Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications

Agostini, Tommaso,Lo Russo, Giulia,Zhang, Yi Xin,Spinelli, Giuseppe,Lazzeri, Davide Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.2

Background A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimal skin resurfacing. Several techniques have been described to thin an ALT flap including an adipocutaneous flap, an adipofascial flap and delayed debulking. Methods By systematically reviewing all of the available literature in English and French, the present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of the adipofascial variant of the ALT flap. The studies were identified by performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google Scholar. Results The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and 15 articles were identified using the study inclusion criteria. These articles were then reviewed for author name(s), year of publication, flap dimensions and thickness following defatting, perforator type, type of transfer, complications, thinning technique, number of cases with a particular area of application and donor site morbidity. Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects and improve pliability. Its strong and safe blood supply permits adequate immediate or delayed debulking without vascular complications. The presence of the deep fascia makes it possible to prevent sagging by suspending and fixing the flap for functional reconstructive purposes (e.g., the intraoral cavity). Donor site morbidity is minimal, and thigh deformities can be reduced through immediate direct closure or liposuction and direct closure. A safe blood supply was confirmed by the rate of secondary flap debulking.

Through-and-through Nasal Reconstruction with the Bi-Pedicled Forehead Flap

Agostini, Tommaso,Perello, Raffaella,Russo, Giulia Lo,Spinelli, Giuseppe Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.6

Background Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction. Methods Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia. Results Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary. Conclusions This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.

Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications

Tommaso Agostini,Giulia Lo Russo,Yixin Zhang,Giuseppe Spinelli,DAVIDE LAZZERINI 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.2

Background  A thinned anterolateral thigh (ALT) flap  is often harvested to achieve optimal skin resurfacing. Several techniques have been described to thin an ALT flap  including an adipocutaneous flap, an adipofascial flap and delayed debulking. Methods  By systematically reviewing all of the available literature in English and French, the present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of the adipofascial variant of the ALT flap. The studies were  identified by performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google Scholar. Results  The study selection process was adapted from the Preferred Reporting  Items for Systematic Reviews and Meta-Analyses statement, and 15 articles were  identified using the study  inclusion criteria. These articles were then reviewed for author name(s), year of publication, flap dimensions and thickness following defatting, perforator type, type of transfer, complications, thinning technique, number of cases with a particular area of application and donor site morbidity. Conclusions  The adipofascial variant of the ALT flap provides tissue to fill large defects and improve pliability.  Its strong and safe blood supply permits adequate  immediate or delayed debulking without vascular complications. The presence of the deep fascia makes it possible to prevent sagging by suspending and fixing the flap for functional reconstructive purposes (e.g., the  intraoral cavity). Donor site morbidity  is minimal, and thigh deformities can be reduced through  immediate direct closure or  liposuction and direct closure. A safe blood supply was confirmed by the rate of secondary flap debulking. 

Through-and-through Nasal Reconstruction with the Bi-Pedicled Forehead Flap

Tommaso Agostini,Raffaella Perello,Giulia Lo Russo,Giuseppe Spinelli 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.6

Background Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction. Methods Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia. Results Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary. Conclusions This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.

One injection for a great projection: a quick and simple procedure for nipple reconstruction

Tanini, Sara,Calabrese, Sara,Lucattelli, Elena,Russo, Giulia Lo Korean Society of Plastic and Reconstructive Surge 2021 Archives of Plastic Surgery Vol.48 No.2

Women attach great importance to the presence of a three-dimensional nipple upon completion of the breast reconstruction process. To meet patients' expectations, nipple-areolar complex reconstruction should achieve symmetry in position, size, shape, texture, and color, as well as minimizing donor-site morbidity. However, it is well known that regardless of the reconstructive technique, loss of nipple projection can be reasonably expected. We developed and evaluated a quick, simple, and innovative technique using injectable Integra Flowable Wound Matrix to increase nipple projection after reconstruction. Twenty breast cancer patients who underwent nipple reconstruction resulting in unsatisfactory projection were enrolled in our retrospective study. Nipple projection was measured at the time of surgery and after 6 and 12 months. A visual analogue scale was used to assess patients' satisfaction. Our technique yielded reliable results in terms of the long-lasting maintenance of nipple projection. This method is high-priced, but cost-effective, since one kit may suffice for three patients. Furthermore, our patients were very appreciative of this technique as a single-step, minimally invasive, painless procedure with no reported necessity of re-intervention.

