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Franco Carlo MIGLIORI

Director of Plastic Surgery Unit
IRCCS "San Martino - IST"
largo Rosanna Benzi, 10
16132 Genova
ITALY
franco.migliori@fastwebnet.it
Born in Genoa (Italy) in 1956.
Medicine Degree at Genoa University in 1980, discussing Plastic Surgery thesis.
Hospital post-graduate training in Plastic Surgery & Burns at “San Martino” General Hospital in Genoa since 1981 until 1986.
Plastic Surgery Residency at Pavia University since 1986 until 1991.
Board certified in Plastic Surgery at Pavia University in 1991.
Master in Aesthetic Plastic Surgery at Pavia University in 1991/1992.
Assistant in Plastic Surgery & Burns at “San Martino” General Hospital until 1992.
Senior Assistant in Plastic Surgery & Burns at “San Martino” General Hospital since 1993 until 2001.
Director of Plastic Surgery & Burns Unit at “San Martino” University Hospital since 2001 until now.
Consultant Professor at the Residential Boarding School in Plastic Surgery, University of Genoa, Italy
Full Professor in Plastic Surgery at Orthopedics Technique Degree, University of Genoa, Italy
Member of SICPRE (Italian Society of Plastic, Reconstructive and Aesthetic Surgery)
Member of SIUST (Italian Burns Society)
Member of SICOB (Italian Society of Obesity Surgery)
Member of IFSO (International Federation for the Surgery of Obesity)
Active Member of ISAPS (International Society of Aesthetic Plastic Surgery)
Corresponding Member of ASPS (American Society of Plastic Surgeons)
Active Member of EURAPS (European Association of Plastic Surgeons)
Personal surgical casistic of almost 10.000 operations mainly in the following fields:
 Body-contouring (arms, trunk, torso, thighs)
 Breast (reconstruction, aesthetic)
 Rhinoplasty
 Lower limb reconstruction
 Head & neck reconstruction
 Burns
Member of various international High-IQ societies: Mensa Int., One-In-A-Thousand Society (OATH), Triple Nine Society (TNS), International Society for Philosophical Enquiry (ISPE)

Journal articles

2011
F Migliori (2011)  "Upside-Down" Augmentation Mastopexy   Aesthetic Plastic Surgery 35: 4. 593-600 August 2011  
Abstract: Introduction Our wide experience in post-bariatric body-contouring pushed us to find a suitable technique to correct the two most common defects of the M.W.L. breast: 1) hypotrophy, 2) ptosis. To do this, a technique selection algorithm has been created. According with our algorithm, in those cases where a âminor ptosisâ has been diagnosed (< cm.6 of vertical N.A.C. correction), we have developed the âUpside-Downâ technique. Materials and methods The technique is performed as follows: a) complete subcutaneous undermining of glandular upper pole until upper edge of the mammary gland. b) After having rotated around the edge, upside-down retroglandular undermining, taking great care to leave inframammary fold and 2 cm. of gland undetached. c) topside-bottom implant insertion with a âmailbox postingâ action; inframammary fold and undetached gland act like a bra to prevent implant ptosis. The upper â of the prosthesis could be placed beneath pectoralis major muscle, with âdual-planeâ technique, if a round implant is utilized, or left completely retroglandular if an anatomical implant is used. d) the type of implant needed (round vs. anatomical) basically depends on the kind of aesthetical defect: major upper pole defects need round implants, major lower pole defects need anatomical implants. Patientâs preferences are a primary factor in the decision. e) breast lifting through strong anchorage to fascia, muscle and 2nd rib periostium: at least three stitches of threaded non-absorbable 0 or 1 suture are positioned. Whole lower gland pole is left undetached, to guarantee blood perfusion (only 1-2 cm. periareolar are undermined). f) periareolar suture is always performed with âinterlockingâ technique acc. with Hammond. Results From Nov 2001 to May 2010 231 patients have been operated with this technique. The patients were all Caucasian, average age 38 (range 31/53), were all operated bilaterally. The mean operating time was 150 minutes (range 120/180). Mean hospital stay was 3,5 days (range 2/5) after surgery. We evaluated the ptosis recurrence rate, assuming that a N.A.C. sliding > 2 cm., 1 year after surgery, is considered recurrence. With other techniques the recurrence was 27,6%, with this technique 9,1%. Conclusions Natural shape, stable position and short scars are the main advantages of this technique. The typical breast flatness following periareolar access is best corrected by the last generation dual cohesiveness anatomical implants, that we strongly suggest to obtain best results with this technique. B.U.T. (Body Uneasiness Test) study evidenced 100% improvement of patient discomfort.
Notes:
2010
F Migliori, A Gabrielli, R Rizzo, GG Serra Cervetti (2010)  Breast Contouring in post-bariatric patients: a Technique Selection Algorithm   Obesity Surgery 20: 5. 651-656 May 2010  
Abstract: Backgrounds Breast deformities in post-BS patients are different and more challenging then those from non-BS patients. The histological alterations confer the highest clinical consequences to this area: highest degrees of true ptosis, deflated and flattened glands, totally inelastic covering tissues. Plastic surgeon needs an easy-to-use algorithm for technical choices. Methods Ptosis and Volume loss are the main problems to be corrected on Massive Weight Loss breasts. Both problems need specific resolutions, due to their specific characteristics. Depending on the degree of ptosis and the amount of volume loss, a decisional algorithm has been developed: suitable and advisable techniques are pointed out, minimizing the risk/benefit ratio. âPros and consâ with the use of mammary implants are emphasized. Results A group of 195 postbariatric surgery patients underwent breast-contouring since 2001 following the herein presented decisional algorithm. Results have been tested with Body Uneasiness Test (B.U.T.): encouraging data pushed to continue this method and to refine it. Conclusions Referring to this strategy algorithm, the choices 1/2 and 3 appear to be the more frequently applied and better fitted to cover the majority of M.W.L. breast defects. In the future, the birth and the rise of new mammary implant concepts and technologies, could completely change this algorithm.
Notes:
2008
Franco Carlo Migliori, Giacomo Robello, Jean L Ravetti, Giuseppe M Marinari (2008)  Histological alterations following bariatric surgery: pilot study.   Obesity Surgery 18: 10. 1305-1307 Oct 2008  
Abstract: BACKGROUND: Macroscopic clinical evidence of tissue damaging following bariatric surgery pushed plastic surgeons to presume microscopic alterations as well. METHODS: Five preliminary cases studied randomly, and compared with healthy tissues, confirmed these initial suspects. A deeper and wider study has then been structured. RESULTS: Preliminary results are so evident to encourage us to carry on an estimated 2-3 years multidisciplinary study. CONCLUSIONS: What we want to study is if histological post-bariatric alterations are confirmed, and if these can be considered responsible for higher complication rate in body contouring following bariatric surgery.
Notes:
Franco Carlo Migliori, Marco Ghiglione, Gabriele D'Alessandro, Gian Giacomo Serra Cervetti (2008)  Brachioplasty after bariatric surgery: personal technique.   Obesity Surgery 18: 9. 1165-1169 Sept 2008  
Abstract: BACKGROUND: A review of the results of the standard technique for "batwing" deformity after massive weight loss led to the need to optimize the cost/benefit ratio in terms of maximal correction/less visible scars. METHODS: Between 2001 and 2007, 29 patients were operated with a new technique based on a careful preoperative evaluation and markings, followed by an intraoperative skillful handling. This technique is not easy and needs plastic surgery experience and a long learning curve. RESULTS: The esthetic results are far better then those obtained with other techniques, especially the arm lower profile. CONCLUSION: The complication rate is similar to other techniques, even if a potential low risk for ulnar nerve damage is present.
