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1. Clinical presentation and prognosis of COVID-19 in older adults with hypothyroidism: data from the GeroCovid observational study

Author

Bagala, V, Sala, A, Trevisan, C, Okoye, C, Incalzi, R, Monzani, F, Volpato, S, Antognoli, R, Antonietti, M, Bandini, G, Bellelli, G, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bignamini, S, Blandini, D, Boffelli, S, Bugada, M, Calsolaro, V, Calvani, D, Carpagnano, E, Carrieri, B, Castaldo, V, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Coin, A, Corsi, A, Custodero, C, D'Agostino, F, D'Errico, M, De Iorio, A, De Marchi, A, Desideri, G, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Filippini, C, Fiore, L, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Fumagalli, S, Gareri, P, Giordano, A, Giuliani, E, Greco, A, Herbst, A, Ielo, G, La Marca, A, Porta, U, Lazzari, I, Lelli, D, Longobucco, Y, Lucchini, F, Lucente, D, Maestri, L, Maggio, M, Mainqua, P, Marengoni, A, Martin, B, Massa, V, Mazza, L, Mazzoccoli, C, Mossello, E, Morellini, F, Mussi, C, Orio, G, Paglia, A, Pelagalli, G, Pelizzoni, L, Picci, A, Ranhoff, A, Remelli, F, Resta, O, Riccardi, A, Rinaldi, D, Rozzini, R, Sabba, C, Sacco, L, Santoliquido, M, Savino, M, Scarso, F, Sergi, G, Serviddio, G, Sidoli, C, Solfrizzi, V, Soli, B, Tafaro, L, Tedde, A, Testa, G, Tinti, M, Tonarelli, F, Tonon, E, Vitali, A, Zoccarato, F, Zotti, S, Bagala V., Sala A., Trevisan C., Okoye C., Incalzi R. A., Monzani F., Volpato S., Antognoli R., Antonietti M. P., Bandini G., Bellelli G., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bignamini S., Blandini D., Boffelli S., Bugada M., Calsolaro V., Calvani D., Carpagnano E., Carrieri B., Castaldo V., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Coin A., Corsi A., Custodero C., D'Agostino F., D'Errico M. M., De Iorio A., De Marchi A., Desideri G., Di Matteo E., Espinosa E., Esposito L., Fazio C., Filippini C., Fiore L., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Fumagalli S., Gareri P., Giordano A., Giuliani E., Greco A., Herbst A., Ielo G., La Marca A., Porta U., Lazzari I., Lelli D., Longobucco Y., Lucchini F., Lucente D., Maestri L., Maggio M., Mainqua P., Marengoni A., Martin B., Massa V., Mazza L., Mazzoccoli C., Mossello E., Morellini F., Mussi C., Orio G., Paglia A., Pelagalli G., Pelizzoni L., Picci A., Ranhoff A. H., Remelli F., Resta O., Riccardi A., Rinaldi D., Rozzini R., Sabba C., Sacco L., Santoliquido M., Savino M., Scarso F., Sergi G., Serviddio G., Sidoli C., Solfrizzi V., Soli B., Tafaro L., Tedde A., Testa G. D., Tinti M. G., Tonarelli F., Tonon E., Vitali A., Zoccarato F., Zotti S., Bagala, V, Sala, A, Trevisan, C, Okoye, C, Incalzi, R, Monzani, F, Volpato, S, Antognoli, R, Antonietti, M, Bandini, G, Bellelli, G, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bignamini, S, Blandini, D, Boffelli, S, Bugada, M, Calsolaro, V, Calvani, D, Carpagnano, E, Carrieri, B, Castaldo, V, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Coin, A, Corsi, A, Custodero, C, D'Agostino, F, D'Errico, M, De Iorio, A, De Marchi, A, Desideri, G, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Filippini, C, Fiore, L, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Fumagalli, S, Gareri, P, Giordano, A, Giuliani, E, Greco, A, Herbst, A, Ielo, G, La Marca, A, Porta, U, Lazzari, I, Lelli, D, Longobucco, Y, Lucchini, F, Lucente, D, Maestri, L, Maggio, M, Mainqua, P, Marengoni, A, Martin, B, Massa, V, Mazza, L, Mazzoccoli, C, Mossello, E, Morellini, F, Mussi, C, Orio, G, Paglia, A, Pelagalli, G, Pelizzoni, L, Picci, A, Ranhoff, A, Remelli, F, Resta, O, Riccardi, A, Rinaldi, D, Rozzini, R, Sabba, C, Sacco, L, Santoliquido, M, Savino, M, Scarso, F, Sergi, G, Serviddio, G, Sidoli, C, Solfrizzi, V, Soli, B, Tafaro, L, Tedde, A, Testa, G, Tinti, M, Tonarelli, F, Tonon, E, Vitali, A, Zoccarato, F, Zotti, S, Bagala V., Sala A., Trevisan C., Okoye C., Incalzi R. A., Monzani F., Volpato S., Antognoli R., Antonietti M. P., Bandini G., Bellelli G., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bignamini S., Blandini D., Boffelli S., Bugada M., Calsolaro V., Calvani D., Carpagnano E., Carrieri B., Castaldo V., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Coin A., Corsi A., Custodero C., D'Agostino F., D'Errico M. M., De Iorio A., De Marchi A., Desideri G., Di Matteo E., Espinosa E., Esposito L., Fazio C., Filippini C., Fiore L., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Fumagalli S., Gareri P., Giordano A., Giuliani E., Greco A., Herbst A., Ielo G., La Marca A., Porta U., Lazzari I., Lelli D., Longobucco Y., Lucchini F., Lucente D., Maestri L., Maggio M., Mainqua P., Marengoni A., Martin B., Massa V., Mazza L., Mazzoccoli C., Mossello E., Morellini F., Mussi C., Orio G., Paglia A., Pelagalli G., Pelizzoni L., Picci A., Ranhoff A. H., Remelli F., Resta O., Riccardi A., Rinaldi D., Rozzini R., Sabba C., Sacco L., Santoliquido M., Savino M., Scarso F., Sergi G., Serviddio G., Sidoli C., Solfrizzi V., Soli B., Tafaro L., Tedde A., Testa G. D., Tinti M. G., Tonarelli F., Tonon E., Vitali A., Zoccarato F., and Zotti S.

