Bruno Battiston - Academia.edu (original) (raw)

Papers by Bruno Battiston

Schwann cells play a critical role in peripheral nerve regeneration. When a non-nervous conduit i... more Schwann cells play a critical role in peripheral nerve regeneration. When a non-nervous conduit is used to bridge a nerve defect, the conduit is soon colonized by a number of Schwann cells that make a pathway for regrowing axons. By using electron microscopy, immunohis-tochemistry, and reverse transcriptase-polymerase chain reaction analysis, we have investigated the behavior of migratory glial cells along a particular type of autologous tissue-engineered conduit made of a vein filled with fresh skeletal muscle, using the rat sciatic nerve model. With this particular type of autograft, our data show that many Schwann cells soon take up a close relationship with grafted muscle fibers, and especially with their basal lamina, which appears to serve as a migration pathway for them. The early and massive colonization of the conduit is sustained by both Schwann cell migration and proliferation, as demonstrated by PCNA immunostaining. Later, as they meet regenerating axons, Schwann cells become closely associated with them and eventually lose their connections with grafted muscle fibers because of the formation of perineurial envelopes. Because previous studies showed that 2a-2b NRG1 is overexpressed at early stages along the muscle-vein combined tubes, we have also investigated mRNA expression of its two receptors, erbB2 and erbB3. Both messengers are overexpressed, although with different time courses. Overall, our results provide some morphological and biochemical bases for explaining the effectiveness of fresh muscle-vein combined nerve guides and throw an interesting light on the possible role of 2a-2b NRG1 through the erbB2/erbB3 heterodimer receptor for nerve regeneration inside non-nervous conduits. J. Comp. Neurol. 489:249 –259, 2005.

The quantitative assessment of motor function is an important requirement for studies on peripher... more The quantitative assessment of motor function is an important requirement for studies on peripheral nerve injury and repair. So far, most studies on peripheral nerves have been performed on the sciatic nerve model using walking track analysis for assessing motor function. Alternatively, the employment of the median nerve model, which allows motor function evaluation by means of a simple behavioural test named grasping test (GT), have been more recently proposed. In this paper, the efficacy of the GT for the quantitative assessment of motor function recovery is re-appraised and a modified device for its carrying out is described. Finally, the rationale for the employment of the median nerve model as an alternative to the sciatic nerve model is critically discussed.

$Research paper thumbnail of Tibial pilon fractures$

Tibial pilon fractures are challenging to treat, as they are typically intra-articular and associ... more Tibial pilon fractures are challenging to treat, as they are typically intra-articular and associated with extensive soft tissue damage. We briefly review the anatomy of the distal tibia, as well as the pathophysi-ology of pilon fractures. The treatment of tibial pilon fractures is still controversial in the literature, and we present some of the available options. Consideration is also given to peri-operative complications, such as preoperative oedema and blistering and late post-operative traumatic arthritis. Finally, we propose a treatment algorithm (used in our institution), taking into account the level of associated soft tissue injuries. The use of a 2-phase treatment protocol is recommended ; however, to date, no absolute treatment protocol exists for these injuries.

Many surgical techniques are available for bridging peripheral nerve defects. Autologous nerve gr... more Many surgical techniques are available for bridging peripheral nerve defects. Autologous nerve grafts are the current gold standard for most clinical conditions. In selected cases, alternative types of conduits can be used. Although most efforts are today directed towards the development of artificial synthetic nerve guides, the use of non-nervous autologous tissue-based conduits (biological tubulization) can still be considered a valuable alternative to nerve autografts. In this paper we will overview the advancements in biological tubulization of nerve defects, with either mono-component or multiple-component autotransplants, with a special focus on the use of a vein segment filled with skeletal muscle fibers, a technique that has been widely investigated in our laboratory and that has already been successfully introduced in the clinical practice.

