Publications by authors named "Pietro Giovanoli"

Secondary lymphedema is a common sequel of oncologic surgery and presents a global health burden still lacking pharmacological treatment. The infiltration of the lymphedematous extremities with CD4T cells influences lymphedema onset and emerges as a promising therapy target. Here, we show that the modulation of CD4FOXP3CD25regulatory T (T) cells upon anti-CTLA4 treatment protects against lymphedema development in patients with melanoma and in a mouse lymphedema model.

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Objective: Lower extremity trauma significantly impacts patients' lives, requiring a nuanced approach to evaluate outcomes beyond clinical measures. The LIMB-Q, a patient-reported outcome measure (PROM), assesses the multifaceted impacts of lower extremity trauma, including physical and emotional dimensions, from the patient's perspective. This study validates the German version of the LIMB-Q.

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Introduction: Free flap surgery is a reliable and safe procedure for breast reconstruction. The survival of free flaps depends on their vascular pedicle initially, but neovascularization can sustain their blood supply after a while. Management of late pedicle occlusion in free flap breast reconstruction and potential implications of late pedicle occlusion on the transferred tissue are controversial.

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Progressive hemifacial atrophy (PHA) and linear scleroderma (LS) are both rare conditions and defined by atrophy and/or sclerosis of the skin and subcutaneous tissue. The ideal timing of reconstructive intervention in these patients is controversial. We compared the outcome and satisfaction of autologous lipofilling performed during active and stable phases of the diseases in adults.

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Article Synopsis
  • Tendon injuries are the second most common hand injuries, and effective repair techniques are critical for restoring patients' daily function.
  • This study compared the mechanical properties of two suture techniques: the standard U-Tang 4-strand suture and a modified cross-locked U-Tang 4-strand suture, using rabbit Achilles tendons.
  • Results showed that the cross-locked version had significantly greater strength and elastic modulus, suggesting it offers a better method for tendon repair while using the same materials.
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  • This study investigates the effectiveness of robotic-assisted microsurgery, focusing on a learning curve observed in 13 participants with varying surgical backgrounds who performed nine microsurgical anastomoses each on 2 mm vessel models! -
  • All participants demonstrated significant improvements in their surgical performance, decreasing the time taken for anastomoses and increasing their scores on a standardized assessment of microsurgical skills throughout the study sessions! -
  • Results indicate that prior surgical experience played a role in performance but became less significant over time, while factors like gender, age, hand dominance, and gaming experience did not affect the outcomes, suggesting promising potential for robotic systems in microsurgery!
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The first set of data refers to PAR-2 gene expression with the target gene rbF2rl1 assessed in tenocytes harvested from New Zealand White Rabbits' Achilles tendons. These tenocytes were stimulated with 20 ng/mL platelet-derived growth factor-BB (PDGF-BB) and compared to the corresponding cell culture without growth factor PDGF-BB. In addition, three inhibitors were tested.

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Background: Recent advances in robotic microsurgery have enabled the application of robotic technology in central lymphatic reconstruction. Although the use of microsurgical robots demands careful consideration of associated costs and potentially prolonged operating times, it may offer improved surgical approaches and enhanced accessibility to deeper anatomical structures such as the thoracic duct (TD).

Methods: We report on successful reconstruction of the central lymphatic system using the Symani Surgical System in four patients with lesions of the central lymphatic system.

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Article Synopsis
  • Robotic surgery, specifically using the Symani Surgical System, has shown promise in reconstructive procedures, particularly for extremity reconstruction through microsurgical anastomosis.
  • The study analyzed 8 patients with soft tissue defects who underwent free tissue transfer and found that the system allows for various anastomosis techniques while achieving an average procedure time of about 33 minutes.
  • The results indicate that robotic-assisted surgery is a safe and effective method with potential benefits in precision and ergonomics, suggesting a positive future for reconstructive microsurgery.
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Background: Sarcomas present a unique challenge within healthcare systems due to their rarity and complex treatment requirements. This study explores the economic impact of sarcoma surgeries across three Swiss tertiary healthcare institutions, utilizing a consistent surgical approach by a single surgeon to eliminate variability in surgical expertise as a confounding factor.

Methods: By analyzing data from 356 surgeries recorded in a real-world-time data warehouse, this study assesses surgical and hospital costs relative to institutional characteristics and surgical complexity.

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Critical-size bone defects necessitate bone void fillers that should be integrated well and be easily vascularized. One viable option is to use a biocompatible synthetic polymer and sonocoat it with zinc oxide (ZnO) nanoparticles (NPs). However, the ideal NP concentration and size must be assessed because a high dose of ZnO NPs may be toxic.

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Objective: Vascularized lymph node transfer (VLNT) has become an important surgical technique in the treatment of lymphedema. Considering the different available regions available for flap harvest, we aimed to analyze different donor sites for VLNT with respect to donor site morbidity, impact on limb volume, and patient-reported outcome measurements (PROMs).

Methods: A single-center prospective study of all patients undergoing VLNT at the Department of Plastic Surgery and Hand Surgery of the University Hospital Zurich between September 2016 and 2023 was conducted.