Abstract

Background: The prevalence of hypothyroidism among older patients hospitalized for COVID-19 and its association with mortality is unclear. This study aims to investigate the prevalence of hypothyroidism in older COVID-19 inpatients and verify if this comorbidity is associated with a specific pattern of onset symptoms and a worse prognosis. Methods: COVID-19 inpatients aged ≥ 60 years, participating in the GeroCovid acute wards cohort, were included. The history of hypothyroidism was derived from medical records and the use of thyroid hormones. Sociodemographic data, comorbidities, symptoms/signs at the disease onset and inflammatory markers at ward admission were compared between people with vs without history of hypothyroidism. The association between hypothyroidism and in-hospital mortality was tested through Cox regression. Results: Of the 1245 patients included, 8.5% had a history of hypothyroidism. These patients were more likely to present arterial hypertension and obesity compared with those without an history of hypothyroidism. Concerning COVID-19 clinical presentation, patients with hypothyroidism had less frequently low oxygen saturation and anorexia but reported muscle pain and loss of smell more commonly than those without hypothyroidism. Among the inflammatory markers, patients with hypothyroidism had higher lymphocytes values. At Cox regression, hypothyroidism was associated with reduced in-hospital mortality only in the univariable model (HR = 0.66, 95% CI 0.45–0.96, p = 0.03); conversely, no significant result were observed after adjusting for potential confounders (HR = 0.69, 95% CI 0.47–1.03, p = 0.07). Conclusions: Hypothyroidism does not seem to substantially influence the prognosis of COVID-19 in older people, although it may be associated with peculiar clinical and biochemical features at the disease onset.