Treatment of painful neuromas in continuity of the median nerve at the wrist level is a challengi... more Treatment of painful neuromas in continuity of the median nerve at the wrist level is a challenging problem. Nine median nerve neuromas were covered with the pronator quadratus muscle preelevated as an island flap. Patients were followed for 10 to 60 months after surgery. Results showed a marked improvement in terms of symptoms in all patients. In particular, 6 patients had complete pain relief and 3 patients complained of mild intermittent pain. Adani R, Tarallo L, Battiston B, Marcoccio I. Management of neuromas in continuity of the median nerve with the pronator quadratus muscle flap. Ann Plast Surg 2002;48:35– 40

Over the last 10 years, we have investigated a particular type of bioengineered nerve guide, the ... more Over the last 10 years, we have investigated a particular type of bioengineered nerve guide, the muscle-vein-combined tube, which is made by filling a vein with skeletal muscle. In our previous studies we have always used fresh skeletal muscle to fill vein conduits. In the present study we compared the use of fresh and predegenerated (freeze-thawed) skeletal muscle for muscle-vein-combined nerve guides. In this study, a 10-mm-long rat median nerve defect was repaired using either type of nerve guide. The samples were analyzed 5 and 30 days after surgery by light and electron microscopy. In addition, reverse transcription polymerase chain reaction (RT-PCR) was carried out to investigate the expression of mRNAs coding for glial markers, as well as glial growth factor (NRG1) and its receptors (erbB2 and erbB3). Results showed differences between the two types of nerve guides at postoperative day 5; however, no difference was detected at day 30 suggesting that both types of tissue-engineered conduit are effective for repairing peripheral nerve defects in this experimental model. V V C 2007 Wiley-Liss, Inc. Microsurgery 27:48–55, 2007.

Tissue engineering has recently seen great advancements in many medical fields, including periphe... more Tissue engineering has recently seen great advancements in many medical fields, including peripheral nerve reconstruction. In the rat median nerve model, we investigated nerve repair by means of bioengineered tissue scaffolds (muscle-vein-combined tubes) focusing on changes in the neuregulin-1/ErbB-receptor system which represents one of the main regulatory systems of axo-glial interaction in peripheral nerves. Repaired nerves were withdrawn at 5, 15, and 30 days postoperative and processed for morphological and retro-transcriptase polymerase chain reaction (RT-PCR) analysis. Results revealed an early and progressive increase in the expression of NRG1a isoform only, while the appearance of the b isoform of NRG1, which is normally present in peripheral nerves, was delayed. In regards to ErbB2 and ErbB3 receptors, their expression increased progressively inside the muscle-vein-combined scaffolds, though with different kinetics. Taken together, these results suggest that variations in neuregulin-1/ErbB system activation play a key role in peripheral nerve regenera-tion along bioengineered muscle-vein-combined scaffolds. Since similar variations are also detectable in denervated skeletal muscles, it can be hypothesized that the existence of a NRG1's autocrine/paracrine trophic loop shared by both glial and muscle fibers could be responsible for the effectiveness of muscle-vein-combined conduits for repairing nerve defects. V

Diagnosis becomes more complex when there is an association of a brachial plexus injury with an a... more Diagnosis becomes more complex when there is an association of a brachial plexus injury with an arterial lesion. The principal clinical picture in most cases is acute ischemia that requires initial treatment in the emergency room, and the final results of nerve repair are generally poorer. Although delayed brachial plexus reconstruction is preferred by some authors, our experience leads us to the opinion that a combined repair presents several advantages. Immediately after trauma, the surgical field is free of scar tissue, and a precise evaluation of both the number and level of damaged nerves may be made. Vascular and nerve repair may be mutually agreed upon by both the vas-cular surgeon and microsurgeon, and simple sutures may often be used instead of grafts in early nerve repair. Even if the extent of nerve damage may sometimes be difficult to assess, the results of early, easier repairs can be observed in our series of 14 combined lesions. Our results indicate that collaboration between microsurgeons and vascular surgeons is a very important factor in providing a correct approach to these problematic patients. V

