Maria Elisa Lozano Miralles

Policlinico di Modena

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Riccardo Cipriani

Azienda USL di Bologna

Marco Pignatti

Azienda USL di Bologna

Valentina Pinto

University of Modena and Reggio Emilia

Federico A. Giorgini

Policlinico di Modena

Salvatore D’Arpa

La Maddalena

Giorgio De Santis

Policlinico di Modena

Chiara Gelati

Azienda USL di Bologna

Giacomo Cannamela

Pierluigi Viale

University of Bologna

Katia Mancuso

Istituto di Ematologia di Bologna

Cooperative Institutions

Policlinico S.Orsola-Malpighi

Azienda USL di Bologna

University of Bologna

Istituti di Ricovero e Cura a Carattere Scientifico

Istituto delle Scienze Neurologiche di Bologna

Policlinico di Modena

University of Modena and Reggio Emilia

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Istituto Ortopedico Rizzoli

Società Italiana di Cardiologia

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Abdominal Wall Transplantation with Microsurgical Technique

Springer eBooks (2023)

Riccardo Cipriani Valentina Pinto Federico Contedini Chiara Gelati Maria Elisa Lozano Miralles

Immunosuppression

10.1007/978-3-031-21520-9_28

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Citations (3)

Meta‐analysis of the effects of venous super‐drainage in deep inferior epigastric artery perforator flaps for breast reconstruction

Microsurgery (2020)

Marco Pignatti Valentina Pinto Federico A. Giorgini Maria Elisa Lozano Miralles Giacomo Cannamela

Abstract Introduction Venous congestion is the most common vascular complication of the deep inferior epigastric artery perforator (DIEP) flaps. Adding a second venous drainage by anastomosing a flap vein and a recipient vein (super‐drainage) is considered the solution of choice. Evidence to support this procedure, had not yet been confirmed by an analysis of the literature. We aimed to provide this evidence. Materials and methods We searched the literature (MedLine, Scopus, EMBASE, Cochrane Library, and Google Scholar), for studies discussing venous congestion and venous super‐drainage in DIEP flap for breast reconstruction. Thirteen of the 35 articles compared results between one or two venous anastomoses. Meta‐analysis was performed following PRISMA guidelines. Pooled risk ratio (RRs) for congestion, fat necrosis, partial necrosis, and total necrosis with corresponding 95% confidence intervals (CI) were calculated using a fixed‐effect model with the Mantel–Haenszel method. The need to return to surgery (95% CI) was estimated with a random effect model using the DerSimonian and Liard method. Results We showed a statistically significant advantage of super‐drainage to reduce the venous congestion of the flap (RR: 0.12, 95% CI: 0.04–0.34, p ‐value <.001), partial flap necrosis (RR: 0.50, 95% CI: 0.30–0.84, p ‐value .008), total flap necrosis (RR: 0.31, 95% CI: 0.11–0.85, p ‐value .023), and the need to take the patient back to surgery for perfusion‐related complications (RR: 0.45, 95% CI: 0.21–0.99, p value .048). Conclusions Performing a second venous anastomosis between the SIEV and a recipient vein (venous superdrainage) reduces venous congestion and related complications in DIEP flaps for breast reconstruction.

DIEP flap

Fat necrosis

10.1002/micr.30682

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Citations (15)

3D Exoscope-Assisted Microvascular Anastomosis: An Evaluation on Latex Vessel Models

Journal of Clinical Medicine (2020)

Valentina Pinto Federico A. Giorgini Maria Elisa Lozano Miralles Achille Tarsitano Maria Martina Panella

Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical field: microsurgical procedures can be performed with the aid of this instrument. Here, we describe our preliminary experience with a high-definition 3D exoscope (VITOM®, Karl Storz, Tuttlingen, Germany), evaluating the characteristics of the instrument, and also its use as a magnification device for microanastomosis training.Six microsurgeons with various levels of experience were asked to perform three end-to-end anastomoses and two end-to-side anastomoses on latex vessel models, using, as a magnification system, the VITOM® 3D 4K exoscope. None of the surgeons involved had previous experience with the exoscope, with robotic surgery, with endoscopic surgery, nor with training simulators.The results of the reported evaluation of the tool's qualities, (VITOM Quality Assessment Tool) included: a good focusing of the surgical field; high image quality; strong luminance; good magnification; clear stereoscopy; and excellent freedom of movement. The exoscope proved to be user-friendly. A constant reduction in the time needed to perform the microsurgical anastomosis at each exercise was recorded. Among other advantages were the easy switching from the magnified image to the macroscopic view, superior ergonomics allowing a relaxed posture while performing the anastomosis, adequate space, and a convenient setting for the assistants to view the operating field.Our study showed that the exoscope VITOM 3D can be successfully used as a magnification tool for microsurgical anastomosis on synthetic vessels, and that it can also be helpful during training courses in microsurgery.

