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Biomedical subjects

Nicolò Scuderi

Publications and source records attributed to Nicolò Scuderi.

At least 19 recordsLinked to original sources
PubMed2006

Role of adipokines in the obesity-inflammation relationship: the effect of fat removal.

During the past 10 years, there has been a dramatic increase in the prevalence of obesity in the United States and other developed nations. Recent studies indicate that adipose tissue is an endocrine organ producing numerous proteins, collectively referred to as adipokines, with broad biological activity, that play an important autocrine role in obesity-associated complications. Adipose tissue in general and visceral fat in particular are thought to be key regulators of inflammation. Inflammation is heavily involved in the onset and development of atherothrombotic disease. Moreover, chronic inflammation may also represent a triggering factor in the origin of the metabolic syndrome and type 2 diabetes mellitus. According to a hypothesis, stimuli such as overnutrition, physical inactivity, and aging would result in cytokine hypersecretion and eventually lead to insulin resistance and diabetes in genetically or metabolically predisposed individuals. This article discusses the current understanding of important adipokines thought to be involved in the metabolic and cardiovascular risk associated with obesity. Available evidence linking fat removal by liposuction to modification of cardiovascular risk and vascular inflammatory markers in the obese patient is also presented. Most studies have shown that liposuction produces beneficial effects on insulin resistance and vascular inflammation in the obese patient, reducing its cardiovascular risk. Besides having a significant role in body contouring of the obese patient at the end of the lengthy process of bariatric surgery and massive weight loss, plastic surgery should be incorporated into a multifaceted program of lifestyle changes that allows the obese patient to obtain weight loss and, more importantly, to maintain the reduced weight in the long term.

Adiponectin↗
PubMed2006

Repositioning of posterior auricular muscle combined with conventional otoplasty: a personal technique.

Prominent ears are the most common deformity of the external ear in children. Since 1881 various treatments have been described but the choice of procedure still remains at the surgeon's preference. A posterior auricular muscle malposition is frequently present in prominent ear deformity even though this muscle shows only a rudimentary function in man. This article presents a technique to reposition the posterior auricular muscle as an adjunct to conventional otoplasty. A quadrangular cartilage paddle, where the muscle inserts, is raised with the muscle as a chondro-muscular flap that can be advanced and reset more peripherally. Eighty consecutive patients, followed up for at least 12 months, have been reviewed. The posterior auricular muscle repositioning combined with a lozenge shaped conchectomy has been successfully performed in 103 ears. The cartilage paddle proved to be a strong support which facilitates the re-insertion of the muscle. Repositioning of posterior auricular muscle allows a more anatomical correction of both ear's projection and slope improving symmetry with the contralateral side.

Adolescent↗
PubMed2006

Correction of hypospadias with a vertical preputial island flap: a 23-year experience.

PURPOSE: We report our experience using the preputial island flap technique (Scuderi procedure) to correct penile hypospadias. MATERIALS AND METHODS: A total of 152 patients underwent repair between 1982 and 2004. Nine patients (6%) had proximal hypospadias, 46 (30%) had mid penile hypospadias and 97 (64%) had distal hypospadias. A total of 146 patients (96%) had not previously undergone surgical treatment, while 6 (4%) had undergone surgery. RESULTS: After the primary repair 3 patients had fistula and 10 had mild stenosis. The immediate success rate was 91.4% (139 of 152 patients), which later increased to 98% (149 of 152) after nonsurgical treatment of the stenoses. CONCLUSIONS: Preputial island flap urethroplasty is a versatile operation that corrects hypospadias and is particularly indicated if there is associated severe penile curvature, with a low complication rate and superior cosmetic results.

Child, Preschool↗
PubMed2006

Extended cutaneous 'thoracoabdominal' flap for large chest wall reconstruction.