Published
2023

2. Clinical profile of trazodone users in a multisetting older population: data from the Italian GeroCovid Observational study

Author

Coin, A, Noale, M, Gareri, P, Trevisan, C, Bellio, A, Fini, F, Abbatecola, A, Del Signore, S, Malara, A, Mossello, E, Fumagalli, S, Volpato, S, Monzani, F, Bellelli, G, Zia, G, Incalzi, R, Andrieri, D, Antognoli, R, Antonietti, M, Bagalà, V, Bandini, G, Bazzano, S, Bellotti, F, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bianchi, P, Biasin, F, Bignamini, S, Blandini, D, Boffelli, S, Bontempi, C, Bordignon, A, Bracchitta, L, Bugada, M, Cafariello, C, Caleri, V, Calsolaro, V, Calvani, D, Campagna, F, Capasso, A, Capurso, S, Carino, S, Carpagnano, E, Carrieri, B, Castaldo, V, Castelli, M, Castellino, M, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Ceretti, A, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Colombo, M, Corsi, A, Crispino, A, Cucunato, R, Custodero, C, D’Agostino, F, D’Errico, M, D’Amico, F, De Iorio, A, De Marchi, A, Dell’Armi, A, Delmonte, M, Desideri, G, Devita, M, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Ferro, C, Filippini, C, Fiore, L, Fiorillo, S, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Gasbarri, P, Giordano, A, Giuliani, E, Granata, R, Coin A., Noale M., Gareri P., Trevisan C., Bellio A., Fini F., Abbatecola A. M., Del Signore S., Malara A., Mossello E., Fumagalli S., Volpato S., Monzani F., Bellelli G., Zia G., Incalzi R. A., Andrieri D., Antognoli R., Antonietti M. P., Bagalà V., Bandini G., Bazzano S., Bellotti F., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bianchi P., Biasin F., Bignamini S., Blandini D., Boffelli S., Bontempi C., Bordignon A., Bracchitta L. M., Bugada M., Cafariello C., Caleri V., Calsolaro V., Calvani D., Campagna F. A., Capasso A., Capurso S., Carino S., Carpagnano E., Carrieri B., Castaldo V., Castelli M., Castellino M., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Ceretti A., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Colombo M., Corsi A., Crispino A., Cucunato R., Custodero C., D’Agostino F., D’Errico M. M., D’Amico F., De Iorio A., De Marchi A., Dell’Armi A., Delmonte M., Desideri G., Devita M., Di Matteo E., Espinosa E., Esposito L., Fazio C., Ferro C., Filippini C., Fiore L., Fiorillo S., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Gasbarri P. P., Giordano A., Giuliani E., Granata R., Coin, A, Noale, M, Gareri, P, Trevisan, C, Bellio, A, Fini, F, Abbatecola, A, Del Signore, S, Malara, A, Mossello, E, Fumagalli, S, Volpato, S, Monzani, F, Bellelli, G, Zia, G, Incalzi, R, Andrieri, D, Antognoli, R, Antonietti, M, Bagalà, V, Bandini, G, Bazzano, S, Bellotti, F, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bianchi, P, Biasin, F, Bignamini, S, Blandini, D, Boffelli, S, Bontempi, C, Bordignon, A, Bracchitta, L, Bugada, M, Cafariello, C, Caleri, V, Calsolaro, V, Calvani, D, Campagna, F, Capasso, A, Capurso, S, Carino, S, Carpagnano, E, Carrieri, B, Castaldo, V, Castelli, M, Castellino, M, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Ceretti, A, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Colombo, M, Corsi, A, Crispino, A, Cucunato, R, Custodero, C, D’Agostino, F, D’Errico, M, D’Amico, F, De Iorio, A, De Marchi, A, Dell’Armi, A, Delmonte, M, Desideri, G, Devita, M, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Ferro, C, Filippini, C, Fiore, L, Fiorillo, S, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Gasbarri, P, Giordano, A, Giuliani, E, Granata, R, Coin A., Noale M., Gareri P., Trevisan C., Bellio A., Fini F., Abbatecola A. M., Del Signore S., Malara A., Mossello E., Fumagalli S., Volpato S., Monzani F., Bellelli G., Zia G., Incalzi R. A., Andrieri D., Antognoli R., Antonietti M. P., Bagalà V., Bandini G., Bazzano S., Bellotti F., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bianchi P., Biasin F., Bignamini S., Blandini D., Boffelli S., Bontempi C., Bordignon A., Bracchitta L. M., Bugada M., Cafariello C., Caleri V., Calsolaro V., Calvani D., Campagna F. A., Capasso A., Capurso S., Carino S., Carpagnano E., Carrieri B., Castaldo V., Castelli M., Castellino M., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Ceretti A., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Colombo M., Corsi A., Crispino A., Cucunato R., Custodero C., D’Agostino F., D’Errico M. M., D’Amico F., De Iorio A., De Marchi A., Dell’Armi A., Delmonte M., Desideri G., Devita M., Di Matteo E., Espinosa E., Esposito L., Fazio C., Ferro C., Filippini C., Fiore L., Fiorillo S., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Gasbarri P. P., Giordano A., Giuliani E., and Granata R.

