Pier Paolo Pangrazi - Academia.edu (original) (raw)

Papers by Pier Paolo Pangrazi

Minerva orthopedics, Dec 31, 2023

Case reports in plastic surgery & hand surgery, Feb 26, 2024

The journal of hand surgery, Feb 1, 1997

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 1997

Journal of Craniofacial Surgery, Sep 1, 2019

Background: Radical resections of ethmoidal tumors with intracranial extension present highly com... more Background: Radical resections of ethmoidal tumors with intracranial extension present highly complex surgical and reconstructive problems. The purpose of report is to describe the authors' use of adipofascial radial forearm free flaps following unsuccessful anterior cranial fossa oncological surgery. Methods: Adipofascial radial forearm free flaps were used to treat 3 similar cases of cutaneous fistula following bone resorption with communication to anterior cranial fossa and nasal cavity. Results: No flap loss, no deaths, and no postoperative complications were observed. All patients underwent a nasal endoscopy, revealing adequate vitality and integration of the free flaps. One of the patients consented to additional surgery to improve outcome. Conclusions: Meticulous preoperative selection and an experienced interdisciplinary team are required to achieve the best surgical outcomes in complex cases. Free adipofascial forearm flaps could be an excellent therapeutic option in the reconstruction of the anterior skull base, notably in cases involving major postoperative complications.

Archives of Plastic Surgery, Mar 15, 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may... more Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair > 10-cm peripheral nerve gap injuries related to upper limb trauma.

$Research paper thumbnail of K-wire fixation vs 23-gauge percutaneous hand- crossed hypodermic needle for the treatment of distal phalangeal fractures$

BMC Musculoskeletal Disorders, Sep 2, 2020

Background: Distal Phalanx (DP) fractures are the most common hand injuries. Bone fixation associ... more Background: Distal Phalanx (DP) fractures are the most common hand injuries. Bone fixation associated with soft tissue reconstruction, is often required to ensure more effective outcomes. The aim of the present study is to compare functional outcomes of DP fractures surgically treated with crossed manual drilled 23 Gauge needles vs crossed Kirschner-wires (k-wire). Methods: Clinical data included analysis of patient demographics, range of motion (ROM), and complications. Radiographic assessment considered fracture type, location, fracture displacement, and radiographic union. Functional outcomes analysis was performed.The statistical significance was assessed at the level of probability lower than 5%. Results: A total of 60 patients from 2012 to 2015 were retrospectively enrolled and among them 12 patients suffering from diabetes or current smokers. A total of 60 DP fractures were treated, 32 with needles (group A) and 28 with k-wire fixation (group B). Time to union, showed in different time points, was significantly lower in group A (≤ 40 days, p = 0.023*) compared to group B. ROM of the distal interphalangeal joint at six months follow-up was 60°in group A and 40°in group B. A significant improvement was observed (p = 0.001*) in the 23 G needle treated group. Functional outcome analysis showed that VAS was significantly lower in group A compared to group B (p = 0.023*). Conclusion: Our study showed that the 23 G needle yielded satisfactory results in terms of time to union and range of motion compared to k-wire fixation especially for tuft and shaft DP fractures. Therefore, should be a valid alternative to k-wire fixation in selected patients.

Microsurgery, 2005

The treatment of severe wounds of the extremities, characterized by large posttraumatic tissue lo... more The treatment of severe wounds of the extremities, characterized by large posttraumatic tissue loss, represents a clinical problem difficult to resolve, especially when the lesion is surrounded by large areas of ischemic distrophic tissue which progressively aggravate and extend the initial lesion, with frequent exposure of bone and joint structures making the amputation of the limb an inevitable outcome. The authors present their experience based on combined treatments by medical support methods such as hyperbaric oxygen (HBO) and vacuum-assisted closure therapy (VAC) and microsurgical reconstruction of the limbs, within a precise therapeutic protocol. The use of this protocol in appropriate times and ways allowed us to successfully treat severe posttraumatic sequelae of the limbs, avoiding the delayed healing typical of these pathologies, both on the donor site of the flap and on the repaired area, and avoiding unsuitable microsurgical reconstruction of limbs, allowing satisfactory morpho-functional restoration and a reduction of the hospitalization period.

Hand, Sep 16, 2020

BackgroundComplete extension of the thumb and activation of the extensor pollicis longus (EPL) te... more BackgroundComplete extension of the thumb and activation of the extensor pollicis longus (EPL) tendon are fundamental to ensure maximum function. Many EPL repair techniques are described in the literature.MethodsThe authors present an alternative technique using the brachioradialis (BR) tendon. Thirty patients with injuries of the EPL tendon in zone 8 were studied. In all cases, neither direct suture repair nor traditional tendon transfer was possible.ResultsThumb extension was restored in all patients with satisfactory extension recovery. All patients achieved excellent extension; good functional results were observed in 2 cases, and in 1 case satisfactory results were achieved using the Geldmacher assessment and the Kapandji assessment. The overall results were rated as excellent, good, fair, or poor according to the Quick Disabilities of the Arm, Shoulder, and Hand Scale.DiscussionThe BR tendon was suitable to treat all cases, in particular injuries occurring near Lister’s tubercle, due to its appropriate length for tenorrhaphy albeit with a short distal head.

