Annali italiani di chirurgia最新文献

{"title":"Efficacy of Contouring-Assisted Resection in the Crus of Helix Cartilage Region for Congenital Preauricular Fistula.","authors":"Jichan Wang, Juntian Lang","doi":"10.62713/aic.4590","DOIUrl":"https://doi.org/10.62713/aic.4590","url":null,"abstract":"<p><strong>Aim: </strong>This study comparatively evaluates the efficacy and safety of contouring-assisted resection versus traditional fistula tract excision in the crus of helix cartilage region for the treatment of congenital preauricular fistula (CPF).</p><p><strong>Methods: </strong>This retrospective cohort study recruited 198 CPF patients who underwent surgical treatment at Ruijin Hospital between January 2018 and June 2024. Based on surgical technique, patients were divided into a contouring group (n = 98), who underwent contouring-assisted resection involving systematic dissection along the anterior and deep surfaces of the crus of helix cartilage while preserving the cartilage framework, and a traditional surgery group (n = 100), who underwent conventional fistula tract identification and excision. Baseline characteristics, recurrence rate, operative time, postoperative complications, and patient satisfaction were statistically compared between the two groups.</p><p><strong>Results: </strong>The recurrence rate was significantly lower in the contouring group than in the traditional group (2.0% vs. 18.0%, <i>p</i> < 0.001). Patients in the contouring group experienced significantly longer operative time (<i>p</i> < 0.001), while intraoperative blood loss did not differ significantly between groups. The overall complication rate was significantly lower in the contouring group (4.1% vs. 20.0%, <i>p</i> < 0.001), with a particularly reduced rate of incision-related infection in this group (1.0% vs. 8.0%, <i>p</i> = 0.044). Patient satisfaction scores were significantly higher in the contouring group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The contouring-assisted resection approach was associated with a significantly lower recurrence rate and higher patient satisfaction compared with traditional fistula tract excision, without an increase in specific complications such as chondritis, hematoma requiring intervention, or persistent sensory abnormality. These observations suggest this method is an effective and safe surgical option for patients with CPF in the crus of the helix region.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1146-1152"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Preoperative Thromboelastography, C-Reactive Protein, and Thrombomodulin for Postoperative Complications Following Hepatectomy in Patients With Hepatocellular Carcinoma.","authors":"Yiling Hu, Weifeng Shen, Hui Zhou, Dongmei Tang","doi":"10.62713/aic.4609","DOIUrl":"https://doi.org/10.62713/aic.4609","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;Postoperative complications following hepatectomy remain common and are closely associated with patient prognosis. Conventional preoperative assessment may not adequately capture perioperative coagulation disturbances, systemic inflammation, and endothelial injury. This study aimed to develop and internally validate a multidimensional preoperative prediction model integrating thromboelastography (TEG)-related parameters with inflammatory and endothelial biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study included 195 consecutive patients who underwent elective hepatectomy between March 2022 and May 2025. The cohort was randomly divided into a training set (n = 136) and a validation set (n = 59) at an approximate 7:3 ratio. The primary outcome was the occurrence of Clavien-Dindo grade ≥II complications within 30 days postoperatively. All clinically relevant candidate variables were entered into a least absolute shrinkage and selection operator (LASSO) regression model for feature selection. Variables retained by LASSO were further evaluated before inclusion in the multivariable model. Two multivariable logistic regression models were subsequently constructed: a baseline clinical model (Model 1) and an extended biomarker model (Model 2), which additionally incorporated C-reactive protein (CRP), thrombomodulin (TM), and thromboelastography maximum amplitude (MA). Model discrimination, reclassification, calibration, and potential clinical utility were assessed, and Shapley Additive exPlanations (SHAP) were applied as a supplementary interpretability analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 195 patients were included, of whom 56 (28.72%) developed postoperative complications. The final model retained seven predictors: albumin, prothrombin time, portal hypertension, surgical approach, CRP, TM, and MA. Model 2 demonstrated superior discriminative performance compared with Model 1 in the training cohort (area under the curve (AUC) 0.88 vs. 0.74, &lt;i&gt;p&lt;/i&gt; = 0.006); a similar advantage was observed in the validation cohort (AUC 0.84 vs. 0.67, &lt;i&gt;p&lt;/i&gt; = 0.001). Model 2 also achieved higher net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values in both cohorts. Incremental value analysis indicated that the performance gain of Model 2 was primarily attributable to MA, while CRP and TM provided only limited additional predictive value. Calibration and decision curve analyses further supported the overall performance and potential clinical utility of Model 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The extended preoperative prediction model demonstrated superior overall predictive performance compared with the model based solely on conventional clinical indicators. This improvement was driven primarily by MA, while CRP and TM, included as exploratory biomarkers within the extended framework, contributed only modest incremental value. These findings sho","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1218-1231"},"PeriodicalIF":0.