Carmine Alfano

Sapienza University of Rome, Roma, Latium, Italy

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Publications (87)75.16 Total impact

  • No preview · Article · Jul 2015 · Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery
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    ABSTRACT: Post-traumatic hand and forearm defects always represent a challenge for reconstructive surgeons, especially when multiple structures are involved, because of a high rate of amputation. A 21 years old woman arrived to the E.R. with a complex crush-burn trauma of the upper limb caused by an accident with an industrial ironing machine, resulting in a ulnar bone fracture, ulnar artery laceration and a wide burn of the dorsum of the right forearm. We achieved toTAL limb salvage with coverage of the "nobles" structures of the forearm. Different reconstructive methods have been used over time to treat these defects focusing the attention on both functional and cosmetic aspects. The abdominal pedicle flap was one of the achiest reconstructive methods for hand and forearm defects. In an era in which microsurgery takes the lion's share, some basic procedure may be helpful, especially in certain cases. In this study the authors reported a case of a young woman with a complex trauma of the right arm resulting from an occupational accident. Abdominal Flap, Hand Forearm burn Hand reconstruction.
    No preview · Article · Jun 2015
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    ABSTRACT: Background: Despite the great variety of mammaplasty techniques, outcome assessment remains a challenging issue. Objectives: The authors devised an objective method to evaluate mammary symmetry based on statistical analysis of objective manual breast measurements and validated the method by applying it to results of a randomized controlled trial on the correction of breast asymmetry. Methods: Sixty consecutive patients with hypoplastic breasts and small-volume asymmetry were enrolled in the study and randomly assigned to 1 of 2 groups. One group received a fixed-volume implant in 1 breast and an adjustable-volume implant in the other. The other group received 2 fixed-volume implants of different sizes. The differences in specific breast and chest measurements, obtained before surgery and during follow-up, were analyzed statistically with the Wilcoxon signed rank test. Results: Correction of the asymmetry resulted in the reduction of the differences between left and right values for each specific breast measurement. Placement of an adjustable implant on 1 side yielded better symmetry than placement of 2 fixed-volume prostheses of different sizes. Patient and physician satisfaction was high for both groups. Conclusions: This objective analysis of clinical parameters enables comparing results for different patients in large clinical trials and for the same patient at different follow-up periods. Level of Evidence: 3
    No preview · Article · Sep 2014 · Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery
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    ABSTRACT: Lip cancer is the most common malignant tumour of the oral cavity and the oral commissure is the origin of the tumour in 6% to 8.5% of cases. Reconstruction of oral commissure defects aims at securing oral competence and providing an acceptable appearance. Satisfactory reconstruction of defects affecting the lip commissure is always challenging. The authors present a selected group of 22 patients, who, between November 2005 and 31st October 2012, underwent reconstruction for primary or secondary defects involving the oral commissure. The results were generally satisfactory, both functionally and cosmetically. The patients had been followed up for 5 years. All patients had excellent oral competence during rest, speaking and eating. Good sphinteric function was obtained in early postoperative days. No drooling or air leakage. The aesthetic results were good in all patients. Lip cancer, Oral commissure cancer, Oral commissure reconstruction.
    No preview · Article · Sep 2014 · Annali italiani di chirurgia
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    ABSTRACT: Aim: Poland syndrome is a constellation of rare congenital anomalies of the chest wall, with or without alterations to the ipsilateral superior extremity. Actually Foucras' classification is commonly used to choose the most appropriate surgical treatment, but often only a radiological classification proves unsatisfactory in order to achieve the best aesthetic result. Material And Methods: Since November 2006 in our institute have been treated 6 patients (3 M, 3 F) with Poland Syndrome affected by only chest wall and/or breast deformities. Results: We treated 6 patients opting for different surgical procedures, depending on the deformity detected. We experienced only one procedural complication, a fat necrosis with superior migration of the prosthesis, successfully managed. Discussion: Surgical alternative treatments of the Poland's abnormalities of the chest wall are independent from the corrective surgery of the ipsilateral affected forearm ad hand. Surgeons should be able to develop an operative plan to address aesthetic goals while preserving muscular functionality. Indeed surgical techniques should be minimally invasive and possible available in every hospital structure. Conclusions: This study has been designed to review a series of surgical options of breast reconstruction in patients with Poland Syndrome in order to develop a new flow chart to plan the best surgical choice analyzing only breast/chest wall deformities according to Blondeel's point of view about reconstruction of the new breast and thoracic wall.
