Effects of a tailored rehabilitation treatment in lower limb Soft Tissue Sarcomas reconstruction: a case series Andrea Demofonti, Beniamino Brunetti, Marco Germanotta, Marco Morelli Coppola, Francesca Falchini, Alice Valeri, Stefania Tenna, Sergio Valeri, Irene Giovanna Aprile Journal of Neuroengineering and Rehabilitation, 2026 Abstract Purpose The primary treatment for lower limb Soft Tissue Sarcoma (LL-STS) consists of wide surgical resection followed by the Free Functional Muscle Transfer (FFMT) when restoration of muscular continuity and contractile function is needed. Despite the promising results, this approach led to the onset of neuromotor disabilities, reducing the patients’ sensorimotor capabilities during walking. Nowadays, the role of rehabilitation in neuromuscular recovery after FFMT has not been deeply analyzed. The aim of the study was to evaluate the effect of a customized rehabilitation protocol on walking capabilities of patients with LL-STS who underwent radical resection followed by microsurgery reconstruction using FFMT. Methods Three patients after wide surgical resection and microsurgical reconstruction followed a personalized rehabilitation protocol according to the site of the lesion (hamstrings or quadriceps). Their ambulation performance was evaluated at the beginning, at the end of rehabilitation, and at long-term follow-up using an optoelectronic system, surface and invasive electromyography. Simultaneously, a clinical survey on physical limitations, post-operative neuropathic pain, and perceived quality of life was submitted to the patients. Results The patients showed progressive improvements in lower limb joint kinematics and spatio-temporal parameters for both limbs. These results were confirmed by the electromyography analysis demonstrating a complete reinnervation of the flap in all cases, with muscle activation patterns close to physiological one. Indeed, the patients developed coordinated activation patterns and compensatory strategies in the hamstrings and quadriceps femoris that supported limb stability and joint control during movement. The clinical scales demonstrated both a reduction in neuropathic pain and an improvement in physical functionalities and perceived quality of life. Conclusion The proposed rehabilitation approach was effective in enhancing ambulation performance of patients following FFMT. These results highlight the critical role of rehabilitation in maximizing functional outcomes after complex oncologic-musculoskeletal surgeries. Trial registration ClinicalTrials.gov (ID NCT06282237, Registration date: 2024-02-28)
From Palliation After Angiosarcoma Resection to Totally Autologous Aesthetic Breast Reconstruction Combining Kiss Latissimus Dorsi Flap and Contralateral Breast Sharing Internal Mammary Artery Perforator Flap: A Case Report Beniamino Brunetti, Valeria Petrucci, Martina Ponzo, Fiorella Oliveri, Matteo Pazzaglia, Marco Morelli Coppola, Mauro Barone, Stefania Tenna, Paolo Persichetti Microsurgery, 2026 Angiosarcoma of the breast is a rare but aggressive disease that often requires wide‐margin resection resulting in massive thoracic defects. In this report we present the unique case of a patient who underwent primary chest wall reconstruction with palliative intent using Kiss Latissimus Dorsi (LD) Flap after resection of a huge angiosarcoma of the right breast, followed 3 years later by a secondary shift to totally autologous aesthetic breast reconstruction which was achieved by combining the first flap with breast‐sharing internal mammary artery perforator (IMAP) flap and simultaneous contralateral breast reduction. The defect after extended mastectomy, measuring 24 × 18 cm, was resurfaced with a Kiss LD flap designed with two skin paddles of 24 × 13 and 14 × 5 cm, respectively. Three years after the initial reconstruction, the patient was tumor‐free and required breast symmetrization. Therefore, a left reduction mammaplasty with simultaneous breast sharing Internal Mammary Artery Perforator (IMAP) flap was performed, augmenting the hypoplastic right breast with the entire lower pole of the contralateral side, transferring an 18 × 9 cm flap based on the fifth IMAP. Vascular safety of the procedure was guaranteed by intra‐operative indocyanine green angiography evaluation. Recovery was uneventful and the 6 months post‐operative follow‐up confirmed flap integration, volume symmetry and high aesthetic satisfaction. This report underlines the versatility of this innovative combination of flaps in complex reconstructive scenarios where complex microsurgical transfers are contraindicated.
