110 research outputs found
STATIC TREATMENT OF PARALYTIC LAGOPHTALMOS WITH AUTOGENOUS TISSUES
No full textStatic treatment of paralytic lagophthalmos with autogenous tissues.
Pirrello R, D'Arpa S, Moschella F.
Source
Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Universitá di Palermo, Via del Vespro, 129, 90138 Palermo, Italy.
Abstract
BACKGROUND:
Long-standing facial paralysis is frequently seen in patients who have undergone surgical procedures with sacrifice of the facial nerve and have never been counseled about limiting its consequences. Lagophthalmos must always be treated in these patients to protect vision. The authors describe their techniques of static treatment for lagophthalmos using autologous tissues and their classification system for standardizing patients.
METHODS:
From July 2001 to September 2005, 12 patients (9 men and 2 women) ranging in age from 37 to 77 years (mean, 58.5 years) were treated. Their paralysis was attributable to acoustic neuroma resection in seven cases, to resection of a cerebral vascular anomaly in two cases, and to total parotidectomy with facial nerve sacrifice in three cases. The patients were treated with elongation of the levator palpebrae superioris muscle using a fascia lata graft, bolstering of the lower eyelid with a conchal cartilage graft, or both, combined with a Kuhnt type resection when needed.
RESULTS:
Complete closure was achieved for nine patients (75%). For all the patients, resolution of symptoms and keratitis was achieved. No complications were observed. The follow-up period ranged from 14 to 51 months (mean, 39.5 months). The cosmetic outcome also was satisfactory.
CONCLUSIONS:
For candidates eligible to undergo static treatment of lagphthalmos, the techniques described may be considered valuable options for the correction of lagophthalmos using autologous tissues, thus avoiding the complications related to alloplastic material implantatio
Bleeding Prophylaxis in a Child With Cleft Palate and Factor VII Deficiency: A Case Report
No full textBleeding prophylaxis in a child with cleft palate and factor VII deficiency: a case report.
Pirrello R, Siragusa S, Giambona C, D'Arpa S, Cordova A, Moschella F.
Source
Dipartimento di Discipline Chirurgiche ed Oncologiche, Sezione di Chirurgia Plastica e Ricostruttiva, Università di Palermo, Palermo, Italy.
Abstract
The association between factor VII deficiency and cleft palate has never been described. The case of a child with cleft palate and factor VII deficiency who successfully underwent palatoplasty is described in this article. To allow surgical treatment, through maintenance of a normal prothrombin time, the patient was given 15 microg/kg of recombinant factor VIIa every 12 hours, starting 20 minutes before surgery and ending the third postoperative day. No abnormal perioperative bleeding was observed. Use of recombinant factor VIIa in bleeding prophylaxis or treatment is widespread. Doses are much higher in these cases. The reduction of dosage allows easier administration, especially in pediatric patients, without affecting drug efficac
Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series.
No full textSuperior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series.
Cordova A, Pirrello R, D'Arpa S, Moschella F.
Source
Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. [email protected]
Abstract
BACKGROUND:
On the basis of a previously published anatomic study on the superior auricular artery (SAA) and on a series of 52 consecutive cases, the authors propose a new superior pedicle retroauricular island flap (SP-RIF) for defects of the upper half of the ear and for temporal region or superficial helical defects.
METHODS:
Twenty five auricular regions were dissected after colored latex injection in the carotid artery of 13 fresh cadavers to investigate the SAA. A SP-RIF was used in 52 consecutive cases after tumor excision. In 51 cases, the defect involved the upper half of the ear. In one case, the defect was in the temporal region.
RESULTS:
The SAA originates either from the superficial temporal artery (44%) or from its parietal branch (56%). Length, caliber, and course have been assessed. Esthetic results of the reconstruction were excellent. There were no major complications in this series. No sequelae at the donor site were recorded.
CONCLUSIONS:
The SP-RIF can be considered as a first choice option to repair nonmarginal losses of substance of the upper half of the ear. Because of its wide arc of rotation, it can also be used for superficial marginal defects of the helix and in selected cases of temporal region defect
Retroauricular skin: a flaps bank for ear reconstruction.
