45 results on '"Ciclamini D"'
Search Results
2. Classificazione e trattamento dell’instabilità scafo-lunata post-traumatica
- Author
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Battiston, B., Ciclamini, D., Panero, B., and Boffano, M.
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- 2010
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3. Which are the Limits Nowadays for Indication to Replantation?
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Pierluigi, T, Ciclamini, D, Crosio, A, Odella, S, and Battiston, B
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ddc: 610 ,Replantation ,exeptional replantations ,610 Medical sciences ,Medicine - Abstract
Objectives/Interrogation: Over the years upper limb replantation of small and large segments has experienced a progressive widening of indications because of the improvements in reconstructive techniques. While there are clear indications for replantation or amputation (general and local conditions[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)
- Published
- 2020
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4. Fibulo scapho lunate arthrodesis: an option in case of important loss of substance of the distal radius
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Odella, S, Ciclamini, D, Crosio, A, Bastoni, S, Daolio, P, Battiston, B, Tos, P, Odella, S, Ciclamini, D, Crosio, A, Bastoni, S, Daolio, P, Battiston, B, and Tos, P
- Published
- 2020
5. One bone forearm with vascularized fibular graft. Clinical experience and literature review
- Author
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Artiaco, S., primary, Ciclamini, D, additional, Teodori, J., additional, Dutto, E., additional, Benigno, T., additional, and Battiston, B., additional
- Published
- 2020
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- View/download PDF
6. Flexor digitorum superficialis tenodesis for treatment of flexible swan neck deformity of fingers. Comparison between two surgical techniques to fix the tendon: A pilot study
- Author
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Ciclamini, D, Tos, P, Monticelli, A, Crosio, A, De Blasi, P, and Battiston, B
- Published
- 2019
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- View/download PDF
7. The outcomes of the radial artery forearm free-flap phalloplasty in transgender men: A focus on surgical technique and flap vascular complications
- Author
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Preto, M., primary, Falcone, M., additional, Timpano, M., additional, Ciclamini, D., additional, Crosio, A., additional, Baattiston, B., additional, Tos, P., additional, and Gontero, P., additional
- Published
- 2020
- Full Text
- View/download PDF
8. Treatment of flexor tendon reconstruction failures: multicentric experience with Brunelli active tendon implant
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Poggetti, A., primary, Novi, M., additional, Rosati, M., additional, Ciclamini, D., additional, Scaglione, M., additional, and Battiston, B., additional
- Published
- 2017
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- View/download PDF
9. SC17 - The outcomes of the radial artery forearm free-flap phalloplasty in transgender men: A focus on surgical technique and flap vascular complications
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Preto, M., Falcone, M., Timpano, M., Ciclamini, D., Crosio, A., Baattiston, B., Tos, P., and Gontero, P.
- Published
- 2020
- Full Text
- View/download PDF
10. Indications for use of spare parts
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Battiston, B, Tos, Pierluigi, Sard, A, Ciclamini, D, and Matteotti, R.
- Published
- 2010
11. Protezione sensitiva del muscolo scheletrico denervato. studio sperimentale
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Chirila, L, Tos, Pierluigi, Ciclamini, D, Geuna, Stefano, Ronchi, Giulia, and Battiston, B.
- Published
- 2007
12. Riparazione delle perdite di sostanza nervosa attraverso tubulizzazione
- Author
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Battiston, B, Tos, Pierluigi, Conforti, Lg, Ciclamini, D, Artiaco, S, and Geuna, Stefano
- Published
- 2007
13. Sensory protection of denervated skeletal muscles: experimental results
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Ciclamini, D, Chirila, L, Tos, Pierluigi, Vasario, G, Geuna, Stefano, Ronchi, Giulia, and Battiston, B.
- Published
- 2007
14. Reconstruction of traumatic losses of substance at the elbow
- Author
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Battiston, B., primary, Vasario, G., additional, Ciclamini, D., additional, Rollero, L., additional, and Tos, P., additional
- Published
- 2014
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15. L'artromiolisi secondo Judet nel trattamento delle rigidità post-traumatiche di ginocchio. Analisi retrospettiva di 21 casi
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Pazzano, S., Masse', Alessandro, Biasibetti, A., Dutto, E., Zoccola, K., and Ciclamini, D.