Major chest wall reconstructions are usually required after radical excision of advanced cancer stages and large radionecrosis in patients with poor general conditions. Fasciocutaneous, muscular, and musculocutaneous flaps have all been described, with the last ones being commonly considered a first choice. The authors introduce an extended pure cutaneous flap from the omolateral thoracoabdominal area that is able to cover extensive defects. The vascular supply is provided by the lateral cutaneous branches from intercostal, subcostal, and lumbar arteries. Between February 2002 and 2005, 18 female patients underwent major chest wall reconstruction with this technique. Flap dimensions ranged between 15 x 15 and 25 x 30 cm. No major complications were registered. Four flaps sustained a partial loss at the distal margin but 1 case only required further surgical debridement. The extended cutaneous "thoracoabdominal" flap proved to be a quick, single-stage procedure with a low morbidity rate, specifically indicated in patients with a poor prognosis.

Aged↗
PubMed2006

Surgical management of perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Report of three cases.

Giant condyloma acuminatum (GCA) is a slow-growing, large, cauliflower-like tumor located in the anogenital region. This tumor has a locally destructive behavior, a high recurrence rate and occasional transformation to squamous cell carcinoma. Risk factors include anoreceptive intercourse, HIV and immunosuppression. There is no general agreement on the choice of treatment for this tumor. Wide radical excision with plastic reconstruction of skin defects seems to be the best treatment, while adjuvant therapies, such as radiotherapy and immunotherapy, may achieve good results, but their effectiveness is still uncertain. Loop colostomy, considered mandatory by several authors in order to minimize wound contamination risk, does not appear to be necessary (except in cases of anal canal involvement beyond the dentate line) if a combination of bowel cleansing, non-fiber diet and loperamide can be administered. The authors report 3 cases of perianal GCA treated by radical local excision and reconstruction by S-plasty grafts, without performing loop colostomy

Adult↗
PubMed2005

Prospective study on Trilucent soybean oil-filled breast prosthesis.

BACKGROUND: The use of Trilucent breast implants dates back to 1995. These implants were produced in an attempt to overcome the perceived shortcomings of other implants filled with saline and silicone gel. The filler material, which was derived from soybean oil, was said to be biodegradable and biocompatible. When this prosthesis was subsequently found to be prone to rapid aging and rupture of the silicone shell, the company that manufactured this implant decided to withdraw it from the market and offered to remove or replace all Trilucent prostheses. METHODS: The authors present a clinical study of the Trilucent implant in which 36 patients received a total of 63 implants and 33 patients had 58 implants removed. The authors also examined the implant shell of the removed prostheses to investigate the possible cause of silicone implant aging and rupture. RESULTS: Each of the implants removed was carefully inspected visually, and samples of the implant shell were analyzed by scanning electron microscopy. All the implants removed had a very bizarre appearance; they were variegated in color, with shades of yellow and brown, and were studded with whitish yellow nodules whose number grew in proportion to the time the prosthesis was implanted. Scanning electron microscopic analysis of the implant shell revealed a heterogeneous inner surface of the implant together with fissures and globoid deposits on the cut surface. CONCLUSIONS: The authors' findings on Trilucent implants are similar to those reported in previously published studies for other types of breast implants for the first 2 years after implantation, after which a progressive, rapid deterioration was observed.

Adult↗
PubMed2005

Total and subtotal upper eyelid reconstruction with the nasal chondromucosal flap: a 10-year experience.

BACKGROUND: The authors review their 10-year experience with the nasal chondromucosal flap for total and subtotal upper eyelid reconstruction. METHODS: After several modifications, the flap is now designed along the lateral nasal wall and is based on the terminal branch of the dorsal nasal artery, to include the subcutaneous tissues down to the periosteum and the cranial portion of the upper lateral cartilage. A skin graft is applied for cutaneous coverage. The flap can be harvested unilaterally or contralaterally. RESULTS: Fifteen patients, aged 50 to 75 years, have been operated on with this technique for total or subtotal defects of the upper eyelid since 1993. Follow-up included assessment of position, closure, presence of epiphora, length of palpebral rim, eyelid opening, levator function, aesthetic balance, and donor-site morbidity. The flap result was viable in every patient, without total or partial necrosis. Static parameters were within normal ranges, and 8 to 18 mm of levator function (mean, 13 mm) was achieved. CONCLUSIONS: Compared with other frequently used techniques, namely, the Cutler-Beard advancement flap and the Mustarde lid switch flap, this procedure is a one-stage operation, does not damage the lower lid, and provides a thin, mobile eyelid with an anatomically complete reconstruction. The nasal chondromucosal flap has thus become the authors' standard for large full-thickness defects of the upper lid.