Notes:
2007
Laura Pecori, Gian Giacomo Serra Cervetti, Giuseppe M Marinari, Franco Migliori, Gian Franco Adami (2007)  Attitudes of morbidly obese patients to weight loss and body image following bariatric surgery and body contouring.   Obesity Surgery 17: 1. 68-73 Jan 2007  
Abstract: BACKGROUND: The authors evaluated body image attitudes in post-obese persons following bariatric surgery who require cosmetic and body contouring operations. METHODS: We studied 20 morbidly obese women prior to biliopancreatic diversion (BPD) (OB group), 20 post-obese women at >2 years following BPD (POST group), 10 post-obese women following BPD who required cosmetic procedures (POST-A group), 10 post-obese women after BPD and subsequent cosmetic surgery (POST-B group), and 20 healthy lean controls. Attitudes to weight and shape were evaluated by means of the Body Uneasiness Test (BUT). RESULTS: In comparison with the obese patients in the POST group, lower BUT scores were observed, while in the POST-A group the values were very similar to those observed in the non-operated obese individuals. In the individuals having received cosmetic surgery, the BUT findings were similar to those recorded in the POST group patients, the values approaching data found in the controls. CONCLUSION: Despite a fully satisfactory weight loss and maintenance, the post-BPD individuals requiring aesthetic surgery showed some disparagement of body image; in these subjects, cosmetic and body contouring procedures may actually improve body weight and shape attitudes towards normality.
Notes:
2006
GG Serra Cervetti, A Gabrielli, R Rizzo, M Ghiglione, G D'Alessandro, C Rosati, F Migliori (2006)  Utilizzo di derma coltivato in vitro in un caso di arrotamento dell'arto inferiore   Clinical and Experimental Plastic Surgery 38: 1-2. 99-102  
Abstract: This case takes part of our wide experience in utilizing autologous cellular cultures. Following a severe post-traumatic loss of substance in a lower extremity, with an important loss of muscular mass, as well as of the whole dermal and sub-dermal mantle, missing tissues have been reconstructed by means of cultivated autologous derma. Such a reconstructed derma allowed a successful skin graft.
Notes:
Franco Migliori, Cristina Rosati, Gabriele D'Alessandro, Gian Giacomo Serra Cervetti (2006)  Body contouring after biliopancreatic diversion.   Obesity Surgery 16: 12. 1638-1644 Dec 2006  
Abstract: BACKGROUND: From Nov 2001 to Mar 2006, 176 patients underwent body contouring plastic surgery after prior biliopancreatic diversion (BPD). Weight loss had varied from 30-100 kg. The plastic surgery targeted the arms (24 patients), breast (58), abdomen (62) and thighs (20), plus torsoplasty (12). METHODS: BPD is a "non-cosmetic" bariatric operation which results in malabsorption and subsequent major weight loss within 12 to 18 months. The typical "empty" aspect of the slimmed areas directed our surgical choices to specific techniques: brachioplasty, reduction mammaplasty and/or mastopexy (with or without prosthesis or "self-prosthesis" technique), thigh-lift, abdominoplasty and torsoplasty. We do not consider any liposuction technique suitable for this kind of patient, because of the specific histological changes caused by BPD. RESULTS: The metabolic discrepancies following BPD affect postoperative management of these patients. A higher incidence of complications has been reported, of both systemic and local nature; the local ones, common in the abdominal wall, convinced us to perform an arteriographic study preoperatively, to check anatomical alterations following the BPD. CONCLUSIONS: Although the characteristics of BPD patients limit the choices, we are satisfied with the results of cosmetic correction and quality of life. All the patients, without exception, noted a high rate of positive thinking and have undergone further body-contouring surgery (or plan to do so).
Notes:
2005
M Ghiglione, R Rizzo, G Giannini, F Migliori (2005)  Lyell Syndrome: A New Therapeutic Approach   The Mediterranean Journal of Surgery and Medicine 13: 1-3. 37-38 Jan-Sept 2005  
Abstract: The so-called Lyell syndrome (toxic necrotic epidermolysis, herein after TNE) represents one of the most serious type 4 drug induced reactions. The overall incidence rate is extremely low and the pathogenetic mechanisms are still incompletely known, even if a multifactorial origin, involving both a genetic defect in the drug metabolism and a cell-mediated immunologic reaction, has been postulated. Age between 20 and 50, female sex and pre-existing immunodeficiency constitute significant risk factors. The onset (that can be preceded by flu-like symptoms) is characterized by typical cutaneous lesions that rapidly show dermoâepidermal detachment with bleb formation. Such lesions create systemic damage similar to the acute burn condition, accompanied by a 40 â 50 % mortality rate. Mucosal involvement is observed in 90% of cases. Until now TNE treatment has been based on drug interruption, proper i.v. infusion and immunoglobulin administration at a 0,4 â 0,5 gr./kg./day dose. We recently adhered to the new therapeutic protocol developed by Marco Lissia that is based on: - Interruption of any drug assumed during the three weeks preceding the onset of symptoms - Patient placed in a micro-sphere fluidized bed Clinitron âUpliftâ. This device is effective in preventing decubitus, helping skin regeneration, and maintaining a proper body temperature. - Incannulation of a major venous vessel (usually subclavian or jugular vein) to allow infusion of high volumes of fluids and constant monitoring of the central venous pression. - Hour by hour monitoring of the urinary output - Total parenteral nutrition with attention to the extremely high caloric requirement - Gastro-protection - Antibiotic therapy only in case of demonstrated infection - Topical medication as in burn patients - Infusion of high dose immunoglobulin: for three days 1 gr./kg./day is administered intravenously, followed by 0,5 gr./kg./day for three further days - On second, fourth and sixth day from the beginning of immunoglobulin infusion, patients undergo plasmapheresis sessions. We utilized a continuous flow cell separator (Dideco Excel) that allowed to carry out normovolemic plasmatic exchanges of about 2500 ml/session, substituted by 4% human albumin (Kedrion). CLINICAL CASES We treated two female patients, respectively 60 and 74 years old, over the last 4 months. The patients had been transferred at our Burn Center from other units after TNE was diagnosed and assumption of the drug responsible of the syndrome had been interrupted. In both cases severe cutaneous and mucosal lesions were evident all over the body at admission. It was therefore possible to immediately begin immunoglobulin infusion, which led to immediate clinical improvement and to a sudden regression of the lesions at the third day of therapy, while a fast re-epithelisation was observed (all lesions, cutaneous and mucosal, healed in max. 10 days). CONCLUSIONS In this two cases of our limited experience we could better control the acute systemic symptoms of TNE, comparing with our previous, traditional approach. The very short time required for cutaneous lesions healing and the rapid return of the patients to a well-being condition seems to further support the effectiveness of this approach whose most innovative aspect is represented by the high dose immunoglobulin infusion combined with plasmapheresis sessions. REFERENCES - Lissia M., Figus A., Rubino C.: Intravenous human immunoglobulins and plasmapheresis combined treatment in patient with toxic epidermal necrolysis. - Fritsch PO, Sidoroff A.: Drug-induced Stevens-Johnson sindrome/toxic epidermal necrolisis. Am. J. Clin. Dermatol. 1 (6) : 349-360, 2000 - Magina S, Lisboa C, Goncalves E, Conceicao F, Leal V, Mesquita-Guimares J: A case of toxic epidermal necrolysis treated with intravenous immunoglobulin. Br. J. Dermatol. 142 (1) :191-2, 2000 - Paquet P, Jacob E, Damas P, Pierard GE: Treatment of drug-induced toxic epidermal necrolysis (Lyellâs syndrome) with intravenous human immunoglobulin. Burns 27 (6) : 652-5, 2001 - Ying S, Ho W, Chan HH: Toxic epidermal necrolysis: 10 years experience of a burns centre in Hong Kong. Burns 27 (4) : 372-5, 2001 - Smoot EC 3rd: Treatment issues in the care of patient with toxic epidermal necrolysis. Burns 25 (5) : 439-42, 1999 - Stella M., Cassano P., Bollero D., Clemente A., Giorio G.: Toxic epidermal necrolysis treated with intravenous high-dose immunoglobulins: our experience. Dermatology 203 (1) : 45-9, 2001 - Egan CA, Grant WJ, Morris SE, Saffle JR, Zone JJ: Plasmapheresis as an adjunct treatment in toxic epidermal necrolysis. J. Am. Acad. Dermatol. 40 (3) : 458-61, 1999 - Dudic I, Shalom A, Rising W, Nagamoto K, Munster AM: Outcome of patient with toxic epidermal necrolysis syndrome revisited. Plast. Reconstr. Surg. 110 (3) : 768-73, 2002
Notes:
2004
M Valbonesi, G Giannini, F Migliori, R Dalla Costa, A M Dejana (2004)  Cord blood (CB) stem cells for wound repair. Preliminary report of 2 cases.   Transfus Apher Sci 30: 2. 153-156 Apr 2004  
Abstract: In 2 patients, to promote skin wound/lesion repair we used fibrin-platelet glue combined with HLA compatible (2 mismatches accepted) buffy coats containing CD 34+ cord blood cells. The fibrin platelet glue was prepared with autologous apheresis platelets and cryoprecipitate. The original product was divided into 3 and 4 aliquots respectively for a correspondent number of applications. At each application, the margins of the lesion were infiltrated with 3 ml of cord blood buffy coat, containing 30 x 10(3) CD 34+ cells. No graft versus tissue reaction was seen in our patients in a follow-up of 3-7 months. The level of improvement, scored arbitrarily from 0 to 4, was 3 and 4, respectively. Our conclusion is that the use of cord blood cells along with fibrin platelet glue is of clinical interest.
