Marco Morelli Coppola
@policlinicocampusbiomedico.it
Department of Plastic, Reconstructive and Aesthetic Surgery
Fondazione Policlinico Universitario Campus Bio-Medico, Roma
Scopus Publications
Scopus Publications
Beniamino Brunetti, Valeria Petrucci, Stefania Tenna, Marco Morelli Coppola, Rosa Salzillo, Alessandra Putti, Chiara Camilloni, Matteo Pazzaglia, and Paolo Persichetti
Elsevier BV
Beniamino Brunetti, Marco Morelli Coppola, Stefania Tenna, Rosa Salzillo, Valeria Petrucci, Matteo Pazzaglia, Sergio Valeri, Rossana Alloni, Bruno Vincenzi, Giuseppe Tonini,et al.
Wiley
AbstractIntroductionThigh reconstruction after oncological resection represents a challenge in terms of ideal morphological and functional outcomes to aim for. Very few papers presented a comprehensive approach to this topic, most of them being only small cases series. The purpose of this article was to review our institutional experience in the field of thigh soft‐tissue reconstruction, proposing an algorithm to choose the most convenient pedicled or free flap approach according to the different clinical scenarios and the specific morpho‐functional requirements of the case.Patients and methodsThe authors retrospectively reviewed patients who received flap reconstruction for thigh soft‐tissue defects after oncological resection between 2014 and 2021. Demographic and operative data were recorded. Twelve months post‐operatively, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5‐point Likert scale. Additionally, for patients receiving a free functional muscle transfer to restore quadriceps or hamstring function, recovery was evaluated with the Medical Research Council Scale for Muscle Strength.ResultsSeventy flap reconstructions of the thigh were, respectively, performed after sarcoma (n = 43), melanoma (n = 13) and non‐melanoma skin cancer (n = 14) resection. Pedicled flaps were used in 55 patients: 46 perforator flaps (32 ALT, 4 AMT, 4 PAP, 2 TFL, 2 MSAP, 2 DIEP) and 9 muscle or myocutaneous flaps (4 medial gastrocnemius, 2 gracilis, and 3 VRAM). Microsurgical reconstruction was performed in 15 patients for extensive defects (2 SCIP, 1 latissimus dorsi—LD, 1 thoracodorsal artery perforator—TDAP, 1 ALT, 2 DIEP flaps) or when >50% of the quadriceps or hamstring compartments were resected (eight free functional muscle transfer including five vastus lateralis, two LD, and one rectus femoris). Extensive defect surface, previous irradiation and neoadjuvant chemotherapy appeared to be predictors of free flap reconstruction. Complication (49% vs. 26.6%; p > .05) and readmission rates (32.7% vs. 13.3%; p > .05) were comparable between pedicled and free flap groups, as well as complications severity scores according to Clavien‐Dindo classification (1.15 vs. 1.29; p > .05). However, patients with previous irradiation experienced worse outcomes when receiving pedicled rather than free flaps in terms of reintervention (87.5% vs. 28.6%; p = .04) and readmission rates (87.5% vs. 14.29%; p = .01), and severity of surgical complications. Overall patients' satisfaction was high, with esthetic and functional mean score of 4.31 and 4.12, respectively (p > .05). In the FFMT group, M5, M4, M3, and M2 strength was observed in 3, 3, 1, and 1 patients, respectively.ConclusionOncological thigh defects are usually well addressed with pedicled perforator flaps. Microsurgical reconstruction offers reliable and reproducible results in extensive defects and in previously irradiated fields or when functional restoration is indicated.
