Eugenio Grignaffini

The biological and clinical basis for the use of adipose-derived stem cells in the field of wound healing

Worldwide, hard-to-heal lower limb wounds are estimated to affect 1.5–3% of the adult population with a treatment-related annual cost of

Procedure, applications, and outcomes of autologous fat grafting

10 billion. Thus, chronic skin ulcers of the lower limb are a matter of economic and public concern. Over the years, multiple medical and surgical approaches have been proposed but they are still inadequate, and no effective therapy yet exists. Regenerative medicine and stem cell-based therapies hold great promise for wound healing. Recently, many plastic surgeons have studied the potential clinical application of adipose-derived stem cells (ASCs), which are a readily available adult stem cell population that can undergo multilineage differentiation and secrete growth factors that can enhance wound-healing processes by promoting angiogenesis, and hence increase local blood supply. ASCs have been widely studied in vitro and in vivo in animal models. However, there are few randomized clinical trials on humans, and these are still ongoing or recruiting patients. Moreover, there is no consensus on a common isolation protocol that is clinically feasible and which would ensure reproducible results. The authors aim to provide readers with an overview of the biological properties of ASCs as well as their clinical application, to help better understanding of present and future strategies for the treatment of hard-to-heal wounds by means of stem cell-based therapies.

Autologous fat transplantation for breast reconstruction: A literature review

Objective To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. Patients and methods Literature review of publications concerning autologous fat grafting. Results Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The “wet” method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. Conclusions Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.

Analysis of Complications in Postbariatric Abdominoplasty: Our Experience.

Introduction The use of autologous fat transplantation to correct volume and contour defects, scars, and asymmetry after breast cancer surgery has increased over the past 20 years. Many developments and refinements in this technique have taken place in recent years, and several studies of the safety of lipofilling in the breast have been published. Presentation of case We performed a literature review of this technique, highlighting the crucial role of lipofilling in breast cancer reconstruction. Discussion The efficacy of the fat graft transplantation depends on the experience and the technique used by the surgeon. The ASCs (adipose-derived stem cells) contained in the fat graft has proven to be crucial for breast reconstruction by mean the regeneration of tissue, through the chemotactic, paracrine, and immunomodulatory activities and their in situ differentiation. Conclusion The role of lipofilling for breast reconstruction could be more significant with the application of the findings of experimental research on tissue engineering and ASCs.

Endoscopic forehead muscle resection for nerve decompression: a modified procedure.

Abdominoplasty is one of the most popular body-contouring procedures. It is associated with a significant number of complications: the most common ones are seroma, hematoma, infection, wound-healing problems, and skin flap necrosis. From January 2012 to December 2014, 25 patients (18 women and 7 men) (mean age: 51 years) underwent abdominoplastic surgery at the Plastic Surgery Section, Department of Surgical Sciences, University of Parma, Italy. All patients reported a weight loss between 15 kg and 47 kg. All of the of 25 patients were included in the study; minor and major complications were seen in 17 (68%) and 8 (32%) patients, respectively. The percentage of complications in our patients was as follows: 9 patients with seroma (36%); 4 patients with wound dehiscence with delayed wound healing (16%); 3 cases with hematoma (12%); 2 patients with postoperative bleeding (8%); 1 patient (4%) with an umbilical necrosis; 1 patient (4%) with a deep vein thrombosis; 3 patients with infected seroma (12%); and 2 patients with wound infection (8%). There were no cases of postoperative mortality. The aim of this study is to analyze our complications in postbariatric abdominoplasty.