Notes:
2002
M Valbonesi, G Giannini, F Migliori, R Dalla Costa, A Galli (2002)  The role of autologous fibrin-platelet glue in plastic surgery: a preliminary report.   Int J Artif Organs 25: 4. 334-338 Apr 2002  
Abstract: To promote wound healing, we used autologous fibrin-platelet glue in 14 patients with skin and soft tissue losses caused by recent trauma or chronic pathology. The level of improvement was scored, arbitrarily, from 0 to 4. Very favourable results (score 3-4) were seen in 11 out of 14 patients. The glue preparation is very easy, inexpensive and creates excellent and stable hemostasis. From a general point of view, we have confirmed the utility of fibrin-platelet glue in terms of reduced infections and length of hospital stay.
Notes:
1990
R Dalla Costa, F Migliori, P Tavilla, R Rizzo, F Cecchi (1990)  Amikacin in the topical treatment of small losses of substance   Minerva Chir 45: 12. 891-893 Jun  
Abstract: The paper describes the use of aminoglucoside amikacin over 3 years in a group of 187 patients for the topical treatment of skin lesions extending over a maximum 10% of body surface area. The use of amikacin for topical treatment was chosen on the basis of clinical factors; in the majority of cases these were associated to poor circulation in the affected region which created uncertainty as to whether an efficacious dose would be provided by intravenous administration.
Notes:
1986
1982
1981

Book chapters

2013
2010

Conference papers

2012
F Migliori (2012)  "Upside-Down" Augmentation Mastopexy   In: 21st ISAPS Congress Edited by:ISAPS. International Society of Aesthetic Plastic Surgery Genéve (Switzerland): Sept 4-8  
Abstract: Introduction The authorâs wide experience with postbariatric body contouring pushed him to find a technique suitable for correcting the two most common defects of the MWL breast: hypotrophy and ptosis. For these defects, a technique selection algorithm has been created. According to the algorithm, the ââupside-downââ technique was developed for those cases with a diagnosis of ââminor ptosisââ (<6 cm of vertical nippleâareolar complex correction). Methods The upside-down technique is performed as follows. (1) Complete subcutaneous undermining of glandular upper pole to the upper edge. (2) Rotation around the edge, upside-down retroglandular undermining, leaving the inframammary fold and 2 cm of gland undetached. (3) Topside-bottom implant insertion with ââmailbox postingââ action. IMF and undetached gland act as a bra to prevent implant ptosis. (4) Type, shape and dimensions of implant needed depend on the aesthetic defect and patientâs preferences. Dual cohesiveness anatomic implants (style 510) are strongly recommended. (5) Breast lifting and strong anchorage to the fascia, muscle, and second rib periosteum, performed through three stitches of threaded nonabsorbable 0 or 1 suture. (6) Periareolar ââinterlockingââ suture. Results From 2001 to 2012, 285 patients underwent âupside-downâ augmentation mastopexy. The patients were all Caucasian, average age 38 years (range, 31â53 years), 276 bilateral, 9 monolateral. Mean operating time 150 min (range, 120â180 min), mean hospital stay 3.5 days (range, 2â5 days). The ptosis recurrence rate was evaluated, identified when the NAC slides more than 2 cm 1 year after surgery. The recurrence rate was 27.6% for other techniques versus 9.1% for the âupside-downâ technique. Conclusions Natural shape, stable position, and short scars are the main advantages of the âupside-downâ technique. The typical breast flatness after periareolar access is best corrected by the last-generation dual-cohesiveness anatomic implants. The Body Uneasiness Test (BUT) study showed 100% improvement of patient discomfort.
Notes:
2011
F Migliori (2011)  "Upside-Down" Augmentation Mastopexy   In: 22° EURAPS Meeting Edited by:EURAPS. European Association of Plastic Surgeons Mykonos (Greece): Jun 2-4  
Abstract: Introduction The authorâs wide experience with postbariatric body contouring pushed him to find a technique suitable for correcting the two most common defects of the MWL breast: hypotrophy and ptosis. For these defects, a technique selection algorithm has been created. According to the algorithm, the ââupside-downââ technique was developed for those cases with a diagnosis of ââminor ptosisââ (<6 cm of vertical nippleâareolar complex correction). Methods The upside-down technique is performed as follows. (1) Complete subcutaneous undermining of glandular upper pole to the upper edge. (2) Rotation around the edge, upside-down retroglandular undermining, leaving the inframammary fold and 2 cm of gland undetached. (3) Topside-bottom implant insertion with ââmailbox postingââ action. IMF and undetached gland act as a bra to prevent implant ptosis. (4) Type, shape and dimensions of implant needed depend on the aesthetic defect and patientâs preferences. Dual cohesiveness anatomic implants (style 510) are strongly recommended. (5) Breast lifting and strong anchorage to the fascia, muscle, and second rib periosteum, performed through three stitches of threaded nonabsorbable 0 or 1 suture. (6) Periareolar ââinterlockingââ suture. Results From 2001 to 2010, 231 patients underwent âupside-downâ augmentation mastopexy. The patients all were Caucasian, average age 38 years (range, 31â53 years), all bilateral. Mean operating time 150 min (range, 120â180 min), mean hospital stay 3.5 days (range, 2â5 days). The ptosis recurrence rate was evaluated, identified when the NAC slides more than 2 cm 1 year after surgery. The recurrence rate was 27.6% for other techniques versus 9.1% for the âupside-downâ technique. Conclusions Natural shape, stable position, and short scars are the main advantages of the âupside-downâ technique. The typical breast flatness after periareolar access is best corrected by the last-generation dual-cohesiveness anatomic implants. The Body Uneasiness Test (BUT) study showed 100% improvement of patient discomfort.
Notes:
2010
F Migliori (2010)  Arm Liposuction and Brachioplasty   In: 6th European Masters in Aesthetic & Anti-aging Medicine (EMAA) 2010 EuroMediCom Paris (France): Oct 15-17  
Abstract: Surgical correction of the upper limb appears to be rather exclusive because the request is definitely lower than for other regions. On the other hand, the worse the defect, the higher invasive the procedures. For these reasons, the evaluation, the choice and the performance of any surgical correction of the arm should be left to those surgeons highly skilled in this particular field. Great care should be taken before deciding to perform a brachioplasty, because only the best possible should be pursued, optimizing cost/benefit ratio in terms of maximal correction/less visible scars. If this strategy cannot be applied, brachioplasty should be discouraged, also considering the possible complications. Liposuction is certainly a safer procedure, but can correct only minor defects and should be considered much more as a refinement rather than a solution by itself. In this particular anatomical district there is nothing easy-to-use: only highly specialized procedures can lead to reasonable aesthetic improvements.
Notes:
2009
F Migliori (2009)  Brachioplasty   In: Hand Aesthetics: Surgery, Medicine & Art MEGA HAND Paris (France): Feb 27-28  
Abstract: Background: A review of the results of the standard technique for âbatwingâ deformity after massive weight loss led to the need to optimize the cost/benefit ratio in terms of maximal correction/less visible scars. Methods: Between 2001 and 2008 36 patients were operated with a new technique based on a careful pre-operative evaluation and markings, followed by an intra-operative skillful handling. The pre-op drawings only determine the extension of excision, while the amount of tissue to be removed is intra-op determined, aiming the higher amount of tissue to be excised. A careful post-op management and follow-up is needed. Results: The aesthetic results are far better then those obtained with other techniques, especially referred to the arm lower profile. Complication rate is similar to other techniques, even if a potential low risk for ulnar nerve damage is present. Conclusions: This technique is not easy and needs plastic surgery experience and a long learning curve. Nevertheless, despite actual technical difficulties, seems to confer the best natural arm shape and profile.