- Published
- 2003
16. Il trattamento delle fratture dell'omero prossimale con endoprotesi di spalla
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Chiavola, M., Ciclamini, D., Zoccola, K., and Masse', Alessandro
- Published
- 2003
17. LOP05
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Tos, P., primary, Ciclamini, D., additional, Panero, B., additional, and Titolo, P., additional
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- 2012
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18. A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery
- Author
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Fabrizio Schonauer, Alexandru Nistor, Santolo Cozzolino, Mario Cherubino, Marco Pignatti, Davide Ciclamini, Salvatore D'Arpa, Valentina Pinto, Pierluigi Tos, Cesare Tiengo, Cristina Garusi, Federico A. Giorgini, Mihai Ionac, Lucian P. Jiga, Alexandru Valentin Georgescu, Giorgio De Santis, Eva Di Maro, Pignatti M., Tos P., Garusi C., Schonauer F., Cherubino M., Tiengo C., Ciclamini D., Cozzolino S., Di Maro E., Jiga L.P., Ionac M., Nistor A., Georgescu A.V., Pinto V., Giorgini F.A., De Santis G., D'Arpa S., Pignatti, M., Tos, P., Garusi, C., Schonauer, F., Cherubino, M., Tiengo, C., Ciclamini, D., Cozzolino, S., Di Maro, E., Jiga, L. P., Ionac, M., Nistor, A., Georgescu, A. V., Pinto, V., Giorgini, F. A., De Santis, G., D'Arpa, S., Pignatti, Marco, Tos, Pierluigi, Garusi, Cristina, Schonauer, Fabrizio, Cherubino, Mario, Tiengo, Cesare, Ciclamini, Davide, Cozzolino, Santolo, Di Maro, Eva, Jiga, Lucian P., Ionac, Mihai, Nistor, Alexandru, Georgescu, Alexandru V., Pinto, Valentina, Giorgini, Federico A., De Santis, Giorgio, and D'Arpa, Salvatore
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medicine.medical_specialty ,Microsurgery ,Superior epigastric artery ,medicine.medical_treatment ,Mammaplasty ,education ,Animal model ,Flap teaching ,Perforator flaps ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Medicine ,Perforator flaps, Animal model, Flap teaching, Microsurgery ,Animals ,Humans ,Medical physics ,General Environmental Science ,Sequence (medicine) ,030222 orthopedics ,business.industry ,Dissection ,030208 emergency & critical care medicine ,Epigastric Arteries ,Learning curve ,General Earth and Planetary Sciences ,business ,Perforator Flap ,Learning Curve - Abstract
Introduction The training to learn how to perform perforator flaps requires practice on a living model to optimize dissection and to evaluate outcome. The purpose of this study was to describe a training model that optimizes the use of animals in order to perform the maximum number of exercises per animal. Material and methods The sequence has been planned and practiced by the first and last author, recorded perfected and implemented in a two-day surgical course. The sequence was then evaluated by the trainers and the trainees by means of a questionnaire. Results All students were able to complete the sequence of exercises before the end of the second day except two (8/10) who could not complete one exercise each. The students considered the Deep Superior Epigastric Artery Perforator flap the most difficult to perform, being the most technically demanding. The sequence of exercises was judged either easily reproducible or reproducible by all the students. Two students suggested to postpone the DSEAP flap to the second day, after some training, to optimize the experience with the most challenging and rewarding flap. Conclusions The training sequence proposed offers a wide range of exercises and allows four trainees, divided in two teams, to work and learn on the same animal. They can perform a wide range of flaps and also harvest the internal mammary vessels. The living model allows for evaluation of the quality of the surgical performance, judged by the difficulties and complications encountered during dissection, and finally through the feedback of flap perfusion.
- Published
- 2020
19. Biopsy of the anterior interosseous motor branch for the pronator quadratus muscle: a safe and minimally invasive diagnostic tool for peripheral neuropathies. Anatomical surgery and surgical technique.
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Titolo P, Rampini AD, Lavorato A, Battiston B, Ciclamini D, Isoardo G, Vincitorio F, Garbossa D, Papalia I, Costa AL, Galeano M, and Colonna MR
- Abstract
Background and Objectives: Choosing the correct site for a nerve biopsy remains a challenge due to nerve sacrifice and major donor site complications, such as neuroma, as seen in sural nerve biopsy. Selecting a deeper donor nerve can help in burying nerve stumps in deep soft tissues, preventing neuroma. Moreover, using an expendable, deeply situated motor nerve can aid indiagnosis when a motor neuropathy is suspected. The authors propose using the pronator quadratus (PQ) branch for this purpose, as it is located deep between the bellies of the flexor muscles and the interosseous membrane in the forearm. This branch is expendable since the denervation of the PQ has a negligible effect on forearm pronation, which is primarily sustained by the pronator teres., Methods: The surgical approach is the same as the approach for anterior interosseous nerve transfer to the motor component of the ulnar nerve in the distal forearm: access is in the midline in the middle third of the forearm under local anesthesia Blunt dissection is performed, separating and retracting the flexor musculotendinous junction to reach the interosseous membrane where the PQ branch is identified. A careful dissection of the nerve branch is performed, allowing a 2 cm long segment to be cut and removed. The proximal stump is then buried into an adjacent muscle belly and the surgical site is closed., Results: The technique is safe and reproducible in experienced hands., Conclusion: This technique may be especially applicable in cases where neurologists need to study motor neuropathies. Contraindications of the technique include wrist instability and high median nerve palsies., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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20. Single-stage versus two-stage bone flap reconstruction in chronic osteomyelitis: Multicenter outcomes comparison.