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Introduction: Postoperative chronic lymphocele and lymphedema represent severe burdens for soft tissue sarcoma patients who are already physically handicapped after an extensive surgery and a long recovery time. Incidences are high in the upper medial thigh. We have shifted our focus to lymphedema and lymphocele risk reduction with immediate lymphovenous anastomosis (LVA) after sarcoma resection.

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Introduction: Botulinum toxin A (BoTA) is a neurotoxin formed by Clostridium botulinum, with a broad medical application spectrum. While the primary effect of BoTA is on the muscles, the effects of BoTA in other systems including the blood vasculature have already been examined, revealing unexpected actions. However, no studies exist to the best of our knowledge regarding the potential effects of BoTA on the lymphatic vascular system, possessing a critical role in health and disease.

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Introduction: In recent years advances have been made in the microsurgical treatment of congenital or acquired central lymphatic lesions. While acquired lesions can result from any surgery or trauma of the central lymphatic system, congenital lymphatic lesions can have a variety of manifestations, ranging from singular thoracic duct abnormalities to complex multifocal malformations. Both conditions may cause recurrent chylous effusions and downstream lymphatic congestion depending on the anatomical location of the thoracic duct lesion and are associated with an increased mortality due to the permanent loss of protein and fluid.

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Article Synopsis
  • Robotic-assisted microsurgery is a new type of surgery that helps doctors perform very precise operations in hard-to-reach areas of the body.
  • Over the last 2.5 years, this method has been successfully used to help patients with lymphatic problems, where doctors performed surgery on 67 patients without any major issues after the surgery.
  • The study shows that using the robotic system made surgeries safer and more effective, even though it took a bit longer to set everything up.
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The duodenum acts as a vital organ that performs fundamental physiological functions like digestion and nutrient absorption. Situated in the lower abdomen, the duodenum is located between the stomach and the jejunum. Usually, the duodenum is divided into four anatomical portions.

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The surgical repair of a ruptured tendon faces two major problems: specifically increased fibrous adhesion to the surrounding tissue and inferior mechanical properties of the scar tissue compared to the native tissue. Bacterial attachment to implant materials is an additional problem as it might lead to severe infections and impaired recovery. To counteract adhesion formation, two novel implant materials were fabricated by electrospinning, namely, a random fiber mesh containing hyaluronic acid (HA) and poly(ethylene oxide) (PEO) in a ratio of 1:1 (HA/PEO 1:1) and 1:4 (HA/PEO 1:4), respectively.

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Background: Burn patients are in a state of activated coagulation, putting them at risk for thromboembolic events. Additionally, certain patient-related factors are associated with an increased risk of thrombus formation. This study aimed to evaluate the incidence of thromboembolic events and identify potential risk factors, including patient characteristics, surgical treatment, anticoagulation strategies, and laboratory parameters.

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Robotic systems have successfully been introduced into other surgical fields in the past. First attempts with different setups are made in the field of microsurgery. The Symani® Surgical System, a flexible platform consisting of two robotic arms, features motion scaling with tremor filtration to address the demands and complexity of microsurgery.

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Advances in the development of robotic systems have recently enabled the use of robotic technology in reconstructive lymphatic surgery. Although the advantages of microsurgical robots must be weighed carefully against the costs, their use may allow for smaller surgical approaches and easier access to anatomically deeper structures or even smaller vessels. We report on a case of a patient with central lymphatic dilation causing abdominal pain and severely reduced physical capacity.

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In the oral cavity the tongue is an important muscular organ that supports the swallowing of food and liquids. It is responsible for the sense of taste, based on the many different taste buds it contains. Research in the field of tongue diseases demands for suitable preclinical models.

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This review outlines an overview of up-to-date, stage-appropriate treatment methods for burn injuries as practiced at the National Burn Center of the University Hospital Zurich. It intends to provide practitioners with recommendations for the management of acute minor to severe burn injuries based on scientific evidence as well as the long-term experience of the Burn Center. The focus is on a practical guideline and various options including novel, innovative conceptual approaches.

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Situated in the oral cavity, the rabbit palatine tonsils are part of the mucosal immune system and help to defend the body against foreign pathogens. Expressed as two oval protrusions in the wall of the oropharynx, the rabbit palatine tonsils are characterized by excretory ducts and trabeculae. We here compare paraffin embedded and cryosections of the healthy rabbit tonsils.

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Synopsis of recent research by authors named "Pietro Giovanoli"

  • - Pietro Giovanoli's recent research focuses on advancements in reconstructive and microsurgery, particularly in the context of lymphatic reconstruction and innovative surgical techniques using robotic systems. His studies highlight the impact of surgical complexity, institutional practices, and innovative treatments on patient outcomes.
  • - He has published significant findings on the timing of reconstructive interventions in scleroderma patients and the effectiveness of autologous fat grafting during different disease phases, emphasizing patient satisfaction and outcome optimization.
  • - Giovanoli's work also explores biomechanical aspects of tendon repair, the learning curve for robotic-assisted surgeries, and novel materials to enhance angiogenesis, showcasing a strong commitment to integrating technology and evidence-based practices in surgical procedures.