Giorgia Caruana

A novel and effective strategy for the isolation of adipose-derived stem cells: minimally manipulated adipose-derived stem cells for more rapid and safe stem cell therapy.

Summary: Adipose-derived stem cells are an ideal mesenchymal stem cell population for regenerative medical application. The isolation procedure is performed by mechanical isolation under a laminar air flow bench without using serum or animal-derived reagents; cells were characterized by flow cytometric analysis. Cell availability is improved compared with enzymatic digestion procedures. The adipose-derived stem cell mechanical isolating procedure presented here is easier, safer, cheaper, and faster than traditional currently performed enzymatic procedures.

A Standardized Method of Isolating Adipose-Derived Stem Cells for Clinical Applications.

AbstractWhite adipose tissue is the most abundant and accessible source of stem cells in the adult human body. In this paper, we present a standardised and safe method of isolating and maximizing the number of adipose-derived stem cells (ASCs) from conventional liposuction for clinical applications, which was carried out through both mechanical (centrifuge) and enzymatic (collagenase) means. Isolated cells were characterized through flow cytometry assay. Gathered data showed a greater amount (9.06 × 105 ASCs from 100 mL of adipose tissue) of isolated ASCs compared to previous protocol, also with high (99%) cell vitality; the procedure we presented is easy and fast (80 minutes), allowing collecting a significative number of mesenchymal stem cells, which can be used for clinical purposes, such as wound healing.

A simple technique for the excision of cutaneous carcinoma: the round block purse-string suture

BackgroundPurse-string suture is a simple technique that can be used to reduce the surface area of circular wounds in an effort to obtain minimal scarring. In this report, we provide evidence of the effectiveness of the purse-string suture as a stand-alone procedure that allows a permanent primary complete closure of small to moderate skin defects. The procedure is used primarily for the repair of skin defects due to cutaneous tumor excision in older patients.MethodsThe purse-string suture is executed by using a 1-0 absorbable suture, always by exiting and reentering intradermally and never penetrating the epidermis, in a circumferential fashion.ResultsThe immediate postoperative folds flatten in about a 4-week postoperative time span, and the resulting scar is the smallest obtainable.ConclusionsThe round block purse-string suture is a simple technique which allows complete closure of skin defects without importing tissue from a distance, and it can be particularly suitable for older patients because of their skin laxity.

Video-assisted Thoracic Sympathicotomy for the Treatment of Palmar and Axillary Hyperhidrosis: A 17-Year Experience.

Purpose: Advances in video-assisted thoracoscopic surgery have allowed endoscopic surgical sympathicotomy to become a viable safe therapy for upper limb hyperhidrosis. We evaluated if and how this procedure improves the quality of life in patients after a mean follow-up of 9.5 years. Methods: Between 1995 and 2013, the senior author performed 1440 upper dorsal sympathicotomies in 720 patients. Questionnaires were submitted to randomized patients, both to evaluate the durability of the results and to assess their quality of life after surgery. Results: In 46 patients, anatomical distinctive features obscured the sympathetic chain, precluding partial or total completion of the procedure. The other 674 patients reported complete relief of symptoms. A mean follow-up of 9.5 years (range, 2 to 17 y) was carried out on 450 patients: 6 recurrences have been observed, severe compensatory sweating was reported in 3 patients, and 441 patients were satisfied with nothing to complain. Furthermore, when comparing presurgery and postsurgery results, a statistically significant difference between most of patients answers came out (P=0.001). Conclusion: According to the data obtained, the procedure we described significantly improves the quality of life of treated patients, also proving the durability of this procedure. Discussion: Minimally invasive endoscopic transthoracic sympathicotomy has proven to be an effective and durable surgical treatment for severe primary hyperhidrosis.

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

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.