- Author
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Piccato A, Crosio A, Antonini A, Battiston B, Titolo P, Tos P, and Ciclamini D
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- Humans, Retrospective Studies, Cohort Studies, Surgical Flaps surgery, Chronic Disease, Treatment Outcome, Debridement methods, Plastic Surgery Procedures, Osteomyelitis surgery
- Abstract
Background: Chronic osteomyelitis is an invalidating disease, and its severity grows according to the infection's particular features. The Cierny-Maiden criteria classify it according to the anatomical aspects (I to IV) and also by physiological class (A host being in good immune condition and B hosts being locally (L) or systemically (S) compromised). The surgical approach to chronic osteomyelitis involves radical debridement and dead space reconstruction. Two-stage management with delayed reconstruction is the most common surgical management, while one-stage treatment with concomitant reconstruction is a more aggressive approach with less available literature. Which method gives the best results is unclear. The purpose of this study is to compare single and two-stage techniques., Methods: The authors carried out a retrospective multicentric cohort study to compare two primary outcomes (bone union and infection healing) in one versus two-stage reconstructions with vascularized bone flaps in 23 cases of limb osteomyelitis (22 patients, 23 extremities). Thirteen subjects (56.5%) sustained a single-stage treatment consisting of a single surgery of radical debridement, concomitant soft tissue coverage, and bone reconstruction. Ten cases (43.5%) sustained a two-stage approach: radical debridement, simultaneous primary soft tissue closure, and antibiotic PMMA spacers implanted in 7 patients., Results: No statistical differences were observed between one- and two-stage approaches in bone union rate and infection recurrence risk. Even though bone union seems to be higher and faster in the two-stage than in the one-stage group, and all infection relapses occurred in the one-stage group, data did not statistically confirm these differences. Two of the six cases (33.3%) of bone nonunion occurred in compromised hosts (representing only 17.4% of our sample). The B-hosts bone union rate was 50.0%, while it reached 78.9% in A-hosts, but the difference was not statistically significant (p = .5392). Infection recurrence was higher in B-hosts than in A-hosts (p = .0086) and in Pseudomonas aeruginosa sustained infections (p = .0208), but in the latter case, the treatment strategy did not influence the outcome (p = .4000)., Conclusions: Bone union and infection healing rates are comparable between one and two-stage approaches. Pseudomonas aeruginosa infections have a higher risk of infection relapse, with similar effectiveness of one- and two-stage strategies. B-hosts have a higher infection recurrence rate without comparable data between the two approaches. Further studies with a larger sample size are required to confirm our results and define B-hosts' best strategy., Level of Evidence: Level III of evidence, retrospective cohort study investigating the results of treatments., (© 2023 The Authors. Microsurgery published by Wiley Periodicals LLC.)
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- 2024
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21. Orthoplastic limb reconstruction using free fibula flap after trauma: Outcomes from a retrospective European multicenter study.
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Di Summa PG, de Schoulepnikoff C, Guillier D, Cigna E, Jiga LP, Jandali Z, Vezza D, Giacalone F, Ciclamini D, Battiston B, Elia R, and Maruccia M
- Subjects
- Humans, Fibula transplantation, Retrospective Studies, Bone Transplantation methods, Treatment Outcome, Plastic Surgery Procedures, Free Tissue Flaps
- Abstract
Background: Free vascularized fibula flap represents the gold standard vascularized bone graft for the management of segmental long bone defects after traumatic injury. The current study represents the largest retrospective multicenter data collection on the use of free fibula flap (FFF) for extremities' orthoplastic reconstruction after trauma aiming to highlight current surgical practice and to set the basis for updating current surgical indications., Methods: The study is designed as a retrospective analysis of prospectively collected data between 2009 and 2021 from six European University hospitals. Patients who underwent fibula flap reconstruction after acute traumatic injury (AF) or as a late reconstruction (LF) after post-traumatic non-union of upper or lower limb were included. Only extra-articular, diaphyseal fracture were included in the study. Surgical data were collected. Time to bone healing and complications were reported as clinical outcomes., Results: Sixty-two patients were included in the study (27 in the AF group and 35 in the LF group). The average patients' age at the time of the traumatic event was 45.3 ± 2.9 years in the AF group and 41.1 ± 2.1 years in the LF group. Mean bone defect size was 7.7 ± 0.6 cm for upper limb and 11.2 ± 1.1 cm (p = .32) for lower limb. Bone healing was uneventful in 69% of treated patients, reaching 92% after complementary procedures. Bone healing time was 7.6 ± 1.2 months in the acute group and 9.6 ± 1.5 months in the late group. An overall complication rate of 30.6% was observed, with a higher percentage of late bone complications in the LF group (34%), mostly non-union cases., Conclusions: FFF reconstruction represents a reliable and definitive solution for long bone defects with bone healing reached in 92% cases with a 8.4 months of average bone healing time., (© 2023 Wiley Periodicals LLC.)
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- 2024
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22. Bioengineered dermal matrix (Integra®) reduces donor site morbidity in total phallic construction with radial artery forearm free-flap.
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Falcone M, Preto M, Ciclamini D, Peretti F, Scarabosio A, Blecher G, Cirigliano L, Ferro I, Plamadeala N, Scavone M, Timpano M, and Gontero P
- Abstract
Total phallic construction with radial artery forearm free-flap (RAFFF) is widely regarded as the gold standard approach for phalloplasty. However, donor-site morbidity remains a significant concern, which is typically managed by using a full-thickness skin graft (FTSG) on the forearm. Split thickness skin grafts (STSG) have been proposed as an alternative, along with the use of an acellular dermal matrix substitute. A retrospective comparative analysis was performed to assess the differences in operative, functional and cosmetic outcomes between FTSG (Group A) and the combination of acellular dermal matrix with STSG (Group B). A retrospective cohort study was conducted on all patients who underwent total phallic construction with RAFFF, between 2016 and 2021. Post-operative surgical and functional outcomes were evaluated using validated tools. A total of 34 patients were included in the study, with 18 patients (52.9%) in Group A and 16 patients (47.1%) in Group B. Group B demonstrated a significant advantage in terms of healing time (24 days vs. 30 days, p = 0.003) and complete graft take (93.8% vs. 27.8%, p = 0.001). Group B also had significantly shorter operative times (310 min vs. 447 min, p = 0.001) and a reduced median hospital stay (8 days vs. 10 days, p = 0.001). Satisfaction with cosmesis was significantly higher in Group B (93.8% vs. 66.7%, p = 0.048)., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)
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- 2023
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23. Correlation between Risk Factors and Healing Times in Long Bone Nonunions Treated with Corticoperiosteal Flap from the Medial Femoral Condyle.
