Tommaso Agostini

Publications (89) View all

• Article: A Novel Design of the Multilobed Latissimus Dorsi Myocutaneous Flap to Achieve Primary Donor-Site Closure in the Reconstruction of Large Defects.

  Yi Xin Zhang, Caroline Messmer, Fong Kuong Pang, Yee Siang Ong, Shao Qing Feng, Yunliang Qian, Giuseppe Spinelli, Tommaso Agostini, L Scott Levin, Davide Lazzeri
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  ABSTRACT: BACKGROUND:: The main drawback of the latissimus dorsi myocutaneous flap for large defect repairs is the relatively small skin paddle size that can be raised to allow primary closure of the donor site. In this article, the authors describe a novel design of the flap using multiple separate skin paddles, with each paddle nourished by independent perforators, to repair very large defects while maintaining primary donor-site closure. METHODS:: After the size of the defect was calculated, its total area was split into two or three skin paddles and marked on the back skin so that the largest width of each paddle did not exceed 8 cm. A multilobed skin paddle was designed with a total area that was much larger than traditional latissimus dorsi flaps. After harvesting the flap, several smaller skin paddles were transferred and rejoined at the recipient site. RESULTS:: From June of 2009 to March of 2012, this method was used to restore posttraumatic and postoncologic defects of the head in seven cases and lower limb defects in two cases. Seven flaps were raised as bilobed flaps, and two flaps were raised as trilobed flaps. The donor site was closed primarily in all cases. One case was complicated by partial necrosis of one paddle and required further local flap coverage. Donor-site breakdown was not observed in any of the cases. CONCLUSIONS:: The multilobed myocutaneous latissimus dorsi flap enables a customized reconstruction of large defects for all types of patients and direct closure of the donor site. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
  Plastic and reconstructive surgery 05/2013; 131(5):752e-758e. · 2.74 Impact Factor
• Article: Thoracoacromial Artery Perforator Flap: Anatomical Basis and Clinical Applications.

  Yi Xin Zhang, Hu Yongjie, Caroline Messmer, Yee Siang Ong, Zan Li, Xiao Zhou, Giuseppe Spinelli, Tommaso Agostini, L Scott Levin, Davide Lazzeri
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  ABSTRACT: BACKGROUND:: Concerns and criticism have been reported on the feasibility and vascular reliability of the thoracoacromial artery perforator flap because of the inconsistent size of the pectoral branch of the thoracoacromial artery and its cutaneous perforators. The authors have investigated its vascular basis through a cadaver dissection and described their clinical experience in the surgical strategy, range of application, and indications for the thoracoacromial artery perforator flap. METHODS:: Twelve fresh human cadavers were dissected to define the anatomy of the branches of the thoracoacromial artery and their perforators and the anatomical landmarks for clinical application. Single pectoral branch perforators were injected to measure the extension of the thoracoacromial artery perforator vascular territory. RESULTS:: A constant thoracoacromial artery perforator was present in the septum between the clavicular and sternocostal heads of the pectoralis major muscle in 21 of 24 hemichests. The mean caliber of the perforator was 0.7 mm and the mean length of the vascular pedicle was 7.1 cm. The territory of the thoracoacromial artery perforator flap extended up to the fourth intercostal space inferiorly. Between 2006 and 2011, the thoracoacromial artery perforator flap was used to reconstruct head and neck defects in seven patients. All patients healed uneventfully. CONCLUSIONS:: The authors' studies provide evidence of the vascular supply and the clinical application of the thoracoacromial artery perforator flap. The recruitment of the chest skin through a thoracoacromial artery perforator flap resulted in an adequate color match, texture, and pliability for local adjacent defect restoration and for head and neck reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
  Plastic and reconstructive surgery 05/2013; 131(5):759e-770e. · 2.74 Impact Factor
• Article: Reverse Bipaddle Posterior Interosseous Artery Perforator Flap.