Notes:
F Migliori (2009)  Augmentation Mastopexy with Upside-Down technique   In: 6° BAPRAS Congress (ISAPS Postgraduate 1-Day Symposium) Edited by:Smilja Tudzarova-Gjorgova. Balkan Association of Plastic, Reconstructive and Aesthetic Surgery Ohrid (FYROM Macedonia): June 4-7  
Abstract: Introduction Our wide experience in post-bariatric body-contouring pushed us to find a suitable technique to correct the two most common defects of the M.W.L. breast: 1) hypotrophy, 2) ptosis. To do this, a technique selection algorithm has been created. According with our algorithm, in those cases where a âminor ptosisâ has been diagnosed (< cm.6 of vertical N.A.C. correction), we have developed the âUpside-Downâ technique. Materials and methods The technique is performed as follows: a) complete subcutaneous undermining of glandular upper pole until upper edge of the mammary gland. b) After having rotated around the edge, upside-down retroglandular undermining, taking great care to leave inframammary fold and 2 cm. of gland undetached. c) topside-bottom implant insertion with a âmailbox postingâ action; inframammary fold and undetached gland act like a bra to prevent implant ptosis. The upper â of the prosthesis could be placed beneath pectoralis major muscle, with âdual-planeâ technique, if a round implant is utilized, or left completely retroglandular if an anatomical implant is used. d) the type of implant needed (round vs. anatomical) basically depends on the kind of aesthetical defect: major upper pole defects need round implants, major lower pole defects need anatomical implants. Patientâs preferences are a primary factor in the decision. e) breast lifting through strong anchorage to fascia, muscle and 2nd rib periostium: at least three stitches of threaded non-absorbable 0 or 1 suture are positioned. Whole lower gland pole is left undetached, to guarantee blood perfusion (only 1-2 cm. periareolar are undermined). f) periareolar suture is always performed with âinterlockingâ technique acc. with Hammond. Results From Nov 2001 to May 2009 213 patients have been operated with this technique. The patients were all Caucasian, average age 38 (range 31/53), were all operated bilaterally. The mean operating time was 150 minutes (range 120/180). Mean hospital stay was 6 days (range 3/9) after surgery. We evaluated the ptosis recurrence rate, assuming that a N.A.C. sliding > 2 cm., 1 year after surgery, is considered recurrence. With other techniques the recurrence was 27,6%, with this technique 9,1%. Conclusions Natural shape, stable position and short scars are the main advantages of this technique. The typical breast flatness following periareolar access is best corrected by the last generation dual cohesiveness anatomical implants, that we strongly suggest to obtain best results with this technique. B.U.T. (Body Uneasiness Test) study evidenced 100% improvement of patient discomfort.
Notes:
F Migliori (2009)  Torsoplasty after Massive Weight Loss   In: 11th ESPRAS Congress Edited by:European Society of Plastic, Reconstructive and Aesthetic Surgery. ESPRAS Rhodes (Greece): Sept 20-26  
Abstract: Backgrounds Torsoplasty can be considered the most invasive but at the same time the most aesthetically improving Body Contouring procedure in the post-bariatric patient. Traditional methods for âtorsoâ area reshaping (like abdominoplasty, belt lipectomy or body lifting) can manage alone only a part of the inaesthetisms of post-bariatric patients. The main evaluation to be done in this area is whether the defect is confined on the plane of the abdominal wall (2 dimensions), or it is extended to all the torso area (3 dimensions). Methods A deep evaluation of the patient âsilhouetteâ (through multiple projections pictures) is needed. Careful pre-op measuring and drawings are mandatory, in order to estimate the right amount of correction. Pre-op and post-op therapy and management must be carefully organized. The surgical procedures are performed in prone-supine sequence, using specific intra-op procedures. Case management expertise and procedures assessment have progressively reduced complication occurrence. Results Within 52 operated cases follow-up between 3-18 months the quality of silhouette improvement is higher than any other technique. The long scar is usually well-positioned, easy masked under a bikini and well accepted. The patient quality life is greatly improved. The patient compliance is always tested with Body Uneasiness Test (B.U.T.). Conclusions All patients achieve nearly an ideal torso contour, addressing very effectively all functional and aesthetical concerns of M.W.L. patients. This BC surgery is, with no doubt, highly challenging both for surgeon and patient: adequate learning curve and careful patients selection and education are essential in reaching a good outcome.
Notes:
F Migliori (2009)  Breast Contouring in post-bariatric patients: an Algorithm for Technique Selection   In: 11th ESPRAS Congress Edited by:European Society of Plastic, Reconstructive and Aesthetic Surgery. ESPRAS Rhodes (Greece): Sep 20-26  
Abstract: Introduction Breast deformities in postbariatric women are mainly two: Ptosis and Volume loss. The specific histological alterations confer highest degrees of true ptosis, deflated and flattened glands, totally inelastic covering tissues. Plastic surgeon needs an easy-to-use algorithm for technique choice. Material and Methods Ptosis has been surgically classified on the amount of nipple-areola complex excursion: if NAC lifting is < 6 cm. is defined as âminor ptosisâ, if it is > 6 cm. is defined as âmajor ptosisâ. Volume evaluation has to be subjective (patient) and objective (surgeon), since no granted procedure or device exists up to date. So a definition of âsuitable volumeâ or âlacking volumeâ is given. Depending on these previous rules, four surgical choices have been developed: 1. âMinor ptosis/Suitable volumeâ: round block mastopexy 2. âMinor ptosis/Lacking volumeâ: round block mastopexy + âmailboxâ implant 3. âMajor ptosis/Suitable volumeâ: vertical mastopexy + autoprosthesis 4. âMajor ptosis/Lacking volumeâ: vertical mastopexy + implant Every choice has âpros and consâ which have been pointed out in order to minimize the risk/benefit ratio. The use of mammary implants emphasized problems with their weight and the need of new dedicated prosthesis. Results 211 postbariatric patients (2001-2008) followed this decisional algorithm. Results have been tested: ⢠by ptosis recurrence rate: 1 year post-op, a NAC sliding > 2 cm. is considered recurrence. Techniques with implants have higher recurrence than those without; ⢠by self-administered Body Uneasiness Test (B.U.T.): techniques with shorter scars have higher compliance than those with longer scars. Conclusions Referring to this algorithm, choices 2 and 3 appear to be the more frequently applied and better fitted to cover the majority of postbariatric breast defects. In the future new mammary implants and new techniques could completely change this algorithm, which is intended to be âopenâ rather than âstone printedâ.
Notes:
2008
F Migliori, C Rosati, G G Serra Cervetti, F Dodi, G V Tommasi (2008)  Costagliola's technique for a stable resolution of lower limb chronic venous ulcers   In: Skin Ulcer Therapy: A Bridge between Tradition and Innovation VII AIUC National Congress Roma (Italy): Sept 24-27  
Abstract: Introduzione: Le ulcere venose degli arti inferiori rappresentano da sempre un problema âcronicoâ e di fatto non risolto dalle classiche tecniche ricostruttive, in quanto causate da un meccanismo fisiopatogenetico di base ben preciso che non viene riconosciuto ed affrontato dai protocolli convenzionali. Tali pazienti, infatti, vengono solitamente seguiti per anni da svariati ambulatori specialistici senza conseguire alcun risultato significativo. Materiali e metodi: Il protocollo di trattamento proposto da M. Costagliola (Tolosa) affronta il problema nei suoi aspetti fisiopatologici, permettendo la guarigione definitiva delle ulcere con un intervento costituito da due tempi chirurgici distanziati fra loro di 15-20 gg. Lâindicazione di tale trattamento è ristretta alle ulcere con prevalente componente venosa e scarsa o nulla componente arteriosa: per questo motivo è necessaria una attenta diagnostica clinica e strumentale preoperatoria, che noi eseguiamo seguendo un preciso percorso multidisciplinare. Risultati: Nella nostra esperienza di 13 casi trattati, con un ricovero medio di 30-35 gg., abbiamo avuto il 100% di risoluzione della patologia. Il paziente viene completamente riabilitato, ritorna autonomo nella vita di relazione e definitivamente liberato dalla dipendenza da medicazioni croniche e da controlli ambulatoriali. Conclusioni: Lâutilizzo di questo protocollo, così rivoluzionario per la risoluzione di una patologia grave e invalidante, permette al paziente di essere pienamente recuperato sia dal punto di vista sociale che lavorativo.