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Guzzini M, Ciclamini D, Arioli L, Titolo P, Carrozzo A, Latini F, Battiston B, and Ferretti A
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- Humans, Femur surgery, Fracture Healing, Risk Factors, Bone Transplantation methods, Retrospective Studies, Fractures, Ununited surgery, Free Tissue Flaps
- Abstract
Background: The rate of fracture nonunion varies depending on the anatomical site. Numerous procedures have been proposed to treat recalcitrant nonunions. The vascularized medial femoral condyle corticoperiosteal free flap (MFCCFF) is increasingly used in nonunions with small bone loss.The percentage of success of the MFCCFF is high but the factors involved in delayed bone healing or failure of this technique or the contraindications are not described in the literature.This multicentric study aims to identify and report the different factors involved in determining the time of bone healing in the treatment of atrophic nonunion of long bones with the vascularized medial MFCCFF., Methods: All patients who underwent vascularized medial MFCCFF from January 2011 to December 2020 for the treatment of recalcitrant atrophic nonunions of long bones. Patients were reviewed at 2 and 6 weeks, and 3, 6, and 12 months postoperatively and evaluated by physical and radiographic examinations and patient-reported outcome measures., Results: The final study population comprised 59 patients with a mean follow-up of 26.2 ± 7.6 months, a rate of bone healing of 94.9% with a mean radiographic bone healing time of 4.1 ± 1.3 months, and low morbidity of the donor site. Diabetes mellitus, a body mass index (BMI) ≥30 kg/m
2 , and ≥2 previous surgeries on the fracture site were factors predicting timing for bone healing at the multivariate analysis., Conclusion: This study demonstrates the MFCCFF as an effective and safe procedure for the treatment of the recalcitrant atrophic nonunion of long bones. An association was found between the lengthening of bone healing time and a high BMI, presence of ≥2 previous surgical interventions, and diabetes mellitus, indicating these comorbidities as risk factors (not absolute contraindications) for this microsurgical treatment. So, to our knowledge, the MFCCFF could be the first-choice treatment for atrophic nonunion of long bones., Competing Interests: A.F. is consultant for Arthrex. A.C. received instructional grant from Arthrex. The other authors declare that they have no competing interests., (Thieme. All rights reserved.)- Published
- 2023
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24. Fibulo-scapho-lunate fusion after resection of the distal radius: Case series, review of the literature and critical analysis of bone fixation.
- Author
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Tos P, Odella S, Crosio A, Ciclamini D, Piana R, Bastoni S, and Daolio PA
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- Bone Plates, Fibula diagnostic imaging, Fibula surgery, Humans, Radius diagnostic imaging, Radius surgery, Wrist Joint diagnostic imaging, Wrist Joint surgery, Bone Neoplasms, Radius Fractures diagnostic imaging, Radius Fractures surgery
- Abstract
Fibulo-scapho-lunate fusion is a technique that allows residual movement in the wrist in case of wide bone resection replacing the distal radius by a vascularised fibular transfer. Some authors have used this technique with favourable results but the distal synthesis seems to not be standardised at all, many different osteosynthesis methods have been proposed. This paper reports a complete review of the present day literature about this subject and, evaluating the different proposed osteosynthesis techniques referred in literature, suggests a standardization of the synthesis methods with dorsal plating. We report some technical considerations and results of three cases operated with a stable dorsal osteosynthesis (twice with a double plate and once with a long plate). We evaluate the time of healing and the clinical result., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest., (Copyright © 2020. Published by Elsevier Ltd.)
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- 2020
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25. A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery.
- Author
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Pignatti M, Tos P, Garusi C, Schonauer F, Cherubino M, Tiengo C, Ciclamini D, Cozzolino S, Di Maro E, Jiga LP, Ionac M, Nistor A, Georgescu AV, Pinto V, Giorgini FA, De Santis G, and D'Arpa S
- Subjects
- Animals, Dissection, Epigastric Arteries, Humans, Learning Curve, Mammaplasty, Perforator Flap
- Abstract
Introduction: The training to learn how to perform perforator flaps requires practice on a living model to optimize dissection and to evaluate outcome. The purpose of this study was to describe a training model that optimizes the use of animals in order to perform the maximum number of exercises per animal., Material and Methods: The sequence has been planned and practiced by the first and last author, recorded perfected and implemented in a two-day surgical course. The sequence was then evaluated by the trainers and the trainees by means of a questionnaire., Results: All students were able to complete the sequence of exercises before the end of the second day except two (8/10) who could not complete one exercise each. The students considered the Deep Superior Epigastric Artery Perforator flap the most difficult to perform, being the most technically demanding. The sequence of exercises was judged either easily reproducible or reproducible by all the students. Two students suggested to postpone the DSEAP flap to the second day, after some training, to optimize the experience with the most challenging and rewarding flap., Conclusions: The training sequence proposed offers a wide range of exercises and allows four trainees, divided in two teams, to work and learn on the same animal. They can perform a wide range of flaps and also harvest the internal mammary vessels. The living model allows for evaluation of the quality of the surgical performance, judged by the difficulties and complications encountered during dissection, and finally through the feedback of flap perfusion., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Ltd.)
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- 2020
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26. Long-term clinical results of 33 thumb replantations.