Beniamino Brunetti, Rosa Salzillo, Stefania Tenna, Valeria Petrucci, Marco Morelli Coppola, Sergio Valeri, and Paolo Persichetti
Wiley
Extensive tridimensional defects of the abdominal wall are usually addressed with soft tissue flaps combined with meshes. In this scenario, the additional value of dynamic abdominal wall reconstruction with functional flaps has yet to be demonstrated. In this paper the authors describe for the first time a unique case of total abdominal wall reconstruction with the free functional L-shaped latissimus dorsi (LD) flap, designed to increase the surface area of skin flap coverage while minimizing donor site morbidity, highlighting technical tips and long-term outcomes. A 65-year-old patient underwent abdominal wall resection for a dermatofibrosarcoma protuberans, leaving her with a 23 × 15 cm full-thickness defect. After placing a mesh, a myo-cutaneous free LD Flap with an L-shaped configuration was planned. The flap was composed of Paddle A, designed vertically along the anterior margin of the muscle and Paddle B, designed over the inferior aspect of the LD muscle, extending obliquely from the midline and intersecting Paddle A laterally with a 60° angle. End-to-end anastomoses to the deep inferior epigastric artery and vein and thoracodorsal nerve coaptation to a sizeable intercostal nerve were performed. The LD muscle was sutured according to its native tension while the two skin islands allowed an almost complete resurfacing of the abdominal wall defect. Donor site was closed primarily. Post-operative course was uneventful. One year postoperatively, good abdominal contour was observed, with adequate abdominal tone at rest in laying and standing position. Muscle neurotization was confirmed with clinical examination showing voluntary contraction of the transplanted muscle and the patient reported very high functional outcomes at the hernia-related quality-of-life (HerQles) questionnaire. The free L-shaped LD flap represents an innovative solution to reconstruct extensive full-thickness defects of the abdominal wall while reducing donor site morbidity. Flap neurotization should be attempted whenever possible to improve functional outcomes of the procedure.
Barbara Cagli, Marco Morelli Coppola, Federica Augelli, Francesco Segreto, Stefania Tenna, Annalisa Cogliandro, and Paolo Persichetti
Springer Science and Business Media LLC
Beniamino Brunetti, Rosa Salzillo, Stefania Tenna, Barbara Cagli, Morelli Coppola M, Valeria Petrucci, Chiara Camilloni, Yi Xin Zhang, and Paolo Persichetti
Elsevier BV
Stefania Tenna, Marco Morelli Coppola, Rosa Salzillo, Mauro Barone, Beniamino Brunetti, Barbara Cagli, Annalisa Cogliandro, and Paolo Persichetti
Springer Science and Business Media LLC
Beniamino Brunetti, Marco Morelli Coppola, Silvia Ciarrocchi, Rosa Salzillo, Stefania Tenna, and Paolo Persichetti
Ovid Technologies (Wolters Kluwer Health)
Summary: Abdominal wall reconstruction represents a complex challenge for plastic surgeons, given the variable range of clinical situations requiring restoration of abdominal wall integrity. When significant myofascial defects are encountered, repair with either a synthetic or biological mesh is indicated, both of which have advantages and drawbacks. Taking inspiration from Gillies’ fourth commandment of plastic surgery—Thou shalt not throw away a living thing—an innovative technique to obtain a vascularized autologous mesh from the tissues usually discarded during abdominal contouring procedures was conceived. The authors describe how to maximize the use of perforator flaps derived from abdominoplasty excision patterns in abdominal wall reconstruction to simultaneously obtain restoration of abdominal wall integrity and improvement of the abdominal contour.
Beniamino Brunetti, Rosa Salzillo, Stefania Tenna, Marco Morelli Coppola, and Paolo Persichetti
Wiley
The anterolateral thigh (ALT) flap represents a workhorse in reconstructive microsurgery but its use in a free style fashion as perforator‐based flap has yet to be popularized. We describe our experience with lateral circumflex femoral artery (LCFA) sparing perforator‐based ALT flaps for thigh reconstruction after oncological resection in a case series of 24 consecutive patients.
