11 results on '"Cigna E"'
Search Results
2. Extensor Pollicis Brevis Transosseous Tenodesis Technique for Treatment of Acquired Metacarpophalangeal Hyperextension Deformity of the Thumb: A Preliminary Report.
- Author
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Hernández-Cortés P, Hernández-Peregrina P, Pajares-López M, Cigna E, Sánchez-Montesinos I, and Roda O
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Range of Motion, Articular, Metacarpophalangeal Joint surgery, Plastic Surgery Procedures methods, Tendon Transfer methods, Tenodesis methods, Thumb surgery
- Abstract
Summary: Hyperextension deformity of the metacarpophalangeal joint of the thumb causes pain and loss of function. Although many treatments have been proposed, none of them are universally accepted as ideal. The authors report a study of 12 symptomatic hyperextension deformities of the thumb metacarpophalangeal joint in 10 patients who underwent surgical correction. The purpose of this study was to describe a new technique of tenodesis of the thumb metacarpophalangeal joint using the extensor pollicis brevis tendon. The technique consists of extensor pollicis brevis tenotomy at the wrist and tendon transfer through two bone tunnels to the palmar aspect of the metacarpophalangeal joint before metacarpal fixation with a flexor tenodesis effect. Correction of hyperextension and range of motion were assessed. Functional changes were evaluated by Quick Disabilities of the Arm, Shoulder, and Hand score, pain visual analogue scale, Kapandji opposition scheme, and pinch strength. The Wilcoxon test was used for statistical analysis. Mean preoperative and postoperative metacarpophalangeal joint hyperextension deformities were +50.83 ± 5.57 degrees and -17.91 ± 7.82 degrees, respectively. Thumb opposition improved by one point on Kapandji's scheme. Mean perceived pain decreased from 7.66 to 1.16. On average, the Quick Disabilities of the Arm, Shoulder, and Hand score was reduced by 34.4 points and pinch strength increased by 50.42 percent. The authors found that extensor pollicis brevis transosseous tenodesis is a safe and minimally invasive method for successfully correcting the functionality and cosmetic appearance of metacarpophalangeal joint hyperextension deformities in posttraumatic and trapeziometacarpal osteoarthritis cases. The patients retained functional active flexion, even in deformities greater than 40 degrees., Clinical Question/level of Evidence: Therapeutic, IV., Competing Interests: Disclosure: The authors have no conflicts of interest or financial disclosures to report., (Copyright © 2022 by the American Society of Plastic Surgeons.)
- Published
- 2022
- Full Text
- View/download PDF
3. Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes.
- Author
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Casella D, Di Taranto G, Marcasciano M, Sordi S, Kothari A, Kovacs T, Lo Torto F, Cigna E, Calabrese C, and Ribuffo D
- Subjects
- Adult, Aged, Breast Implantation methods, Breast Neoplasms pathology, Breast Neoplasms surgery, Cohort Studies, Esthetics, Female, Follow-Up Studies, Graft Survival, Hospitals, University, Humans, Italy, Middle Aged, Retrospective Studies, Risk Assessment, Time Factors, Treatment Outcome, Young Adult, Breast Implants, Mammaplasty methods, Mastectomy, Subcutaneous methods, Surgical Mesh
- Abstract
Background: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes., Methods: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors' institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time., Results: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05)., Conclusion: The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction., Clinical Question/level of Evidence: Therapeutic, IV.
- Published
- 2019
- Full Text
- View/download PDF
4. Antithrombotic Therapies in Digit Replantation with Papaverine Administration: A Prospective, Observational Study.
- Author
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Lo Torto F, Kaciulyte J, Ciudad P, Cigna E, and Ribuffo D
- Subjects
- Amputation, Traumatic, Humans, Prospective Studies, Replantation, Fibrinolytic Agents, Papaverine