  Yi Xin Zhang, Yunliang Qian, Zheming Pu, Yee Siang Ong, Caroline Messmer, Qinfeng Li, Tommaso Agostini, Detlev Erdmann, L Scott Levin, Davide Lazzeri
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  ABSTRACT: BACKGROUND:: The reverse posterior interosseous artery perforator flap is useful for covering defects over the distal forearm, wrist, and hand, but some of its major limitations include short vascular pedicle, inadequate distal reach, difficult pedicle dissection, and risk of venous congestion. Some of these drawbacks have been overcome with refinements over the years, but the problems of donor-site morbidity and inability to reconstruct multiple subunits of the hand in a single stage remain. The authors developed a variant of the original distally based flap to extend its applications and minimize donor-site morbidity. METHODS:: Eleven cases of reverse bipaddle posterior interosseous artery perforator flap reconstruction were reviewed. Defect locations included the first web space, proximal thumb, dorsum of the hand, palm, wrist, and the radial or ulnar half of the hand. RESULTS:: Eleven patients were successfully treated with the bipaddle posterior interosseous artery perforator flap with no major complications. In seven cases, the type A chain-like variant was used to cover defects involving two different units of the hand. In four patients, the type B "kiss" pattern was required to resurface a large defect of a single unit of the hand. In all type B cases, the donor site was closed directly. All patients were satisfied with their outcomes. CONCLUSIONS:: The reverse bipaddle posterior interosseous artery perforator flap is an excellent method of covering large defects of the hand involving multiple subunits. The authors confirm its vascular reliability and highlight several recommendations for skin island location, pedicle dissection, and flap raising and insetting. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
  Plastic and reconstructive surgery 04/2013; 131(4):552e-562e. · 2.74 Impact Factor
• Article: Adipofascial anterolateral thigh flap safety: applications and complications.

  Tommaso Agostini, Giulia Lo Russo, Yi Xin Zhang, Giuseppe Spinelli, Davide Lazzeri
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  ABSTRACT: A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimal skin resurfacing. Several techniques have been described to thin an ALT flap including an adipocutaneous flap, an adipofascial flap and delayed debulking. By systematically reviewing all of the available literature in English and French, the present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of the adipofascial variant of the ALT flap. The studies were identified by performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google Scholar. The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and 15 articles were identified using the study inclusion criteria. These articles were then reviewed for author name(s), year of publication, flap dimensions and thickness following defatting, perforator type, type of transfer, complications, thinning technique, number of cases with a particular area of application and donor site morbidity. The adipofascial variant of the ALT flap provides tissue to fill large defects and improve pliability. Its strong and safe blood supply permits adequate immediate or delayed debulking without vascular complications. The presence of the deep fascia makes it possible to prevent sagging by suspending and fixing the flap for functional reconstructive purposes (e.g., the intraoral cavity). Donor site morbidity is minimal, and thigh deformities can be reduced through immediate direct closure or liposuction and direct closure. A safe blood supply was confirmed by the rate of secondary flap debulking.
  Archives of plastic surgery. 03/2013; 40(2):91-6.
• Article: A novel combined surgical approach to head and neck dermatofibrosarcoma protuberans.

  Tommaso Agostini, Mario Dini, Alessandro Quattrini Li, Luca Grassetti, Andrea Mori, Giuseppe Spinelli, Giulia Lo Russo, Davide Lazzeri
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  ABSTRACT: INTRODUCTION: The surgical management of dermatofibrosarcoma protuberans has historically been a challenge, particularly in the head and neck and other aesthetic areas. The current priority is to achieve local oncologic control and a good reconstructive outcome. Here, we present our experience using a novel combined approach with a dermal regenerative template, sub-atmospheric pressure and skin graft. MATERIALS AND METHODS: Five patients presenting at the Department of Plastic and Reconstructive Surgery of the University of Florence between January 2010 and October 2011 were included in the study following Institutional Review Board approval. All patients underwent a wide local excision of dermatofibrosarcoma protuberans affecting the head and neck. RESULTS: The combined approach using the negative-pressure device, a dermal regenerative template and skin grafting proved effective in the management of this type of sarcoma with a good aesthetic and functional outcome, particularly on the neck or the supraclavicular region. CONCLUSION: Although the present multi-step technique requires patient compliance, it results in good local oncologic control of the resection margins. It is possible to perform a wider excision in the event of positive margins without interfering with the last reconstructive outcome.
  Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 02/2013; · 1.25 Impact Factor