No full textRetroauricular skin: a flaps bank for ear reconstruction.
Cordova A, D'Arpa S, Pirrello R, Giambona C, Moschella F.
Source
Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro 129, 90127 - Palermo, Italy. [email protected]
Abstract
BACKGROUND:
The retroauricular skin has always been given much attention by the reconstructive surgeon for ear and face reconstruction because it is richly vascularised, as many anatomical investigations show, it is hidden behind the ear, its skin is very similar to that of ear and face. All these reasons make it an ideal donor site for ear reconstruction. The authors propose their own algorithm for reconstruction of every kind of anterior defects of the auricle with different Retroauricular Island Flaps (RIFs) based on the location and size of the defect developed over a 16 years single institution's experience with a series of 216 consecutive cases.
MATERIALS AND METHODS:
216 patients have undergone ear reconstruction with RIFs from 1999 to 2006. In 52 a Superior Pedicle RIF (SP-RIF) was used for defects of the upper half of the auricle. In 68 cases a Perforator RIF (P-RIF) was used for conchal reconstruction. In 96 cases an Inferior Pedicle RIF (IP-RIF) was used for reconstruction of nonmarginal and superficial marginal defects of the auricle.
RESULTS:
No flap failure was recorded. Excellent morphological reconstruction was obtained with these flaps with no sequealae at the donor site in terms of form and function. Only in the case of P-RIFs the sulcus becomes flat in its central part, but this has never affected the possibility of wearing spectacles. The SP-RIFs may sometimes show some signs of venous stasis that invariably resolve in the first two postoperative days.
CONCLUSIONS:
The retroauricular skin may be considered a flaps bank for ear reconstruction. It offers in fact a great variety of island flaps that are suitable for every kind of loss of substance of the ear, have a safe vascularisation, skin of similar colour and texture, are easy to harvest under local anaesthesia on an outpatient basis and cause no relevant morbidity at the donor site. Location and size of the defects lead the choice between the different types of RIFs
Anatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap.
No full textAnatomic study on the transverse cervical vessels perforators in the lateral triangle of the neck and harvest of a new flap: the free supraclavicular transverse cervical artery perforator flap.
Cordova A, D'Arpa S, Pirrello R, Brenner E, Jeschke J, Moschella F.
Source
Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro, 129-90127, Palermo, Italy. [email protected]
Abstract
BACKGROUND:
Vessels in the supraclavicular area and their contribution to skin vascularization have always been studied for flaps planning in head and neck reconstruction and many pedicled flaps have been described based on those vessels. Little has been written instead about the vascularization of the supraclavicular skin itself for the use as a free flap. The purpose of this anatomical study was to assess the vascularization of the supraclavicular skin and the possibility of finding an adequate pedicle to harvest it as a free flap in order to close the donor site directly.
METHODS:
A total of 25 cadavers, 10 formalin fixed and 15 fresh, have been studied in cooperation with the Division for Clinical-Functional Anatomy, Department of Anatomy, Histology and Embryology, Innsbruck Medical University, Innsbruck, Austria and the Laboratoire d'Anatomie, Universiteé R. Descartes, Paris, France.
RESULTS:
The supraclavicular skin was nourished by perforators coming from the transverse cervical artery and constantly present in an average number of four. Venous drainage was accomplished through the superficial cervical vein, and not through the venae comitantes of the transverse cervical artery.