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Giardi D, Crosio A, Rold ID, Magistroni E, Tos P, Titolo P, Battiston B, and Ciclamini D
- Subjects
- Female, Hand Strength, Humans, Male, Replantation, Thumb surgery, Amputation, Traumatic surgery, Finger Injuries
- Abstract
Introduction: Thumb replantation following complete amputation is a relatively frequent and well-established surgical procedure. In literature many studies report a discrepancy between the objective measurements and the subjective satisfaction of the patients. Nowadays, evaluation of the patient long-term benefit obtained by replantation is uncertain. The aim of this study was to consider the long-term results of 33 thumb replantation procedures., Methods: The period considered is from January 1997 to December 2015, 33 subjects fulfilled the study inclusion criteria and were included in the study. We evaluated in each patient: ROM (performing Kapandji test), level and mechanism of amputation, force peak of three grips using Dexter dynamometer (five-handle, key, tri-digital grips), sensibility (using Disk-Criminator and aesthesiometers of Semmes-Weinstein) and subjective perception of disability (using DASH questionnaire)., Results: All patients were males, 94% of them returned to their previous occupation. Average follow-up was 9±4 years. The prevalent mechanism of injury was a combined amputation in 58% of cases. Levels involved in more than half of patients were interphalangeal joints and proximal phalanxes. Ratios of strength recovery were: for the five-handle grip equal to 0.90±0.28 kg (p=0.63), 0.78±0.30 kg (p=0.64) for key grip and 0.75±0.32 kg (p=0.78) for tri-digital grip. Results for Kapandji test was 8±2 and for DASH test was 16±21. The protective tactile threshold was recovered in 49% of patients; S2PD test resulted positive in 54% and D2PD test in 39% of cases., Conclusions: Results confirm and strengthen evidence of positive long-term functional outcomes of thumb replantation interventions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Ltd.)
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- 2020
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27. The surgical outcomes of radial artery forearm free-flap phalloplasty in transgender men: single-centre experience and systematic review of the current literature.
- Author
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Falcone M, Preto M, Timpano M, Ciclamini D, Crosio A, Giacalone F, Battiston B, Tos P, and Gontero P
- Subjects
- Humans, Male, Forearm surgery, Penis surgery, Radial Artery surgery, Retrospective Studies, Treatment Outcome, Sex Reassignment Surgery, Transgender Persons
- Abstract
Radial artery forearm free-flap (RAFFF) phalloplasty is considered by most authors as the gold-standard technique for genital gender-affirming surgery (GGAS). RAFFF surgical complications have rarely been investigated, and the aim of this study and literature review is to analyse and focus on the surgical technique and its postoperative vascular complications. From May 2016 to January 2020, a consecutive series of 25 transgender men who underwent GGAS were enrolled in the present study. Age, BMI and smoking habits were recorded for all patients. Overall, vascular flap complications occurred in 20% of cases. Complete flap loss due to acute arterial thrombosis was recorded in a single case (4%). In 8% of cases, limited ventro-proximal arterial ischaemia was detected, while in the remaining 8% of cases, venous ventral ischaemia was reported. These results were compared with the current literature results. Indeed, from our analysis, the number of flap veins (<2) was the only predictive factor for vascular complications. In conclusion, RAFFF represents a reliable option for total phallic construction, leading to satisfactory results in terms of flap survival. To optimize the surgical outcomes, venous vascular drainage should be recommended., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.)
- Published
- 2020
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28. Compound or Specially Designed Flaps in the Lower Extremities.
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Battiston B, Ciclamini D, and Tang JB
- Subjects
- Bone Transplantation, Female, Fractures, Bone therapy, Fractures, Ununited surgery, Hand Injuries surgery, Humans, Lower Extremity injuries, Male, Skin Transplantation, Soft Tissue Injuries surgery, Lower Extremity surgery, Plastic Surgery Procedures methods, Surgical Flaps blood supply
- Abstract
Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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29. The Robotic Scope can be a Useful Tool for Hand and Microsurgical Procedures during the COVID-19 Pandemic.
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Battiston B, Artiaco S, and Ciclamini D
- Abstract
Competing Interests: Conflict of Interest None declared.
- Published
- 2020
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30. Treatment of chronic Osteomyelitis with vascularized bone flaps in one-stage-procedure.
- Author
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Ciclamini D, Antonini A, Tos P, Crosio A, Piccato A, and Battiston B
- Subjects
- Bone Transplantation, Debridement, Humans, Retrospective Studies, Surgical Flaps surgery, Treatment Outcome, Osteomyelitis surgery, Plastic Surgery Procedures
- Abstract
Background: Chronic osteomyelitis is a long-standing infection of the bone. Treatment is often combined, using antibiotics and surgery (with radical debridement and secondary or concomitant reconstruction). One-stage management is an alternative approach, with few reported cases in literature., Patients/material and Methods: We carried out an observational retrospective multicenter study to evaluate the results of one-stage reconstructions with vascularized bone flaps. We assessed bone and infection healing in 14 cases, with a mean follow-up of 63.6 months., Results: Bone union was obtained in 10 cases (71.4 %) in a mean period of 7.9 months. Nonunion occurred in 4 cases (28.6 %), 2 of them with infection persistence. Bone nonunion risk increases in polymicrobial infections (p = 0.0269) and in compromised hosts (p = 0.0110). Infection healing was achieved in 11 cases (78.6 %). Fistula recurred in 3 cases of forearm osteomyelitis (21.4 %) in 10 months on average. Infection recurrence is associated with polymicrobial infections (p = 0.0378) and is higher in internal fixation and compromised hosts with no statistically significant relation., Conclusions: One-stage surgical treatment seems to be an effective approach in selected patients, in particular when an important impairment of local soft tissue and bone exposure are present, and immediate bone coverage with vascularized soft tissue is needed. Most complications occurred in compromised hosts and in patients with polymicrobial cultures. Further research, with comparison between one and two-stage procedures, is needed in order to strengthen the level of evidence., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2020
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31. The medial femoral condyle free corticoperiosteal flap versus traditional bone graft for treatment of nonunions of long bones: a retrospective comparative cohort study.