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F Migliori (2008)  L’autoprotesi nel Breast-Contouring dopo M.W.L.: una tecnica indispensabile ed insostituibile   In: XVI SICOB National Congress Società Italiana di Chirurgia dell'Obesità Capri (Italy): Apr 14-16  
Abstract: Introduzione Il nostro algoritmo decisionale nella scelta delle tecniche di rimodellamento mammario dopo perdite massive di peso, evidenzia vaste aree di inapplicabilità delle protesi mammarie. Si rende pertanto necessario, laddove possibile, lâuso di tecniche che non prevedano lâimpiego di protesi. Materiali e Metodi Il video mostra la progettazione ed i principali passaggi chirurgici per lâesecuzione della cosiddetta âautoprotesiâ. Questa tecnica trova il suo ideale campo di applicazione nelle mammelle fortemente ptosiche e che, nonostante la notevole perdita di volume, conservino tessuto ghiandolare mammario sufficiente. Questo aspetto si reperta frequentemente nelle mammelle post-bariatriche. Risultati Vengono mostrate le immagini comparate pre- e post-operatorie, che dimostrano lâottima correzione della ptosi e lâottimo aumento della proiezione antero-posteriore del complesso areola-capezzolo. Conclusioni Il breast-contouring con autoprotesi rappresenta una tecnica indispensabile ed insostituibile, allo stato attuale dellâarte, nella paziente post-bariatrica. Verificate le effettive difficoltà con lâuso delle protesi in questa particolare categoria di pazienti, lâimpiego dellâautoprotesi dovrebbe essere forzato il più possibile.
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F Migliori (2008)  Scythian Bow in Rhinoplasty Project   In: 19° EURAPS Meeting Edited by:EURAPS. European Society of Plastic Surgeons Madeira (Portugal): May 29-31  
Abstract: Introduction/Purpose The ideal facial lower â profile (from tip of the nose to tip of the chin) can be represented by the shape of an ancient weapon called âScythian Bowâ. This mould seems to settle the harmony between nose and face profile, and reproduces results universally perceived as nice and aesthetic. Material and Methods Two parameters are taken in consideration, on patient lateral view: 1. âScythian Bowâ. The profile from nasal tip to chin tip is drawn (âbowâ): the bow, centered on mouth rim, must be symmetric. The tangent line to nose and chin tips (âstringâ of the bow) is drawn as well: the distance of this line from naso-labial fossa and chin-labial fossa must be equal. This evaluation determines the amount of correction needed on inferior nasal spine (bone removal or cartilage graft), the amount of correction of nasal tip (shortening or lengthening), beside possible chin or lips corrections. 2. âParallel linesâ. A line running across the anterior and posterior vertices of the nostril is drawn: this line should run parallel to the line running along upper lip edge. This evaluation determines the right amount of tip rotation needed (alar cartilage removal, rectangular cartilage caudal edge correction). Pre-operative project is performed on patient profile pictures, making drawings and evaluating parameters diverging from normal values. Intra-operative step-by-step control is made, using a straight instrument (i.e. a liposuction cannula) as âstring of the bowâ. Post-operative evaluation on pictures is made comparing bow and lines with pre-operative ones. Follow up is performed at least 6 months post-operatively. Results According with âScythian Bowâ surgical project, 368 patients (307 females, 61 males) have been operated since 1990, with an average follow-up of 6 months. The patients have been divided in 6 groups according with geographical and ethnic belonging. The patients were studied since 2000 through 3 kind of self-administered Rating Scales: 1) Body Uneasiness Test (BUT); 2) Body Dysmorphic Disorder Examination (BDDE); 3) Hamilton Rating Scale for Depression (HAM-D); plus 4) a short personalized Questionnaire, evaluating epidemiologic and psychological parameters. All tests are administered before, shortly after, and 6 months after surgery, and valued by an independent Psychiatric Unit. 90,15% of patients referred relevant improvements. Conclusions âScythian Bowâ project enhances harmonic relations between nose and mouth, and gives a model which can be easily applied and reproduced on 100% of patients. The results are perceived as ânaturalâ and âgood-lookingâ both from patients and surgeons.
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F Migliori (2008)  Breast Contouring in Post-Bariatric patients: a Technique Selection Algorithm   In: 3° IFSO-EC Congress Edited by:Obesity Surgery. Vol. 18, p. 473, 159 International Federation for the Surgery of Obesity, European Chapter Capri (Italy): Apr 17-19  
Abstract: Backgrounds: Breast deformities in postbariatric surgery patients are different and more challenging than those from nonbariatric surgery patients. The histological alterations confer the highest clinical consequences to this area, as highest degrees of true ptosis, deflated and flattened glands and totally inelastic covering tissues. The clinician needs an easy-to-use algorithm for technical choices. Methods: Ptosis and volume loss are the main problems to be corrected on breasts of patients having experienced major weight loss. Both problems need specific resolutions, due to their specific characteristics. Depending on the degree of ptosis and the amount of volume loss, a decisional algorithm has been developed; suitable and advisable techniques are pointed out, minimizing the risk/benefit ratio. âPros and consâ with use of mammary implants are emphasized. Results: A group of 195 postbariatric surgery individuals underwent breast-contouring since 2001 following the herein presented decisional algorithm. Results have been tested with body uneasiness test (BUT). Encouraging data push to continue this method and to refine it. Conclusions: Referring to strategy algorithm shown above, the choices 1/2 and 3 appear to be the more frequently applied and better fitted to cover the majority of massive weight loss breast defects. In the future, the birth and the rise of new mammary implant concepts and technologies could completely change this algorithm.
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F Migliori (2008)  Torsoplasty after Massive Weight Loss   In: 3° IFSO-EC Congress Edited by:Obesity Surgery. Vol. 18, p. 473, 158 International Federation for the Surgery of Obesity, European Chapter Capri (Italy): Apr 17-19  
Abstract: Backgrounds: Torsoplasty has to be considered the most invasive but at the same time the most aesthetically improving body contouring procedure in the postbariatric patient. Traditional methods for âtorsoâ area reshaping (like abdominoplasty, belt lipectomy or body lifting) can deal only with a part of the inaesthetisms of postbariatric patients. The main evaluation that has to be done regarding this area by a plastic surgeon is whether the defect is confined on the plane of the abdominal wall (two dimensions), or it is extended to all the torso area (three dimensions). Methods: A deep evaluation of the patient âsilhouetteâ (through multiple projections pictures) is needed. Careful pre-operative measuring and drawings are mandatory in order to estimate the right amount of correction. Furthermore, the preoperative and postoperative therapy and management must be carefully organized. The surgical procedures are performed in prone-supine sequence, using specific procedures. Case management expertise and procedures assessment have progressively reduced occurrence of postoperative local complications. Results: Within 32 operated cases followed between 3â18 months, the quality of silhouette improvement is better than after any other cosmetic surgical procedure. The long scar is usually well positioned, easy masked under a bikini and well accepted and the patient quality life is greatly improved. Conclusions: All patients achieve a nearly deal torso contour after major weight loss addressing very effectively all functional and aesthetical concerns. This bariatric surgery is undoubtedly challenging both for cosmetic surgeon and patient: adequate learning curve and careful patients selection and education are essential in reaching a good outcome.
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2007
G G Serra Cervetti, M Ghiglione, F Migliori (2007)  Programma “Body Contouring”: Criteri di arruolamento dei pazienti postbariatrici   In: 56° SICPRE National Congress Edited by:SICPRE. Società Italiana di Chirurgia Plastica, Ricostruttiva ed Estetica Fasano BA (Italy): Sept 26-29  
Abstract: Introduzione LâU.O. di Chirurgia Plastica dellâA.O. âSan Martinoâ di Genova si occupa dei trattamenti chirurgici per pazienti âex obesiâ. Questi trattamenti, facenti parte a tutti gli effetti del âbody-contouringâ, rappresentano per la nostra U.O. una mission direzionale di importanza strategica. Materiali e Metodi Presso gli Ambulatori della U.O. di Chirurgia Plastica vengono visitati settimanalmente molti pazienti che richiedono di essere inseriti nel programma di body-contouring. Per facilitare il compito dei medici che afferiscono a tali ambulatori si sono stabiliti dei criteri fondamentali per poter arruolare ed inserire i pazienti idonei nellâampio programma chirurgico âbody-contouringâ: ⢠Essere stati sottoposti da almeno un anno ad intervento di chirurgia bariatrica o avere seguito dieta alimentare con perdita di almeno il 30% del peso corporeo iniziale; ⢠B.M.I. non rientrante (per quanto possibile) negli indici di obesità; ⢠Valutazione tramite test psicologici tesi ad analizzare lâimmagine della propria immagine pre-op e post-op. Conclusioni Una volta così selezionati, i pazienti entrano a far parte a tutti gli effetti del programma chirurgico âbody-contouringâ che prevede una successione di interventi messi a disposizione dello stesso paziente dal medico proponente. Per ogni distretto corporeo sono individuabili ulteriori criteri di inclusione o esclusione dal programma. Questi interventi, la cui successione e necessità va valutata e condivisa dallâinterfaccia medico-paziente, sono rappresentati da: ï Brachioplastica; ï Mastoplastica (riduttiva; mastopessi con e senza incremento volumetrico); ï Addominoplastica; ï Torsoplastica; ï Rimodellamento dellâarto inferiore.
