Papers by Gianni Guarneri
Case Reports in Plastic Surgery and Hand Surgery, 2020
Erosive lichen planus is an uncommon variant of lichen planus. We report a case of longstanding a... more Erosive lichen planus is an uncommon variant of lichen planus. We report a case of longstanding and refractory plantar ELPs causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with Rigenera V R micrografts. After approximately 9 months followup, no clinical recurrence or pain were observed. Erosive lichen planus (ELP) is an uncommon variant of lichen planus, involving oral cavity and genitalia and, less often plantar areas, where it usually presents with chronic erosions of the soles, along with intense, disabling pain and progressive loss of toenails. An abnormal immune cellular response (CD8þ lymphocytes and macrophages) and the consequent altered production of multiple mediators (interleukin-12, interferon-c, tumor necrosis factor-a, RANTES and MMP-9), seem to play a crucial role in the pathogenesis, although the etiology remains uncertain. From a histological point of view, ELP shows keratinocyte apoptosis, intense inflammatory response and basal epithelial keratinocytes TNF-a overexpression. Several therapies have been proposed, with variable and controversial results. While topical corticosteroids and topical calcineurin inhibitors are the treatments of choice for localized forms, short pulses of systemic glucocorticoids, phototherapy, and systemic immunosuppressants are recommended for generalized cases. Surgery has been reported as a possible therapeutic option in refractory and stable cases with localized lesions, either alone or with cyclosporine. Herein, we report a case of longstanding and refractory plantar ELPS causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with RigeneraV R micrografts.
Archives of Plastic Surgery, 2020
We sincerely thank Lavinia Bucciarelli (graphic designer; Udine, Italy) for her assistance with t... more We sincerely thank Lavinia Bucciarelli (graphic designer; Udine, Italy) for her assistance with the illustration presented in Fig. 1.
JPRAS Open, 2018
There is a wide range of surgical procedures that require placement of drains. It is important to... more There is a wide range of surgical procedures that require placement of drains. It is important to ensure that the drains remain in the correct position until their removal. The classic method for fixing drains to the skin involves the use of surgical knots. Typically, one or more of them are tied directly to the skin surface, close to the drain exit site, so potentially giving rise to problems involving tissue damage or the development of obvious scars, if the knots are excessively tight around the skin. With the drain fixation technique that we developed none of the knots constricts the skin, so avoiding any kind of damage to it.
Indian Journal of Surgery, 2019
The benefits of placing breast implants below the muscle very often outweigh placing them above t... more The benefits of placing breast implants below the muscle very often outweigh placing them above the muscle. This dissection plane is less vascularized than the retroglandular one, and favoring this option may reduce hematoma incidence. Furthermore, the correct submuscular dissection is not easy to perform (mostly for beginners); thus, the pocket is not carried out quickly. To solve these problems, we present an alternative submuscular surgical technique, which uses hydrodissection to delimitate the submuscular pocket dissection. We analyzed the results of 11 patients with breast cancer who underwent mastectomy and breast implant reconstruction and eight patients who underwent breast implant augmentation from March 2016 to September 2017. First, the submuscular plane is accessed via an inframammary incision, then creates a small cavity at the lateral border of major pectoralis muscle, above the distal insertion of minor pectoralis muscle. After that, a 60-mL syringe (catheter tip) is inserted and a tumescence solution is infiltrated (epinephrine and saline solution). With hydrodissection, the soft tissue is separated using the gentle force of the water-jet (atraumatic dissection); the epinephrine allows vasoconstriction and an easier preventive hemostasis is established. Minimum follow-up after surgery was 1 year, with an average of 14.8 months. Among the treated patients, the percentage of complications was extremely low and time of surgery was very fast. This technical note explains a very simple, economical, and less time-consuming method to perform the submuscular pocket. It may be applied to all procedures within the field of the breast augmentation, including reconstructive and esthetic surgery.
Journal of Cutaneous Medicine and Surgery, 2019
Figure 1. Excision of a neoformation of the scalp. The markings of the limit of the excisions are... more Figure 1. Excision of a neoformation of the scalp. The markings of the limit of the excisions are drawn toward the centre, to reach the fix visual point to confirm that a direct closure is appropriate.
