Microsurgery Unit

Firenze, Italy

Microsurgery Unit

Firenze, Italy
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Berrone M.,University of Turin | Crosetti E.,Candiolo Cancer Institute | Tos P.L.,Microsurgery Unit | Pentenero M.,University of Turin | Succo G.,University of Turin
Acta Otorhinolaryngologica Italica | Year: 2016

Virtual surgical planning technology in head and neck surgery is witnessing strong growth. In the literature, the validity of the method from the point of view of accuracy and clinical utility has been widely documented, especially for bone modelling. To date, however, with its increased use in head and neck oncology, and consequently the increased need for bone and soft tissue reconstruction, is important to carry out the virtual programme considering not only bone reconstruction but also all aspects related to the reconstruction of soft tissue using composite flaps. We describe our approach to virtual planning in the case of composite flaps. The study reports six consecutive patients with malignant disease requiring mandibular bone and soft tissue reconstruction using fibular osteocutaneous flaps. In all six patients, the resection and reconstruction were planned virtually focusing on the position of cutaneous perforator vessels in order to schedule fibula cutting guides. There were no complications in all six cases. The technique described allowed us to schedule composite fibula flaps in mandibular reconstruction virtually with good accuracy of the position of the bone segment in relation to the cutaneous paddle, important for soft tissue reconstruction. Despite the limited number of cases, the preliminary results of the study suggest that this protocol is useful in virtual programmes using composite flaps in mandibular reconstruction. Further investigations are needed. © 2016, Pacini Editore S.p.A. All rights reserved.


PubMed | Microsurgery Unit and Orthopaedic and Trauma Center
Type: Case Reports | Journal: Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology | Year: 2015

During recent decades, the concept of surgical treatment of malignant bone and soft tissue sarcomas has evolved, with the aim of preserving limb function. In this paper we report a case of metatarsal reconstruction by means of serratus and rib free flap after excision of a synovial sarcoma located in the dorsal aspect of the midfoot. Five years after the operation, the patient was free from recurrence and recovered full foot function. Amputation has been widely used in the past and this procedure still remains a valuable option when limb salvage is not possible. Nevertheless, in selected cases, reconstruction by means of composite free flaps may be successfully used for limb preservation in the treatment of malignant foot tumors after surgical excision.


Schmulder A.,RWTH Aachen | Gur E.,Microsurgery Unit | Zaretski A.,Microsurgery Unit
Microsurgery | Year: 2011

Background: Microvascular free flap has become an increasingly popular useful method of reconstruction over the past few decades. Minimizing failure rates in these operations is a primary goal in every microsurgical unit that can be accomplished by early recognition. Methods: In this retrospective study, we tracked the admission of the implantable Doppler in the microsurgical unit (2000-2007) and evaluated parameters measured from 473 consecutive patients who underwent a total of 548 microsurgical procedures (489 primary surgeries and 59 reexplorations). The effectiveness of the Cook-Swartz Doppler (Cook MedicalÂ) was examined in juxtapose general and subspecialty's aspects: in each microsurgical subspecialty, we compared the overall success and failure rates of the group with the implantable Doppler (n = 259) with the control group monitored by clinical means (n = 289). We also examined the duration, outcomes, and the effectiveness of this device in reexploration operations. Results: Overall, success rates were improved by using the implantable Doppler contrary to clinical assessment (96.14% vs. 89.27%) with a statistical significant (P < 0.005). The device was most effective in ENT (94.6% vs. 84%), breast reconstructive surgeries (97.3% vs. 82.36%), and orthopedic oncology (97.37% vs. 83.72%), whereas with reanimation operations and trauma/orthopedics subspecialties, it showed no necessity. In neurosurgery and in other/esthetic surgeries, the study was too small to draw definite deductions. Conclusions: We recommend the usage of the implantable Doppler probe as an effective monitoring system for free-flap surgeries, with emphasis on subspecialties where the device demonstrated better results than traditional monitoring methods. © 2010 Wiley-Liss, Inc. Microsurgery, 2011. Copyright © 2010 Wiley-Liss, Inc.


Nthumba P.M.,AIC Kijabe Hospital | Nthumba P.M.,Pedro Cavadas Foundation | Cavadas P.C.,Hand Surgery and Microsurgery Unit | Landin L.,Microsurgery Unit
Annals of Plastic Surgery | Year: 2011

Cutaneous malignancies are the most common malignancies in Whites; traditionally considered rare among Blacks, their occurrence in sub-Saharan Africa is yet to be fully characterized.Data on specimens submitted between 1992 and April 2008 on all histologically proven primary cutaneous malignancies were collected from the Pathology Department, including patient age, sex, anatomic site of malignancy, and histologic diagnosis. There were 1900 patients with primary cutaneous malignancies, aged between 8 months and 110 years, with a mean age of 49 years. There were 14 different types of malignancies found, with squamous cell carcinoma representing 45% of the total. A number of the rarer types have not been reported previously, from this region.Cutaneous malignancies in Africa present a number of management challenges including the following: difficulties in early diagnosis in the dark skin, late presentation, access to treatment, and the ability to pay for the appropriate treatment. The current human immunodeficiency virus/acquired immune deficiency syndrome scourge on the continent may lead a significant increase in cutaneous malignancies, posing even bigger challenges. Copyright © 2011 by Lippincott Williams & Wilkins.


