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Rizzo, Michela (2016) IL LIPOFILLING PERIORALE NELLA SCLERODERMIA. [Tesi di dottorato]

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Abstract (inglese)

ABSTRACT

Background: Perioral modifications are significant stigmata of systemic sclerosis, with functional implications that negatively impact daily life. Lips stiffening results in microstomia, dryness, easy ulceration, difficult speech, food biting, oral hygiene and dental care, besides alteration in psychosocial interactions.

Objective: As fat grafting has emerged as a “regenerating” treatment for scarred and fibrotic tissues, scleroderma patients may receive significant benefits from the procedure.

Methods: fat grafting was proposed to patients with perioral fibrosis in systemically stable scleroderma. 8 patients in 2 years met inclusion criteria and accepted grafting. Patients were stadiated for functional impairments with a specifically designed questionnaire. Follow up for up to 12 months included a post-operative questionnaire for subjective functional performance of the perioral region (-5/+5 scale), serial echographic assesments of fat grafts, and lips width measurement.

Results: patients reported pre-operative impairment concentrated in three daily activities (speech, eating, oral hygiene) and three psychosocial items (uneasiness with others, tension in interactions, embarrassment in interactions). After fat grafting, all patients reported significant benefit in lips softness, mouth opening and appearance at 1 and 3 months. One patient reported total regression of achieved benefits by the third month. All other patients reported a partial regression of functional benefits between the 3 and 6 months, with results then stable at 1 year, with subjective perception of improvements >+3 (in -5/+5 scale) in lips sensibility, lips/mouth dryness, movement, opening, softness, as well as aesthetics and easiness in social interactions. Serial echography confirmed a significant increase in thickness in grafted areas, with progressive reabsorption over time. No variations in lips diameters were detected.

Conclusions: fat grafting seems an option to provide functional relief to systemic sclerosis patients with perioral impairment. Even if not all patients may respond, most seem to receive long term functional benefits.

Abstract (italiano)

RIASSUNTO

Introduzione: Le modifiche periorali sono stigmate significative della sclerosi sistemica, con implicazioni funzionali che influiscono negativamente sulla vita quotidiana. L’irrigidimento labiale provoca microstomia, secchezza, facili ulcerazioni, difficoltà all’eloquio e masticazione, nell’igiene orale e cure dentistiche, oltre ad alterazioni delle interazioni psicosociali.

Scopo della tesi: Avvalorato il beneficio dell'innesto di grasso come trattamento "rigenerante" per i tessuti sfregiati e fibrotici, nel campo della Chirurgia Plastica, scopo della tesi è verificare se i pazienti con sclerodermia possono ricavare benefici significativi dalla procedura.

Materiali e metodi: L’ innesto di grasso è stato proposto in pazienti con fibrosi periorale nella sclerodermia sistemica stabile. 8 pazienti in 2 anni hanno soddisfatto i criteri di inclusione e accettato l’innesto. I pazienti sono stati studiati per le menomazioni funzionali, con un questionario appositamente progettato. È stato eseguito un follow-up fino a 12 mesi, incluso un questionario post-operatorio per prestazioni soggettive funzionali della regione periorale (scala +/- 5), valutazioni ecografiche di serie, e misurazione della larghezza labiale.

Risultati: Al momento preoperatorio i pazienti hanno riportato difficoltà, concentrate in tre attività quotidiane (eloquio, alimentazione, igiene orale) e tre elementi psicosociali (disagio con gli altri, tensione nelle interazioni, imbarazzo nelle interazioni). Dopo l'innesto di grasso, tutti i pazienti hanno riportato un significativo beneficio alle labbra: morbidezza, apertura della bocca e aspetto a 1 e 3 mesi. Un paziente ha riportato una regressione totale dei benefici ottenuti, a partire dal terzo mese. Tutti gli altri pazienti hanno riportato una regressione parziale dei benefici funzionali tra 3 e 6 mesi, con risultati quindi stabili a 1 anno, con la percezione personale di miglioramenti> 3 (scala +/-5) per quanto riguarda la sensibilità delle labbra, la secchezza della bocca,il movimento, l’apertura, la morbidezza, così come l'estetica e la facilità nelle interazioni sociali. Le ecografie hanno confermato un significativo aumento di spessore nelle zone innestate, con progressivo riassorbimento nel tempo. Non sono state rilevate variazioni dei diametri delle labbra.

Conclusioni: l'innesto di grasso sembra un'opzione utile a fornire sollievo funzionale dei pazienti affetti da sclerosi sistemica con insufficienza periorale. Anche se non tutti i pazienti possono rispondere, la maggior parte sembra mantenere i benefici funzionali a lungo termine.

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Tipo di EPrint:Tesi di dottorato
Relatore:Cozzi, Franco
Dottorato (corsi e scuole):Ciclo 28 > Scuole 28 > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > SCIENZE REUMATOLOGICHE
Data di deposito della tesi:23 Gennaio 2016
Anno di Pubblicazione:23 Gennaio 2016
Parole chiave (italiano / inglese):Sclerodermia; Lipofilling
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/16 Reumatologia
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari
Codice ID:9059
Depositato il:21 Ott 2016 16:37
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