Beniamino Brunetti, Paolo Marchica, Marco Morelli Coppola, Rosa Salzillo, Stefania Tenna, Franco Bassetto, and Paolo Persichetti
Wiley
Lateral lumbar defects are rarely encountered and difficult to manage because of the limited reach of loco‐regional flaps and the unfavorable position of recipient vessels for microsurgical transfer. The purpose of this report is to describe the innovative application of an extended latissimus dorsi (LD) flap with propeller ascending design in the field of lumbar reconstruction, reviewing current reconstructive options accepted for lateral lumbar defect. A 68‐year‐old male patient underwent wide full thickness resection for a solitary hepatocellular carcinoma metastatic lesion arising in the left lumbar region, resulting in an extensive soft‐tissue defect (20 x 13 cm) with deep structures exposure. An extended LD flap with propeller ascending orientation was obliquely designed, with the distal third of the skin island laying over the trapezius muscle. The skin paddle measured 34 x 9 cm. The flap, including a cuff of proximal LD muscle spared by the oncological resection and a fasciocutaneous superior extension, underwent 90°clockwise rotation on the main thoracodorsal artery perforator and further caudal advancement allowed by section of the LD cranial tendinous insertion. The rotation‐advancement movement allowed tension‐free flap insetting, while donor site was closed by primary intention. The post‐operative course was uneventful without any complications registered. At 12‐months follow‐up, a satisfactory result and a stable coverage were achieved. Due to the surgical complexity traditionally associated with the repair of defects located in the lumbar region, the case reported may help to provide a new alternative solution to extend the indications of local flaps in similar cases and simplify such reconstructions.
Beniamino Brunetti, Marco Morelli Coppola, Stefania Tenna, Rosa Salzillo, Silvia Ciarrocchi, and Paolo Persichetti
Ovid Technologies (Wolters Kluwer Health)
Beniamino Brunetti, Silvia Ciarrocchi, Rosa Salzillo, Marco Morelli Coppola, Stefania Tenna, and Paolo Persichetti
Wiley
Marco Morelli Coppola, Beniamino Brunetti, Silvia Ciarrocchi, Stefania Tenna, and Paolo Persichetti
Ovid Technologies (Wolters Kluwer Health)
FIGURE 1. Preoperative view, showing the wide defect after radical resection of the whole posterior compartment of the left leg. W e thank the authors for sharing their useful experience in microsurgical reconstruction of lower leg defects using the medial sural artery and vein(s) as recipient vessels. This possibility has been widely explored in literature in the setting of posttraumatic conditions; however, only a few articles addressed it in postoncological reconstruction. Vessels depletion, indeed, is a common issue in lower leg traumatic injuries, but is less frequent in oncological surgery. We hereby report the case of a 57-year-old man, affected by a huge pleomorphic liposarcoma of the posterior compartment of the left lower leg. Full-body computed tomography scan excluded distant metastasis. The patient underwent neoadjuvant radiochemotherapy with partial response and was then scheduled for radical excision of the neoplasia. Compartmental resection of the tumor with the adjacent muscles and overlying skin was done: the excision involved all themuscles of the superficial (medial and lateral gastrocnemius, soleus) and deep (popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus) compartment of the lower leg including the Achilles tendon, with depletion of the tibial nerve and the posterior tibial and peroneal vessels and exposure of the posterior aspect of the tibia and the fibula, both deprived of their periosteum. Defect size measured 33 6 cm (Fig. 1). Clinically, the major issues consisted in deficit in foot plantar flexion and anesthesia of the sole, associated with pain and tenderness. The reconstructive procedure was delayed until the histopathological examination had confirmed the negativity of the margins of excision. A functional reconstruction with an LDmyocutaneos flap was planned, providing a skin paddle measuring 44 8 cm (Fig. 2). With the patient marked preoperatively, surgery was performed in left lateral decubitus, thus allowing 2 different microsurgical teams to respectively harvest the flap and to prepare the recipient vessels at the same time. We used the medial sural artery and vein as recipient vessels
Beniamino Brunetti, Silvia Ciarrocchi, Rosa Salzillo, Marco Morelli Coppola, Stefania Tenna, and Paolo Persichetti
Wiley
