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Sant'Ambrogio di Torino, Italy

Quint U.,Orthopaedic and Trauma Center | Bordon G.,Neurosurgical Section Hochtaunus Kliniken and Neurosurgical Associates | Preissl I.,Neurosurgical Section Hochtaunus Kliniken and Neurosurgical Associates | Sanner C.,Hochtaunus Kliniken GGmbH | Rosenthal D.,Neurosurgical Section Hochtaunus Kliniken and Neurosurgical Associates
European Spine Journal | Year: 2012

Problem Thoracic disc disease with radicular pain and myelopathic symptoms can have serious neurological sequelae. The authors present a relevant treatment option. Methods Data of patients with single level symptomatic thoracic disc herniation treated with thoracoscopic microdiscectomy were prospectively collected over a period of 10 years. Data collection included the preoperative status and the follow-up status was 6, 12 and 24 months after surgery for every patient. Results A total of 167 single level thorascoscopic discectomies without previous surgery on the level of the procedure were included in this study. The average preoperative duration of pain symptoms was 14.3 months, myelopathic symptoms were present for an average of 16.7 months before surgery. After the procedure pain scores measured with visual analog scale (VAS) decreased by 4.4 points and the muscle strength improved by a mean of 4.6 points (American Spinal Injury Association ASIA motor score). After 2 years, 79% of the patients reported a excellent or good outcome for pain and 80% of the patients reported a excellent or good outcome for motor function. The overall complication rate was 15.6%. Conclusions Thoracoscopic microdiscectomy for single level symptomatic disc herniation is a highly effective and reliable technique, it can be performed safely with low complication rate. © 2011 Springer-Verlag. Source

Myers S.R.,Academic Plastic Surgery Group | Froschauer S.,Microsurgical Training and Research Center | Akelina Y.,Columbia University | Tos P.,Orthopaedic and Trauma Center | And 2 more authors.
Archives of Plastic Surgery | Year: 2013

Current educational interventions and training courses in microsurgery are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess current training tools in microsurgery education and devise alternative methods that would enhance training. Simulation is an increasingly important tool for educators because, whilst facilitating improved technical proficiency, it provides a way to reduce risks to both trainees and patients. The International Microsurgery Simulation Society has been founded in 2012 in order to consolidate the global effort in promoting excellence in microsurgical training. The society's aim to achieve standarisation of microsurgical training worldwide could be realised through the development of evidence based educational interventions and sharing best practices. © 2013 The Korean Society of Plastic and Reconstructive Surgeons. Source

Battiston B.,Orthopaedic and Trauma Center | Artiaco S.,Orthopaedic and Trauma Center | Piana R.,Orthopaedic and Trauma Center | Boux E.,Orthopaedic and Trauma Center | Tos P.,Microsurgery Unit
Journal 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. © 2015, The Author(s). Source

Tos P.,Orthopaedic and Trauma Center | Geuna S.,University of Turin | Papalia I.,Messina University | Conforti L.G.,Orthopaedic and Trauma Center | And 2 more authors.
Acta Neurochirurgica, Supplementum | Year: 2011

The last 15 years have seen a growing interest regarding a technique for nerve repair named end-to-side coaptation. Since 2000, we have carried out experimental studies on end-to-side nerve repair as well as employed this technique to a series of selected clinical cases. Here we report on the results of this experience. For experimental studies, we have used the model represented by median nerve repair by end-to-side coaptation either on the ulnar (agonistic) or the radial (antagonistic) nerve. For time course assessment of median nerve functional recovery we used the grasping test, a test which permits to assess voluntary control of muscle function. Repaired nerves were processed for resin embedding to allow nerve fibre stereology and electron microscopy. Results showed that, in either experimental group, end-to-side-repaired median nerves were repopulated by axons regenerating from ulnar and radial donor nerves, respectively. Moreover, contrary to previously published data, our results showed that voluntary motor control of the muscles innervated by the median nerve was progressively recovered also when the antagonistic radial nerve was the donor nerve. As regards our clinical experience, results were not so positive. We have treated by end-to-side coaptation patients with both sensory (n = 7, collateral digital nerves) and mixed (n = 8, plexus level) nerve lesions. Results were good, as in other series, in sensory nerves whilst they were very difficult to investigate in mixed nerves at the plexus level. Take together, these results suggest that clinical employment of end-to-side coaptation should still be considered at the moment as the ultima ratio in cases in which no other repair technique can be attempted. Yet, it is clear that more basic research is needed to explain the reasons for the different results between laboratory animal and humans and, especially, to find out how to ameliorate the outcome of end-to-side nerve repair by adequate treatment and rehabilitation. © 2011 Springer-Verlag/Wien. Source

Artiaco S.,Orthopaedic and Trauma Center | Battiston B.,Orthopaedic and Trauma Center | Colzani G.,Orthopaedic and Trauma Center | Bianchi P.,The Second University of Naples | And 3 more authors.
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. © 2014 Stefano Artiaco et al. Source

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