Abstract

Background and objectives: Depression is highly prevalent in older adults, especially in those with dementia. Trazodone, an antidepressant, has shown to be effective in older patients with moderate anxiolytic and hypnotic activity; and a common off-label use is rising for managing behavioral and psychological symptoms of dementia (BPSD). The aim of the study is to comparatively assess the clinical profiles of older patients treated with trazodone or other antidepressants. Methods: This cross-sectional study involved adults aged ≥ 60 years at risk of or affected with COVID-19 enrolled in the GeroCovid Observational study from acute wards, geriatric and dementia-specific outpatient clinics, as well as long-term care facilities (LTCF). Participants were grouped according to the use of trazodone, other antidepressants, or no antidepressant use. Results: Of the 3396 study participants (mean age 80.6 ± 9.1 years; 57.1% females), 10.8% used trazodone and 8.5% others antidepressants. Individuals treated with trazodone were older, more functionally dependent, and had a higher prevalence of dementia and BPSD than those using other antidepressants or no antidepressant use. Logistic regression analyses found that the presence of BPSD was associated with trazodone use (odds ratio (OR) 28.4, 95% confidence interval (CI) 18-44.7 for the outcome trazodone vs no antidepressants use, among participants without depression; OR 2.17, 95% CI 1.05-4.49 for the outcome trazodone vs no antidepressants use, among participants with depression). A cluster analysis of trazodone use identified three clusters: cluster 1 included mainly women, living at home with assistance, multimorbidity, dementia, BPSD, and depression; cluster 2 included mainly institutionalized women, with disabilities, depression, and dementia; cluster 3 included mostly men, often living at home unassisted, with better mobility performance, fewer chronic diseases, dementia, BPSD, and depression. Discussion: The use of trazodo

Published
2023

3. Clinical profile of trazodone users in a multisetting older population: data from the Italian GeroCovid Observational study

