The Assessment of Thromboembolism Risk in Postbariatric Patient: Our Experience in 936 Patients

open3openTanzillo, Giuseppe; Vindigni, Vincenzo; Bassetto, FrancoTanzillo, Giuseppe; Vindigni, Vincenzo; Bassetto, Franc

Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources.

Abstract PURPOSE: The reverse posterior interosseous artery flap has several advantages, not sacrificing any major blood vessel, but its relatively short pedicle limits the use to cover defects up to the metacarpophalangeal joint. Our purpose is to demonstrate that the ligature of the anterior interosseous artery (AIA), proximal to the communicating branch with the posterior interosseous artery, leads to an improved flap rotation arch, preserving both vascular sources. METHODS: Sixteen fresh cadavers with latex perfusion were analyzed before and after our technique of elongation, and the so-obtained measures were standardized in "percentage of elongation of the pedicle." Eight patient with the loss of substance at the dorsal aspect of the hand have been treated with this technique, and results were evaluated in terms of flap survival and complication rates. RESULTS: The medium length of the pedicle in the normal flap was 10.8\u2009cm, and after the section of the AIA, the medium length of the pedicle was 13.6\u2009cm with a medium increase of 2.8\u2009cm. It means a medium increase of 24% of the length of the pedicle. In all patients treated, full coverage of the defect was obtained, and we did not experience major complications. CONCLUSIONS: This anatomical study supported by our clinical experience demonstrates that the use of the variant described above permits to reach more distal part of the hand without being afraid to stretch the pedicle because of the connection with the anastomotic arcades of the AIA at the wrist reducing the risk of ischemia of the flap

Behavioral and electrophysiological correlates of cognitive control in ex-obese adults

Impaired cognitive control functions have been documented in obesity. It remains unclear whether these functions normalize after weight reduction. We compared ex-obese individuals, who successfully underwent substantial weight loss after bariatric surgery, to normal weight participants on measures of resistance to interference, cognitive flexibility and response inhibition, obtained from the completion of two Stroop tasks, a Switching task and a Go/NoGo task, respectively. To elucidate the underlying brain mechanisms, event-related potentials (ERPs) in the latter two tasks were examined. As compared to controls, patients were more susceptible to the predominant but task-irrelevant stimulus dimension (i.e., they showed a larger verbal Stroop effect), and were slower in responding on trials requiring a task-set change rather than a task-set repetition (i.e., they showed a larger switch cost). The ERP correlates revealed altered anticipatory control mechanisms (switch positivity) and an exaggerated conflict monitoring response (N2). The results suggest that cognitive control is critical even in ex-obese individuals and should be monitored to promote weight loss maintenance

New Developments in Tissue Engineering of Microvascular Prostheses

none3noneV. VINDIGNI; ABATANGELO G; BASSETTO FVindigni, Vincenzo; Abatangelo, Giovanni; Bassetto, Franc

Critical Upper Limb Ischemia Due to Brachial Tourniquet in Misdiagnosed Thoracic Outlet Syndrome after Carpal Tunnel Decompression: A Case Report

We present the case of a 68-year-old woman, referred to our department for critical upper limb ischemia, which had occurred a few days after homolateral surgical ligamentotomy for carpal tunnel syndrome, diagnosed and confirmed by electromyography, and performed with a brachial tourniquet. The patient was later admitted for subsequent progressive necrosis of the first three fingers of the left hand, accompanied by signs of upper limb ischemia. An accessory cervical rib was identified, completely obliterating the subclavian artery distally at the origin of the suprascapular artery. A complete humeral artery occlusion was also found at the middle third of the humerus. The accessory rib was resected and the subclavian artery recanalized. A few days later, necrosis of the distal third of the first two fingers appeared and surgical resection was performed. Despite this chronic condition, the acute occlusion of collateral circles was probably induced by the brachial tourniquet. This represents a rare event, never previously reported in the literature: a case of critical upper limb ischemia due to a brachial tourniquet in a patient with misdiagnosed thoracic outlet syndrome. Until specific electrophysiological criteria for this syndrome can be found, attention should focus on history and clinical examination in patients with suspected carpal tunnel syndrome