BMC Surgery

Background Ulnar nerve entrapment at the elbow is the second most common cause of nerve entrapmen... more Background Ulnar nerve entrapment at the elbow is the second most common cause of nerve entrapment in the upper limb. Surgical techniques mainly include simple decompression, decompression with anterior transposition and medial epicondylectomy. Methods We performed decompression with anterior transposition and protected ulnar nerve by adipofascial flap (a random flap with radial based vascularization, harvested through the avascular plane of Scarpa’s fascia. We analyzed patients who underwent ulnar nerve ante-position from 2015 to 2022 according to inclusion and exclusion criteria for a total of 57 patients. All patients included were graded on the McGowan's classification Messina criteria and the British Medical Research Council modified by Mackinnon and Dellon. Results The average McGowan’s score was 2.4 (± 0.6), Messina’s criteria 91.2% indicated a satisfactory or excellent result, sensibility at 6 months was 98.5% S3 or more. A preferential technique has not yet been defined...

Trauma Care

Background: Nerve recovery after a complex trauma is affected by many factors and a poorly vascul... more Background: Nerve recovery after a complex trauma is affected by many factors and a poorly vascularized bed is often the cause of failure and perineural scar. Many techniques have been devised to avoid this problem and the possibility to transfer a nerve with a surrounding viable sliding tissue could help in this purpose; Methods: We performed an anatomic study on 8 injected specimens to investigate the possibility to raise a medial sural artery perforator (MSAP) flap including the sural nerve within its vascularized sheath; Results: In anatomic specimens, a visible direct nerve vascularization was present in 57% of legs (8 out of 14). In 43% a vascular network was visible in the fascia layer. There were no vascular anomalies. In one patient the MSAP flap was raised including the sural nerve with its proximal tibial and peroneal components within the deep sheath. The tibial and peroneal component of the sural nerve were anastomized independently with the common digital nerve of 4th ...

Medicina-lithuania, Jan 31, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Journal of Hand Surgery Global Online

Strategies in Trauma and Limb Reconstruction

Background: Complex elbow injuries (CEIs) are severe and rare lesions, difficult to treat correct... more Background: Complex elbow injuries (CEIs) are severe and rare lesions, difficult to treat correctly due to the different patterns of clinical presentations. Standard methods cannot often be applied. The main goals of the treatment are performing a stable osteosynthesis of all fractures, obtaining a concentric and stable reduction of the elbow by repairing the soft tissue constraint lesions, and allowing early motion. Since the introduction of virtual reality (VR) approaches in clinical practice, three-dimensional (3D) computed tomography (CT) and 3D printing have revolutionised orthopaedic surgeries, thus helping to understand the anatomy and the pathology of complex cases. Case description: We discussed a case of CEI, characterised by an extended soft tissue (IIIB Gustilo classification) and neurovascular lesions associated with bone loss in a young female patient. Olecranon fracture was type IIIB according to Mayo classification. We outlined the steps of a pluri-tissue reconstructive approach and stressed the importance of 3D printing in the preoperative planning for such cases. Finally, peculiar final functional patient outcomes were reported. Conclusion: In this case, we found out that triceps reinsertion and scar process may provide for the joint stability in a low-demanding patient. 3D printing and VR approaches in clinical practice can be useful in the management of CEIs associated with an important bone and soft tissue loss.

Supplemental material, supplemental_Table_1,2,3,4,5 for Brachioradialis Muscle Tendon Transpositi... more Supplemental material, supplemental_Table_1,2,3,4,5 for Brachioradialis Muscle Tendon Transposition in Extensor Pollicis Longus Reconstruction: Anatomical Study and a New Surgical Approach by Francesco De Francesco, Pierfrancesco Pugliese, Marialuisa De Francesco, Pier Paolo Pangrazi and Michele Riccio in HAND

Trauma Case Reports, 2022

Complex trauma of the upper limb is a common consequence of involvement in serious accidents. Los... more Complex trauma of the upper limb is a common consequence of involvement in serious accidents. Loss of substance including nerve, bone, tendons and vascular defects are challenging surgical issues. A 27- year-old male presented with complex upper limb trauma and loss of a proximal third of the posterior forearm structure as well as loss of active finger extension, ulnar and radial nerve territory anesthesia and ulnar fracture. A composite nerve-tendon-muscle-skin gracilis free flap was retrieved from the contralateral leg, related to tendon transfer of BR to ELP, to supply active hand extension. The patient was required to adhere to intensive post-surgical rehabilitation and monitored for a 3-year follow-up period. Our assessment revealed adequate skin trophism and sufficient muscle strength recovery against resistance (M5). The functional flap associated with tendon transfer was considered an efficient procedure for the management of a complex trauma with loss of posterior interosseous nerve and bone exposition. The free re-innervated gracilis flap may be used to repair complex soft tissue defects with exposed bone and to restore finger extension following severe forearm injuries.

$Research paper thumbnail of Early stimulation of bone consolidation in patients with pathological phalanges fracture: the role of biophysics stimulation$

Objectives/Interrogation: The aim of a treatment when hand surgeon facing with a fracture is to p... more Objectives/Interrogation: The aim of a treatment when hand surgeon facing with a fracture is to promote bone healing. It is not always easy to understand if and with which probability, a fracture will evolve to a delayed consolidation or a pseudoarthrosis. Currently we do not have clinical, instrumental[for full text, please go to the a.m. URL]

$Research paper thumbnail of Distal phalanx fractures menagement with 23 gauge percutaneous needles vs kirschner wires$

Objectives/Interrogation: The most common fractured bone in the hand is the distal phalanx (DP). ... more Objectives/Interrogation: The most common fractured bone in the hand is the distal phalanx (DP). These fractures are often managed conservatively but the presence of high comminution or articular fractures with injuries of nail beds sometimes require a surgical approach. In literature, different[for full text, please go to the a.m. URL]