Author

Coin A., Noale M., Gareri P., Trevisan C., Bellio A., Fini F., Abbatecola A. M., Del Signore S., Malara A., Mossello E., Fumagalli S., Volpato S., Monzani F., Bellelli G., Zia G., Incalzi R. A., Andrieri D., Antognoli R., Antonietti M. P., Bagalà V., Bandini G., Bazzano S., Bellotti F., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bianchi P., Biasin F., Bignamini S., Blandini D., Boffelli S., Bontempi C., Bordignon A., Bracchitta L. M., Bugada M., Cafariello C., Caleri V., Calsolaro V., Calvani D., Campagna F. A., Capasso A., Capurso S., Carino S., Carpagnano E., Carrieri B., Castaldo V., Castelli M., Castellino M., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Ceretti A., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Colombo M., Corsi A., Crispino A., Cucunato R., Custodero C., D’Agostino F., D’Errico M. M., D’Amico F., De Iorio A., De Marchi A., Dell’Armi A., Delmonte M., Desideri G., Devita M., Di Matteo E., Espinosa E., Esposito L., Fazio C., Ferro C., Filippini C., Fiore L., Fiorillo S., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Gasbarri P. P., Giordano A., Giuliani E., Granata R., Coin, A, Noale, M, Gareri, P, Trevisan, C, Bellio, A, Fini, F, Abbatecola, A, Del Signore, S, Malara, A, Mossello, E, Fumagalli, S, Volpato, S, Monzani, F, Bellelli, G, Zia, G, Incalzi, R, Andrieri, D, Antognoli, R, Antonietti, M, Bagalà, V, Bandini, G, Bazzano, S, Bellotti, F, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bianchi, P, Biasin, F, Bignamini, S, Blandini, D, Boffelli, S, Bontempi, C, Bordignon, A, Bracchitta, L, Bugada, M, Cafariello, C, Caleri, V, Calsolaro, V, Calvani, D, Campagna, F, Capasso, A, Capurso, S, Carino, S, Carpagnano, E, Carrieri, B, Castaldo, V, Castelli, M, Castellino, M, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Ceretti, A, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Colombo, M, Corsi, A, Crispino, A, Cucunato, R, Custodero, C, D’Agostino, F, D’Errico, M, D’Amico, F, De Iorio, A, De Marchi, A, Dell’Armi, A, Delmonte, M, Desideri, G, Devita, M, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Ferro, C, Filippini, C, Fiore, L, Fiorillo, S, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Gasbarri, P, Giordano, A, Giuliani, E, and Granata, R

Subjects
BPSD, Profile, Clinical characteristic, Depression, Trazodone, Dementia
Abstract

Background and objectives: Depression is highly prevalent in older adults, especially in those with dementia. Trazodone, an antidepressant, has shown to be effective in older patients with moderate anxiolytic and hypnotic activity; and a common off-label use is rising for managing behavioral and psychological symptoms of dementia (BPSD). The aim of the study is to comparatively assess the clinical profiles of older patients treated with trazodone or other antidepressants. Methods: This cross-sectional study involved adults aged ≥ 60 years at risk of or affected with COVID-19 enrolled in the GeroCovid Observational study from acute wards, geriatric and dementia-specific outpatient clinics, as well as long-term care facilities (LTCF). Participants were grouped according to the use of trazodone, other antidepressants, or no antidepressant use. Results: Of the 3396 study participants (mean age 80.6 ± 9.1 years; 57.1% females), 10.8% used trazodone and 8.5% others antidepressants. Individuals treated with trazodone were older, more functionally dependent, and had a higher prevalence of dementia and BPSD than those using other antidepressants or no antidepressant use. Logistic regression analyses found that the presence of BPSD was associated with trazodone use (odds ratio (OR) 28.4, 95% confidence interval (CI) 18-44.7 for the outcome trazodone vs no antidepressants use, among participants without depression; OR 2.17, 95% CI 1.05-4.49 for the outcome trazodone vs no antidepressants use, among participants with depression). A cluster analysis of trazodone use identified three clusters: cluster 1 included mainly women, living at home with assistance, multimorbidity, dementia, BPSD, and depression; cluster 2 included mainly institutionalized women, with disabilities, depression, and dementia; cluster 3 included mostly men, often living at home unassisted, with better mobility performance, fewer chronic diseases, dementia, BPSD, and depression. Discussion: The use of trazodone was highly prevalent in functionally dependent and comorbid older adults admitted to LTCF or living at home. Clinical conditions associated with its prescription included depression as well as BPSD.

Published
2023

7. [New abdominal wall reconstruction technique with a plastic-rehabilitative intent (back pain improvement)].

