Alfio Luca Costa | University of Messina (original) (raw)

Papers by Alfio Luca Costa

BACKGROUNDBlood flow is translated into biochemical inflammatory or anti-inflammatory messages ba... more BACKGROUNDBlood flow is translated into biochemical inflammatory or anti-inflammatory messages based on the type of shear stress, by means of sensitive receptors located on the endothelium. Recognition of the phenomenon is of paramount importance for the advancement in the understanding of the pathophysiological processes of vascular remodeling.The endothelial glycocalyx is a pericellular matrix, identified in both arteries and veins, acting as sensors responsive to the flow changes. Venous and lymphatic physiology is interconnected; however, to our knowledge, a lymphatic glycocalyx-like structure has never been identified in humans. The objective of this investigation is to identify glycocalyx-like structures from ex vivo lymphatic human samples. METHODSLower limb vein and lymphatic vessels were harvested. The samples were analyzed by electron microscopy. The specimens were also examined by immunohistochemistry.RESULTS Scanning electron microscopic identified a glycocalyx-like stru...

Radiology Case Reports, 2021

Nodular fasciitis is a benign tumor of soft tissues originating from the proliferation of fibrobl... more Nodular fasciitis is a benign tumor of soft tissues originating from the proliferation of fibroblasts and myofibroblasts, generally developing between the subcutaneous tissue and the underlying muscular layer. Nodular fasciitis predominantly localizes in the upper extremities, trunk, head and neck. Biomolecular and immunohistochemical analyses result essential to demonstrate the benign origin of the process, also confirmed by very low recurrence rate after complete excision, which represents the gold standard for treatment. We report the case of a 36 years-old man who developed a nodular protuberance clinically evident in the upper-left side of the thorax. We further, highlight the main characteristics of this rare neoplasm trough a thorough review of the literature.

American Journal of Case Reports, 2022

Journal of Plastic Surgery and Hand Surgery, 2022

The lack of meticulous knowledge concerning the topographical anatomy of the deep branch of the u... more The lack of meticulous knowledge concerning the topographical anatomy of the deep branch of the ulnar nerve (DUN) may pose difficulties, leading to a delay or a misdiagnosis of a DUN injury. Identification of the DUN is quite difficult without precise anatomical landmarks as reference points. The current study investigates the topography of the DUN between genders, taking as a reference point a well-known landmark, the Kaplan line, used in hand surgery for carpal tunnel release. Twenty-two (15 males and 7 female) fresh frozen adult cadaveric hands were dissected by using magnifying loupes (3.5 and 5.0 x). We marked values proximal to the Kaplan line as positive (+), while we marked distal ones as negative (-). The mean distance DUN-Kaplan line was 1.69 ± 4.45 mm. In male hands, the mean distance was 4.17 ± 1.88 mm, distal to the Kaplan line, while in females, the mean distance was -4.92 ± 0.69 mm proximal to the Kaplan line. Gender dimorphism was detected, with higher statistically significant values in male hands (p = 0.001). Cadaveric studies of the DUN topography, course, and distribution pattern are uncommon. The current study provides an accurate description of the DUN topography, taking the Kaplan line as a reference point, emphasizing gender differences. The DUN is located distally in males and proximally in females. Knowledge of these predictable anatomical relations may help hand surgeons intraoperatively when dealing with a DUN lesion, because of hand trauma or during the decompression of the DUN.

Phlebology: The Journal of Venous Disease, 2021

Background Lack of physical activity represents a risk factor for both cardiovascular and chronic... more Background Lack of physical activity represents a risk factor for both cardiovascular and chronic venous diseases (CVD), nevertheless a specific exercise protocol for CVD patient is still missing. This investigation was aimed to assess the impact of a standardized exercise protocol in a thermal water environment on physical fitness and quality-of-life (QoL) in CVD patients. Methods Sixteen (16) CVD patients performed 5 standardized exercise sessions in a thermal water pool. Before starting the exercise protocol, the cohort filled International Physical Activity Questionnaire (IPAQ) to determine their physical activity level. At baseline and at the end of the exercise program, leg volume, QoL, musculoskeletal and cardiovascular physical fitness were assessed by means of water plethysmography, validated questionnaire and functional test, blood pressure and heart rate at rest were also reported. Results All the patients were categorized as physically inactive: average activity time 235...

HAND, 2020

Background Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum pro... more Background Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum profundus and course distally along the radial side of the corresponding metacarpophalangeal joints, in front of the deep transverse metacarpal ligament. The first and second lumbrical muscles are typically innervated by the median nerve, and third and fourth by the ulnar nerve. A plethora of lumbrical muscle variants has been described, ranging from muscles’ absence to reduction in their number or presence of accessory slips. The current cadaveric study highlights typical and variable neural supply of lumbrical muscles. Materials Eight (3 right and 5 left) fresh frozen cadaveric hands of 3 males and 5 females of unknown age were dissected. From the palmar wrist crease, the median and ulnar nerve followed distally to their terminal branches. The ulnar nerve deep branch was dissected and lumbrical muscle innervation patterns were noted. Results The frequency of typical innervations of lumbri...