- Published
- 2018
- Full Text
- View/download PDF
5. Impact of Evolving Radiation Therapy Techniques on Implant-Based Breast Reconstruction.
- Author
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Lo Torto F, Parisi P, Casella D, Di Taranto G, Cigna E, and Ribuffo D
- Subjects
- Breast Implantation, Breast Implants, Breast Neoplasms radiotherapy, Humans, Mammaplasty, Mastectomy
- Published
- 2018
- Full Text
- View/download PDF
6. Skin-Reduction Breast Reconstructions with Prepectoral Implant.
- Author
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Caputo GG, Marchetti A, Dalla Pozza E, Vigato E, Domenici L, Cigna E, and Governa M
- Subjects
- Acellular Dermis, Adult, Aged, Female, Follow-Up Studies, Humans, Middle Aged, Nipples surgery, Retrospective Studies, Time Factors, Treatment Outcome, Breast Implants, Breast Neoplasms surgery, Mammaplasty methods, Mastectomy methods, Pectoralis Muscles transplantation, Surgical Flaps
- Abstract
Unlabelled: Skin-reduction mastectomy with prepectoral implant reconstruction is a novel technique for immediate breast reconstruction, with subcutaneous implant placement in patients eligible for skin-reducing mastectomy. Implants were placed above the pectoralis muscles in a compound pocket made by a dermal flap and acellular dermal matrix. The procedure was performed on 33 breasts in 27 selected patients. In three cases, there was skin ischemia; in one case, it healed spontaneously; and in two patients, a surgical necrosectomy and primary closure were needed. No implant loss occurred. This new technique proved to be a useful alternative, with good cosmetic results, in selected patients requiring mastectomy. These preliminary results need to be confirmed by long-term and comparative studies., Clinical Question/level of Evidence: Therapeutic, IV.
- Published
- 2016
- Full Text
- View/download PDF
7. The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study.
- Author
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Cigna E, Chen HC, Ozkan O, Sorvillo V, Maruccia M, and Ribuffo D
- Subjects
- Adult, Cadaver, Female, Humans, Male, Middle Aged, Thigh anatomy & histology, Thigh surgery, Perforator Flap, Plastic Surgery Procedures methods
- Abstract
Background: Perforator flaps have become the choice of most reconstructive surgeons because they have decreased donor-site morbidity. Among these flaps, the free anteromedial thigh flap has not yet become a first-choice flap because of the inconstant anatomy of its pedicle. This study aimed to describe the anatomy from different perspectives to highlight common patterns and simplify the flap's application in clinical cases., Methods: The study started in 2004 and took 9 years to complete. It was performed on 12 clinical anteromedial thigh flap cases, 48 clinical cases of anterolateral thigh flap in which the vascular anatomy of the anteromedial thigh flap was studied, and 48 cadaver dissections., Results: In "type of perforators," the authors found an almost total consistency between clinical cases (group 1) and dissections in patients (group 2) (χ = 0.164 and p = 0.92), whereas the cadaver dissections (group 3) were minimally homogeneous (χ = 13.7 and p = 0.0082). Then, taking into account the parameter "origin of perforators," they noticed the same trend with a clear alignment between the first two groups (χ = 1.84 and p = 0.87) and a strong inhomogeneity in relation to the third group (χ = 19.8 and p = 0.03)., Conclusions: Anatomical study of the anteromedial thigh flap pedicle showed a marked variability that makes preoperative planning difficult, and thus more stressful to realize. This evidence confirms that the flap can be used as a second choice or simultaneously with the anterolateral thigh flap. In addition, the authors strongly suggest a preoperative radiological study to minimize the possible anatomical variabilities during surgery.