ASSESSING BURN DEPTH BY INDOCYANINE GREEN ANGIOGRAPHY: A SYSTEMATIC REVIEW AND ALGORITHM FOR CLINICAL USE Annals of Burns and Fire Disasters, 2026
Re-Vision of Geometric Flap Design in Lower Limb Reconstruction: A Comparative Analysis on Perforator Enhancement Martino Guiotto, Daniel Schmauss, Giorgio Mariotti, Marco Morelli Coppola, Paolo Persichetti, Pietro Giovanni di Summa Journal of Clinical Medicine, 2026 Background: Perforator flaps improved the reconstruction paradigm in the lower extremity, increasing coverage possibilities. This study aims to quantify how added perforators could enhance standard geometrical patterns (compared to random flaps). Methods: A total of 29 cases of lower limb soft tissue reconstruction (STR)—52% trauma, 21% osteomyelitis with skin fistulas, 21% healing disorders with unstable scarring and 6% cancer-related surgery—were performed in our institution between 2012 to 2023 with geometric random (GR) local flaps (34%), geometric perforator-enhanced (GP) flaps (32%) or pure propeller perforator (PP) flaps (34%), were retrospectively analysed. Patients with proximal thigh defects, a follow up of less than 3 months and those who received an axial, muscle or free flap were excluded. Geometric patterns (as length:width ratio (L:W)) were compared among groups, analysing healing outcomes and complications. Results: Leg defects were categorized into 62% distal, 14% middle, 14% proximal third and 10% distal thigh. No significant difference in defect size was detected among groups. Mean flap size was significantly larger for GP (70.5 cm2, (p < 0.05)) and PP (74.4 cm2, (p < 0.01)) than GR (53.7 cm2). The L:W ratio was significantly higher in GP (L:W 2.2:1, (p < 0.05)) and PP (L:W 2.8:1, (p < 0.01)) than in GR (1.5:1), but no significant difference was found between GP and PP. A reduced complications rate (partial flap loss, infection, healing, revision surgery, etc.) was observed in the GP group, when compared to GR. Conclusions: Flap geometric design can be significantly improved by the inclusion of perforators, maintaining spatial advantages with larger ductility and improved vascular solidity.
Hybrid Total Achilles Tendon Reconstruction Combining Acellular Dermal Matrix Placement and Free Latissimus Dorsi Flap Coverage: A Report of Two Cases Beniamino Brunetti, Chiara Camilloni, Matteo Pazzaglia, Valeria Petrucci, Marco Morelli Coppola, Rosa Salzillo, Stefania Tenna, Irene Giovanna Aprile, Marco Germanotta, Sergio Valeri, Mauro Barone, Paolo Persichetti Microsurgery, 2025 Reconstruction of complex Achilles tendon defects involving both the tendon and the overlying soft tissues represents a challenging scenario for plastic surgeons. In this report, we present an innovative technique of hybrid total Achilles tendon reconstruction combining acellular dermal matrix placement to restore the full‐thickness continuity of the tendon and free latissimus dorsi (LD) flap coverage to allow graft integration and simultaneously resurface the soft tissue defect, ultimately leading to lower limb salvage. Between August 2023 and February 2024 two patients received microsurgical hybrid reconstruction of complex defects, measuring 10 × 10 cm and 17 × 14 cm, respectively, involving the lower third of the leg and the Achilles tendon region, due to trauma with multiple previous failed surgeries and sarcoma resection. The full‐thickness continuity of the tendon was reconstructed by use of an XCM BIOLOGIC Tissue Matrix (DePuy Synthes, Johnson & Johnson), measuring 6 and 10 cm long, respectively, folded in a three‐layered tridimensional structure to recreate the shape and function of a new tendon. Subsequently, a free myo‐cutaneous LD flap, was used to wrap and revascularize the neo‐tendon and resurface the soft tissue defect. In both patients the flaps healed uneventfully, and neo‐tendon integration was documented by MRI examination. The follow‐up was uneventful. Long‐term functional evaluation showed almost normal tendon excursion with both patients walking without assistance. The proposed hybrid approach may be a good alternative and innovative solution for the reconstruction of complex Achilles tendon defects consequent to trauma or oncological resection. Such results are more than promising for future studies on large series of patients.