Nerve repair is usually accomplished by direct suture when the two stumps can be approximated wit... more Nerve repair is usually accomplished by direct suture when the two stumps can be approximated without tension. In the presence of a nerve defect, the placement of an autologous nerve graft is the current gold standard for nerve restoration. However, over the last 20 years, an increasing number of research articles reported on the use of non-nervous tubes (tubulization) for repairing nerve defects. The clinical employment of tubes (both biological and synthetic) as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autografts and the related morbidity. In addition, tubulization was proposed as an alternative to direct nerve sutures in order to create optimal conditions for nerve regeneration over the short empty space intentionally left between two nerve stumps. This paper outlines recent important advances in this field. Different tubulization techniques proposed so far are described, focusing in particular on studies that reported on the employment of tubes with patients. Our personal clinical experience on tubulization repair of sensory nerve lesions (digital nerves), using both biological and synthetic tubes, is presented, and the clinical results are compared. In our case series, both types of tubes led to good clinical results. Finally, we speculate about the prospects in the clinical application of tubulization for peripheral nerve repair.

Replantation of an amputation is no longer a difficult technical problem. Indeed, the experience ... more Replantation of an amputation is no longer a difficult technical problem. Indeed, the experience gathered over the last few decades, right from the first concepts posed by the pioneers up to the present era and the improved technical aids, all go to suggest that the majority of amputated segments may now be reconstructed. However, what we really want from a replant is not just survival but function. Indications for replantations must follow careful and objective patient selection together with the evaluation of type and site of lesion and possible complications. Furthermore, the important role of emergency organization in this type of surgery is to be emphasized. Nowadays, clean cut injuries are rarer and are being substituted by high energy trauma which may produce extensive tissue lesions that increase complications and lead to poor functional results. Consequently, some authors were induced to describe evaluation systems for decision making which still present problems which are in part due to the large number of parameters to be taken into consideration as well as to the complex functionality of the upper limb. This led us to evaluate our case series of 52 major replantations of the upper limb over the last 10 years and to compare it with other published series. The best form of reconstruction following total amputation of a major limb segment is still its replantation. The highly significant increase in the quality of life is able to justify the higher social costs and the number of operations required.

We used end-to-side nerve coaptation combined with standard end-to-end neurotizations to treat 11... more We used end-to-side nerve coaptation combined with standard end-to-end neurotizations to treat 11 patients who presented with complete (six cases) or incomplete (five cases) traumatic brachial plexus injuries. All patients were available for functional evaluation at a minimum of 2 years post-operatively. In three patients with shoulder abduction recovery, electromyographical studies (EMG) showed a contribution from the end-to-side neurotization. In the remaining cases end-to-side neurotizations were unsuccessful. Our study did not demonstrate a reliable role for end-to-side nerve suture in brachial plexus surgery. We believe that at present end-to-side suture must not be a substitute for standard reconstructive techniques in brachial plexus surgery. Occasionally termino-lateral nerve sutures may represent a support to standard reconstructive procedures especially in case of severe injuries when few undamaged donor nerves are available.

The aim of this retrospective study was to analyse the results of 20 thumb replantations with spe... more The aim of this retrospective study was to analyse the results of 20 thumb replantations with special and
exhaustive attention on functional outcomes. Twenty patients with traumatic thumb amputation were
enrolled in the study. Range of motion, grip strength, sensory recovery, and subjective perception of
overall hand function recovery were measured. The average age at the time of surgery was 35 years
(range, 13–73 years). The mean follow-up was 3.25 years (range, 1.9–10.25 years). The long-term results
of thumb replantation confirmed satisfactory outcomes in terms of general upper limb function,
handgrip and pinch strength, and social and work reintegration. Sensory recovery remained
unsatisfactory despite the fact that we did not need to perform any kind of revision surgery as a
consequence of inadequate thumb sensibility. For the first time in the existing literature, no functional
parameter that contributes to the assessment of the function of replanted thumbs has been excluded. We
resume in the same study the analysis of all functional parameters that are useful to define results of
thumb replantation.