- Published
- 2014
- Full Text
- View/download PDF
8. Microvascular free tissue transfer in patients with hematological disorders.
- Author
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Özkan Ö, Chen HC, Mardini S, Cigna E, Hao SP, Hung KF, and Chen HS
- Subjects
- Adolescent, Adult, Child, Female, Humans, Male, Microsurgery, Middle Aged, Retrospective Studies, Wounds and Injuries complications, Hematologic Diseases complications, Plastic Surgery Procedures, Surgical Flaps, Wounds and Injuries surgery
- Abstract
Background: Microsurgical procedures performed in patients with hematological disorders can pose significant challenges. The literature is lacking in reports that specifically address the safety, reliability, and management techniques related to performing microvascular surgery in this group of patients., Methods: A retrospective chart review of all patients with hematological disorders who received free flaps from 1995 to 2004 was performed. All patients had a hematologic work-up that confirmed the stability of the underlying disease. There were three male and three female patients with an average age of 27.6 years (range,12 to 63 years). Patients had leukemia (n = 2), hereditary spherocytosis, non-Hodgkin's lymphoma, and hemophilia (n = 2). Their defects were in the areas of the nasocolumella/upper lip, palate, palate and midface, and lower extremities., Results: All patients received free flaps and all but one had an uneventful postoperative course. That patient, with hemophilia, 1 day after factor replacement was halted, had bleeding that required surgical re-exploration along with aggressive hematologic management. All flaps survived without vascular compromise. No wound infections were observed. All donor sites healed without complications., Conclusions: Essential ingredients in the treatment plan of patients with hematologic disorders undergoing free flaps include familiarity with the preoperative medical condition and potential postoperative complications, close monitoring of the patients and their medical condition before and after surgery, meticulous surgical technique, and close cooperation with the hematologists and infectious disease specialists. By following this regimen, patients with hematologic disorders and an otherwise stable medical history can undergo free tissue transfer safely and effectively with reliable outcomes.
- Published
- 2006
- Full Text
- View/download PDF
9. The innervated anterolateral thigh flap: anatomical study and clinical implications.
- Author
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Ribuffo D, Cigna E, Gargano F, Spalvieri C, and Scuderi N
- Subjects
- Cadaver, Femoral Nerve anatomy & histology, Humans, Peripheral Nerves anatomy & histology, Reference Values, Skin innervation, Thigh anatomy & histology, Surgical Flaps innervation, Thigh innervation, Thigh surgery
- Abstract
During the past 20 years, the neural anatomy of many flaps has been investigated, although no extensive studies have been reported yet on the anterolateral thigh flap. The goal of this study was to describe the sensory territories of the nerves supplying the anterolateral thigh flap with dissections on fresh cadavers and with local anesthetic injections in living subjects. The sensate anterolateral thigh flap is typically described as innervated by the lateral cutaneous femoral nerve. Two other well-known nerves, the superior perforator nerve and the median perforator nerve, which enter the flap at its medial border, might have a role in anterolateral thigh flap innervation. Twenty-nine anterolateral thigh flaps were elevated in 15 cadavers, and the lateral cutaneous femoral nerve, the superior perforator nerve, and median perforator nerve were dissected. In the injection study, the lateral cutaneous femoral nerve, superior perforator nerve, and median perforator nerve in 16 thighs of eight subjects were sequentially blocked. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked anterolateral thigh flap territory. The study shows that the sensate anterolateral thigh flap is basically innervated by all three nerves. The lateral cutaneous femoral nerve was present in 29 of 29 thighs, whereas the superior perforator nerve was present in 25 of 29 and the median perforator nerve in 24 of 29 thighs. Furthermore, in the proximal half of the flap, the lateral cutaneous femoral nerve lies deep, whereas the superior perforator nerve and median perforator nerve lie more superficially. Whereas the lateral cutaneous femoral nerve innervates the entire flap, the superior perforator nerve innervates 25 percent of the flap and the median perforator nerve innervates 60 percent of the flap. Clinically, a small anterolateral thigh flap (7 x 5 cm) can be raised sparing the lateral cutaneous femoral nerve and using only the selective areas innervated by the superior perforator and median perforator nerves. Alternatively, a large anterolateral thigh flap can be raised with this multiple innervation. This can be helpful if one wants to harvest the flap under local anesthesia. Sensate bilobed flaps can be harvested when dual innervated flaps are required.
- Published
- 2005
- Full Text
- View/download PDF
10. Medicine and plastic surgery: science or art?
- Author
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Cigna E
- Subjects
- Clinical Competence, Esthetics, Humans, Physician's Role, Art, Medicine, Science, Surgery, Plastic
- Published
- 2004
- Full Text
- View/download PDF
11. At the end of the ladder . . . the triangle!
- Author
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Cigna E
- Subjects
- Humans, Plastic Surgery Procedures
- Published
- 2003
- Full Text
- View/download PDF
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