CONCLUSIONS:
Based on the results of this investigation, a free supraclavicular transverse cervical artery perforator (STCAP) flap seems to be feasible pedicled on perforators from the transverse cervical artery and drained by the superficial cervical vein. Due to its thickness and skin texture, it can be indicated for facial and intraoral defects, with the limitations of a relatively short pedicle. Primary closure of the donor site can be accomplished concealing the scar in the neck creas
Exploring the role of downy mildew susceptibility genes in Vitis by studying the genetic variation and the in vivo function
No full textViticulture is worldly threatened by fungal pathogens. Management of vineyards entails the use of
great amounts of fungicides in several applications each year, generating a harmful environmental
impact on human health and local biodiversity. In the last decades, resistance (R) loci scouting and
deployment have been the main strategy to cope with some of the most aggressive grapevine
pathogens: Erysiphe necator, the causal agent of powdery mildew (PM), and Plasmopara viticola,
the causal agent of downy mildew (DM). However, R loci-based resistance can be easily overcome
by pathogens within a few years from their introgression. Recently, susceptibility (S) genes have been
used as a new source of durable and broad-spectrum resistance in many crops and tree species. In
grapevine, S genes like VvMLO7 were associated with susceptibility to PM and their role has been
studied, also using knock down mutants. On the other hand, S genes associated to susceptibility to
DM are not yet available in grapevine. Loss of function mutations in AtDMR6 and AtDLO provide
resistance against DM in Arabidopsis, therefore their putative grapevine orthologs VvDMR6.1,
VvDMR6.2, VvDLO1 and VvDLO2 are candidate S genes, likely associated to DM in grapevine .In
this thesis, we explored the role of the aforementioned grapevine S genes starting from a broad genetic
diversity analysis to a functional characterization study on dmr6.1 grapevine plants.
Regarding the survey on genetic variability, VvDMR6.1, VvDMR6.2, VvDLO1 and VvDLO2
were investigated in 190 grapevine genotypes belonging to Vitis vinifera spp., wild species, hybrids
and the so-called hybrid/wild species, in order to find S genes natural mutants. The scouted genes
were deep-sequenced and reads were mapped on PN40024 12× V2 reference genome. A bottleneck
analysis was carried out in order to, firstly, identify SNPs (Single Nucleotide Polymorphisms)
impacting on the coding sequence, then investigate the potential disrupting role of impacting SNPs
on codons and the amino acid sequence and therefore on the protein folding and function. A
representative handful of disrupting SNPs were chosen for confirmation by Sanger sequencing. The
disrupting impact of amino acid mutations caused by the validated SNPs was then checked on a
protein three-dimensional model. DM resistance phenotypic data were collected and compared to the
frequency of the reconstructed haplotypes per each gene. Two of them, in VvDMR6.2, were found
significantly more represented in DM resistant genotypes. VvMLO7 was sequenced in the 190
grapevine accessions as well, and the resulting data were subjected to the same bottleneck analysis.
Once amino acid sequence-disrupting mutations were scouted, we took advantage of the known MLO
protein model to identify those mutations that were changing conserved amino acids. Ten mutations
were predicted to impact protein function, but no association with phenotypic data was possible
since all SNPs were at the heterozygous state. This broad survey provided a resource for grapevine and plant genetics and could corroborate genomic-assisted breeding
programs as well as tailored gene-editing approaches for resistance to biotic stresses.
Functional characterizations of VvDMR6.1, VvDMR6.2, VvDLO1 and VvDLO2 were carried
out taking advantage of dmr6.1 grapevine plants previously obtained by the CRISPR/Cas9 genome
editing technique. Plants of four different edited lines (each line originated from a separate
transformation event) were subjected to P. viticola inoculation assay. Leaves were sampled at 0, 24,
96 hours post-inoculation (hpi) and 8 days post-inoculation (dpi). Samples were collected for several
purposes. A gene expression analysis of VvDMR6 and VvDLO genes and pathogenesis-related genes
was carried out on 0, 24 and 96 hpi samples. Samples taken at 8 dpi were used for symptom
assessment via visual, digital, and histological observation. Since the salicylic acid (SA)-inactive
forms 2,5-dihydrobenzoic acid (2,5-DHBA) and 2,3-DHBA are products of S5H (SA-5-
hydroxylases) and S3H enzymes, putatively encoded by VvDMR6 and VvDLO, these metabolites
were quantified through LC-MS in the same samples collected at 0, 24 and 96 hpi.
This overview on the many aspects related to VvDMR6 and VvDLO gene function, made it
clear that no uniform effect of VvDMR6.1 knock-out was detectable among different edited lines and
further investigations are needed to define the role of the single genes and the relationship among
them
Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy
No full textSurgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy.
Cordova A, Corradino B, Pirrello R, Di Lorenzo S, Dispenza C, Moschella F.
