Marco Brioschi

Posterior tibial artery perforator flaps for coverage of Achilles region defects

BACKGROUND Defects of the Achilles tendon region still represent a tricky issue in lower limb surgery. Among the several reconstructive possibilities, local propeller perforator flaps have gained popularity in the last decade. MATERIALS AND METHODS We report our experience with eight patients affected by small-to-moderate soft-tissue defects of the Achilles tendon region, who underwent surgical reconstruction with local flaps based on posterior tibial perforator branches. RESULTS All patients healed successfully in terms of aesthetic and functional aspect. In only one case a transient venous congestion was observed and this resolved spontaneously. CONCLUSIONS Although the surgical technique requires much care and skill, including an extremely gentle dissection of perforator vessels, local propeller flaps should be considered the first-line choice for reconstruction in small-to-medium size soft-tissue defects in the Achilles region.

Allogeneic epidermal substitutes in the treatment of chronic diabetic leg and foot ulcers

Aim: Diabetic foot ulcers are the most common cause of nontraumatic lower extremity amputations in the industrialized world. Tissue-engineering products offer a lower extremity salvage strategy when healing does not proceed according to the standard of care. New allogeneic sheets are available for the management of diabetic leg and foot ulcers. Methods: The endpoints of this case series study regard preliminary outcomes of the application of allogeneic keratinocytes composed of benzyl ester of hyaluronic acid to 16 diabetic foot and leg ulcers in 11 patients with type 2 diabetes mellitus. Results: Between 21 and 70 days after cellular therapy, 6 out of 16 lesions were completely healed, reducing the wound dimension by 70% and improving the wound bed score by 52%. Conclusion: The clinical results of the new allogeneic sheets indicate that allogeneic keratinocytes may represent an effective and safe therapy for diabetic foot and leg ulcers in the multidisciplinary approach to this diabetes-related complication.

Decision-Making in Anterior Shoulder Instability

The choice of operative treatment after shoulder instability depends highly on the risk of recurrent instability. Although Balg et al. has developed the instability severity index score (ISIS) to aid in the surgical decision making, including the factors contributing to a high risk of recurrent dislocation such as younger age (≤ 20 years old), participation in competitive or contact/forced overhead sport, shoulder hyperlaxity and presence of a Hill-Sachs lesion or glenoid bone loss on anteroposterior radiographs, there are still many other factors to be accounted for. The surgical decision making thus proves to be a challenging process with many factors of influence.

Le vie chirurgiche conservative: anca

The most common conservative approaches to the hip joint are the anterior, the Ganz safe surgical dislocation and the medial approach. The anatomy of these approaches is described in detail in this review. Each approach is also evaluated considering the surgical conservative indications, technique, and complications.

Presepsin: A potential biomarker of PJI? A comparative analysis with known and new infection biomarkers

There is still no “gold standard” for the diagnosis and prognosis of post-operative periprosthetic joint infection (PJI). Among serum biomarkers, an emerging molecule is presepsin, the soluble fraction of CD14, recently described in other settings as a powerful diagnostic tool to detect sepsis at different degrees of severity. The aim of this study was to investigate the diagnostic and prognostic value of presepsin in PJI. A total of 30 patients with PJI and 30 patients without PJI were enrolled. Presepsin, C-reactive protein (CRP), serum interleukin (IL)-6, triggering receptor expressed on myeloid cells 1 (TREM-1), CCL2, matrix metalloproteinase 9 (MMP-9), CD163, osteopontin (OPN), and toll-like receptor 2 (TLR2) were measured at different times after surgery. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker. Presepsin showed greater diagnostic value than CRP and IL-6; CD163, TREM-1, and MMP-9 had very low diagnostic potential. Presepsin, OPN, CCL2, suPAR, and TLR2 all decreased significantly with increasing time of recovery after surgery in PJI patients. Presepsin can be considered a useful tool for the diagnosis and clinical monitoring of PJI and can be backed by a panel of new inflammatory markers involved in monocyte-/macrophage-mediated inflammatory responses, such as OPN, CCL2, TLR2, and suPAR.

General Aspects on Hip Arthroscopy

Sometimes, hip pain is difficult to investigate. This is especially true in pathologies at their first stages. Stages where a hip arthroscopy may be indicated. Pain felt around the hip may be due to intra-articular or extra-articular diseases [1] or to elsewhere-located pathological entities: spine, visceral, or neurological disorders.

La protesi totale d’anca negli esiti traumatici dell’acetabolo

Total hip arthroplasty (THA) for post-traumatic osteoarthritis is a challenging surgery. Several factors should be considered to achieve a successful result: infection risk, surgical approach, possibly hardware removal, ectopic ossification, acetabular bone loss, nonunion and deformity. Different strategies are present in literature. This paper provides a wide revision of available literature. A personal diagnostic and treatment algorithm is proposed to guide surgeons in this atypical decision-making process.