Journal of Surgical Case Reports, 2021

Schwannomas are mainly benign tumors arising from the Schwann cells of the peripheral nerve sheat... more Schwannomas are mainly benign tumors arising from the Schwann cells of the peripheral nerve sheath. These tumors can often be associated with non-specific symptoms, such as abdominal heaviness. In this article, we present a detailed description of the surgical management of a giant sacral schwannoma in an elderly patient, for which intraoperative neuromonitoring made it possible to distinguish easily the nerves of the sacral plexus from which the tumor originated and to remove it without complications. Treatment of these rare and symptomatic giant tumors is still a challenge for surgeons; to treat adequately these tumors; a multidisciplinary approach is required to ensure an optimal therapeutic approach to reduce the risk of recurrence and, on the other hand, is not associated with unnecessary iatrogenic neurological damage.

Plastic & Reconstructive Surgery, 2020

Supercharge end-to-side (SETS) anterior interosseous (AIN) to ulnar motor nerve transfer is commo... more Supercharge end-to-side (SETS) anterior interosseous (AIN) to ulnar motor nerve transfer is commonly performed in our institution to augment intrinsic hand function. Following observations of recovery patterns, we hypothesized that despite its more distal innervation the first dorsal interosseous (FDI) recovers to a greater extent than the abductor digiti minimi (ADM). The objective of this work was to evaluate the clinical and electrodiagnostic pattern of reinnervation of intrinsic hand musculature following SETS AIN to ulnar motor nerve transfer. A retrospective cohort of prospectively collected data included all patients who underwent a SETS AIN to ulnar motor nerve transfer. Two independent reviewers performed data collection. Reinnervation was assessed with two primary outcome measures: (i) clinically with serial Medical Research Council strength assessments and (ii) electrodiagnostically with serial motor amplitude measurements. Statistical analysis was performed using non-parametric statistics. Seventeen patients (65% male, mean age 56.9±13.3 years) were included with a mean follow-up of 16.7±8.5 months. Preoperatively, all patients demonstrated clinically significant weakness and electrodiagnostic evidence of denervation. Postoperatively, strength and motor amplitude increased significantly for both the FDI (p=0.002, p=0.016) and the ADM (p=0.044, p=0.015). Despite comparable preoperative strength (p=0.098), postoperatively FDI achieved significantly greater strength when compared to the ADM (p=0.023). Following SETS AIN to ulnar motor nerve transfer recovery of intrinsic muscle function differs between ADM and FDI, with better recovery observed in the more distally innervated FDI. Further work to elucidate the underlying physiologic and anatomic basis for this discrepancy is indicated.

Journal of Reconstructive Microsurgery, 2019

Background Preclinical training in perforator flap harvesting is typically conducted on living an... more Background Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. Methods A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. Results The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ...

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2021

Axonal count is the base for efficient nerve transfer; despite its capital importance, few studie... more Axonal count is the base for efficient nerve transfer; despite its capital importance, few studies have been published on human material, most research approaches being performed on experimental animal models of nerve injury. Thus, standard analysis methods are still lacking. Quantitative data obtained have to be reproducible and comparable with published data by other research groups. To share results with the scientific community, the standardization of quantitative analysis is a fundamental step. For this purpose, the experiences of the Italian, Austrian, German, Greek, and Iberian-Latin American groups have been compared with each other and with the existing literature to reach a consensus in the fiber count and draw up a protocol that can make future studies from different centers comparable. The search for a standardization of the methodology was aimed to reduce all the factors that are associated with an increase in the variability of the results. All the preferential methods to be used have been suggested. On the other hand, alternative methods and different methods have been identified to achieve the same goal, which in our experience are completely comparable; therefore, they can be used indifferently by the different centers according to their experience and availability.

BioMed Research International

Introduction. The aim of this research was to test, in an animal model, the nerve regeneration te... more Introduction. The aim of this research was to test, in an animal model, the nerve regeneration technique with a hypoallergenic acellular dermal matrix used to wrap the microsurgical neural suture. Materials and Methods. Two groups of rats received the cut of limb right median nerves. The regeneration technique considers for both groups an end-to-end nerve suture. In the experimental group (A) was used also a wrapping protocol by a conduit of collagen matrix currently used in oral surgery. The animals underwent functional grasping tests (at 1, 3, 5, and 7 months) and a histological and quantitative analysis of distal nerve was performed at the end of experimental time. Result. After seven months, the grasping test reveals functional recovery in each tested animal; this improvement is more evident in Group A. The fibers appear well organized with restored myelin sheaths in both groups. Group A showed a great quantity of connective tissue surrounding the nerve. The quantitative morphol...

Plastic and Aesthetic Research

Nerve transfers were used, originally, to restore shoulder and elbow function in brachial plexus ... more Nerve transfers were used, originally, to restore shoulder and elbow function in brachial plexus lesions. This concept has been developed over the years and applied to distal nerve injuries in which lower functionality was expected because of the gap between the injury site and the target muscle. The aim of this review is to describe nerve transfers in the distal forearm and hand for isolated lesions of the median, ulnar and radial nerves. The different advantages achieved by transposition of a functional nerve stump near the effector muscle have opened up new options for the management of nerve lesions. Some of these alternatives have only been recently reported and a few are exclusively case reports.