Photolysis of Br₂in CCl₄studied by time-resolved X-ray scattering

Kong, Qingyu,Lee, Jae Hyuk,Lo Russo, Manuela,Kim, Tae Kyu,Lorenc, Maciej,Cammarata, Marco,Bratos, Savo,Buslaps, Thomas,Honkimaki, Veijo,Ihee, Hyotcherl,Wulff, Michael International Union of Crystallography 2010 Acta crystallographica. Section A, Foundations of Vol.66 No.2

<P>A time-resolved X-ray solution scattering study of bromine molecules in CCl4is presented as an example of how to track atomic motions in a simple chemical reaction. The structures of the photoproducts are tracked during the recombination process, geminate and non-geminate, from 100 ps to 10 µs after dissociation. The relaxation of hot Br2<SUP>*</SUP>molecules heats the solvent. At early times, from 0.1 to 10 ns, an adiabatic temperature rise is observed, which leads to a pressure gradient that forces the sample to expand. The expansion starts after about 10 ns with the laser beam sizes used here. When thermal artefacts are removed by suitable scaling of the transient solvent response, the excited-state solute structures can be obtained with high fidelity. The analysis shows that 30% of Br2<SUP>*</SUP>molecules recombine directly along the<I>X</I>potential, 60% are trapped in the<I>A</I>/<I>A</I>′ state with a lifetime of 5.5 ns, and 10% recombine non-geminately<I>via</I>diffusive motion in about 25 ns. The Br-Br distance distribution in the<I>A</I>/<I>A</I>′ state peaks at 3.0 Å.</P>

Spatiotemporal reaction kinetics of an ultrafast photoreaction pathway visualized by time-resolved liquid x-ray diffraction.

Kim, Tae Kyu,Lorenc, Maciej,Lee, Jae Hyuk,Lo Russo, Manuela,Kim, Joonghan,Cammarata, Marco,Kong, Qingyu,Noel, Sylvie,Plech, Anton,Wulff, Michael,Ihee, Hyotcherl National Academy of Sciences 2006 PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF Vol.103 No.25

<P>We have studied the reaction dynamics for HgI(2) in methanol by using time-resolved x-ray diffraction (TRXD). Although numerous time-resolved spectroscopic studies have provided ample information about the early dynamics of HgI(2), a comprehensive reaction mechanism in the solution phase spanning from picoseconds up to microseconds has been lacking. Here we show that TRXD can provide this information directly and quantitatively. Picosecond optical pulses triggered the dissociation of HgI(2), and 100-ps-long x-ray pulses from a synchrotron probed the evolving structures over a wide temporal range. To theoretically explain the diffracted intensities, the structural signal from the solute, the local structure around the solute, and the hydrodynamics of bulk solvents were considered in the analysis. The results in this work demonstrate that the determination of transient states in solution is strongly correlated with solvent energetics, and TRXD can be used as an ultrafast calorimeter. It also is shown that a manifold of structural channels can be resolved at the same time if the measurements are accurate enough and that global analysis is applied. The rate coefficients for the reactions were obtained by fitting our model against the experimental data in one global fit including all q-values and time delays. The comparison between all putative reaction channels confirms that two-body dissociation is the dominant dissociation pathway. After this primary bond breakage, two parallel channels proceed. Transient HgI associates nongeminately with an iodine atom to form HgI(2), and I(2) is formed by nongeminate association of two iodine atoms.</P>

Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities

Alessia Celeste Bocchino,Marta Pezzoli,Juan Ignacio Martínez-Salamanca,Giorgio Ivan Russo,Arturo Lo Giudice,Andrea Cocci 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.2