Dear Editor, We read with great interest the article by Driessen et al. (2020) in which the authors show the usefulness of a template-based ALT flap for head and neck reconstruction. We compliment the authors for the effort produced to show how a standardized approach can improve both flap harvesting and insetting and we would like to present our experience with the template-based free flap planning for reconstruction of sarcoma defects. In our clinical practice, we routinely obtain a template from a sterile polyurethane foam (Biatain Coloplast, Humlebaek, Denmark), a dressing used for common wound management, which resembles thickness and pliability of the normal skin (its thickness is comparable to a thin free flap like radial forearm or superficial circumflex iliac perforator flap). The dressing is applied at the level of the wound to obtain a precise template of the defect to be reconstructed (Figure 1a), which is retailed taking in consideration the orientation of the defect, the location of the recipient vessels and the course and the desired length of the vascular pedicle (Figure 1b). Such information is marked on the template to simplify the reconstructive process. Then the template is placed on the donor site and the flap designed accordingly (Figure 1c), in order to guarantee a direct and easy flap insetting before or after microvascular anastomoses (Figure 1d). Wide resection of soft tissues sarcomas usually produces defects of significant size, whose reconstruction requires flaps of huge dimensions. In such cases, we make every possible effort to avoid the additional morbidity related to skin graft placement at the level of the
Silvia Ciarrocchi, Mauro Barone, Marco Morelli Coppola, Barbara Cagli, Annalisa Cogliandro, and Paolo Persichetti
Ovid Technologies (Wolters Kluwer Health)
Beniamino Brunetti, Marco Morelli Coppola, Silvia Ciarrocchi, Stefania Tenna, and Paolo Persichetti
Elsevier BV
Beniamino Brunetti, Marco Morelli Coppola, Pierfilippo Crucitti, Francesco Spinelli, Francesco Stilo, Filippo Longo, Livio Cortese, Stefania Tenna, and Paolo Persichetti
Ovid Technologies (Wolters Kluwer Health)
Supplemental digital content is available in the text. Abstract A patient affected by a voluminous synovial sarcoma of mediastinum received radical surgery, resulting in injury of both phrenic nerves. Because of the cancer location, reconstruction of the left phrenic nerve was not possible, so to prevent the patient's ventilator dependence, the right phrenic nerve was reconstructed via an autograft from the residual proximal stump of the contralateral one. In 3 months, the right hemidiaphragm function showed a full recovery, documented by ultrasonographic and radiographic assessment of diaphragmatic excursion, and the patient was weaned from mechanical ventilation. When a nerve autograft is indicated, the sural nerve still remains the criterion standard, because of the low morbidity of the donor site and ease of harvesting; however, in particular situations, such as in this unique case, the choice of an orthotopic graft may offer promising results.
Giovanni F. Marangi, Francesco Segreto, Marco Morelli Coppola, Lucrezia Arcari, Marco Gratteri, and Paolo Persichetti
Wiley
Postoperative seroma is a common complication of many surgical procedures in which anatomical dead space has been created. A particular case of lesion in which seroma occurs is the Morel‐Lavallée lesion (MLL), which is an uncommon closed soft‐tissue degloving injury that develops after high‐energy trauma or crush injury where shearing forces separate the subcutaneous tissue from the underlying fascia. The diagnostic evaluation begins with an adequate history and physical examination, followed by instrumental research with ultrasonography, computed tomography, and magnetic resonance imaging. Postoperative seromas and MLLs share a similar pathology and natural evolution as both injuries, once chronic, develop a pseudobursa; thus, the authors think that the same treatment algorithm may be suitable for both the lesions. Several strategies for the treatment of post‐surgical and post‐traumatic seromas have been described in the literature, ranging from conservative measures for acute and small injuries to surgical management and sclerotherapy for chronic and large ones. Despite some seromas resolving with conventional management, lesion recurrence is a matter of concern. The authors present their experience in the treatment of both post‐surgical and post‐traumatic chronic seromas not responsive to conservative treatments by surgical drainage of the seroma, capsulectomy, and application of vacuum‐assisted closure therapy to allow granulation tissue formation, dead spaces obliteration, and wound healing. Primary wound closure with closed suction drain placement and an elastic compression bandaging are finally performed. From 2014 to 2019, a total of 15 patients (9 females and 6 males) were treated for recurrent chronic seromas with the proposed surgical approach. Five cases were MLLs, while 10 cases were postoperative seromas. The patients were between 33 and 79 years old, and they were followed up at 4 weeks and 3 and 6 months after surgery. All 15 patients with chronic seromas not responsive to conservative treatment showed a complete resolution of the lesions with the proposed treatment approach with no evidence of lesion recurrence, proving its effectiveness.