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Ciclamini D, Tos P, Guzzini M, Soldati A, Crosio A, and Battiston B
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Fractures, Ununited surgery, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult, Bone Transplantation methods, Femur surgery, Fracture Healing, Fractures, Bone surgery, Free Tissue Flaps, Ilium transplantation, Periosteum transplantation, Plastic Surgery Procedures methods
- Abstract
Fracture healing is a complex process and many factors change the local biology of the fracture and reduce the physiologic repair process. Since 1991 the free vascularised corticoperiosteal graft has been proposed to treat nonunions. In this study we compare the healing rate and the healing time of the free vascularised corticoperiosteal graft harvested from medial femoral condyle versus the traditional cancellous bone graft from the iliac crest combined with other biologic or pharmacologic factors. We performed a retrospective cohort study. The main measures of outcomes were the rate of bone union and the mean healing time from surgery. The authors performed 10 free vascularised corticoperiosteal grafts in the cohort A and 10 patients received traditional cancellous bone graft plus other biologic or pharmacologic treatment in the same period in the cohort B. The mean follow up in cohort A was 18.6 months with a healing rate of 100% (10/10). In cohort B the mean follow up was 22.5 month with a healing rate of 90%. The mean time to obtain union (healing time) in the group that was treated with the free flap procedure was significantly shorter, 3.2 months versus a mean time of 8.8 months in the other group. Some studies describe a high healing rate of recalcitrant nonunions with treatments different from vascularized bone flaps: it is difficult to compare the results of vascularized bone transfers with the results of other case series. Our groups are very homogeneous even if it is difficult to define correct inclusion criteria because there is still no agreement about what is defined a recalcitrant or difficult nonunion, and the number of trials of previous surgery before to perform a vascularized free flap. Even if our study cohort is small, we have demonstrated that the MFCCF generally seems to give a better healing chance with a shorter healing time compared to other treatments., (Copyright © 2019. Published by Elsevier Ltd.)
- Published
- 2019
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32. Combining nerve and tendon transfers in tetraplegia: a proposal of a new surgical strategy based on literature review.
- Author
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Titolo P, Fusini F, Arrigoni C, Isoardo G, Conforti L, Artiaco S, Ciclamini D, Sicari M, and Battiston B
- Subjects
- Humans, Muscle Strength, Muscle, Skeletal physiopathology, Quadriplegia classification, Tenodesis, Time Factors, Nerve Transfer, Quadriplegia physiopathology, Quadriplegia surgery, Tendon Transfer, Upper Extremity physiopathology
- Abstract
Spinal cord injury (SCI) is very common, most frequently resulting from motor vehicle accidents and falling from a height. Often, SCI occurs at the cervical level, resulting in tetraplegia, which consists of loss of effective arm and/or hand function. For these patients, hand function is considered the most desired function, above bowel, bladder and sexual function. Fortunately, understanding about nerve and tendon transfers is steadily growing, providing new surgical solutions for functional restoration in tetraplegia patients. The primary aim of this systematic review of the literature is to assess all the various ways to improve upper-limb function, using both nerve transfers and classical tendon transfers in patients suffering from tetraplegia. Surgical indications, optimum timing and contraindications were reviewed. In accordance with the International Classification for Surgery of the Hand in Tetraplegia, ten subgroups of tetraplegic patients were analysed and a proposal for treatment combining nerve and tendon transfers formulated for each subgroup, seeking alternatives to classical surgical strategies. We also sought to propose strategies that, in instances of failure, still would allow for the use of some classical surgical approach. Starting with traditional management, we proposed new strategies using tenodesis and tendon transfers in association with nerve surgery. We believe that the suggestions described in the current paper could both improve and complete current surgical strategies and contribute to ensuring that more patients benefit from these options in future.
- Published
- 2019
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33. Below Knee Stump Reconstruction with a Foot Fillet Flap.
- Author
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Tos P, Antonini A, Pugliese P, Panero B, Ciclamini D, and Battiston B
- Subjects
- Amputation Stumps physiopathology, Humans, Knee Joint physiopathology, Salvage Therapy, Treatment Outcome, Amputation Stumps surgery, Foot transplantation, Graft Survival physiology, Knee Joint surgery, Plastic Surgery Procedures methods, Surgical Flaps blood supply, Tissue and Organ Harvesting
- Abstract
Competing Interests: Conflict of Interest: None.
- Published
- 2017
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34. Peripheral Nerve Defects: Overviews of Practice in Europe.
- Author
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Battiston B, Titolo P, Ciclamini D, and Panero B
- Subjects
- Europe, Humans, Radial Nerve injuries, Transplantation, Autologous, Peripheral Nerve Injuries surgery, Radial Nerve surgery
- Abstract
Many surgical techniques are available for the repair of peripheral nerve defects. Autologous nerve grafts are the gold standard for most clinical conditions. In selected cases, alternative types of reconstructions are performed to fill the nerve gap. Non-nervous autologous tissue-based conduits or synthetic ones are alternatives to nerve autografts. Allografts represent another new field of interest. Decision making in the treatment of nerve defects is based on timing of referral, level of the injury, type of lesion, and size of any gap. This review focuses on current clinical practice, influenced by the numerous new experimental researches., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
35. Compound or Specially Designed Flaps in the Lower Extremities.
- Author
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Battiston B, Ciclamini D, and Tang JB
- Subjects
- Bone Transplantation, Fracture Fixation, Internal, Humans, Treatment Outcome, Fractures, Ununited surgery, Hand Injuries surgery, Leg Injuries surgery, Plastic Surgery Procedures, Soft Tissue Injuries surgery, Surgical Flaps
- Abstract
Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
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36. Replantation: current concepts and outcomes.