    No preview · Article · Jul 2014 · Annali italiani di chirurgia
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    ABSTRACT: Aim: Our aim is focused on the field of action of plastic surgery in the cephalic malformation and on description of the surgical indications and techniques for their correction. Material of study: We looked at 27 patients from 2006 to 2012 with cephalic district deformities. All patients underwent surgical and rehabilitative treatments. Results: After a median follow-up from one to five years, in most cases we reached both morphological and functional reconstruction, alone or in a surgical team together with other surgical disciplines. Discussion: The correction of craniofacial malformations makes use of a surgical discipline particularly demanding, which must associate a basic surgical training with a learning techniques specific to the area and a knowledge of craniofacial malformation. Conclusions: The surgical treatment of craniofacial malformations can be seen only through a joint neurosurgical and plastic-maxillo-facial surgery, guided by knowledge of the malformation, under the close supervision of anesthetists and pediatricians. This surgery is not limited to remodel the morphology but has its bases on the recovery of the functions, maintained by rehabilitation treatment.
    No preview · Article · Jun 2014 · Annali italiani di chirurgia
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    ABSTRACT: To restore testicular functional competence after traumatic avulsion of the scrotum, accompanied by penile decortication, by means of ad hoc surgery and post-surgical medical treatment. A 26 years old patient underwent a on the job perineal trauma that resulted in loss of one testis while the other one was rescued together with the deferential duct. The spared testis was buried in a subcutaneous thigh pocket after creating a tunnel from the inguinal area. Because of post-traumatic ensued hypogonadism, the patient was treated with corticosteroids, phosphodiesterase 5 inhibitors and anti-oxidizing agents. Hypogonadism related clinical findings in terms of oligospermia, erectile dysfunction and alterations of the pituitary- testis axis, with low testosterone levels progressively improved along the post-traumatic months. Preservation of testis vascular supply associated with ad hoc medical therapy restored erectile dysfunction and spermatogenesis, and in the end at 6 months of the trauma the patients was able to regain fatherhood capability. The obtained results demonstrate that an appropriate testis burying in the subcutaneous thigh region, upon traumatic scrotum avulsion, followed by an ad hoc medical therapy may rescue male fertility. This is unlikely to happen in the clinical routine and previous published reports negate restoration of the testis function, that completely vanishes within 1 year of the intervention. Full restoration of testis and penile functions resulted in induction of spontaneous pregnancy in the patient's female partner may occur only if good reconstructive surgery is coupled with an efficient medical therapy. Burying, Fertility, Scrotum, Testis.
    Full-text · Article · Feb 2014
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    ABSTRACT: The use of negative pressure in the dressing of splitthickness skin grafts has been shown to promote healing by a variety of mechanisms, including a decrease in interstitial edema, an increase in perfusion, and a decrease in bacterial colonization. An observational study was performed on 52 patients at the Department of Plastic Surgery, University of Perugia in Perugia, Italy, undergoing split-thickness skin grafting for acute wounds after trauma and for chronic wounds, such as pressure ulcers and diabetic wounds. The dressing used consisted of a single foam sheet, a conventional disposable closed-system suction drain, and an adhesive dressing. In all patients, there was a 95% take of the graft, with 5% of partial loss. There were no significant complications encountered. Negative pressure wound therapy is an innovative and commercially successful concept for the management of difficultto- treat wounds of nearly every etiology, and the authors' technique is an alternative to commercially available negative pressure dressings..
    No preview · Article · Nov 2013
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    ABSTRACT: The preservation of the sensitivity of the nipple-areola complex after reduction mammoplasty is an important goal of the modern surgery. The aim of this paper is to evaluate the differences in the recovery of sensitivity after reduction mammoplasty using different techniques. Using the Semmes-Weinstein monofilament the sensitivity was evaluated in 64 patients undergone to a bilateral reduction mammoplasty: 36 were treated with inferior pedicle technique and 28 with a superior pedicle techniques. The evaluation of the sensitivity was performed in nine points: the nipple, the four quadrants of the areola and the 4 quadrants of the skin around the areola both in the preoperative and at 3 weeks, 3, 6 and 12 months postoperatively. The major alterations were found in the sensitivity of the nipple: the major deficiencies were seen in women treated with a superior pedicle techniques. Minor differences were found about the sensitivity of the areola and periareolar skin. The techniques which provide the preparation of a glandular flap with superior pedicle have an increased risk of altering the innervation of the nipple-areola complex. The preparation of a glandular flap with inferior pedicle allows the restoration of the pre-operative sensitivity in 6-12 months. Breast sensitivity, Reduction mammoplasty, Sensitivity alteration.