Surgical Treatment of Frontal and Occipital Migraines: A Comparison of Results

During the last few years, multiple studies have demonstrated the efficacy of migraine and tension-type headache trigger site deactivation surgery, hence expanding the indications of endoscopic techniques and also increasing the therapeutic potentiality of plastic surgery.1–5 These procedures are performed based on headache onset location: 4 trigger points that may cause the compression of the trigeminal branches have been described.3 Intranasal abnormalities (headaches with an intranasal origin) are currently treated with septoplasty and turbinectomy; for patients whose headaches start in the temporal region, a segment of the zygomaticotemporal branch of the trigeminal nerve is resected; for the occipital trigger point, a portion of the semispinalis capitis muscle is removed and the underlying nerve is shielded using a subcutaneous flap to isolate it from surrounding muscles; finally, hyperactive muscles from the glabellar group are dissected in patients with forehead headaches. Currently, forehead headache triggers deactivation is performed through endoscopic surgical decompression of the peripheral branch of trigeminal nerve under general anesthesia. It relies on 3–5 1.5-cm-long access incisions, and it is performed by means of 2 distinct surgical instruments: an endoscope and a dissector. The aim of this study was to demonstrate the efficacy of surgical decompression by means of an innovative minimally invasive endoscopic selective myotomy technique, with the purpose of reducing the invasiveness of the currently adopted techniques.

Surgical therapy of cutaneous squamous cell carcinoma: our experience

METHODS We performed a retrospective comparison between 2 surgical procedures: our modified technique of selective endoscopic myotomies of corrugator supercilii, depressor supercilii, and procerus muscles6–8 for frontal migraine (group A) versus the surgical isolation of the greater and the lesser occipital nerves for disease originating on the posterior region (group B). Both procedures were performed under local anesthesia as 1-day surgery. Group A was constituted by 43 patients who, after a 1.5-cm long midline scalp incision (Fig. 1) and subgaleal dissection, underwent selective myotomies and decompression of the supraorbital and supratrochlear nerves. In group B, 22 patients, after an 8-cm-long scalp incision along the superior nuchal midline (Fig. 2) and dissection of local muscles, underwent release of the greater and the lesser occipital nerves by ligation of the (usually dilated) occipital vascular bundles. For both groups, followup ranged from 6 to 24 months.

Reduction mammoplasty techniques in post-bariatric patients: our experience

Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, with an excellent prognosis after surgical removal. However, nodal metastasis are present in about 5% of cases and the death rate is about 2%. Presentation of case: The aim of this study is to report our experience about the surgical treatment of cSCC at the Cutaneous, Regenerative, Mininvasive and Plastic Surgery Unit, University of Parma, Italy, between January 2014 and February 2016. We statistically analyzed the group of patients regarding the average age, gender, localization and size of the lesions. The surgical margins of the excisions are studied and we report the results obtained after a follow up of 3 to 25 months. Discussion: Between January 2014 and February 2016 in our Cutaneous, Regenerative, Mininvasive and Plastic Surgery Unit, we removed 36 squamous cell carcinomas, including 11 cSCCs in situ. The average annual incidence of squamous cell carcinoma in northeast of Italy is about 28,9 cases per 100,000 individuals.The number of cSCCs that we removed is lower than the Italian average. In our opinion, this is due to an increase in the early diagnosis of precancerous lesions and their medical or surgical treatment. This reduces the incidence of squamous cell carcinomas developing from precancerous lesions. Conclusion: The excision of cutaneous squamous cell carcinoma should be undertaken with a safety margin of at least 0.9 mm to minimize recurrence and metastasis. (www.actabiomedica.it)

Adipose-derived Stem Cells Added to Platelet-rich Plasma for Chronic Skin Ulcer Therapy.

Background and aim of the work: Excessive body weight represents a huge problem affecting a wide part of world population, causing significant physical and psychological consequences. To solve their obesity-related problems, patients should begin a bariatric treatment to lose an adequate percentage of their body mass and therefore, they should be subjected to body contouring surgery. In this article we describe our experience in applying breast remodeling techniques to post-bariatric patients. Methods: We did a retrospective study on our post-bariatric patients subjected to breast reduction and/or mastopexy during a five-years period, considering breast features, kind of surgery performed, aesthetic and psychological outcomes and postoperative complications. Results: Thirty-six post-bariatric patients underwent breast surgery in our unit between 2010 and 2015; their average age was 43 years. The follow up period ranged from 6 months to 4 years and an half. The most frequent surgical techniques performed were Thorek and inferior pedicle breast reduction. The prevalent complications observed were surgical wound delayed healing and nipple-areolar complex (NAC) partial or complete necrosis as immediate ones and unfavorable scarring as delayed ones. Conclusions: Breast reshaping after a massive loss of weight should be forerun by an accurate analysis of breast volume, shape and ptosis degree, in order to obtain optimal results both for the surgeon and the patient. (www.actabiomedica.it)