Relationship between lunar cycle and haemorrhagic complication rate in surgery

Abstract Background: The aim of this study was to evaluate a possible relationship between lunar cycles and haemorrhagic complication rate in surgery. Materials and methods: The possible relationship between moon phases and surgical outcome was tested by evaluating the haemorrhagic complication rate for 18,760 patients who underwent surgery between January 2001 and December 2008 at the National Institute for Cancer Research in Genoa. A total of 103 lunar phases were considered using Chi-square (χ2) test analysis, and patients were allocated a surgery date. Results: One hundred and sixty-seven haemorrhagic complications were observed. Three hundred and nine new moon phase days were analysed and 12 incidences of complications detected, with a 3.9% complication rate per day. In the waxing moon phase, 1184.5 d were analysed with 68 incidences of complications at a daily rate of 5.7%. In the full moon phase there was a 4.9% complication rate per day (15 incidences in 309 d), whereas in the waning moon phase, the 6% percentage rate per day resulted from 72 incidences in 1184.5 d. Conclusions: No statistically significant correlations were found between moon cycles and postoperative haemorrhagic complications (p = .50).

Tips for the surgical treatment of occipital nerve-triggered headaches

BackgroundLiterature from the last decade has shown a correlation between resection of the forehead and/or occipital muscles and relief from migraine headaches.MethodsThe study cohort was 13 patients presenting with well-defined occipital nerve-triggered headaches unresponsive to conservative treatment. We undertook a modified version of the currently used method of occipital migraine surgery. Patients completed questionnaires before and after surgery, and results were compared.ResultsTo identify all trigger points, we used a constellation of symptoms referred to by the patient rather than injection of botulinum toxin type A. The entire procedure was carried out under local anesthesia. It also involved possible isolation of the lesser occipital nerve due to its potential compression sites. No flap was transposed for the purpose of covering isolated nerves. In 11 of 13 patients (85 %) in whom a dilated/aneurysmal occipital artery was found, the procedure was limited to ligation of the occipital artery, with no further undermining of muscles or neurolysis, which reduced the invasiveness of the procedure considerably.ConclusionsThe main differences between our procedure and the currently used method were that (i) extensive undermining or muscular resection was not necessary and (ii) no flap was transposed with the purpose of covering isolated nerves. Hence, our method could improve the currently used method while minimizing its invasiveness and shortening the duration of hospitalization.Level of Evidence: Level IV, therapeutic study.

Minimally Invasive Endoscopic Surgical Treatment of Headache

Migraine and tension-type headache are two very common disabling primary disorders. Their high prevalence and great socioeconomic and personal impacts have been widely documented. Although the prevalence and disabling nature of these disorders has roused the interest of many, these conditions remain widely underdiagnosed and undertreated.

Video-Assisted Thoracoscopic Sympathicotomies for the Treatment of Palmar and Axillary Hyperhidrosis

Hyperhidrosis of the upper limbs is a relatively common functional disorder (1–3 % prevalence) that may negatively impact patients’ daily activities and quality of life, with social and occupational challenges. The prevalence and embarrassing nature of this disorder has roused the interest of many, but significant controversies still surround surgical treatments of primary hyperhidrosis. Conservative treatments such as topical aluminum chloride hexahydrate, anticholinergic drugs, iontophoresis, or injection of botulinum toxin have proved to be only partially useful for a short time.

Scalp Surgery: Quantitative Analysis of Follicular Unit Growth.

Background: Over the years, different kinds of hair transplantation have been compared in an attempt to overcome male pattern alopecia and, at the same time, maximize both the survival and growth rate of grafted hair. In this study, we have assessed the survival and growth rate of follicular units (FU) in an in vitro model, as compared with that of conventional hair micrografts, to experimentally evaluate and elaborate on the differences between these 2 approaches in hair transplantation procedures. Methods: Group A (control; n = 100 follicles) was composed of hair micrografts, whereas FUs were assigned to Group B (experimental; n = 100 follicles, n = 35 FUs). Each group was cultured for a period of 10 days; the total stretch of follicles was measured soon after the harvest and 10 days later. The Kruskal-Wallis one-way analysis of variance on ranks test was used to perform statistical analysis. Results: The growth rate of follicles from Group A (mean 10-day shaft growth rate = 0.30 mm) proved to be statistically different compared with that of Group B (mean 10-day shaft growth rate = 0.23 mm). Conversely, our data did not show any significant difference between the survival rate of hair grafts from these 2 groups. Conclusions: Our data highlighted a reduced FU shaft growth compared with that of hair micrografts, corroborating, to a certain extent, the hypothesis that a significant amount of adipose tissue surrounding the follicle included in the graft may result in an inadequate nourishment supply to follicular cells.