    No preview · Article · Aug 2013
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    ABSTRACT: Purpose of this study is to assess different surgical techniques, comparing them in order to remove nasal skin cancer by restoring the anatomy and the function of the respiratory system without neglecting the aesthetic result. A total of 107 patients were enrolled in the study between January 2006 and December 2012. We compared the results obtained using 23 front-glabellar flaps, 30 bilobed flaps, 27 nose-cheek flaps, 15 sliding flaps, 12 frontal island flaps. We obtained the oncological radicality with good aesthetic results. There were no infections and no sensory (numbness and tenderness) and motor abnormalities of the facial nerve. None of the used techniques has lead to scarring ectropion or to alteration of the nasal filter. The best nasal reconstruction mostly depends on skin cancer location and on the amount of tissue to be removed to definitely eradicate the neoplastic lesion; during the planning of a nasal reconstruction we also must assess adjacent tissue characteristics, the presence of fixed structures and the donor skin area (color, thickness, pils, etc) . Using these parameters we have chosen for the ala the nose-cheek flap, for the dorsum the front-glabellar flap, the bilobed flap and the sliding flap (lateral region) and for the tip both the frontal island flap and the bilobed flap. Cancer of the face, Flap local, Nose reconstruction.
    No preview · Article · Apr 2013
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    ABSTRACT: Aim: The aim of this paper was to report our experience using VarioscopeÒM5 in hypospadia surgical correction. To suggest the use of microsurgical principles that can result in the successful repair of hypospadias with a few complications. Methods: Forty-three patients (age 12-16 months), affected by hypospadia, underwent longitudinal dorsal preputial island flap (Scuderi's technique) surgical procedure. All the procedures were performed with Varioscope®M5. This new device is a head-mounted miniaturized microscope which combines a microsurgical microscope illumination and magnification with the freedom of loupes. Results: In 39 (91.1%) of the patients the postoperative course was uneventful. One patient (2.3%) developed urethral fistula and a second intervention was necessary to correct it. He was affected by fourth degree hypospadia. In 3 patients (6.6%) we observed a mild stenosis. Urethral strictures were dilated during multiple sessions, by weekly introduction of catheters of progressively increasing caliber. At 3 months after surgery all urethral strictures had been solved by non surgical treatment, thus decreasing complication rate of the surgical procedure from 8.9% to 2.3%. Evaluation of flow rate was repeated at 3 weeks, 6 and 12 months. The aesthetic outcome was evaluated by the parents on a VAS scale. Results were judged optimal (8-9 out of 10). Conclusion: In order to achieve a better aesthetic and functional outcome and to reduce complications we deem a perfect flap dissection and anastomosis necessary. A well lighted and magnified surgical field is essential to achieve the best result due to the small anatomical structures involved in the surgical technique we have adopted. The Varioscope®M5 offers essential advantages in this regard.
    No preview · Article · Apr 2013 · Minerva chirurgica
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    ABSTRACT: Our interest continues in discovering phytocomplexes from medicinal plants with phototoxic activity against human melanoma cells; thus the aim of the present study was to assess antioxidant, anti-inflammatory and phototoxic activity of Hypericum perforatum L. subsp. perforatum, and relate these properties to the plant's chemical composition. Components of H. perforatum subsp. perforatum were extracted by hydroalcoholic solution and chemical profiles of preparations (HyTE-3) performed by HPTLC. Linoleic acid peroxidation and DPPH tests were used to assess antioxidant activity, while MTT assay allowed evaluation of anti-proliferative activity with respect to A375 human melanoma cells after irradiation with UVA dose, 1.8 J/cm(2) . Inhibition of nitric oxide production of macrophages was also investigated. HyTE-3 indicated better antioxidant activity with β-carotene bleaching test in comparison to DPPH assay (IC50 = 0.89 μg/ml); significant phototoxicity in A375 cells at 78 μg/ml concentration resulted in cell destruction of 50%. HyTE-3 caused significant dose-related inhibition of nitric oxide production in murine monocytic macrophage cell line RAW 264.7 with IC50 value of 342 μg/ml. The H. perforatum subsp. perforatum-derived product was able to suppress proliferation of human malignant melanoma A375 cells; extract together with UVA irradiation enhanced phototoxicity. This biological activity of antioxidant effects was combined with inhibition of nitric oxide production.