Rectus Abdominis Fascia Plication Within DIEP Flap Breast Reconstruction: Impact on Abdominal Wall Morbidity and Patient Satisfaction Evaluated with the BREAST-Q Beniamino Brunetti, Rosa Salzillo, Giuseppe A. G. Lombardo, Chiara Camilloni, Matteo Pazzaglia, Marco Morelli Coppola, Valeria Petrucci, Mauro Barone, Stefania Tenna, Paolo Persichetti Journal of Clinical Medicine, 2025 Background: The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction, but donor site morbidity, such as abdominal bulging, remains a concern. Rectus fascia plication is a recognized treatment for rectus abdominis diastasis, yet its role in DIEP closure is scarcely evaluated. This study investigates whether plication reduces abdominal morbidity and improves patient satisfaction. Methods: A multicenter retrospective case–control study was performed on women who underwent unilateral DIEP breast reconstruction between 2018 and 2024. Patients were allocated to the plication or control group according to operative notes. Outcomes included abdominal complications, postoperative bulging (clinically and photographically assessed), and patient-reported satisfaction using the BREAST-Q. Standardized postoperative photographs were also rated by blinded expert surgeons. Results: Sixty-two patients met the inclusion criteria: 25 with fascia plication and 37 without. Groups were comparable in demographics and surgical details, though diastasis was more prevalent in the plication group (4.1 cm vs. 0 cm, p < 0.0001). Plication did not increase early or late complications. Abdominal bulge occurred in 16.2% of controls and 0% of the plication group (p = 0.0727). Logistic regression confirmed a significant protective effect (OR = 0.095, 95% CI 0.001–0.87, p = 0.034). BREAST-Q “Physical well-being: abdomen” scores were higher with plication (35.7 ± 18.0 vs. 23.0 ± 17.2, p = 0.0316), which was confirmed by multivariate analysis. Expert photographic assessments showed no significant differences. Conclusions: Rectus fascia plication during DIEP flap breast reconstruction is safe, improves abdominal well-being, and reduces postoperative bulging, especially in patients with preoperative diastasis. This additional step may represent a simple and effective strategy to enhance donor site outcomes.
Aesthetic use of recycled perforator flaps to correct contour deformities during abdominoplasty procedures B. Brunetti, M. Morelli Coppola, C. P. Mureddu, V. Petrucci, S. Tenna, M. Barone, P. Persichetti Annales De Chirurgie Plastique Esthetique, 2025 Pedicled perforator flaps can be used not only in reconstructive scenarios but also for aesthetic purposes, thereby enhancing both the aesthetics and functionality of the treated area. The authors present two representative cases demonstrating an innovative indication for correcting contour deformities using de-epithelialized perforator flaps recycled from abdominoplasty excision patterns. Two patients presented with abdominal skin redundancy and contour deformities due to previous surgeries. The first patient, with a history of bladder exstrophy, underwent a fleur-de-lys abdominoplasty, with the soft tissue deficiency in the pubic region corrected using two DIEP flaps. The second patient, with a history of multiple surgeries for bilateral congenital hip dislocation, presented with retracted scars at the groins, which were corrected with bilateral SCIP flaps, harvested during a conventional abdominoplasty. The post-operative course was uneventful, and both patients reported a significant improvement in their perception of the operated regions according to the BODY-Q administered before and one year after surgery. Perforator flaps recycled from abdominoplasty excision patterns may represent a reliable tool for correcting contour deformities during abdominoplasty procedures. This initial experience should be considered before sacrificing tissues that could potentially be better employed