Leonardo Sartore

Electrochemotherapy for disseminated superficial metastases from malignant melanoma

The aim of the study was to determine predictive factors for effectiveness, toxicity and local disease control in patients with malignant melanoma treated with bleomycin‐based electrochemotherapy (ECT).

Facial basal cell carcinoma: analysis of recurrence and follow-up strategies.

Rates of recurrence after incomplete surgical excision of basal cell carcinoma (BCC) range from 4 to 16.6% of analyzed cases. The aim of the present study was to identify the predictive factors associated with facial BBC recurrence following excision and their influences, in order to establish a proper therapeutic strategy. A monocentric retrospective study was performed reviewing all BCCs surgically excised at the Institute of Plastic Surgery, University of Padua, with particular focus on the involvement of surgical margins and recurrence. Seven hundred and nineteen lesions in 605 patients were studied. Correlations between recurrence probability and various characteristics of BCC were analyzed using a logistic regression model. It was observed that incomplete excision, deep margin involvement, the presence of sclerodermiform or metatypic basaloid squamous cells, as well as pleomorphous histological variants and/or peritumoral inflammatory infiltrates, were all related to an increase in the probability of recurrence. BCC excision must be followed by individualized management with particular consideration for the localization, the histological type and other known predisposing factors; the treatment strategy and, in particular, the length of the surveillance period and the frequency of patient assessment should be evaluated on the basis of the recurrence probability outlined.

Tailored PVA/ECM Scaffolds for Cartilage Regeneration

Articular cartilage lesions are a particular challenge for regenerative medicine due to cartilage low self-ability repair in case of damage. Hence, a significant goal of musculoskeletal tissue engineering is the development of suitable structures in virtue of their matrix composition and biomechanical properties. The objective of our study was to design in vitro a supporting structure for autologous chondrocyte growth. We realized a biohybrid composite scaffold combining a novel and nonspecific extracellular matrix (ECM), which is decellularized Whartons jelly ECM, with the biomechanical properties of the synthetic hydrogel polyvinyl alcohol (PVA). Whartons jelly ECM was tested for its ability in promoting scaffold colonization by chondrocytes and compared with polyvinyl alcohol itself and the more specific decellularized cartilage matrix. Our preliminary evidences highlighted the chance of using Whartons jelly ECM in combination with PVA hydrogels as an innovative and easily available scaffold for cartilage restoration.

ECM-based triple layered scaffolds for vascular tissue engineering

The present study focused on the development of three layered small-diameter (<6 mm) extracellular matrix (ECM)-based vessels. These were engineered artificially through the freeze-drying technique. A layer of decellularized bovine aorta (DAM) was deposited on a mandrel and, after lyophilization, it was dipped into a poly-L-lactide acid (PLLA)/polyethylene glycol (PEG) 2000 dichloromethane solution then quickly wrapped with a pre-prepared thin DAM sheet. Mechanical properties of three-layered scaffolds were evaluated by means of uniaxial tensile measurement. Furthermore, human endothelial and smooth muscle cells were seeded on internal and external scaffold surfaces, respectively, and co-cultured for 7 days. Our results demonstrate that i) ECM components provide suitable stimuli for cell adhesion and proliferation, ii) the microporous intermediate PLLA/PEG2000 layer is responsible for the scaffold resistance and iii) the layered deposition technique can be considered a valuable method to obtain layered vascular scaffolds of different sizes and with a good compromise between stiffness and elasticity for optimal cell organization.

Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy

Abstract Background. Peristomal metastases are rare, but potentially associated with relevant morbidity. Surgical resection, followed by stoma relocation, represent the gold standard in most patients. We describe electrochemotherapy (ECT), a minimally invasive method for locally-enhancing drug delivery by means of electric pulses, as an alternative approach. Patient and methods. A 49-year-old man with advanced gastric cancer developed skin metastases around an ileostomy site. The ulcerated and oozing tumor growth impaired patient’s quality of life due to continuous trouble in fitting the ostomy appliance, its poor adherence and consequent stools spillage. ECT consisted of a 20-minute course under mild general sedation. A bleomycin bolus of 15 000 IU/m2 was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode. Results. Post ECT course was uneventful and the patient was discharged on the same day. After one week, tumor nodules were flattened and partial tumor regression was appreciable at one-month follow-up. More importantly, peristomal skin conditions significantly improved, thus allowing for an effective application of the ostomy appliance during the following moths, until patient’s death. Conclusions. This report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors. In selected cases, ECT, by achieving a rapid tumor control, may ensure effective ostomy management and preserve patients’ quality of life.