Author

Palmieri B, Grappolini S, Blandini D, De-Anna D, Savio S, Ferrari P, Ferrari G, William P, Campanini I, Guido V, Tenchini P, Benuzzi G, and Palmieri L

Subjects
Adult, Aged, Back Pain etiology, Back Pain prevention & control, Female, Humans, Male, Middle Aged, Patient Satisfaction, Polypropylenes, Sciatica etiology, Treatment Outcome, Abdominal Wall surgery, Hernia, Ventral surgery, Surgical Mesh
Abstract

Many abdominal wall reconstruction techniques have generally failed to pay attention to a number of anatomical considerations concerning the continuity of the thoraco-lumboabdominal fascia that envelops the dorsal and ventral muscles. We have introduced a new surgical technique (round mesh) developed to improve the abdominal wall weakness or pathology (hernia, laparocele) with the aim of restoring the muscular synergy between the anterior and posterior trunk compartments, thus improving sacroiliac stability, posture, and standing effort endurance. One hundred patients of both sexes were enrolled in this investigation. All were affected by abdominal wall impairment, frank hernia or laparocele, and had been complaining of lumbar and sciatic pain for long periods without any definite intervertebral disk pathology. They underwent pre- and postoperative subjective and objective evaluation and insertion of a prefascial polypropylene mesh with a posterior martingale that passes across the spine and paravertebral muscles, ending in two wider rectangles that are criss-crossed ventrally and finally sutured to the iliopubic brim. All the patients improved either subjectively or objectively with the round mesh procedure. This new technique is particularly useful in cases of reduction or impairment of the recti abdominis, transverse and oblique muscles, because simple suture and plication of these muscles is no guarantee of long-term functional restoration.

Published
2004

9. The "round block" purse-string suture: a simple method to close skin defects with minimal scarring.

Author

Tremolada C, Blandini D, Beretta M, and Mascetti M

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Cicatrix prevention & control, Humans, Middle Aged, Nylons, Polypropylenes, Postoperative Complications epidemiology, Surgery, Plastic methods, Sutures, Time Factors, Dermatologic Surgical Procedures, Suture Techniques
Abstract

We report the use of a subcuticular purse-string suture for closure of surgical skin defects, a simple maneuver that we have found to be very useful in closing difficult wounds and reducing scarring. The purse-string suture is performed with a large nonabsorbable suture that is passed intradermally and left in situ at least 4 weeks. This technique has been applied in 196 patients for a total of 221 sutures over a period of 2 years, being used to close skin defects from 2 x 2 to 8 x 11 cm in many areas of the body. All the patients showed, at closure, a large number of concentric redundant folds as well as considerable distortion of nearby structures; both improved impressively over a period of 2 to 3 weeks and became nearly normal at the time of suture removal (4 to 8.2 weeks, mean 5.7 weeks). The initially very limited and almost circular scar oriented itself along the skin tension lines over a period of a few weeks and, when matured, was always shorter than the original defect. In general, minimal scar widening occurred when we used larger sutures (more than 0-1) that were left longer (more than 6 weeks). Complications have been 23 cases of dehiscence (10.4 percent) in 23 patients (between the fifth and sixteenth days, mean 6.7 days); they were caused by the bad quality of the skin and by the use of too small sutures that cut through the dermis. The "round block" suture has many advantages: 1. It is a simple, inexpensive, and rapid technique for closing wounds by expanding the surrounding skin and often avoiding the use of skin grafts and/or local flaps. 2. It can minimize scarring; the final scars are shorter than the original defect and usually of very good quality. 3. It allows a very useful temporary closure that stretches the surrounding skin while waiting for the definitive histologic report. If this method is not chosen as a definitive closure, later repair with local flaps may be facilitated. 4. For the reasons expressed above, it never compromises the final result even in cases of dehiscence. The main disadvantage is the acceptability of the method on the part of patients, who need to be carefully prepared for both the gross initial distortion and the long time the suture has to be retained; nevertheless, patient satisfaction with the final results in generally very high, especially in large excisions of the face.

Published
1997
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10. Use of a versatile axial dorsonasal musculocutaneous flap in repair of the nasal lobule.