    No preview · Article · Apr 2013 · Cell Proliferation
  • C Alfano · S Chiummariello · M Iera · N Scuderi
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    ABSTRACT: Association of multiple vascular malformations of the face is a rare condition. An arteriovenous malformation (AVM) with a venous malformation as the draining vein is also a rarity. We report a case of extracranial mixed vascular malformations that deformed the normal architecture of the lower face. Removal of the AVM was followed by stability of the jaw and tongue malformation, indicating the AVM used the venous malformation as its draining vein. This approach spared the patient severe cosmetic and functional sequelae.
    No preview · Article · Mar 2013 · Il Giornale di chirurgia
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    ABSTRACT: The reconstruction of post-traumatic losses of substance of the scalp is very difficult due to the unique characteristics of the scalp. The purpose of this paper is to evaluate the results obtained with several techniques in order to identify the most appropriate. We treated 19 patients, 11 men and 8 women aged between 19 and 81 years, with post-traumatic loss of substance of the scalp from January 2006 to June 2011. The chosen treatments were the direct closure and the use of local flaps, the latter combined or not with the graft of the donor area and the post-operative correction of alopecic area with tissue expansion. None of the patients developed severe complications and all flaps were viable. The aesthetic results were variable, between good and satisfactory according to the technique used. The local flaps represent a good choice for the treatment of post-traumatic losses of substance of the scalp, restricting the use of direct suture and the use of skin grafting only in selected cases. Tissue expansion is a good choice for the revision of alopecic and cicatricial areas. Local flaps, Scalp, Tissue expansion.
    No preview · Article · Mar 2013
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    ABSTRACT: Our aim is focused on the management of eyelid injuries and on the chose different techniques for the reconstruction. The reconstructions of the upper eyelid and lower eyelid should be based on both functional and cosmetic aspects. We looked at 47 patients from 2005 to 2011 with eyelid injuries. All patients were subjected to a surgical treatment. After a median follow-up from one to five years, in all cases the skin coverage was reinstated and mobility was restored, thereby adhering to the principles of both morphological and functional reconstruction. Eyelids are complex structures and pose a challenge for reconstruction. They play an important role in protecting the globe from trauma, excessive light and in maintaining the integrity of tear films and moving the tears toward the lacrimal drainage system. Concerning reconstruction by means of flap, the main principles dictate that with this procedure the new coverage will appear as much as possible, "like" the original tissue. There are different techniques available for reconstructions of defects of eyelids. The availability of tissues, technical expertise and the specific needs of the patient have to kept in mind before choosing a particular method. Compared with other frequently used techniques, the nasal chondromucosal flap is a one-stage operation, does not damage the lower lid, and provides a thin, mobile eyelid with an anatomically complete reconstruction. KEY WORDS: Anterior lamella, Eyelid reconstructions, Posterior lamella.
    No preview · Article · Feb 2013 · Annali italiani di chirurgia
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    ABSTRACT: The involvement of the lacrimal ducts in the extreme cephalic trauma is an infrequent condition. A correct diagnosis and appropriate management of injuries of the lacrimal system are essential to prevent the onset of post-traumatic epiphora. In the last 5 years, 37 patients were treated for lacrimal apparatus injury as a result of cephalic trauma: in 16 there was an isolated lacrimal injury and in 21 were documented fractures combined with lacrimal damage. In 16 patients who had only deep lesions, was performed a reconstruction after location lesion localization, and only in 4 cases, because of the gravity of the lesion, it was decided to perform a reconstruction in a second time. In the remaining 21 patients the facial fractures were treated before lacrimal injuries, whose reconstruction was carried out on a second time. The reconstruction of the cephalic district has to be based on the restoration of morpho-functional component and on the identification and treatment of lacrimal injuries. The reduction of fractures in our view should start from the lateral area (centripetal reconstruction) allowing to have a guide for alignment of the fracture lines. The objectives to be achieved in a facial trauma are therefore three: the maintenance of vital functions, the recovery of the function and the restoration of morphological and functional prior to the event.
    No preview · Article · Oct 2012 · Annali italiani di chirurgia
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    ABSTRACT: The purpose of this paper is to evaluate the results obtained in the surgical treatment of upper eyelid coloboma with methods that do not involve a prolonged occlusion of the eye. We treated five patients aged between 7 months and 21 years; the surgical techniques adopted were the direct closure (2 patients), the full-thickness graft from the contralateral upper eyelid (2 patients) and the nasal chondromucosal flap (1 patient). The results were good in all patients with vitality of all grafts and flaps; also absent were hematomas, seromas and infections. None of the patients developed amblyopia and lagophthalmos. The use of these methods prevents the development of some complications, such as amblyopia, occurring with the use of other techniques, as shown in the literature. In addition, allowing the reconstruction with similar tissues or very flexible and thin tissues provides greater functionality to the new eyelid. When possible, early intervention with the use of the described techniques will provide good results in the short and long term, allowing to avoid minimal complications which may arise from a prolonged occlusion of one eye.