Evaluation of vascular grafts based on polyvinyl alcohol cryogels.

The present study designed and developed blood vessel substitutes (BVSs) composed of polyvinyl alcohol (PVA) cryogels. The in vitro results demonstrated that the coating of the polymer with lyophilized decellularized vascular matrix (DVM) greatly enhanced the adhesion of human umbilical vein endothelial cells (HUVECs). However, when PVA̸DVM BVSs were implanted into the abdominal aorta of Sprague‑Dawley rats, DVM was identified as a highly thrombogenic surface resulting in the mortality of all animals 3‑4 days after surgery. By contrast, all rats implanted with PVA survived and were sacrificed after 12 months. The luminal surface of the explanted grafts was completely covered by endothelial cells and the inner diameter was similar to that of the original vessel. In conclusion, the present study indicated that PVA may be considered as a promising biomaterial for the fabrication of artificial vessels.

Reduction Mammaplasty and Mastopexy in Previously Irradiated Breasts: Notes on Safety and Pitfalls

We read with great interest the article from Spear et al1; we commend the authors for their engaging and challenging study, which makes a breakthrough on such a relevant topic as reconstructive procedures after breast conservation therapy (BCT). Advances in breast cancer treatment have made BCT an effective and widely adopted surgical strategy. However, morphological and aesthetic outcomes are often not optimal and require secondary breast remodeling that may be confounded by previous radiation therapy. Although based on a small patient cohort, given the paucity of literature on this topic, the study by Spear et al1 provided informative data that will support surgeons in adopting a safe, therapeutic algorithm for patient care. It is important to note that complication rates (28%) could be reduced—even 2 years …

Pediatric digital replantations: regenerative dermis in a salvage procedure.

1. Coleman S. Hand rejuvenation with structural fat grafting. Plast Reconstr Surg. 2002;110:1731–1744; discussion 1745– 1747. 2. Ghobadi F, Zangeneh M, Massoud BJ. Free fat autotransplantation for the cosmetic treatment of first web space atrophy. Ann Plast Surg. 1995;35:197–200. 3. Puwanant A, Evangelisti SM, Griggs RC. Treating the chief complaint: Hand rejuvenation for Hirayama disease. Neurology 2011;77:190–191. 4. Hovius SE, Kan HJ, Smit X, Selles RW, Cardoso E, Khouri RK. Extensive percutaneous aponeurotomy and lipografting: A new treatment for Dupuytren disease. Plast Reconstr Surg. 2011; 128:221–228. 5. Locke MB, de Chalain TM. Current practice in autologous fat transplantation: Suggested clinical guidelines based on a review of recent literature. Ann Plast Surg. 2008;60:98–102.

Malignant glomus tumor of the leg developed in the context of a superficial typical glomus tumor.

A 41-year-old man presented with a 2-cm painful subcutaneous nodule in his right leg, which had been present for more than 10 years and was recently enlarging. Histologically, the tumor was composed of sheets and nests of cells with variable cytomorphology, including typical round/ovoid glomus cells with clear cytoplasm and well-defined borders, small cells, and spindle cells. Numerous medium to large vessels were present. Nodules with moderate to high cellularity, nuclear atypia, and frequent mitotic figures (42 per 50 high-power fields) were noted. Immunohistochemistry showed cytoplasmic and membranous expression of smooth-muscle actin, vimentin, and membranous expression of type IV collagen. Whereas superficiality, dimensions, and long-term follow-up may suggest classification as a symplastic or uncertain potential glomus tumor (GT), histological features and immunoprofile are indicative of malignant nodules developed in a typical GT. The follow-up has been negative for recurrence/metastases. A search of the literature revealed 17 cases of malignant GTs between 1995 and 2010, all fatal, of which 10 had skin as the primary site.

A Case of Squamous Cell Carcinoma of the Scalp After Several Synthetic Hair Grafts

In the early 1970s a novel method for hair restoration was described and gained a large following: hair implantation of artificial synthetic fibers. Though popular, the procedure faced numerous criticisms from the scientific community by the early 1980s, and several major and minor complications in a large number of patients treated were reported. However, there were no reports of any neoplasms as complications of artificial hair implantation. Thus, we report our experience with a novel case of long-term cutaneous neoplastic degeneration of an artificial hair implantation procedure in order to provide new insight on the complications related to this procedure.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at http://www.springer.com/00266.