To review the evidence of clinical efficacy of low-intensity extracorporeal shock wave therapy (Li-ESWT) for the treatment of erectile dysfunction (ED). A search on PubMed using Medical Subject Headings terms [((low intensity extracorporeal shockwave therapy) OR (Li-ESWT)) AND (erectile dysfunction)] was conducted in August 2022, to obtain studies on the use of Li-ESWT for the treatment of ED. Its success rate in terms of International Index of Erectile Function-5 (IIEF-5) score and Erection Hardness Score (EHS) improvement was recorded and analysed. A total of 139 articles were reviewed. Overall, 52 studies were included in the final review. 17 studies were on vasculogenic ED, 5 on post pelvic surgery ED, 4 specifically on ED in diabetic patients, 24 on non-specified origin ED and 2 on mixed pathophysiological origin ED. The mean age of patients was 55.87±7.91 (standard deviation) years and the duration of ED was 4.36±2.08 years. The mean IIEF-5 score went from 12.04±2.67 at baseline to 16.12±5.72, 16.30±3.26 and 16.85±1.63 respectively at 3, 6 and 12 months. The mean EHS went from 2.00±0.46 at baseline to 2.58±0.60, 2.75±0.46 and 2.87±0.16 respectively at 3, 6 and 12 months. Li-ESWT may be a safe and efficacy option for the treatment and cure of ED. Further studies are needed to assess which patients are more suitable for this procedure and which Li-ESWT protocol can lead to the best outcomes.

Photochemistry of HgBr₂ in methanol investigated using time-resolved X-ray liquidography

Jun, Sunhong,Lee, Jae Hyuk,Kim, Jeongho,Kim, Joonghan,Kim, Kyung Hwan,Kong, Qingyu,Kim, Tae Kyu,Lo Russo, Manuela,Wulff, Michael,Ihee, Hyotcherl Royal Society of Chemistry 2010 Physical chemistry chemical physics Vol.12 No.37

<P>We investigate the photoinduced dissociation of HgBr<SUB>2</SUB> in methanol and the ensuring structural dynamics of the photo-products over a time span from 100 ps to 1 μs after photolysis at 267 nm by using time-resolved X-ray liquidography (TRXL). By making use of the atomic-level structural sensitivity of X-ray scattering and the superb 100 ps time resolution of X-ray pulses from a 3rd-generation synchrotron, the structural dynamics of a chemical reaction in solution can be directly monitored. The measured time-dependent X-ray solution scattering signals, analyzed using global-fitting based on DFT calculations and MD simulations, show that photoexcited HgBr<SUB>2</SUB> dissociates <I>via</I> both two-body (HgBr + Br) and three-body (Hg + Br + Br) dissociation pathways with a ∼2 : 1 branching ratio. Following dissociation, the photoproducts recombine <I>via</I> three reactions involving Br species: (1) Hg + Br, (2) HgBr + Br, and (3) Br + Br. The associated rate constants and branching ratios are determined from the global-fitting analysis. Also, we examine the energy dissipation from reacting solute molecules and relaxation of excited molecules to solvent bath accompanying the temperature rise of 0.54 K. Compared to a previous TRXL study of the photodissociation of HgI<SUB>2</SUB>, the results of this work suggest that the photodissociation pathway of HgBr<SUB>2</SUB> is different from that of HgI<SUB>2</SUB>, which dissociates predominantly <I>via</I> two-body dissociation, at least to within the currently available time resolution of ∼100 ps. In addition, the error analysis of the fit parameters used in the global-fitting are discussed in detail with a comparison of various error estimation algorithms.</P> <P>Graphic Abstract</P><P>The photo-dissociation of HgBr<SUB>2</SUB> in methanol and the structural dynamics of the photo-products were investigated by time-resolved X-ray liquidography. <IMG SRC='http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeContent.ImageService.svc/ImageService/image/GA?id=c002004d'> </P>