10.3390/jcm9103373

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How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northern Italy

Journal of Plastic Reconstructive & Aesthetic Surgery (2020)

Marco Pignatti Valentina Pinto Maria Elisa Lozano Miralles Federico A. Giorgini Giacomo Cannamela

Pandemic

2019-20 coronavirus outbreak

Center (category theory)

10.1016/j.bjps.2020.05.002

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Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia

Microorganisms (2022)

Andrea Sambri Marco Pignatti Sara Tedeschi Maria Elisa Lozano Miralles Claudio Giannini

This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected ("staged approach"). In five cases, the DT was preserved ("single-stage approach"). A wide debridement was performed, and the cavity was filled with antibiotic-loaded PerOssal beads. All patients had a soft-tissue defect covered by a free vascularized flap (anterolateral thigh perforator flap in eight cases, latissimus dorsi flap in five). At the final follow-up (mean 25 months, range, 13-37), no infection recurrence was observed. In one patient, the persistence of infection was observed, and the patient underwent a repeated debridement. In two cases, a voluminous hematoma was observed. However, none of these complications impacted the final outcome. The successful treatment of FRI depends on proper debridement and obliteration of dead spaces with a flap. Therefore, when dealing with DT FRI, debridement of infected bone and soft tissues must be as radical as required, with no fear of the need for massive reconstructions.

Debridement (dental)

10.3390/microorganisms10081640

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Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature

Microorganisms (2023)

Marco Pignatti Giampiero Dolci Elena Zamagni Renato Pascale Ottavio Piccin

Sternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery for severe aortic valve stenosis, followed by sternal wound dehiscence and sternum osteomyelitis due to extended spectrum beta lactamase (ESBL) producing Klebsiella aerogenes. A multiple myeloma diagnosis was also suspected at the positron emission tomography (PET) scan and confirmed with bone marrow biopsy. Multidisciplinary evaluation of the case led to a comprehensive treatment plan. To control the sternal osteomyelitis, total sternectomy was performed followed by immediate reconstruction with a bone (tibia) graft from the tissue bank and fixation with the minimal hardware possible. A microsurgical latissimus dorsi free flap was required to reconstruct the soft tissue defect. After 6 weeks of antibiotic treatment with ertapenem and fosfomycin based on a culture of intraoperative material, no clinical, imaging, or laboratory signs of infection were seen. Multiple myeloma treatment was then started. At 1 year of follow up, no recurrence of infection occurred, and the reconstruction was stable and closed. Multiple myeloma is under chronic treatment with novel agent combination, with an excellent haematological response.

Ertapenem

Sternum

Wound dehiscence

10.3390/microorganisms11112699

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Citations (1)

Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

Journal of Reconstructive Microsurgery (2020)

Marco Pignatti Valentina Pinto Federico A. Giorgini Maria Elisa Lozano Miralles Salvatore D’Arpa

Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV. We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV. Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis. Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.

DIEP flap

10.1055/s-0040-1716349

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Citations (11)

Deep Inferior Epigastric Perforator Breast Reconstruction With Computer-Aided Design/Computer-Aided Manufacturing Sizers

Annals of Plastic Surgery (2019)

Chiara Gelati Maria Elisa Lozano Miralles Paolo G. Morselli Erich Fabbri Riccardo Cipriani

Background The goal of microsurgical breast reconstruction is to return to the precancer state, maximizing symmetry with less morbidity. This requires a long learning curve, in particular where modeling is concerned. In this context, reverse engineering technologies found an application, allowing the creation of molds that can be used during the surgery. Method We created 10 molds named DIEP sizers , which help to simplify deep inferior epigastric perforator (DIEP) flap insetting. For this, we designed a virtual model using Geomagic X software to construct the sizers. Our model has a thorax circumference, breast projection, and footprint correspondent to an average of the measurements we collected from 15 patients undergoing such surgery. We made a comparative study between 2 groups each of 24 patients, using as comparison criteria surgical times in patients undergoing breast microsurgical reconstruction with or without DIEP sizers. In both groups, we included immediate and delayed reconstructions as well as monolateral, bilateral and monolateral with contralateral symmetrization. Result In all the cases we performed with DIEP sizers, we achieved an average time saving of 105 minutes in monolateral reconstruction, 80 minutes in monolateral reconstruction with contralateral symmetrization, and 120 minutes in bilateral reconstruction ( P < 0.001). No major complications occurred. Conclusions We performed 24 breast reconstructions with preformed molds, obtaining a proper “library” with different DIEP sizers that can be used both in preoperative planning and in intraoperative modeling. We recommend the use of a preformed mold in microsurgical breast reconstruction to improve symmetry, to shorten the learning curve and to save time.

DIEP flap

10.1097/sap.0000000000002020

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Citations (4)