- Author
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Bueno RA Jr, Battiston B, Ciclamini D, Titolo P, Panero B, and Tos P
- Subjects
- Humans, Amputation, Traumatic surgery, Finger Injuries surgery, Microsurgery methods, Replantation methods
- Abstract
Techniques to improve the chance of successful replantation of digits are well established. Indications and contraindications for replantation are generally agreed on, but they continue to evolve as excellent outcomes are achieved at centers with experience and expertise. Form and function can be restored with avulsion injuries and distal amputations, with good results and high patient satisfaction. Increased financial pressure to control the costs of health care and increased accountability for evidence-based outcomes may lead to the regionalization of replantation care and shared decision making in recommending replantation or revision amputation., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
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37. Update on nerve repair by biological tubulization.
- Author
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Geuna S, Tos P, Titolo P, Ciclamini D, Beningo T, and Battiston B
- Abstract
Many surgical techniques are available for bridging peripheral nerve defects. Autologous nerve grafts are the current gold standard for most clinical conditions. In selected cases, alternative types of conduits can be used. Although most efforts are today directed towards the development of artificial synthetic nerve guides, the use of non-nervous autologous tissue-based conduits (biological tubulization) can still be considered a valuable alternative to nerve autografts. In this paper we will overview the advancements in biological tubulization of nerve defects, with either mono-component or multiple-component autotransplants, with a special focus on the use of a vein segment filled with skeletal muscle fibers, a technique that has been widely investigated in our laboratory and that has already been successfully introduced in the clinical practice.
- Published
- 2014
- Full Text
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38. Particularities of hand and wrist complex injuries in polytrauma management.
- Author
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Ciclamini D, Panero B, Titolo P, Tos P, and Battiston B
- Subjects
- Carpal Joints diagnostic imaging, Compartment Syndromes diagnostic imaging, Early Diagnosis, Female, Fractures, Bone diagnostic imaging, Hand Injuries diagnostic imaging, Humans, Ligaments, Articular injuries, Ligaments, Articular surgery, Male, Multiple Trauma diagnostic imaging, Radiography, Range of Motion, Articular, Vascular System Injuries diagnostic imaging, Wrist Injuries diagnostic imaging, Compartment Syndromes surgery, Fractures, Bone surgery, Hand Injuries surgery, Multiple Trauma surgery, Vascular System Injuries surgery, Wrist Injuries surgery
- Abstract
Hand and wrist lesions are relatively common in polytraumatised patients. These subjects sustain a wide range of potential life-threatening conditions and hand and wrist injuries incurred are often not diagnosed or are insufficiently treated. Closed lesions are the most frequently missed diagnosis, but even severe open lesions may be incorrectly treated. Most of these hand and wrist injuries can have a strong negative impact on long-term quality of life, particularly when treatment of these injuries is poor or delayed. Orthopaedic and hand surgeons should be vigilant in their assessment and treatment of patients with multiple injuries and a global approach, based on the advanced trauma life support (ATLS)-protocol, must be applied. The very common association of head, chest, abdomen, bone and soft-tissue lesions in the polytraumatised patient requires a multidisciplinary team approach from the beginning. The energy of trauma in these patients often causes complex injuries to the wrist and hand; these require correct treatment in terms of both timing and techniques. It is not possible to create a practical, useful guideline with a "one lesion-one solution" approach, because every case is different; therefore, this paper describes a spectrum of indications and techniques that may be useful in managing hand and wrist injuries, particularly in polytraumatised patients., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
- Published
- 2014
- Full Text
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39. Ultrasound-guided pulse-dose radiofrequency: treatment of neuropathic pain after brachial plexus lesion and arm revascularization.
- Author
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Magistroni E, Ciclamini D, Panero B, and Verna V
- Abstract
Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain.
- Published
- 2014
- Full Text
- View/download PDF
40. Acute compartment syndrome of the arm after minor trauma in a patient with optimal range of oral anticoagulant therapy: a case report.
- Author
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Titolo P, Milani P, Panero B, Ciclamini D, Colzani G, and Artiaco S
- Abstract
Compartment syndrome of the arm is a rare event that can be subsequent to trauma or other pathological and physical conditions. At the arm the thin and elastic fascia may allow accumulation of blood more than in other districts, especially in patients undergoing anticoagulant therapy. We describe a rare case of an acute compartment syndrome of the arm after minor trauma with partial biceps brachii rupture in a patient with warfarin therapy and optimal value of INR. Prompt diagnosis and surgical decompression helped to avoid the occurrence of complications with a satisfying recovery of arm function.
- Published
- 2014
- Full Text
- View/download PDF
41. Clinical applications of end-to-side neurorrhaphy: an update.
- Author
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Tos P, Colzani G, Ciclamini D, Titolo P, Pugliese P, and Artiaco S
- Subjects
- Brachial Plexus injuries, Brachial Plexus pathology, Humans, Plastic Surgery Procedures, Brachial Plexus surgery, Nerve Regeneration, Nerve Transfer methods, Neurosurgical Procedures
- Abstract
End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management.
- Published
- 2014
- Full Text
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42. Lower Limb Core Scale: a new application to evaluate and compare the outcomes of bone and soft-tissue tumours resection and reconstruction.