Inguinocrural dermolipectomy A retrospective study

Inguinocrural dermolipectomy is a constantly increasing surgical procedure, especially for postbariatric patients with significant weight loss. The "crescent medial" and "vertical medial" thigh lifting techniques (CMTL/VMTL) are the most effective type of surgery to treat laxity and excess of skin and soft tissues in the medial region of the thighs Aim of this article is to suggest which patients may be eligible for a surgical thighplasty with an acceptable risk of postoperative complications

Comparison of Patient-reported Outcomes after Implant Versus Autologous Tissue Breast Reconstruction Using the BREAST-Q

Background: The demand for reconstructive breast procedures of various types has accelerated in recent years. Coupled with increased patient expectations, it has fostered the development of oncoplastic and reconstructive techniques in breast surgery. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life are the most significant outcome variables when evaluating surgical success. The aim of this study was to evaluate the quality of life after implant breast reconstruction compared with autologous breast reconstruction. Materials and Methods: A cross-sectional study design was used. A total of 65 women who had completed postmastectomy implant-based or autologous reconstruction in the participating center were asked to complete the BREAST-Q (Reconstruction Module). Results: Data analysis demonstrated that women with autologous breast reconstruction were significantly more satisfied with their breasts (P = 0.0003) and with the overall outcome (P = 0.0001) compared with women with implant breast reconstruction. All other BREAST-Q parameters that were considered and observed were not significantly different between the 2 patient groups. Conclusions: Through statistical analysis, our results showed that patients who underwent autologous tissue reconstruction had better satisfaction with the reconstructed breast and the outcome, while both techniques appear to equally improve psychosocial well-being, sexual well-being, and chest satisfaction

Nanotechnology-based therapies for skin wound regeneration

The cutting-edge combination of nanotechnology with medicine offers the unprecedented opportunity to create materials and devices at a nanoscale level, holding the potential to revolutionize currently available macroscale therapeutics. Nanotechnology already provides a plethora of advantages to medical care, and the success of nanoparticulate systems suggests that a progressive increase in the exploration of their potential will take place in the near future. An overview on the current applications of nanotechnology to wound healing and wound care is presented

EUREKA study - The evaluation of real-life use of a biophotonic system in chronic wound management: An interim analysis

Objective: Interest has grown regarding photobiomodulation (PBM) with low-level light therapy, which has been shown to positively affect the stages of the wound healing process. In a real-life context clinical setting, the objective of the EUREKA study was to investigate efficacy, safety, and quality of life associated with the use of a BioPhotonic gel (LumiHeal\u2122) in the treatment of chronic wounds such as venous leg ulcers (VLUs), diabetic foot ulcers (DFUs), and pressure ulcers (PUs). This BioPhotonic gel represents a new, first-in-class emission spectrum of light, including fluorescence, to induce PBM and modulate healing. Design: The multicenter, prospective, interventional, uncontrolled, open-label study enrolled 100 patients in 12 wound centers in Italy. We performed an early interim analysis based on the first 33 subjects (13 VLU, 17 DFU, 3 PU) in seven centers who completed the study. Main results: Seventeen patients (52%) achieved total wound closure (full re-epithelialization for 2 weeks) during the study period. Two patients (6%) were considered \u201calmost closed\u201d (decrease of the wound area of more than 90% at study end) and three others (9%) were considered \u201cready for skin grafting\u201d. No related serious adverse events were observed, and the compliance was excellent. After the treatment, the average time to \u201cpain-free\u201d was 11.9 days in the VLU group. Quality of life was improved with overall increase of 26.4% of the total score (Cardiff Wound Impact Schedule, p=0.001). Conclusion: The study revealed a positive efficacy profile of the BioPhotonic gel in promoting wound healing and reactivating the healing process in different types of chronic, hard-to-heal wounds. The treatment was shown to be safe and well tolerated by the patients, and a reduction of pain perception was also detected during the treatment period. The improvement of the quality of life was accompanied by a high level of clinician satisfaction