Aged↗
PubMed2005

Power-assisted lipoplasty versus traditional suction-assisted lipoplasty: comparative evaluation and analysis of output.

Power-Assisted lipoplasty (PAL) is a new method introduced to simplify and standardize surgical results of traditional suction-assisted lipoplasty (SAL). Comparative studies already have demonstrated PAL to be a handy, atraumatic, time- and fatigue-sparing technique. The authors performed a pilot study to compare the output capacity of PAL and SAL in 15 healthy female patients. The general and the specific per area outputs over 1 min from symmetrical areas were assessed. The results confirmed the efficiency of PAL (17.41% increase in average specific area output, as compared to SAL) and the distribution of fat in major "fat storage" areas such as the abdomen and the anterior thigh. Specific per area output indicated a higher suction capacity for PAL in all areas except the inner thigh. The efficiency of PAL seemed to be less influenced than that SAL by fat distribution.

Adipose Tissue↗
PubMed2005

Merkel cell carcinoma in the orbitopalpebral region.

Trabecular carcinoma is a rare cutaneous neuroendocrine carcinoma that probably originates from the Merkel cells that are usually found in the basal layer of the epidermis. The treatment of Merkel cell carcinoma is controversial and there is no specific therapeutic protocol because of the small number of cases that have been published. The procedures used to treat Merkel cell carcinoma must be tailored to minimise morbidity while maximising survival. Because the condition is so rare and difficult to diagnose and treat, we report three cases of orbitopalpebral tumours that confirm the local and regional aggressiveness and the high metastatic potential of this tumour.

Aged↗
PubMed2005

The innervated anterolateral thigh flap: anatomical study and clinical implications.

During the past 20 years, the neural anatomy of many flaps has been investigated, although no extensive studies have been reported yet on the anterolateral thigh flap. The goal of this study was to describe the sensory territories of the nerves supplying the anterolateral thigh flap with dissections on fresh cadavers and with local anesthetic injections in living subjects. The sensate anterolateral thigh flap is typically described as innervated by the lateral cutaneous femoral nerve. Two other well-known nerves, the superior perforator nerve and the median perforator nerve, which enter the flap at its medial border, might have a role in anterolateral thigh flap innervation. Twenty-nine anterolateral thigh flaps were elevated in 15 cadavers, and the lateral cutaneous femoral nerve, the superior perforator nerve, and median perforator nerve were dissected. In the injection study, the lateral cutaneous femoral nerve, superior perforator nerve, and median perforator nerve in 16 thighs of eight subjects were sequentially blocked. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked anterolateral thigh flap territory. The study shows that the sensate anterolateral thigh flap is basically innervated by all three nerves. The lateral cutaneous femoral nerve was present in 29 of 29 thighs, whereas the superior perforator nerve was present in 25 of 29 and the median perforator nerve in 24 of 29 thighs. Furthermore, in the proximal half of the flap, the lateral cutaneous femoral nerve lies deep, whereas the superior perforator nerve and median perforator nerve lie more superficially. Whereas the lateral cutaneous femoral nerve innervates the entire flap, the superior perforator nerve innervates 25 percent of the flap and the median perforator nerve innervates 60 percent of the flap. Clinically, a small anterolateral thigh flap (7 x 5 cm) can be raised sparing the lateral cutaneous femoral nerve and using only the selective areas innervated by the superior perforator and median perforator nerves. Alternatively, a large anterolateral thigh flap can be raised with this multiple innervation. This can be helpful if one wants to harvest the flap under local anesthesia. Sensate bilobed flaps can be harvested when dual innervated flaps are required.

Cadaver↗
PubMed2005

Anchor-line abdominoplasty: a comprehensive approach to abdominal wall reconstruction and body contouring.