Author

Blandini D, Tremolada C, Beretta M, and Mascetti M

Subjects
Aged, Carcinoma, Basal Cell surgery, Carcinoma, Squamous Cell surgery, Female, Humans, Male, Nose Deformities, Acquired etiology, Nose Neoplasms surgery, Skin Neoplasms surgery, Nose Deformities, Acquired surgery, Rhinoplasty methods, Surgical Flaps methods
Abstract

We present our 17 years of experience in using a sliding axial musculocutaneous flap from the nasal dorsum in the repair of 53 nasal lobular defects (follow-up 3 to 212 months, mean 47.3 months). This flap is a modification of the classic Rintala flap but is based on a greater understanding of surgical anatomy, the biomechanical properties of skin, and physiology of flaps, all of which allow a more aesthetically satisfactory closure of very distal nasal lobular defects. After excising the tumor, two parallel incisions are made along the sides of the nasal dorsum, and flap is raised in the gliding plane deep to the fibromuscular layer of the nose and superficial to the cartilage and bone and then advanced over the defect, which can be as large as the entire nasal lobule. The flap is very reliable (no failure in our series) and easy to perform; furthermore, it is a fast, one-step reconstructive procedure that leaves the scars in areas of natural shadow. This flap makes use of a wide dorsal and glabellar undermining to recruit sufficient skin; it takes advantage of the mild tension exerted by the underlying nasal framework to lengthen the flap reliably without the need for an extra incision or Burow's triangles, as originally described by Rintala. Neither tip rotation nor glabella flattening has ever been found to be a real problem in our series because the flap elongates in a period of 2 to 6 weeks and tip always comes down, provided that the nasal framework is not modified. We believe that the axial musculocutaneous sliding flap has distinct advantages over other alternative local flaps in the repair of lobular nasal defects; moreover, although this simple operation cannot compete with the quality of the aesthetic results achieved by very skilled masters using frontal flaps, it is an easy, quick, one-step procedure that allows acceptable and reliable aesthetic results to be achieved by the majority of surgeons, and it does not harm the precious forehead donor site, which may become essential in case of the need for further reconstruction.

Published
1996
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11. Iatrogenic nostril stenosis: aesthetic correction using a vestibular labial mucosa flap.

Author

Blandini D, Tremolada C, Beretta M, and Mascetti M

Subjects
Child, Preschool, Constriction, Pathologic, Electrocoagulation adverse effects, Epistaxis surgery, Female, Humans, Iatrogenic Disease, Mucous Membrane transplantation, Nose Deformities, Acquired pathology, Lip surgery, Nose Deformities, Acquired surgery, Surgical Flaps methods
Abstract

Nostril stenosis is an infrequent finding that often has an iatrogenic cause. It is a very difficult problem to resolve and usually requires several months of prosthetic support in order to counteract the recurrence of internal scarring and shrinking. We present a 4-year-old child with a monolateral iatrogenic nostril stenosis. A satisfactory and stable correction was obtained using a "piercing" flap taken from the labial vestibule. The use of a nasal stent (not placed immediately and worn only at night) was necessary for only 2 months. This technique has a number of advantages: the absence of external scars, little or no tendency to recurrence due to the absence of contraction provided by the well-vascularized flap tissue, and the ease and rapidity of the surgical procedure.

Published
1995

12. [Our specific experience in the treatment of epidermolytic lesions in the newborn].

Author

Ercoli A, Saronni A, Fornari M, Blandini D, and Belloni C

Subjects
Beds, Diagnosis, Differential, Humans, Hyperkeratosis, Epidermolytic diagnosis, Infant, Newborn, Male, Skin, Artificial, Time Factors, Hyperkeratosis, Epidermolytic therapy
Abstract

We made use of a peculiar therapeutic practice in a congenital bullous ichthyosiform erythroderma case, which allowed a favourable clinical course and a quick recovery without scared results. We utilized a new skin substitute together with air-fluidized bed, just lonely used in other diseases.

Published
1994

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