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F Migliori (2007)  Breast Contouring in paziente ex obesa   In: "In video veritas" XVII ACOI National Congress of Video Surgery Edited by:ACOI. Associazione Chirurghi Ospedalieri Italiani Genova (Italy): Nov 30  
Abstract: Introduzione Il nostro algoritmo decisionale nella scelta delle tecniche di rimodellamento mammario dopo perdite massive di peso, evidenzia vaste aree di inapplicabilità delle protesi mammarie. Si rende pertanto necessario, laddove possibile, lâuso di tecniche che non prevedano lâimpiego di protesi. Materiali e Metodi Il video mostra la progettazione ed i principali passaggi chirurgici per lâesecuzione della cosiddetta âautoprotesiâ. Questa tecnica trova il suo ideale campo di applicazione nelle mammelle fortemente ptosiche e che, nonostante la notevole perdita di volume, conservino tessuto ghiandolare mammario sufficiente. Questo aspetto si reperta frequentemente nelle mammelle post-bariatriche. Risultati Vengono mostrate le immagini comparate pre- e post-operatorie, che dimostrano lâottima correzione della ptosi e lâottimo aumento della proiezione antero-posteriore del complesso areola-capezzolo. Conclusioni Il breast-contouring con autoprotesi rappresenta una tecnica indispensabile ed insostituibile, allo stato attuale dellâarte, nella paziente post-bariatrica. Verificate le effettive difficoltà con lâuso delle protesi in questa particolare categoria di pazienti, lâimpiego dellâautoprotesi dovrebbe essere forzato il più possibile.
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2006
GG Serra Cervetti, L Pecori, R Dalla Costa, G F Adami, F Migliori (2006)  Abdominoplasty in patients undergoing a previous biliopancreatic diversion: modifications of patients apparence   In: 2° IFSO-EC Congress Edited by:IFSO. Vol. 16, 432 International Federation for the Surgery of Obesity, European Chapter Lion (France): Apr 27-29  
Abstract: Background: Since 2001, 186 post-obese patients underwent a body contouring (BC) operation following to a biliopancretic diversion (BPD). Such surgery included: abdominoplasty, reduction mammoplasty, brachioplasty, thigh lifting and torsoplasty. Following BPD the ultimate weight loss determines a permanent improvement of the patientâs appearance. Methods: Our teamâs idea was to verify whether BC surgery might further improve the patientâs appearance and to which extent. The question was: can BC change and further improve the way the body looks? The B.U.T. - a self-administrated questionnaire including items describing typical features of dysmorphic patients or which more frequently affect body parts or functions â was then handed out to selected patients. As a premise we considered that a patient who had a BPD expected his health, wellness and look to improve, which actually happened. Results and Conclusions: Even if the look does not improve as expected, such a need becomes urgent and obvious for the patient, who then asks for plastic surgery. In such a context, the plastic surgeon must carefully select patients and have a candid and open discussion with each of them. He should propose a psychological consultation as well.
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F Migliori, C Rosati, G D'Alessandro, G G Serra Cervetti (2006)  Transsexuals Augmentation Mastoplasty   In: 55° SICPRE National Congress Edited by:SICPRE. Società Italiana di Chirurgia Plastica, Ricostruttiva ed Estetica Rimini (Italy): Sept 21-23  
Abstract: INTRODUZIONE Scopo della ricerca è sottolineare alcune problematiche specifiche di una metodica comune in un gruppo particolare di pazienti. METODOLOGIE: Lo studio interessa pazienti precedentemente sottoposti ad intervento di transessualismo M-F, successivamente inviati a noi per il rimodellamento della regione mammaria. I principali problemi tecnici incontrati sono stati: 1) la distanza intercapezzolare maggiore rispetto alle pazienti di sesso femminile; 2) la consistenza del tessuto cutaneo e sottocutaneo solitamente molto superiore rispetto alle pazienti femmine (questo dato è comunque variabile a seconda della qualità e quantità di terapia ormonale sostitutiva precedentemente eseguita); 3) l assenza di un solco sottomammario ben definito. RISULTATI: Dopo 12 casi operati con un follow-up da 6 a 24 mesi riteniamo che i migliori risultati siano ottenibili utilizzando protesi mammarie rotonde con via di accesso nel solco sottomammario e posizionamento retroghiandolare. Riteniamo si debba perseguire la massima medializzazione possibile degli impianti indipendentemente dalla posizione del C.A.C. CONCLUSIONI: Lâapplicazione dei concetti sopraesposti permette lâottenimento di risultati sia oggettivamente che soggettivamente soddisfacenti in un gruppo di pazienti caratterizzato da una particolare attenzione all immagine del proprio corpo, dotato di accentuato spirito critico, e mosso da forti aspettative.
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F Migliori (2006)  Brachioplasty after "Massive Weight Loss"   In: 55° SICPRE National Congress Edited by:SICPRE. Società Italiana di Chirurgia Plastica, Ricostruttiva ed Estetica Rimini (Italy): Sept 21-23  
Abstract: Introduzione La Brachioplastica che pratichiamo da molti anni su pazienti dopo MWL utilizza una tecnica a cicatrice lineare e ha dato buoni risultati nonostante che i tessuti minati dallâintervento di Diversione Bilio-Pancreatica o da altra chirurgia bariatrica non sempre consentissero una cicatrizzazione ottimale. Materiali e metodi Dal 2003 ad oggi abbiamo sottoposto 20 pazienti ad intervento di lifting delle braccia. Tutti i pazienti avevano subito in passato interventi di chirurgia bariatrica. Dopo aver attentamente analizzato le varie tecniche proposte dalla letteratura internazionale abbiamo utilizzato una tecnica a incisione lineare che va dallâepicondilo mediale allâapice ascellare seguendo il solco bicipitale mediale. Abbiamo cercato di salvaguardare il più possibile il cavo ascellare nellâipotesi che questo potesse venir interessato da patologie a componente neoplastica di origine mammaria. La tecnica attraverso unâattenta pianificazione pre-operatoria prevede un abbondante quantità di tessuto escisso allo scopo di ottenere un buon risultato estetico eliminando lâeccesso del tessuto ptosico. Il rischio in cui si incorre è di creare una sutura in tensione nonostante lâampio scollamento dei tessuti. Solo in un caso siamo dovuti intervenire in settima giornata post-operatoria per un edema cospicuo dellâarea operata con grave impaccio motorio e sensitivo che si è provveduto a correggere riaprendo la ferita in prima giornata. Risultati e Conclusioni Abbiamo cercato di migliorare lâesito cicatriziale di questo tipo dâintervento che quasi sempre non gratifica lâoperatore e il paziente. Nelle nostre mani la tecnica a cicatrice lineare è risultata lasciare una buona morfologia allâarto non residuando alcuna ptosi e ben celando la cicatrice nel solco bicipitale mediale. Solo raramente abbiamo dovuto ricorrere allâallungamento della cicatrice verso il cavo ascellare correggendo lâeccesso cutaneo residuo. Riteniamo indispensabili alla buona riuscita dellâintervento oltre al corretto disegno pre-operatorio anche unâattenta sutura dei piani con materiali a lento riassorbimento e lâutilizzo di tutori elasto-compressivi ed altri mezzi atti a prevenire la formazioni di cicatrici patologiche.