Stefania Tenna, Rosa Salzillo, Beniamino Brunetti, Marco Morelli Coppola, Mauro Barone, Barbara Cagli, Annalisa Cogliandro, Francesco Franceschi, and Paolo Persichetti
Elsevier BV
Mauro Barone, Annalisa Cogliandro, Rosa Salzillo, Alfredo Colapietra, Mario Alessandri Bonetti, Marco Morelli Coppola, Emile List, Silvia Ciarrocchi, Stefania Tenna, and Paolo Persichetti
Springer Science and Business Media LLC
B. Brunetti, R. Salzillo, M. Morelli Coppola, S. Tenna, M. Barone, and P. Persichetti
Elsevier BV
Stefania Tenna, Marco Morelli Coppola, Beniamino Brunetti, and Paolo Persichetti
Springer Science and Business Media LLC
Beniamino Brunetti, Marco Morelli Coppola, Stefania Tenna, and Paolo Persichetti
Ovid Technologies (Wolters Kluwer Health)
1. Amirlak B, Chung MH, Pezeshk RA, Sanniec K. Accessory nerves of the forehead: A newly discovered frontotemporal neurovascular bundle and its implications in the treatment of frontal headache, migraine surgery, and cosmetic temple filler injection. Plast Reconstr Surg. 2018;141:1252–1259. 2. Andersen NB, Bovim G, Sjaastad O. The frontotemporal peripheral nerves. Topographic variations of the supraorbital, supratrochlear and auriculotemporal nerves and their possible clinical significance. Surg Radiol Anat. 2001;23: 97–104.
M. Barone, A. Cogliandro, E. Tsangaris, R. Salzillo, M. Morelli Coppola, S. Ciarrocchi, B. Brunetti, S. Tenna, V. Tambone, and P. Persichetti
Springer Science and Business Media LLC
Mauro Barone, Annalisa Cogliandro, Marco Morelli Coppola, Gabriella Cassotta, Nicola Di Stefano, Vittoradolfo Tambone, and Paolo Persichetti
Springer Science and Business Media LLC
Marco Morelli Coppola, Rosa Salzillo, Francesco Segreto, and Paolo Persichetti
Informa UK Limited
Keloids are pathological scars presenting as nodular lesions that extend beyond the area of injury. They do not spontaneously regress, often continuing to grow over time. The abnormal wound-healing process underlying keloid formation results from the lack of control mechanisms self-regulating cell proliferation and tissue repair. Keloids may lead to cosmetic disfigurement and functional impairment and affect the quality of life. Although several treatments were reported in the literature, no universally effective therapy was found to date. The most common approach is intralesional corticosteroid injection alone or in combination with other treatment modalities. Triamcinolone acetonide (TAC) is the most commonly used intralesional corticosteroid. The aim of this article was to review the use of TAC, alone or in combination, in the treatment of keloid scars. The response to corticosteroid injection alone is variable with 50–100% regression and a recurrence rate of 33% and 50% after 1 and 5 years, respectively. Compared to verapamil, TAC showed a faster and more effective response even though with a higher complication rate. TAC combined with verapamil was proved to be effective with statistically significant overall improvements of scars over time and long-term stable results. TAC and 5-fluorouracil (5-FU) intralesional injections were found to achieve comparable outcomes when administered alone, although 5-FU was more frequently associated with side effects. Conversely, the combination of 5-FU and TAC was more effective and showed fewer undesirable effects compared to TAC or 5-FU alone. Several kinds of laser treatments were reported to address keloids; however, laser therapy alone was burdened with a high recurrence rate. Better results were described by combining CO2, pulsed-dye or Nd: YAG lasers with TAC intralesional injections. Further options such as needle-less intraepidermal drug delivery are being explored, but more studies are needed to establish safety, feasibility and effectiveness of this approach.