BACKGROUND: Classic abdominoplasty leads to disappointing aesthetic results in patients with preexisting supraumbilical scars. Various techniques involving vertical and horizontal incisions have been described. The authors point out the validity of the "anchor-line" approach. METHODS: In a retrospective study, the authors reviewed the charts of 42 patients who underwent an anchor-line abdominoplasty between March of 1997 and March of 2003 at the Campus Bio-Medico University in Rome. The vascular anatomy of the abdominal wall was carefully reviewed, and they reported Huger's classification into three zones (zones I, II, and III). The third zone, which corresponds to the lateral areas of the abdomen, provides the vascular supply to the undermined abdominal wall flaps. Whenever this lateral vascularization is spared, there is no risk of skin necrosis. The anchor-line abdominoplasty implies the en bloc resection of a lower horizontal ellipsis plus an upper vertical triangle of abdominal skin and subcutaneous fat. The vertical triangle entails the supraumbilical scars. Plication of the rectus muscle sheath is always carried out. RESULTS: Follow-up ranged from 1 to 5 years. The following complications were seen: seroma (n = 3), anemia (n = 2), infection (n = 1), and minor skin necrosis (n = 1). CONCLUSION: The anchor-line technique, because of its easy execution, is a valid procedure in candidates for an abdominoplasty with supraumbilical median or paramedian scars.

Abdominal Wall↗
PubMed2005

Lipid peroxidation inhibition by raxofelast improves angiogenesis and wound healing in experimental burn wounds.

We investigated the effects of raxofelast, a lipid peroxidation inhibitor, in an experimental model of burn wounds. C57BL/6 male mice of 25-30 g were immersed in 80 degrees C water for 10 seconds to achieve a partial-thickness scald burn. Animals received intraperitoneally either raxofelast (20 mg/kg/day for 14 days in 100 microL) or its vehicle alone (100 microL/day for 14 days). On day 14, burn areas were used for measuring conjugated dienes, reduced glutathione levels, histological damage, neoangiogenesis by immunohistochemistry and expression (Western blot) of the specific endothelial marker CD31 as well as quantification of microvessel density, VEGF wound content, endothelial and inducible nitric oxide synthase (eNOS and iNOS) expression and wound nitrite content. Raxofelast decreased tissue conjugated dienes (vehicle 6.1 +/- 1.4 DeltaABS/mg protein; raxofelast 3.7 +/- 0.8 DeltaABS/mg protein), prevented tissue glutathione consumption (vehicle 3.2 +/- 0.9 micromol/g protein; raxofelast 6.7 +/- 1.8 mumol/g protein), increased epithelial proliferation, extracellular matrix maturation, and augmented neoangiogenesis as suggested by the marked increase in microvessel density and by the robust expression of the specific endothelial marker CD31 (vehicle 9.4 +/- 1.1 integrated intensity; raxofelast 14.8 +/- 1.8 integrated intensity). Furthermore, raxofelast enhanced VEGF wound content (vehicle 1.4 +/- 0.4 pg/mg protein; raxofelast 2.4 +/- 0.6 pg/mg protein), caused a marked expression of eNOS (vehicle 16.1 +/- 3 integrated intensity; raxofelast 26.2 +/- 4 integrated intensity) and iNOS (vehicle 9.1 +/- 1.8 integrated intensity; raxofelast 16.2 +/- 3.5 integrated intensity) and increased wound nitrite content. Lipid peroxidation inhibition by raxofelast may be an effective therapeutic approach to improve clinical outcomes after thermal injury.

Animals↗
PubMed2004

Mammary compliance: an objective measurement of capsular contracture.

Capsular contracture is the most unpredictable complication after mammary augmentation. It presents an uncertain evolution, and is one of the most difficulty complications to treat. Evaluation of this condition usually was relegated to the surgeon's judgment, but currently there are three methods for measuring capsular contracture: palpation, applanation tonometry, and measure of mammary compliance. A prospective study was conducted to evaluate the different methods for managing capsular contracture. Particular attention was paid to the measure mammary compliance with a new device: the Anton Paar Mammacompliance system. This study found a good match between clinical and objective measurements, and also between the measure of applanation tonometry and the measure of mammary compliance. The Anton Paar Mammacompliance system seems to be effective in eliminating the descriptive part and keeping to the measurements and objective data. It is easily reproducible in the various check ups. It permits objective assessment for the measure of capsular contracture.