otherwise in order to optimize the morpho-functional outcomes in abdominal contour surgery. IV. Les lambeaux perforants pédiculés peuvent être utilisés non seulement pour des actes de reconstruction, mais aussi à des fins esthétiques, améliorant ainsi l’esthétique et la fonctionnalité de la zone traitée. Les auteurs présentent deux cas représentatifs illustrant une indication innovante pour corriger les déformations de contour à l’aide de lambeaux perforants désépithélialisés, recyclés à partir de modèles d’excision d’abdominoplastie. Deux patientes présentaient un excès de peau abdominale et des déformations de contour dues à des chirurgies antérieures. La première patiente, ayant des antécédents d’extrophie vésicale, a subi une abdominoplastie en fleur de lys, tandis que l’insuffisance des tissus mous dans la région pubienne a été corrigée par deux lambeaux DIEP. La deuxième patiente, ayant bénéficiée de multiples interventions chirurgicales pour une luxation congénitale bilatérale de la hanche, présentait des cicatrices rétractiles au niveau des régions inguinales, qui ont été comblées par des lambeaux SCIP bilatéraux, prélevés lors d’une abdominoplastie conventionnelle. Les suites opératoires se sont déroulées sans incident, et les deux patients ont rapporté une amélioration significative des régions opérées, selon le questionnaire BODY-Q administré avant et un an après l’intervention. Les lambeaux perforants recyclés d’abdominoplastie peuvent constituer un outil fiable pour corriger les déformations du contour corporel. Cette expérience préliminaire devrait être prise en compte avant de sacrifier des tissus qui pourraient potentiellement être mieux utilisés, afin d’optimiser les résultats morpho-fonctionnels de la chirurgie du contour abdominal.
The Gastroepiploic Vascularized Lymph Node Transfer in the Treatment of Male Genital Lymphedema: A Report of Three Cases Marco Morelli Coppola, Wladyslaw Gawel, Rossella Elia, Emilie Uldry, Marie Nicod Lalonde, Michele Maruccia, Pietro Giovanni di Summa Microsurgery, 2025 Male genital lymphedema (MGL) is a debilitating condition that may require surgical intervention. Lymphaticovenous anastomosis (LVA) can be ineffective in primary and advanced cases because of lymphatic disruption, whereas vascularized lymph node transfer (VLNT) can overcome this limitation by promoting neolymphangiogenesis but traditionally carries some risk of donor site complications. Gastroepiploic vascularized lymph node transfer (GEVLNT) has recently emerged as an effective treatment option for upper and lower limb lymphedema, with negligible complications. However, its role in genital lymphedema remains unexplored. This is the first short series reporting the use of GEVLNT in MGL. Three male patients (44, 61, and 52 years old) with GL underwent GEVLNT. The first patient had idiopathic disease, which relapsed after previous treatment with LVA; the other two had secondary lymphedema due to cancer treatment and hydrocele surgery, respectively. In all patients, the right gastroepiploic lymphosome was harvested laparoscopically, with flap sizes of 14 × 5 cm, 15 × 4 cm, and 12 × 4 cm, respectively. The recipient vessels were the deep inferior epigastric artery and vein in the first case, and the superficial external pudendal vessels in the other two. Post‐operative courses were uneventful for all patients, with no complications reported. Follow‐up periods were 36, 23, and 12 months, respectively. In all cases, GEVLNT resulted in significant clinical improvements and reductions in genital lymphedema severity (GLS) scores (7–1, 9–4, and 8–4). Our preliminary experience suggests that GEVLNT could be a viable and effective option for treating male genital lymphedema with minimal donor site morbidity and stable results over time. However, further research with larger patient cohorts, comparative studies, and long‐term follow‐up is needed to fully establish its efficacy.