Aesthetic Plastic Surgery, 2018
The advantages and disadvantages of acellular dermal matrix (ADM) in breast reconstruction have b... more The advantages and disadvantages of acellular dermal matrix (ADM) in breast reconstruction have been well documented. ADM is commonly used in breast reconstruction, but it adds cost to the procedure and has been associated with an increased risk of seroma, flap necrosis and infectious complications. A dermal autograft may be a useful alternative to matrices, and it has a lot of advantages: more biocompatible and more likely to be retained as a free graft, low cost, well tolerated, readily available and integrated. This report discusses a new surgical technique that uses an autologous dermis, which was harvested from the controlateral breast in patients having simultaneous breast reduction/mastopexy. Before the insertion, the autologous dermal matrix was meshed at a ratio of 3:1 to increase the graft surface area, to provide additional draining and to improve the engraftment of the autologous dermal matrix. Consequently, the resulting meshed graft allows for the cover of the inferior pole of a larger breast size implant and decreases the complication rate. In our clinic, this method was used on five women; there was one limited necrosis of the mastectomy flaps. The described technique is straightforward and reliable, it adds minimally to the operative time, and it eliminates costs and covers a bigger part of the prosthesis and promises good results.
International Wound Journal, 2018
Many post‐vulvectomy vulvar reconstruction solutions, using local fasciocutaneous flaps where pos... more Many post‐vulvectomy vulvar reconstruction solutions, using local fasciocutaneous flaps where possible, have been proposed. We report the use of V‐Y advancement flaps from the gluteal fold in medium to large vulvar reconstructions and a simple modification we made to the technique in order to minimise wound‐related complications. Between 2006 and 2016, 30 vulvar reconstructions were performed via a total of 59 flaps, 24 of which were raised using the proposed modification to the plasty design. Short‐ and long‐term (24 months) follow‐up data were analysed, postoperative flap sensitivity was tested, and any arising complications were recorded. The mean age of patients treated was 75.3 years (51‐92 years). The mean monolateral defect dimensions were 7.5 × 4.7 × 2.8 cm. Minor complications were recorded in 23% of patients (14% of flaps). One case of ostial stenosis occurred. Micturition and ambulation recovery was rapid, and flap sensitivity was fully restored 24 months after reconstruc...
Journal of Craniofacial Surgery, 2016
Background and Purpose: The purpose of the present study is to evaluate the vascular malformation... more Background and Purpose: The purpose of the present study is to evaluate the vascular malformations of the head and neck. They are uncommon lesions, but some areas have a significant potential for fatality, due to their massive bleeding. The vascular anatomy of the nose carries a high recurrence rate, due to the unique characteristic of the nose, especially if deep vascular connection is present. Methods: The present article describes 2 patients of nasal dorsum arteriovenous malformations, both using a combined procedure: preoperative selective embolization, en-bloc tumor resection, and reconstruction with a forehead flap. Two female patients with arterio-venous malformations of the nose were examined, subjected to excision procedure and forehead flap reconstruction. Current treatment requires surgical resection of the nose and in conjunction with adjunctive endovascular embolization; it reduces arterio-venous malformations recurrence. Results: The authors report an endovascular and surgical technique to treat nasal arterio-venous malformations, which permits a complete resection and a reconstruction with a forehead flap. There were no major complications such as recurrent ulceration, infection, postoperative bleeding, or flap failure. All the patients responded positively and satisfactory results were achieved in both female patients. Conclusions: To reduce the recurrence of arterio-venous malformations, the multidisciplinary therapy is mandatory. Recent advances in microsurgery and interventional radiology have greatly improved prognosis for patients with arterio-venous malformations. Therefore, a preoperative selective embolization followed by surgical excision seems to be a good compromise for arterio-venous malformations therapy. The forehead flap, for its characteristics, represents the better choice for nasal reconstruction.
Journal of Cutaneous and Aesthetic Surgery, 2015
The involvement of deep margins correlates with a higher incidence of relapse, and so there is a ... more The involvement of deep margins correlates with a higher incidence of relapse, and so there is a further indication for re-excision. We can use three techniques to evaluate the margins: Mohs micrographic surgery, extemporaneous histological examination, and in cases where it is not possible to use the previous methods, a defect can be left open for a few days (without a considerable disadvantage) until the definitive histological examination. When Expanding a Margin of Skin Cancers After Reconstruction with Local Flap: Where to Do It?
Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India
To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropr... more To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropriate materials and take steps to preserve and support tissue vitality. As far as materials are concerned, custom-made porous hydroxyapatite implants are biomimetic, and therefore, provide good biological interaction and biointegration. However, before it is fully integrated, this material has relatively low mechanical resistance. Therefore, to reduce the risk of postoperative implant fracture, it would be desirable to accelerate regeneration of the tissues around and within the graft. The objective was to determine whether integrating growth-factor-rich platelet gel or supportive dermal matrix into hydroxyapatite implant cranioplasty can accelerate bone remodeling and promote soft tissue regeneration, respectively. The investigation was performed on cranioplasty patients fitted with hydroxyapatite cranial implants between 2004 and 2010. In 7 patients, platelet gel was applied to the bone...
European Journal of Plastic Surgery, 2013
Sir, In many cases, benign tumors of the soft tissues appear as moving masses [1], even of consid... more Sir, In many cases, benign tumors of the soft tissues appear as moving masses [1], even of considerable size, and the surgical removal can be difficult, as simply the movement of a limb, or the prone position rather than supine, may modify their location and make them difficult to identify [2, 3]. For instance, the elastofibroma often located in the subscapular region [4] can be easily located preoperatively with patients standing upright by mobilizing their arms. Nevertheless, once the patient is in a prone position for surgery, the lesion is often difficult to locate due to its migration within the subscapular site. At our clinic, we adopt a method that enables us to reduce this motility of the subcutaneous mass and facilitates its identification during the surgical procedure. At the time of their assessment, patients are placed in an upright position with their arms alongside their bodies; then, their arms are mobilized to reveal the neoplasm and its location can be marked with a skin marker pen. With the patient still standing, the area of skin involved is disinfected and two boluses of local anesthetic (using carbocaine with 2 % adrenaline, 2 cm per bolus) are administered subdermally on either side of the lesion, while holding it steady between the fingers. Then a Tuohy needle is inserted and passed through the mass to the opposite side of the lesion (Fig. 1). The patient can then be accommodated in a prone position on the operating table. After completing the skin incision with a size 15 blade and passing through the subcutaneous tissue, the mass is immediately identifiable (Fig. 2) thanks to the previously applied needle. The neoplasm is then resected and detached from the tissue planes. The marker can then be removed and the resection completed (Fig. 3), once the needle has been removed. This method is now used routine at our clinic: it ensures a quick and easy identification of the lesion, which might otherwise shift within the subscapular site, thereby complicating the surgical procedure. It could be used also for other soft tissue lesions, often detected with difficulty and located in other parts of the body,
Journal of Plastic Surgery and Hand Surgery, 2010
The distally-based superficial sural flap has proved to be an easy and reliable method of reconst... more The distally-based superficial sural flap has proved to be an easy and reliable method of reconstruction in soft tissue cover of the distal third part of the leg. There are two ways to prepare this flap: as a fasciocutaneous flap, which includes the fascia with the subcutaneous tissue including the skin; or as an adipofascial flap, which is made up of both the fascia and the subcutaneous adipose tissue. In the latter case, the flap is covered with a partial thickness skin graft either immediately after or at a later stage. The aim of this study was to assess the advantages and disadvantages of the two flaps. The adipofascial flap seems to be better, as it is associated with less donor site morbidity, improved quality of reconstruction, and fewer complications.
International Journal of Oral and Maxillofacial Surgery, 2005
Microsurgery, 2005
The use of ionizing radiation in the breast region while a patient is at developmental age is sti... more The use of ionizing radiation in the breast region while a patient is at developmental age is still responsible for most monolateral hypoplasias and iatrogenic-based breast asymmetries. These alterations often involve several anatomical structures, thus causing severe hypoplasia of the breast and muscle tissues and stiffness of soft tissues, with atrophic and cicatricial skin. Reconstruction methods vary from case to case, but most of the time reconstruction with a homolateral latissimus dorsi with or without a breast implant seems most suitable. In some cases, however, this is not a viable alternative due to particular general and local conditions, making it necessary to consider other solutions. We present the case of a young prepubertal patient who came under our observation due to a radiotherapy outcome in the right breast and thoracic region; she had been previously subjected to breast reconstruction elsewhere, with the fitting of a subcutaneous prosthesis. Due to the patient's particular general and local conditions and the pathological involvement of the homolateral thoracic musculature, to improve the clinical picture, we deemed it appropriate to use the microsurgical reinnervated contralateral latissimus dorsi muscle, which so far has enabled us to obtain considerable and lasting results.
