruction around the knee, with peculiar advantages due to their low donor morbidity and long pedicles. Conclusion: When wound complications occur, prompt management is mandatory. An algorithm for treatment of wound defects is presented, available for both primary and revision knee replacement. © 2010 Springer-Verlag. Source

Salgarello M.,Catholic University of Sacro Cuore | Visconti G.,Catholic University of Sacro Cuore
Spine | Year: 2014

STUDY DESIGN.: A report of 2 cases. OBJECTIVE.: The purpose of this article is to report 2 preliminary cases with instrumentation-related chronic low back pain (CLBP) successfully treated with fat graft in the sacrolumbar region. SUMMARY OF BACKGROUND DATA.: Patients undergoing successful spinal fusion surgery may experience new or recurrent CLBP. Instrumentation-related soft-tissue irritation is a well-known etiology of this frustrating condition. Treatment options vary from conservative treatment till instrumentation removal, with no consensus on their efficacy. METHODS.: A 32-year-old patient and a 37-year-old patient with instrumentation-related debilitating CLBP visual analogue scale score 7 and 10, respectively, underwent 1 session of fat grafting in the sacrolumbar region. RESULTS.: At 9-month and 6-month follow-ups, both patients reported a substantial pain relief, a considerable improvement in daily quality of life and satisfaction for less implant palpability and visibility. CONCLUSION.: The encouraging results of these preliminary cases may open new horizons for a multidisciplinary approach in treating instrumentation-related CLBP. Fat grafting may represent a valid and minimal invasive option to be taken into account when established therapeutic options fail. Further experience with longer follow-up is needed to confirm our findings.Level of Evidence: 5 © 2014 Lippincott Williams and Wilkins. Source

Visconti G.,Catholic University of Sacro Cuore | Eltahir Y.,University of Groningen | Van Ginkel R.J.,University of Groningen | Bart J.,University of Groningen | Werker P.M.N.,University of Groningen
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2011

Primary ectopic breast carcinoma is a rare disease and, at present, no specific guidelines on its diagnosis and treatment are available. The purpose of this article is to review the world literature in English on primary ectopic breast carcinoma located in the armpit and to offer guidelines for diagnosis and treatment. Data for this review were identified by searches of MEDLINE, PubMed, The Cochrane Library, ACNP (Italian catalogue of journals) and references from relevant articles using relevant search terms and data published in the previous reviews. Primary ectopic breast carcinoma of the axilla mostly affects women of over 40 (range 28-90 yrs) years of age. The most frequent histological diagnosis is invasive ductal carcinoma not otherwise specified (NOS) (72%). Because of its rareness, in most cases, the diagnosis is delayed for on average 40.5 months. This disease is rare, but a high level of suspicion for carcinoma is mandatory when confronted with a tumour in this area. Once diagnosed, patients should undergo staging, and prognostic and adjuvant treatment procedures identical to orthotopic breast carcinoma guidelines. There are some limitations for the staging. Loco-regional treatment, on indication, combined with endocrine therapy and/or chemotherapy seems the treatment of choice. © 2010 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. Source

Salgarello M.,Catholic University of Sacro Cuore | Visconti G.,Catholic University of Sacro Cuore | Barone-Adesi L.,Catholic University of Sacro Cuore
Plastic and Reconstructive Surgery | Year: 2012

Background: In postmastectomy radiated patients, autologous tissue reconstruction is preferred over implant reconstruction, because the latter is associated with a higher rate of postoperative complications. Autologous tissue reconstruction, however, is not always feasible and is sometimes refused by the patient. A challenge also arises in breast-conserving surgery patients seeking breast augmentation with an implant. In this article, the authors present a further reconstructive option for irradiated breast cancer patients consisting of fat grafting followed by implant placement. Methods: The authors retrospectively reviewed 16 cases of irradiated breasts treated with fat grafting and subsequent alloplastic reconstruction/breast augmentation. The evaluation methods were clinical and photography-based assessments. The BREAST-Q was used to quantify patient satisfaction. Results: Sixteen patients, with a pretreatment Late Effects on Normal Tissues-Subjective, Objective, Management, Analytic (LENT-SOMA) score of 1 or 2, underwent two to three fat grafts to achieve a LENT-SOMA score of 0. The placement of the breast implant had been performed in a separate stage at least 3 months after the last grafting session. The average follow-up was 15 months. Reconstructive outcomes were graded from excellent to good in 93.7 percent of patients. Patient satisfaction was marked as high to very high. There were no short-term complications. A Baker grade 1 capsule contracture was found in all patients. Conclusions: The authors' experience shows that breast fat grafting followed by implant placement may represent a feasible reconstructive option in highly selected patients with irradiated breasts. Fat grafting seems to reduce radiation-induced complications in implants. Larger studies with a longer follow-up are needed. Copyright © 2012 by the American Society of Plastic Surgeons. Source

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