Catholic University of Sacro Cuore

Rome, Italy

Catholic University of Sacro Cuore

Rome, Italy
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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.

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.

Scupola A.,Catholic University of Sacro Cuore | Mastrocola A.,Catholic University of Sacro Cuore | Sasso P.,Catholic University of Sacro Cuore | Fasciani R.,Catholic University of Sacro Cuore | And 3 more authors.
American Journal of Ophthalmology | Year: 2013

Purpose: To evaluate preoperative and postoperative retinal function in patients who underwent macular surgery for idiopathic macular hole. Design: Prospective, comparative, interventional case series. Methods: Thirty eyes of 30 patients with idiopathic macular hole were included in the study. Patients underwent pars plana vitrectomy and peeling of the internal limiting membrane (ILM). ILM visualization was improved in 15 patients by using triamcinolone acetonide and in the remaining 15 patients by using infracyanine green dye. Spectral-domain optical coherence tomography examination was performed to document macular hole closure. Retinal function was assessed preoperatively and postoperatively over a period of 12 months by best-corrected visual acuity (BCVA) measurement (ETDRS chart), MP-1 microperimetry, and focal electroretinogram recording (fERG). Focal electroretinograms were recorded in response to a sinusoidally modulated (41 Hz), uniform field presented to the macular (18 degrees) and foveal (2.25 degrees) region. Results: Macular hole closure was achieved in all patients in both groups. At 12 months, visual acuity improved in both groups (P <.001), and there were no statistically significant differences between groups. Mean macular sensitivity within the central 2 and 8 degrees increased in both groups, and there were no statistically significant differences between groups at any follow-up. In the triamcinolone acetonide group, 12 months after surgery the amplitude of the fERG's first harmonic (1F) increased both in the macular region (P <.001) and in the foveal region (P <.05). In the infracyanine green group, at 12 months the amplitude of the first harmonic (1F) decreased in both areas. The decrease was significant in the macular region (P <.05) and not significant in the foveal region (P =.095). Conclusion: Vitrectomy and ILM peeling assisted with either triamcinolone acetonide or infracyanine green staining improves visual acuity and mean macular sensitivity at 12 months in patients affected by idiopathic macular hole. However, triamcinolone acetonide staining is associated with an increase of fERG's first harmonic amplitude in the foveal and macular region, whereas in the case of infracyanine green staining it seems to decrease after surgery. The reduction of the amplitude of fERG's first harmonic suggests that infracyanine green may have a late toxic effect on photoreceptor cells. © 2013 by Elsevier Inc. All rights reserved.

Salgarello M.,Catholic University of Sacro Cuore | Rochira D.,Catholic University of Sacro Cuore | Barone-Adesi L.,Catholic University of Sacro Cuore | Farallo E.,Catholic University of Sacro Cuore
Aesthetic Plastic Surgery | Year: 2012

Background: Breast reconstruction for previously augmented patients differs from breast reconstruction for nonaugmented patients. Many surgeons regard conservation therapy as not feasible for these patients because of implant complications, whether radiotherapy-induced or not. Despite this, most authors agree that mastectomy with immediate breast reconstruction is the most suitable choice, ensuring both a good cosmetic result and a low complication rate. Implant retention or removal remains a controversial topic in addition to the best available surgical technique. This study reviewed the authors' experience with immediate breast reconstruction after skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with anatomically definitive implants. Methods: The retrospective records of 12 patients were examined (group A). These patients were among 254 patients who underwent SSM or NSM for breast carcinoma. The control group comprised 12 of the 254 patients submitted to SSM or NSM (group B) who best matched the 12 patients in the studied group. All of them underwent immediate breast reconstruction, with an anatomically definitive implant placed in a submuscular-subfascial pocket. The demographic, technical, and oncologic data of the two groups were compared as well as the aesthetic outcomes using the Breast Q score. The proportion of complications, the type of implant, the axillary lymph node procedure, and the histology were compared between the two groups using Fisher's exact test. Student's t test was used to compare the scores for the procedure-specific modules of the breast Q questionnaire in the two groups. Results: A validated patient satisfaction score was obtained using the breast Q questionnaire after breast reconstruction. The demographic, technical, and oncologic characteristics were not significantly different between the two groups. The previously augmented patients reported a significantly higher level of satisfaction with their breast than the control patients. The scores for the other procedure-specific modules were similar in the two groups. Conclusion: A valid immediate one-stage implant reconstruction can be obtained for previously augmented patients by placing the implant in a submuscular-subfascial pocket reinforced by the periprosthetic capsule of the previous prosthesis. © Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2011.

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.