In Europe the need for clear defi nitions of hand surgery facilities regarding trauma is becoming... more In Europe the need for clear defi nitions of hand
surgery facilities regarding trauma is becoming
really important to guarantee a correct and
up-dated treatment of lesions more and more
frequent and complex. The goal for European
patients should be to have similar treatment
based on appropriate referral and assistance in
centres offi cially accredited for hand surgery.
The target for the European countries, giving
the correct support to the centres and surgeons
treating these problems, should also be to
save the costs of residual invalidities. These are
some of the reasons for the European Federation
of Societies for Surgery of the Hand (FESSH)
decided to form a committee (Hand Trauma
Committee) devoted to study this problem, trying
to give common guidelines and forming an
European net of accredited centres. The fi rst step
was to collect data through a network of national
representatives. Covering a 487 millions population,
309 centres were recorded, including 1 797
surgeons and 20 363 patients treated during
January 2006, then having a clear situation of
hand trauma treatment through Europe. Next,
the HTC worked on 3 defi nitions: hand trauma,
hand trauma surgeons and hand trauma centres
and started to accredit centres applying to these
well defi ned criteria. The HTC is now working on
scientifi c consensus on some traumatic lesions
but also on the important topic of prevention of
hand traumas. This work is expected to improve
an homogenous situation throughout Europe
focusing on the better use of the given resources
for the prevention and the treatment of these
traumatic lesions.

This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright Abstract Chondrosarcoma is the most common primary malignant bone tumour of the hand. This aggressive lesion is extremely rare in the distal phalanx and requires differential diagnosis with enchondroma and onycomatrichoma which are specific neoplasms of this phalanx. We report a case of chondrosarcoma arising from left index distal phalanx, which developed over a long period of time with a progressive deformity of the distal phalanx before becoming painful. The patient was investigated with X-ray and MRI scan which demonstrated a locally aggressive lesion. The surgical procedure was discussed with the patient and consisted of a wide resection with distal phalanx amputation; this surgery left an acceptable functional impairment. Recently, the optimal treatment for chondrosarcoma of the finger has been debated in the literature and a more conservative surgical approach has been proposed. Local recurrence and metastasis have been reported in the literature. Thus, after surgical treatment, the patients should be followed with careful postoperative surveillance. Résumé Le chondrosarcome est la tumeur osseuse maligne primitive la plus fréquente au niveau de la main. Cette affection est particulièrement rare au niveau de la phalange distale où elle doit être distinguée des lésions plus fréquentes à ce niveau : enchondrome et onychomatrichome. Nous rapportons un cas de chondrosarcome de la phalange distale de l'index développé de façon progressive entraînant une déformation avant de devenir douloureux. La radiographie et l'IRM ont identifié une lésion agressive. Le traitement chirurgical –après discussion avec le patient– a comporté une excision large avec amputation de la phalange distale. Il n'y a pas de consensus actuellement concernant la stratégie chirurgicale dans cette indication et un traitement plus conservateur a été proposé. Les récidives locales et à distance ont été rapportées. Après traitement chirurgical une surveillance à long terme est nécessaire. # 2009 Elsevier Masson SAS. Tous droits réservés.

Peripheral nerve lesions with a long segment defect need a grafting conduit to heal. Although aut... more Peripheral nerve lesions with a long segment defect need a grafting conduit to heal. Although autogenous nerve grafting is still considered the best method for bridging nerve defects, several alternative types of conduits (biological and synthetic) have been studied. We have demonstrated in previous experimental research in rats that a graft made using a vein (providing a guide for nerve regeneration) filled with fresh skeletal muscle (to prevent vein collapse and support axon regeneration) gave similar results to traditional nerve grafts. On this basis, we decided to use the muscle-vein-combined grafts in clinical cases. From 1993 to 1997, this technique was applied for bridging both sensory and mixed nerve defects (21 cases). We report good results in 85% of our cases with a minimum follow-up of 14 months. These results, obtained on nerve defects ranging from 0.5 to 6 cm in length, seem to be superior to those reported with other kinds of artificial or biological conduits.