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F Migliori (2006)  Body Contouring after biliopancreatic diversion   In: 2° IFSO-EC Congress Edited by:IFSO. Vol. 16, 412 International Federation for the Surgery of Obesity, European Chapter Lion (France): Apr 27-29  
Abstract: Background: From 11/2001 to 1/2006, 176 patients were operated, previously treated by biliopancreatic diversion (BPD, 1976) and having therefore achieved a body weight loss varying from 30 to100 kg. The surgery targeted mainly the arms (24), breast (58), abdomen (62) and thighs (20), plus torsoplasty (12). Methods: BPD is a ânon-cosmetic bariatric surgeryâ, providing malabsorption and subsequent weight-loss within 12 to18 months. The typical âemptyâ aspect of the slimmed areas led our surgical choices to specific techniques: brachioplasty, reduction mammaplasty and/or mastopexy (with or without prosthesis or âselfprosthesisâ technique), thigh lift, abdominoplasty and torsoplasty. We do not consider any liposuction technique suitable for these patients, due to specific histological changes caused by BPD. Results: The metabolic discrepancies following BPD jeopardize preoperative and postoperative management of these patients. A higher incidence of complications was reported, systemic as well local: the local ones, quite common on the abdominal wall, convinced us to perform a preoperative arteriographic study, to check anatomical alteration following BPD and plastic surgery as well. Conclusions: Although the peculiar characteristics of the BPD patients limit the choices, we can actually consider ourselves satisfied with results regarding cosmetic correction, quality of life and so forth: all the patients, with no exception, notes a high rate of perceived quality (positive thinking) and underwent further body-contouring surgery (or plan to do so).
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2005
F Migliori (2005)  Body Contouring after biliopancreatic diversion   In: 10° ESPRAS Congress Edited by:ESPRAS. OP230 European Society of Plastic, Reconstructive and Aesthetic Surgery Vienna (Austria): Aug 30 - Sep 3  
Abstract: Introduction: From 11/2001 to 11/2004, 122 patients were operated, previously treated by Bilio-Pancreatic Diversion (B.P.D., 1976) and having therefore performed a body weight loss varying from kg. 30 to kg. 100. The surgery interested mainly arms (14), breast (47), abdomen (51) and thighs (10). Materials e methods. B.P.D. is a deviation technique with anastomosis of the gastro-ileal tract, providing a malabsorption and subsequent weight loss within 12 to 18 months. This is a non-cosmetic bariatric surgery. The typical âemptyâ aspect of the slimmed areas led our surgical choices to specific techniques: brachioplasty, reduction mammaplasty and/or mastopexy (with or without prosthesis or âself prosthesisâ technique), abdominoplasty and thigh lift were utilized. Within our experience, we do not consider any liposuction technique suitable for this kind of patients, due to specific histological changes caused by B.P.D. Results. The metabolic discrepancies following B.P.D. jeopardize pre-op and post-op management of these patients. A higher incidence of complications, systemic as well local, was found: the local ones, so frequent on the abdominal wall, convinced us to perform a pre-op arteriographic study, to check anatomical alteration following B.P.D. and plastic surgery as well. Conclusions. Although the peculiar characteristics of the B.P.D. patients hedge the choices, we can actually consider ourselves satisfied with results as for cosmetic correction and quality of life so forth: all the patients, with no exception, referred a high rate of perceived quality (positive thinking) and underwent (or scheduled to) further body-contouring surgery.
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F Migliori, M Ghiglione, R Rizzo, F Cecchi, G G Serra Cervetti (2005)  Criteri di scelta Addominoplastica vs. Torsoplastica   In: 54° SICPRE National Congress Edited by:SICPRE. Società Italiana di Chirurgia Plastica, Ricostruttiva ed Estetica (Costa Romantica): Oct 21-24  
Abstract: Scopo della ricerca: dimostrare la migliore adattabilità della torsoplastica rispetto allâaddominoplastica alle problematiche di body-contouring specifiche nei pazienti dimagriti dopo diversione bilio-pancreatica. Metodologia: una revisione critica dei risultati a distanza delle addominoplastiche eseguite su pz. operati di D.B.P. ha evidenziato frequenti problemi di profilo a livello del giro-vita soprattutto nella proiezione antero-posteriore (mediante un effetto paradosso ben descritto da Matarasso), dovuto soprattutto allâinefficacia della tecnica sulle zone dei fianchi. La non applicabilità della lipoaspirazione su questo particolare tipo di pazienti ci ha convinto ad optare per la addominoplastica circonferenziale (o torsoplastica), pur con le oggettive difficoltà gestionali e rischi generici e specifici. Risultati: dopo 5 casi operati, con un follow-up da 5 mesi ad 1 anno, possiamo dire che la qualità di miglioramento del profilo corporeo allâaltezza dei fianchi è assolutamente superiore rispetto a quello ottenibile con lâaddominoplastica tradizionale. Fra gli aspetti negativi, ci sembra giusto sottolineare la forte anemizzazione intra- e post-operatoria, e la grande estensione della cicatrice residua. Conclusioni: in casi opportunamente selezionati, la torsoplastica ci pare preferibile allâaddominoplastica per migliorare il profilo antero-posteriore e la proiezione dei glutei, soprattutto nei pazienti affetti dal cosiddetto âprofilo Sharpeiâ.
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2004
F Migliori, M Ghiglione (2004)  An Organization Model For The Burn Emergency: The Burn Center In “San Martino” General Hospital, Genoa   In: 53° SICPRE National Congress Edited by:SICPRE. Società Italiana di Chirurgia Plastica, Ricostruttiva ed Estetica Pisa (Italy): Sept 16-18  
Abstract: Introduction The analysis of the literature gives evidence of a worldwide agreement about the importance of a well-conducted management of the emergency period of the burnt patient. However, literature is poor in giving organization models and the few ones are dated. Methods We submit a model of organization applied at our Burn Center, recently rebuilt, in accordance with the Reanimation Unit of âSan Martinoâ General Hospital in Genoa. This model takes benefits from the lucky architectural structure of a new Emergency Dep. wing, and tries to smooth the problematic dualism plastic surgeon/intesivists. A protocol of patients admission, depending on their injury degree, is described, shared among Burn Center, Reanimation Unit and Emergency Call Service (118). A protocol of combined treatment is described as well. Results We refer a 2 years experience which has significantly lowered the infections incidence and mortality rate. Conclusions Our experience could be an encouraging suggestion either for new burn centers projecting, or for reorganizing existing ones. References 1. Arif Rajpura, A review of the specialties that care for inpatient burns and smoke inhalation in the English counties of Lancashire and South Cumbria, Burns 28 (2002), p. 131-134 2. Keith Allison, The UK pre-hospital management of burn patients: current practice and the need for a standard approach, Burns 28 (2002), p. 135-142 3. Jill Webb, Current attitudes to burns resuscitation in the UK, Burns 28 (2002), p. 205 4. Kari M. Rosenkranz and Robert Sheridan, Management of the burned trauma patient: balancing conflicting priorities, Burns 28 (2002), p. 665-669 5. P. G. Shakespeare, Standards and quality in burn treatment, Burns 27 (2001), p. 791-792 6. Johnson K.I., Meyer A.A., Evans S.K., Strategies to improve burn center utilization, J. Burn Care Rehabil. 1988 Jan.-Feb. 9 (1): 102-105 7. HarveyJ.S., Watkins G.M., Sherman R.T., Emergent burn care, South Med. J. 1984 Feb. 77 (2): 204-214 8. Clerici, Bagozzi I., Fundamental concepts utilized in the organization of a Burns Treatement Center, Ann. Chir. Plast. 1968 Mar. 13 (1): 67-71
Notes: 2 years after this model was proposed and widely accepted and estimated, the Burn Center of "San Martino" General Hospital (at the best of its activity) was closed, due to a political decision with no sense, voted to give evidence to the only other Burn Center in Liguria (old, obsolete, located in a peripheral hospital, still working in dreadful conditions). To do this, activity data were taken and rearranged: noboby could do (or had the strength and the interest to do) nothing to stop this felony and this enormous waste of public money. In Italy the science goes in one direction, the politics and administrations in the opposite one.