Salgarello M.,Catholic University of Sacro Cuore | Visconti G.,Catholic University of Sacro Cuore | Farallo E.,Catholic University of Sacro Cuore
Aesthetic Plastic Surgery | Year: 2010

Background: The new indications for radiotherapy in the cure of breast cancer lead to an increasing number of candidates for this adjuvant treatment. However, it raises some concerns with respect to the prosthetic reconstruction of the breast. In fact, the use of implants in the irradiated breast is discouraged by many authors because of the high rate of complications. In these cases autologous tissue reconstruction is being recommended. However, not every patient is a candidate for autologous tissue reconstruction. Furthermore, not all radiotherapies are comparable in dose, timing, and patient tolerance. In this article we present the preliminary results of an alternative surgical management in oncoplastic breast surgery consisting of fat injections before implant placement. Methods: Six months after the last radiation treatment, a lumpectomy patient and a modified radical mastectomy patient each underwent two sessions of fat injection prior to implant placement, with a 3-month interval in between sessions. The implants were placed 3 months after the last fat injection. Results: There was a 12-month follow-up for the modified radical mastectomy case and a 18-month follow-up for the lumpectomy case. In both cases we report no postoperative complications, Baker grade 1 capsule contracture, good aesthetic outcome, and high patient satisfaction. Conclusion: The preliminary results show that fat injection in irradiated tissue prior to breast alloplastic reconstruction may reduce the radiation-related complications on implants. Benefits from fat grafting are in keeping with the theoretical basis of this surgery. Larger studies are needed to confirm our observations. © 2009 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery.

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.

Tiziano F.D.,Catholic University of Sacro Cuore | Neri G.,Catholic University of Sacro Cuore | Brahe C.,Catholic University of Sacro Cuore
International Journal of Molecular Sciences | Year: 2011

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by homozygous mutations of the SMN1 gene. Based on clinical severity, three forms of SMA are recognized (type I-III). All patients have at least one (usually 2-4) copies of a highly homologous gene (SMN2) which produces insufficient levels of functional SMN protein, due to alternative splicing of exon7. Recently, evidence has been provided that SMN2 expression can be enhanced by different strategies. The availability of potential candidates to treat SMA has raised a number of issues, including the availability of data on the natural history of the disease, the reliability and sensitivity of outcome measures, the duration of the studies, and the number and clinical homogeneity of participating patients. Equally critical is the availability of reliable biomarkers. So far, different tools have been proposed as biomarkers in SMA, classifiable into two groups: instrumental (the Compound Motor Action Potential, the Motor Unit Number Estimation, and the Dual-energy X-ray absorptiometry) and molecular (SMN gene products dosage, either transcripts or protein). However, none of the biomarkers available so far can be considered the gold standard. Preclinical studies on SMA animal models and double-blind, placebo-controlled studies are crucial to evaluate the appropriateness of biomarkers, on the basis of correlations with clinical outcome. © 2010 by the authors; licensee MDPI, Basel, Switzerland.

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.

Salgarello M.,Catholic University of Sacro Cuore | Salgarello M.,San Carlo Of Nancy Hospital | Visconti G.,Catholic University of Sacro Cuore | Visconti G.,San Carlo Of Nancy Hospital | And 2 more authors.
Plastic and Reconstructive Surgery | Year: 2011

Background: The role of platelet-rich plasma in enhancing fat graft take is attracting the scientific community. There is, however, a lack of clinical studies on the matter. The aim of this article is to report the authors' experience in breast fat grafting with and without platelet-rich plasma and to investigate the state of the art on adipose tissue platelet-rich plasma enrichment. Methods: The authors retrospectively reviewed 42 women who underwent breast fat grafting between September of 2007 and September of 2009. Seventeen of these patients (40 percent) were grafted with fat (according to Coleman) enriched with platelet-rich plasma at 10 percent (group A), and 25 patients (60 percent) received only fat grafts according to Coleman (group B). All patients underwent preoperative breast ultrasound and mammography and were regularly followed up with breast ultrasound 3 months later and then at 6-month intervals. The reconstructive and aesthetic outcomes were evaluated using the following parameters: (1) clinical outcomes according to the surgeons and the patient, (2) the rate of liponecrosis at breast ultrasound, and (3) the need of further fat grafting to achieve the planned result. Results: The clinical outcomes, the rate of liponecrosis at breast ultrasound, and the need for further fat grafting reveal that fat grafting plus platelet-rich plasma at 10 percent is not superior to Coleman fat grafting alone. Conclusions: In the authors' retrospective analysis, no effect of platelet-rich plasma was seen in enhancing fat graft take when compared with the Coleman fat graft. Further research and prospective clinical studies are needed to understand the role of platelet-rich plasma, if any, in fat grafting. Copyright © 2011 by the American Society of Plastic Surgeons.

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