Adult↗
PubMed2004

Ultrasound-assisted liposuction for the removal of siliconomas.

In the past, the traditional methods of removing siliconomas have been excision of the affected tissues or suction of the injected silicone. Unfortunately siliconomas are often found in exposed areas, where it is undesirable to leave visible scars, and suction is technically difficult and often unsuccessful because the affected tissues are so hard. Because we have used ultrasound-assisted liposuction for other procedures since 1984, it seemed logical to find out whether this technique would be useful to remove siliconomas. We have used it in three such patients, ranging in age from 36 to 84 years. Our mean follow up is 38 months (range 18 months-4 years). We have found that it results in improvement in all patients. The only problem was a minor burn at the entrance port in one patient.

Adult↗
PubMed2004

Salvage of a free flap after late total thrombosis of the flap and revascularisation.

We report a case of successful salvage of a free flap after a late total venous thrombosis. A free forearm flap was used to cover an exposed plate over the ankle. After a normal postoperative course, the patient suddenly developed a total venous thrombosis on day 11. Nevertheless the flap was salvaged completely. This event raises further questions about the revascularisation process, which is commonly thought to occur in 7-8 days.

Adult↗
PubMed2004

Surgical treatment of ulcers caused by extravasation of cytotoxic drugs.

Despite preventive measures, the extravasation of cytotoxic drugs still occurs in 0.6% to 6% of cases. The aetiology is thought to be that tissue necrosis develops into a chronic ulcer, which causes problems if the harmful action of the drug is not blocked. From 1988-2002 at the Department of Plastic Surgery of Rome University "La Sapienza", 240 patients presented with extravasation of cytotoxic drugs; all had been treated with an original conservative protocol first described in 1994, based on the repeated local infiltration of a large quantity of saline solution (90-540 ml) into the area of extravasation. We considered only cases with actively necrotic lesions. Eleven of the 240 patients (5%) had ulcers ranging from small ulcers to extensive areas of tissue necrosis. Of the 11 patients, eight had already had ulcers, while the remaining three were those in whom our conservative protocol had not prevented necrosis. They were all operated on and given grafts, local flaps, reverse radial flaps, and free flaps.

Adolescent↗
PubMed2004

Adipose compartments of the upper eyelid: anatomy applied to blepharoplasty.

Many authors have indicated the presence of ectopic or accessory upper eyelid fat pads, but the effective rate of eyelid fat variations and the corresponding clinical features are still unclear. The purpose of this study was to evaluate the variability of upper lid fat and to define the anatomical landmarks of the adipose pockets of the upper lid. From January of 1998 to January of 2002, the authors investigated the upper eyelid fat compartments of 47 patients who underwent upper blepharoplasty. To support surgical findings, 11 fresh cadavers were also investigated; the anatomy of the intraorbital fat and of the upper eyelid fat compartments was reviewed. Ten patients (21.3 percent) showed an accessory fat pad in the upper lid, which was found on both sides in nine cases. In all patients, the third fat pad was situated lateral to the two classic compartments described by Castanares, behind the orbital septum. Surgical dissections demonstrated that this fat pad derived from the preaponeurotic fat. Anatomical dissections in three cadavers demonstrated an accessory fat compartment protruding under the inferior border of the lacrimal gland. This protruding fat derived from the preaponeurotic fat in all cases and might justify the clinical appearance of a bulge or fullness in the lateral third of the upper eyelid. In the authors' experience, the presence of an accessory upper eyelid fat pad was a frequent finding during blepharoplasty; it could be found and actually resected in about 21 percent of all cases. Surgical and experimental findings put this element as a lateral physiological extension of the preaponeurotic fat that can anteriorly protrude under the inferior border of the lacrimal gland toward the orbital septum. The clinical appearance may be a bulge or fullness in the upper eyelid, and its resection can better define the lateral one third of the supratarsal fold.

Adipose Tissue↗