Tos P.,Microsurgery Unit | Colzani G.,Microsurgery Unit | Ciclamini D.,Microsurgery Unit | Titolo P.,Microsurgery Unit | And 2 more authors.
BioMed Research International | Year: 2014

End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management. © 2014 Pierluigi Tos et al.


Heidekrueger P.I.,TU Munich | Tanna N.,North Shore LIJ Hospital | Weichman K.E.,Montefiori Medical Center | Szpalski C.,Free University of Colombia | And 3 more authors.
Journal of Reconstructive Microsurgery | Year: 2016

Background While implementation of subspecializations may increase expertise in a certain area of treatment, there also exist downsides. Aim of this study was, across several disciplines, to find out if the technique of microsurgery warrants the introduction of a Certificate of Added Qualifications (CAQ) in microsurgery. Methods An anonymous, web-based survey was administered to directors of microsurgical departments in Europe (n = 205). Respondents were asked, among other questions, whether they had completed a 12-month microvascular surgery fellowship and whether they believed a CAQ in microvascular surgery should be instituted. Results The response rate was 57%, and 33% of the respondents had completed a 12-month microvascular surgery fellowship. A total of 61% of all surgeons supported a CAQ in microsurgery. Answers ranged from 47% of support to 100% of support, depending on the countries surveyed. Discussion This is one of the few reports to evaluate the potential role of subspecialty certification of microvascular surgery across several European countries. The data demonstrate that the majority of directors of microsurgical departments support such a certificate. There was significantly greater support for a CAQ in microsurgery among those who have completed a formal microvascular surgery fellowship themselves. Conclusion This study supports the notion that further discussion and consideration of subspecialty certification in microvascular surgery appears necessary. There are multiple concerns surrounding this issue. Similar to the evolution of hand surgery certification, an exploratory committee of executive members of the respective medical boards and official societies may be warranted. © 2016 Georg Thieme Verlag KG Stuttgart.


PubMed | Microsurgery Unit, Montefiori Medical Center, TU Munich, North Shore LIJ Hospital and Free University of Colombia
Type: Journal Article | Journal: Journal of reconstructive microsurgery | Year: 2016

BackgroundWhile implementation of subspecializations may increase expertise in a certain area of treatment, there also exist downsides. Aim of this study was, across several disciplines, to find out if the technique of microsurgery warrants the introduction of a Certificate of Added Qualifications (CAQ) in microsurgery. MethodsAn anonymous, web-based survey was administered to directors of microsurgical departments in Europe (n=205). Respondents were asked, among other questions, whether they had completed a 12-month microvascular surgery fellowship and whether they believed a CAQ in microvascular surgery should be instituted. ResultsThe response rate was 57%, and 33% of the respondents had completed a 12-month microvascular surgery fellowship.A total of 61% of all surgeons supported a CAQ in microsurgery. Answers ranged from 47% of support to 100% of support, depending on the countries surveyed. DiscussionThis is one of the few reports to evaluate the potential role of subspecialty certification of microvascular surgery across several European countries. The data demonstrate that the majority of directors of microsurgical departments support such a certificate. There was significantly greater support for a CAQ in microsurgery among those who have completed a formal microvascular surgery fellowship themselves. ConclusionThis study supports the notion that further discussion and consideration of subspecialty certification in microvascular surgery appears necessary. There are multiple concerns surrounding this issue. Similar to the evolution of hand surgery certification, an exploratory committee of executive members of the respective medical boards and official societies may be warranted.


PubMed | Microsurgery Unit
Type: | Journal: BioMed research international | Year: 2014

End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management.


PubMed | Microsurgery Unit and The Second University of Naples
Type: | Journal: BioMed research international | Year: 2014

The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs.


PubMed | Microsurgery Unit, Victor Babes University of Medicine and Pharmacy Timisoara and Locarnos Regional Hospital
Type: Case Reports | Journal: Chirurgie de la main | Year: 2015

Tendon adhesions in zone IV after proximal phalangeal fractures are common and may lead to loss of range of motion at the proximal interphalangeal joint. The type of fracture, surgical technique and rehabilitation strategy also influence the final functional outcome. Plate fixation is a reliable solution in cases of comminuted phalangeal fracture. This article describes how adhesions between the plate and extensor apparatus in cases of comminuted fractures of the proximal phalanx can be reduced by using an adipofascial flap.

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