Source
Dipratimento di Discipline Chirurgiche ed Oncologiche, Divisione di Chirurgia Plastica e Ricostruttiva, Facolta di Medicina, Universita di Palermo, Palermo, Italy. [email protected]
Abstract
CONCLUSION:
Our experience confirms that pectoralis major flap is the first-choice technique for repairing recurrent hypopharyngeal fistulae in previously irradiated patients in whom microsurgical techniques are not indicated, and that hyperbaric oxygen therapy helps to solve this complex pathology.
OBJECTIVES:
A pharyngostome is a complication encountered when performing surgical operations on pharyngolaryngeal structures. The authors present their experience of treating recurrent complex pharyngostomes in previously irradiated patients in poor physical health. These patients need a simple, safe reconstruction with a low incidence of postoperative complications.
MATERIAL AND METHODS:
A pedicled pectoralis major flap was used for reconstruction: the skin side of the flap was used to restore the continuity of the pharyngeal mucosa, while the muscle was used to reconstruct the intermediate layer. The skin layer was completed by means of a free skin graft. In all cases, surgical treatment was combined with hyperbaric oxygen therapy before and after the operation.
RESULTS:
A total of 10 patients, all of whom had previously undergone surgery and radiotherapy, had recurring or pluri-recurring pharyngostomes. All patients (8 males, 2 females; age range 52-80 years) had previously been affected by carcinoma of the pharyngolaryngeal region. All underwent major local Ablation together with radical neck dissection and radiotherapy. In all cases there was mucosa on the posterior wall; a musculocutaneous pectoralis major flap was used in all cases for reconstructio
Vascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap.
No full textVascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap.
Cordova A, Pirrello R, D'Arpa S, Jeschke J, Brenner E, Moschella F.
Source
Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Palermo, Italy. [email protected]
Abstract
BACKGROUND:
The supraclavicular skin has been studied extensively and used as a pedicled flap for face and neck reconstruction. Its use as a free flap has not paralleled its use as a pedicled flap. The authors performed an anatomical investigation to assess the possibility of harvesting a free supraclavicular flap with the donor-site scar lying in the supraclavicular crease. In this article, the authors present the results of their anatomical study together with the preliminary clinical applications.
METHODS:
Skin vascularization and feasibility of a free supraclavicular perforator flap were studied on 25 cadavers (15 fresh cadavers injected with colored latex at the Universiteé René Descartes in Paris; and 10 formalin-fixed, noninjected cadavers at the Innsbruck Medical University). The flap was used in two patients at the Plastic Surgery Department of the University of Palermo for a cutaneous facial reconstruction and intraoral reconstruction after cancer excision.
RESULTS:
An average of four perforators were consistently found in the supraclavicular area coming from the transverse cervical artery. Venous perforators drain into the superficial venous plexus rather than into the venae comitantes of the transverse cervical artery. Two flaps were successfully used based on these vessels.
CONCLUSIONS:
The vascularization of the supraclavicular skin depends on skin perforators coming from the transverse cervical artery and draining into the superficial venous plexus. Based on these vessels, a reliable free supraclavicular flap seems to be safe to harvest, with the scar hidden in the supraclavicular crease. The preliminary clinical applications of such a flap gave promising results, suggesting its potential applications
NECK DISSECTIONS: MISCONCEPTIONS, MALPRACTICE AND COMMON CONTROVERSIES
No full textB a c k g ro u n d. Neck metastases are the single most
important prognostic factor in Head and Neck Squamous Cell
Carcinoma. Wise approach to neck treatment is then mandatory
to give a chanche for cure.
Still, there are some issues about neck dissection that
need to be clarified.
M e t h o d s. Through a review of the literature and of
everyday clinical observations, the following issues are discussed:
Functional Neck Dissection, biopsies, nodal levels,
Selective Neck Dissections, Spinal Accessory Nerve, neck dissection
classification.
R e s u l t s. Integration of historical, anatomical, clinical
and surgical concepts and up-to-date knowledge can allow to
understand how to behave in diverse clinical situations.
Conclusions. Standardized guidelines are far to be achieved.
Wise behaviour, however, may allow to avoid some
mistakes. The aim of this paper is to make the above mentioned
issues clear and hopefully give more diffusion to concepts that
too often seem to be overlooked
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