    No preview · Article · Oct 2012 · Annali italiani di chirurgia
  • S Chiummariello · G Guarro · A Pica · C Alfano
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    ABSTRACT: Negative-pressure therapy or vacuum-assisted closure (VAC) has been used in clinical applications since the 1940's and has increased in popularity over the past decade. This dressing technique consists of an open cell foam dressing put into the wound cavity, a vacuum pump produces a negative pressure and an adhesive drape. A controlled sub atmospheric pressure from 75 to 150 mmHg is applied. The vacuum-assisted closure has been applied by many clinicians to chronic wounds in humans; however it cannot be used as a replacement for surgical debridement. The initial treatment for every contaminated wound should be the necrosectomy. The VAC therapy has a complementary function and the range of its indications includes pressure sores, stasis ulcers, chronic wounds such as diabetic foot ulcers, post traumatic and post operative wounds, infected wounds such as necrotizing fasciitis or sternal wounds, soft-tissue injuries, bone exposed injuries, abdominal open wounds and for securing a skin graft. We describe our experience with the VAC dressing used to manage acute and chronic wounds in a series of 135 patients, with excellent results together with satisfaction of the patients.
    No preview · Article · Oct 2012 · Il Giornale di chirurgia
  • M Mazzocchi · LA Dessy · C Alfano · N Scuderi
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    ABSTRACT: Capsular contracture is a distressing complication after breast augmentation for both the patient and surgeon. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have recently emerged as effective prophylactic agents in reactive airway diseases. A prospective study was carried out on 60 female patients (120 prostheses implanted) with mild/severe capsular contracture in at least one breast. The hardness of capsular contracture was assessed by means of the mammary compliance method. Patients received zafirlukast (Accolate®) for a 6-month period. Mammary compliance was assessed at the start of the study and thereafter monthly, during drug intake and for one year after drug withdrawal. The results show a significant decrease in breast compliance values in the first 6 months, followed by a significant increase one year after the end of drug intake. Indeed, zafirlukast-treated patients displayed a 6.93 percent reduction in mammary compliance after 1 month, 14.42 percent after 3 months, 22.05 percent after 6 months and 22.52 percent after 7 months (1 month after the withdrawal of the drug). Thereafter, mammary compliance values gradually increased. A 5.47 percent reduction in mammary compliance was observed 1 year after drug withdrawal. The present study suggests that zafirlukast may be effective in reducing breast capsule distortion in patients with long-standing contracture, though reduced capsular contracture values are strictly related to the duration of drug intake.
    No preview · Article · Oct 2012 · International journal of immunopathology and pharmacology
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    ABSTRACT: Many methods have been described for the reconstruction of the lower lip, but each has its own advantages and its disadvantages. The purpose of this study is to evaluate the results obtained with the use of different methods in order to choose the most appropriate method, according to the characteristics of the loss of substance. From January 2006 to March 2011 were treated 110 patients with full-thickness loss of substance of the lower lip using various techniques: direct closure in small losses of substance (20 patients), Abbe flap (14 patients), Johanson technique (12 patients), Gillies fan flap (9 patients), Estlander flap (8 patients), Mc Gregor flap (11 patients), Karapandzic flap (18 patients), the nasolabial flap by Von Bruns (10 patients) and Bernard-Burow flap modified by Webster (8 patients). All flaps were vital and there were no cases of necrosis, infection, seromas or hematoma. Among the main complications, there was a delay in wound healing in 11 patients and the development of microstomia, of variable degrees, in 9 patients. The results from the aesthetic point of view were between good and satisfactory. The extension of the loss of substance is the main criterion that should direct the choice of an appropriate surgical technique: for larger defects reconstruction is less than optimal and obtain an adequate sphincter function is the main goal to achieve also with the use of near tissue.
    No preview · Article · Jul 2012 · Annali italiani di chirurgia

Publication Stats

392 Citations
75.16 Total Impact Points


  • 2002-2015
    • Sapienza University of Rome
      • Department of Experimental Medicine
      Roma, Latium, Italy
  • 2006-2014
    • Università degli Studi di Perugia
      • Sezione di Chirurgia Plastica e Ricostruttiva
      Perugia, Umbria, Italy
    • Catholic University of the Sacred Heart
      • Institute of Hematology
      Roma, Latium, Italy