Riv Chir Mano -Vol. 38 (1) 2001 Clinical results on utilization of biologic and sinthetic tubuliz... more Riv Chir Mano -Vol. 38 (1) 2001 Clinical results on utilization of biologic and sinthetic tubulization in the reconstruction of digital nerves. SUMMARY. This study analyzes and compares the clinical results of 30 cases of collateral digital nerves injuries treated up to 6 months from trauma. All the injuries had a gap from 0,5 cm to 3 cm. Various reconstructive proce-dures have been adopted: Autogenous biological tubulization with vein graft in 10 cases (Group "A"); Sinthetic tubulization with "neurotube" in 7 cases (Group "B"); Autogenous biological tubulization with muscles-vein-com-bined graft in 6 cases (Group "C"); Autogenous Nervous graft reconstruction graft in 7 cases (Group "D", control group). The evaluation of the results was done by mean of the scale of Highet modified Mackinnon + Weber Test. The results were classified according to the parameters of Sakellarides. Follow-up was between 6 and 60 months (mean 26,9). In most...

Neural regeneration research, Jan 15, 2012

It is today widely acknowledged that nerve repair is now more than a matter of perfect microsurgi... more It is today widely acknowledged that nerve repair is now more than a matter of perfect microsurgical reconstruction only and that, to further improve clinical outcome, the involvement of different scientific disciplines is required. This evolving reconstructive/regenerative approach is based on the interdisciplinary and integrated pillars of tissue engineering such as reconstructive microsurgery, transplantation and biomaterials. In this paper, some of the most promising innovations for the tissue engineering of nerves, emerging from basic science investigation, are critically overviewed with special focus on those approaches that appear today to be more suitable for clinical translation.

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 3, 2015

During recent decades, the concept of surgical treatment of malignant bone and soft tissue sarcom... more During recent decades, the concept of surgical treatment of malignant bone and soft tissue sarcomas has evolved, with the aim of preserving limb function. In this paper we report a case of metatarsal reconstruction by means of serratus and rib free flap after excision of a synovial sarcoma located in the dorsal aspect of the midfoot. Five years after the operation, the patient was free from recurrence and recovered full foot function. Amputation has been widely used in the past and this procedure still remains a valuable option when limb salvage is not possible. Nevertheless, in selected cases, reconstruction by means of composite free flaps may be successfully used for limb preservation in the treatment of malignant foot tumors after surgical excision.

BioMed Research International, 2014

Several methods are used to evaluate the functional outcome of tumour resections and reconstructi... more Several methods are used to evaluate the functional outcome of tumour resections and reconstructions in the lower limb. However, one of their most common limitations is that they are specifically developed to evaluate only oncological patients. We introduced the Lower Limb Core Scale (LLCS) to overcome this limitation. The aim of this study was to evaluate the functional and subjective results in the lower limb and to evaluate the use of the LLCS. We conducted a retrospective cohort study using various tools to investigate the outcomes. The results of the LLCS were correlated with the results of other functional tests. A total of 44 patients were included in the study. None of the demographic variables correlated with the functional or health-related quality of life (QoL) scores except for gender, whereby male patients had an increased functional score. The correlation between LLCS and other scores was positive ( 2 = 0.77). The satisfactory QoL scores, and functional outcomes scores indicated the LLCS to be a reliable option for general and specific evaluation of lower limb reconstructions. We suggest using the LLCS for comparisons of oncological reconstructions with lower limb reconstructions in different disciplines.

$Research paper thumbnail of Tibial pilon fractures$

Neural regeneration research, Jan 15, 2012

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 3, 2015

BioMed Research International, 2014