Journal of the European Academy of Dermatology and Venereology, 1998
Letters to the Editor cular slits suggest lymphatic involvement. The negativity of the alkaline p... more Letters to the Editor cular slits suggest lymphatic involvement. The negativity of the alkaline phosphatase reaction in THH may also indicate a lymphatic origin [1,4]. In our opinion, the emergence of the hemangiomatous appearance and the ecchymotic halo in patients with THH lesion may be caused by trauma [3] as in hematolymphangioma circumscriptum, or hormonal factors [6] as reported previously.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2010
Journal of Oral and Maxillofacial Surgery, 2008
Eyelid reconstruction represents a challenge because of the complexity of this structure. Full-th... more Eyelid reconstruction represents a challenge because of the complexity of this structure. Full-thickness eyelid defects demand the reconstruction of 2 fundamental elements: anterior and posterior lamellae. The available reconstructive techniques are all associated with the attention to restore the support and responsibility of eyelid stability, represented physiologically by the tarsus. In 1987, Matsuo proposed a reconstructive technique that involved the use of a chondro-perichondral graft harvested from the auricular concha to reconstruct the posterior lamella, and an adjacent skin flap to restore the anterior lamella. We report our divisional experience of a series of 28 patients operated on from 2000 to 2004, whose eyelid restoration was achieved with the use of Matsuo's technique modified with the purpose to avoid complications such as ectropion or lagophtalmus. All the grafts survived, and no major complication such as ectropion or lagophthalmos has been detected. Our specialistic judgment has ranged from good to excellent regarding symmetry, eyelid closure, and donor site morbidity. Patients were entirely satisfied with the functional result obtained, and generally with the esthetic outcome also, judged as ranging from good to extremely satisfactory. The success of eyelid reconstruction using modified Matsuo's technique depends, in our minds, on an adequate knowledge of traditional eyelid reconstruction methods, and on a few technical fine points that help to reduce postoperative complications and to optimize the quality of the end result; hence, this technique has become the gold standard in lower eyelid reconstruction in our division.
Journal of Cranio-Maxillofacial Surgery, 2010
A cadaver study in preparation of a facial allograft transplantation in humans requires accurate ... more A cadaver study in preparation of a facial allograft transplantation in humans requires accurate dissection of the arterial, venous and nerve pedicles. A simple and cheap method for the use of arterial tree mapping in cadaver soft tissue is presented. Eight fresh cadavers aged 55-89 years at the time of death were studied. Five were female and three were male. All injections were performed within four post-mortem days. Our method determined the perfusion territories of the human face without risk of spillage of the dye from capillary structures and showed the arteries very clearly. Vascular patterns of the face were interpreted after dyed gel mixture injection. This study confirms the current reconstructive procedures on the face, but also helps and allows the anatomical dissection to be carried out in an effective and safe manner. The dyed gel mixture represents a valid, cheap and alternative tool for delineating the vascular structures, without leakage and spillage during the anatomical dissection.
Indian Journal of Plastic Surgery, 2012
A simple way to improve the safety of the surgical field Occupational safety in the operating roo... more A simple way to improve the safety of the surgical field Occupational safety in the operating room is a topic of primary importance. Electrocoagulation produces fumes that contain tiny particles, which can travel considerable distances from the place where the fumes are generated, becoming deposited in the pulmonary alveoli. breasts in 15% and the respiratory system in 10% of cases. Only 1-3% of all reported cases are malignant. [3] Even though the true recurrence rate following resection is unknown, wide resection of the tumour when it occurs in a digital nerve is recommended by Slutsky [1] based on its propensity for local recurrence. The use of radiotherapy and chemotherapy is advisable only in treating the malignant forms of such tumours. [2] This report of granular cell tumour is to draw attention to the management of the granular cell tumour and the need for an understanding of the condition.
Dermatologic Therapy, 2013
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Papers by Gianni Guarneri