- Author
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Monticelli A, Ciclamini D, Boffano M, Boux E, Titolo P, Panero B, Battiston B, Piana R, and Tos P
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Bone and Bones pathology, Cohort Studies, Female, Humans, Lower Extremity pathology, Male, Middle Aged, Quality of Life, Soft Tissue Neoplasms pathology, Treatment Outcome, Bone and Bones surgery, Lower Extremity surgery, Plastic Surgery Procedures methods, Soft Tissue Neoplasms surgery
- Abstract
Several methods are used to evaluate the functional outcome of tumour resections and reconstructions in the lower limb. However, one of their most common limitations is that they are specifically developed to evaluate only oncological patients. We introduced the Lower Limb Core Scale (LLCS) to overcome this limitation. The aim of this study was to evaluate the functional and subjective results in the lower limb and to evaluate the use of the LLCS. We conducted a retrospective cohort study using various tools to investigate the outcomes. The results of the LLCS were correlated with the results of other functional tests. A total of 44 patients were included in the study. None of the demographic variables correlated with the functional or health-related quality of life (QoL) scores except for gender, whereby male patients had an increased functional score. The correlation between LLCS and other scores was positive (r (2) = 0.77). The satisfactory QoL scores, and functional outcomes scores indicated the LLCS to be a reliable option for general and specific evaluation of lower limb reconstructions. We suggest using the LLCS for comparisons of oncological reconstructions with lower limb reconstructions in different disciplines.
- Published
- 2014
- Full Text
- View/download PDF
43. New tendon transfer for correction of drop-foot in common peroneal nerve palsy.
- Author
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Titolo P, Panero B, Ciclamini D, Battiston B, and Tos P
- Subjects
- Female, Humans, Male, Equinus Deformity surgery, Gait Disorders, Neurologic surgery, Peroneal Neuropathies complications, Tendon Transfer methods
- Published
- 2013
- Full Text
- View/download PDF
44. Functional and subjective results of 20 thumb replantations.
- Author
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Ciclamini D, Tos P, Magistroni E, Panero B, Titolo P, Da Rold I, and Battiston B
- Subjects
- Adolescent, Adult, Aged, Amputation, Traumatic epidemiology, Amputation, Traumatic physiopathology, Disability Evaluation, Female, Finger Injuries epidemiology, Finger Injuries physiopathology, Follow-Up Studies, Humans, Italy epidemiology, Male, Microsurgery, Middle Aged, Perception, Range of Motion, Articular, Recovery of Function, Retrospective Studies, Thumb injuries, Thumb physiopathology, Time Factors, Treatment Outcome, Amputation, Traumatic surgery, Finger Injuries surgery, Hand Strength, Plastic Surgery Procedures methods, Replantation methods, Sensation, Thumb surgery
- Abstract
The aim of this retrospective study was to analyse the results of 20 thumb replantations with special and exhaustive attention on functional outcomes. Twenty patients with traumatic thumb amputation were enrolled in the study. Range of motion, grip strength, sensory recovery, and subjective perception of overall hand function recovery were measured. The average age at the time of surgery was 35 years (range, 13-73 years). The mean follow-up was 3.25 years (range, 1.9-10.25 years). The long-term results of thumb replantation confirmed satisfactory outcomes in terms of general upper limb function, handgrip and pinch strength, and social and work reintegration. Sensory recovery remained unsatisfactory despite the fact that we did not need to perform any kind of revision surgery as a consequence of inadequate thumb sensibility. For the first time in the existing literature, no functional parameter that contributes to the assessment of the function of replanted thumbs has been excluded. We resume in the same study the analysis of all functional parameters that are useful to define results of thumb replantation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
45. Primary repair of crush nerve injuries by means of biological tubulization with muscle-vein-combined grafts.
- Author
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Tos P, Battiston B, Ciclamini D, Geuna S, and Artiaco S
- Subjects
- Adolescent, Adult, Female, Follow-Up Studies, Humans, Male, Median Nerve surgery, Middle Aged, Recovery of Function, Retrospective Studies, Treatment Outcome, Ulnar Nerve surgery, Young Adult, Arm Injuries surgery, Guided Tissue Regeneration methods, Median Nerve injuries, Muscle, Skeletal transplantation, Peripheral Nerve Injuries surgery, Ulnar Nerve injuries, Veins transplantation
- Abstract
Despite extensive research and surgical innovation, the treatment of peripheral nerve injuries remains a complex issue, particularly in nonsharp lesions. The aim of this study was to assess the clinical outcome in a group of 16 patients who underwent, in emergency, a primary repair for crush injury of sensory and mixed nerves of the upper limb with biological tubulization, namely, the muscle-vein-combined graft. The segments involved were sensory digital nerves in eight cases and mixed nerves in another eight cases (four median nerves and four ulnar nerves). The length of nerve defect ranged from 0.5 to 4 cm (mean 1.9 cm). Fifteen of 16 patients showed some degree of functional recovery. Six patients showed diminished light touch (3.61), six had protective sensation (4.31), and three showed loss of protective sensation (4.56) using Semmes-Weinstein monofilament test. All the patients who underwent digital nerve repair had favorable results graded as S4 in one case, S3+ in six cases, and S3 in one case. With respect to mixed nerve repair, we observed two S4, two S3+, two S3, one S2, and one S0 sensory recovery. Less favorable results were observed for motor function with three M4, one M3, two M2, and two M0 recoveries. Altogether, the results of this retrospective study demonstrates that tubulization nerve repair in emergency, in case of short nerve gaps, may restore the continuity of the nerve avoiding secondary nerve grafting. This technique preserves donor nerve and, in case of failure, does not preclude a delayed repair with a nerve graft., (Copyright © 2012 Wiley Periodicals, Inc.)
- Published
- 2012
- Full Text
- View/download PDF
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