F Migliori (2004)  Il rimodellamento corporeo dopo diversione biliopancreatica   In: 53° SICPRE National Congress Edited by:SICPRE. Società Italiana di Chirurgia Plastica, Ricostruttiva ed Estetica Pisa (Italy): Sept 16-18  
Abstract: Introduzione. Dal 2001 abbiamo trattato 145 pazienti sottoposti, negli anni precedenti, a Diversione Bilio-Pancreatica (D.B.P. sec. Scopinaro) e che sono andati incontro a dimagrimenti di entità variabile da kg. 30 a kg. 100. La chirurgia ha interessato la regione brachiale, la regione mammaria, lâaddome ed il tronco, le cosce. Materiali e metodi. La D.B.P. è una tecnica di deviazione e riananstomosi del tratto gastro-ileale, che provoca una riduzione dellâassorbimento ed il conseguente dimagrimento in un periodo di 12-18 mesi. Lâaspetto caratteristico (âsvuotatoâ) delle aree dimagrite ha indirizzato la scelta delle tecniche chirurgiche: sono stati utilizzati il lifting delle braccia, la mastopessi (spesso con impiego di protesi), lâaddominoplastica, il lifting delle cosce. Nella nostra esperienza riteniamo non indicata qualsiasi tecnica di lipoaspirazione. Le alterazioni metaboliche conseguenti alla D.B.P. rendono più complessa la gestione pre- e post-operatoria di questi pazienti. Abbiamo rilevato una maggiore incidenza di complicazioni, sia sistemiche che locali: queste ultime, particolarmente frequenti a carico della parete addominale, ci hanno indotto ad iniziare uno studio arteriografico della regione per valutare eventuali alterazioni anatomiche conseguenti a D.B.P. Risultati. Pur con i limiti oggettivamente imposti dalle caratteristiche peculiari dei pazienti trattati, possiamo ritenerci soddisfatti per quanto riguarda la correzione degli inestetismi ed il miglioramento della qualità di vita: riteniamo possano esservi margini di miglioramento nella gestione delle complicanze.
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2003
F Migliori (2003)  Complicazioni dopo addominoplastica in pazienti operati di DBP   In: "Recidive e complicanze in chirurgia" XVII ACOI Regional Liguria Congress Edited by:Fondazione Mediaterraneo. Associazione Chirurghi Ospedalieri Italiani Sestri Levante (Italy): Oct 24  
Abstract: La tecnica di Diversione Bilio-Pancreatica secondo Scopinaro provoca ingenti dimagrimenti in 12-18 mesi, che rendono necessarie svariate tecniche di rimodellamento corporeo (mastoplastiche, addominoplastiche, lifting delle braccia e delle cosce, liposuzioni). Lâaddominoplastica può presentare complicazioni dipendenti in parte dalle caratteristiche peculiari della tecnica chirurgica, ed in parte dalle problematiche specifiche che presentano questi pazienti. La compromissione vascolare che inevitabilmente viene provocata dallâincisione e dallo scollamento della parete addominale in corso di addominoplastica, può essere enfatizzata dalle condizioni di scarso trofismo tissutale che sono clinicamente evidenti a carico della cute, del grasso sottocutaneo, della parete dei vasi, delle fasce muscolari. Questa situazione è probabilmente generata e mantenuta dallâingente dimagrimento in tempi relativamente rapidi e conseguente compromissione del circolo ematico proveniente sia dalle arterie epigastriche che dalle perforanti. Questa ipotesi potrà essere oggetto di un successivo studio specifico al riguardo. Inoltre la presenza sulla parete addominale di cicatrici chirurgiche più o meno estese aumenta il rischio di insorgenza di complicazioni. Le complicazioni sono riconducibili prevalentemente a sofferenze parziali e/o totali delle aree mediane della parete addominale immediatamente craniali allâincisione bisiliaca.
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F Migliori, M Calabrese (2003)  La MRM come metodo elettivo di indagine delle complicazioni in pazienti portatrici di protesi mammarie   In: "Recidive e complicanze in chirurgia" XVII ACOI Regional Liguria Congress Edited by:Fondazione Mediaterraneo. Associazione Chirurghi Ospedalieri Italiani Sestri Levante (Italy): Oct 24  
Abstract: Le pazienti portatrici di protesi mammarie (siano esse impiantate per estetica o per ricostruzione) vanno incontro a svariate complicazioni: meccaniche della protesi (rottura, dislocazione, pieghe, ecc.), contrazione della capsula fibrosa periprotesica, neoplasie. Lâincidenza percentuale di queste complicazioni, nonostante la continua evoluzione dei materiali, continua ad essere non trascurabile. Lo studio ha esaminato 81 donne (età 22-65) portatrici di protesi: 75 impiantate per estetica e 6 per ricostruzione. Lâesame è stato condotto con metodica standardizzata: la prima con sequenze di soppressione del grasso, acqua e silicone per lo studio della protesi; la seconda con sequenza contrastografica con gadolinio per lo studio del parenchima. La durata totale dellâesame è di ca. 40 minuti. Sono state evidenziate, tra le altre, 15 rotture intracapsulari, e 4 carcinomi duttali invasivi (di cui 1 negativo alla mammografia ed allâecotomografia). Tutte le positività sono state valutate e verificate chirurgicamente. La R.M.N. si è rivelata essere unâindagine altamente sensibile (98%) e di buona specificità (83%) per la diagnostica della mammella con protesi. Il suo utilizzo elettivo come âone-shot techniqueâ può essere considerato più attendibile rispetto alle tecniche tradizionali (più difficoltose tecnicamente), nonostante la minore accessibilità ed il maggior costo.
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F Migliori, R Rizzo (2003)  Il Lembo Surale distale: un lembo per la copertura di perdite di sostanza del 1/3 inferiore della gamba, della caviglia e del calcagno. Pregi e difetti   In: "Recidive e complicanze in chirurgia" XVII ACOI Regional Liguria Congress Edited by:Fondazione Mediaterraneo. Associazione Chirurghi Ospedalieri Italiani Sestri Levante (Italy): Oct 24  
Abstract: Il lembo surale è un lembo sufficientemente sicuro, ha una anatomia vascolare costante, è di esecuzione relativamente facile. Anatomia Chirurgica: Arteria surale superficiale (70% poplitea, 30% tronco comune). Rami perforanti dellâa. peroneale. Rami perforanti fascio-cutanei. Anastomosi soprafasciali. Vantaggi: Anatomia costante. Non câè sacrificio di un asse arterioso maggiore. Utilizzabile anche in arteriopatia. Buon mantello cutaneo. Lembo rapido e versatile. Unico tempo chirurgico. Svantaggi: Sacrificio del nervo surale. Cicatrice non estetica del polpaccio. Dimensioni limitate. Spessore consistente. Utilizzo: Metodica ricostruttiva per il 1/3 inferiore dellâA.I., che può essere adottata come prima scelta. Si affianca ad altre metodiche simili non microchirurgiche (ad es. lembo safeno). Offre buona copertura per i malleoli ed il calcagno.
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1984
G Bocciarelli, F Migliori, C Rava, M Gari, C Biggini (1984)  Le infezioni nel paziente ustionato: studio batteriologico sugli agenti eziologici e sulla loro sensibilità antibiotica   In: 33° SICP National Congress Edited by:SICP. Società Italiana di Chirurgia Plastica Capri (Italy): Sept. 26-29  
Abstract: Gli AA. eseguono uno studio batteriologico sulle infezioni delle ferite da ustione su 261 pazienti ustionati ricoverati dal 1979 ad oggi nel Centro Grandi Ustionati degli Ospedali Civili di Genova. Viene inoltre determinato uno schema della sensibilità antibiotica. I batteri comunemente isolati sono lo "Staphylococcus aureus", lo "Pseudomonas aeruginosa", il "Proteus mirabilis" e 1"'Escherichia coli". AI riguardo, lo "Staphylococcus aureus", che è il microorganismo di gran lunga più interessato, sembra colpire precocemente durante le prime settimane, mentre lo "Pseudomonas aeruginosa" compare eventualmente solo in fase già avanzata e mai "d'embleé", ma solo come agente sovrainfettante: rappresenta, di solito, un segno prognostico infausto. Per quanto riguarda la sensibilità antibiotica, tutti i ceppi batterici isolati, escluso lo "Pseudomonas aeruginosa", hanno mostrato una interessante evoluzione nel tempo, che fornisce dati importanti soprattutto per la copertura antibiotica preventiva. Lo "Psuedomonas aeruginosa", invece, ha evidenziato una singolare costanza nella risposta agli antibiotici che sono, fondamentalmente, due: Colimicina e Tobramicina.
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