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Performance of Lymph Node Ratio and Log Odds of Positive Lymph Nodes in Colorectal Cancer: A Comparative Analysis with pN Stage.","authors":"Vural Argın, Ahmet Orhan Sunar, Nurdan Bezir, Muhammed Ikbal Akin, Ömer Faruk Kandaz, Ismail Ertugrul, Erdal Polat, Mustafa Duman","doi":"10.62713/aic.4564","DOIUrl":"https://doi.org/10.62713/aic.4564","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;The lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS) have been proposed as alternative indicators of nodal burden that may enhance prognostic stratification beyond conventional pN stage. This study aimed to evaluate the prognostic impact of LNR and LODDS on disease-free survival (DFS) and overall survival (OS) after curative resection for colorectal cancer, and to compare their performance with pN stage and total lymph nodes examined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included 154 patients who underwent curative-intent resection for stage I-III colorectal cancer between 2016 and 2022. Demographic, surgical, pathological, and follow-up data were analyzed. Patients were stratified according to pN stage, LNR, and LODDS categories. DFS and OS were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards regression models. Receiver operating characteristic (ROC) analyses were also performed to assess the discriminatory ability of nodal parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median number of lymph nodes removed was 28, and adequate lymph node dissection (≥12 lymph nodes) was achieved in 94.8% of patients. During the follow-up period, 18 recurrences and 12 deaths occurred. In the DFS analysis, patients in the LNR 1-2 group showed lower 2-year DFS rates compared to the LNR 0 group (91.0% vs 96.6%). Cox regression analysis indicated a borderline increase in relapse risk in the LNR 1-2 group (hazard ratio (HR): 2.431, 95% confidence interval (CI): 0.963-6.135, &lt;i&gt;p&lt;/i&gt; = 0.060). Although advanced pN stage was associated with lower DFS rates, statistical significance was not achieved in the regression analysis. LODDS was not significantly associated with DFS. In the exploratory multivariate analysis, the model including LNR and age showed the best discriminatory performance, and LNR remained independently associated with the risk of recurrence even after adjusting for age (HR: 2.535, 95% CI: 1.004-6.402, &lt;i&gt;p&lt;/i&gt; = 0.049). For OS, increasing age was significantly associated with a higher risk of death (HR: 1.076, 95% CI: 1.006-1.150, &lt;i&gt;p&lt;/i&gt; = 0.032). In addition, patients undergoing rectal surgery had a lower risk of death compared with those undergoing right/extended colectomy (HR: 0.178, 95% CI: 0.037-0.849, &lt;i&gt;p&lt;/i&gt; = 0.030). Neither LNR nor LODDS showed a significant association with OS. ROC analysis showed limited prognostic discrimination overall, but the LNR demonstrated relatively higher predictive performance for DFS compared to pN stage and LODDS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among the lymph node parameters evaluated, LNR showed a trend toward improved prognostic discrimination for short-term DFS, whereas LODDS did not demonstrate significant prognostic value in this cohort. However, the overall discriminatory performance of all lymph node indices remained limited. Therefore, these findings should be interpreted with caution, particularly gi","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1270-1278"},"PeriodicalIF":0.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Multimodal Pain Management Protocols Following Pediatric Liver Transplantation.","authors":"Jin-Feng Zhuo, Hui-Ying Zhong, Xian-Ling Zhang","doi":"10.62713/aic.4532","DOIUrl":"https://doi.org/10.62713/aic.4532","url":null,"abstract":"<p><strong>Aim: </strong>To develop and implement a pain management program aimed at improving pain control and promoting postoperative recovery following liver transplantation in pediatrics.</p><p><strong>Methods: </strong>This study was a retrospective analysis of 95 children who underwent liver transplantation between May 2020 and May 2025. Patients were divided into observation and control groups according to the actual postoperative pain management plan they received. The observation group received a multimodal analgesia protocol incorporating both drug and non-drug interventions. Pain was assessed regularly, and corresponding interventions were implemented as needed. The control group received conventional analgesic management. Pain score, recovery time, and family satisfaction were the primary outcome measures. Independent-sample <i>t</i>-tests and chi-square tests were used for between-group comparisons.</p><p><strong>Results: </strong>Pain scores in the observation group were significantly lower than those of the control group during the T3-T7 stages (the afternoon of the first postoperative day, and T7 refers to the afternoon of post operative day 3) (<i>p</i> < 0.05). Time to ambulation was significantly shorter in the observation group (<i>p</i> = 0.002), with shorter hospitalization duration (<i>p</i> = 0.004) than those in the control group. Pain-related stress indicators also improved significantly in the observation group (<i>p</i> < 0.05). Additionally, significant differences were observed between the two groups regarding the distribution of satisfaction levels for nursing rounds (<i>p</i> = 0.030) and health education (<i>p</i> = 0.005).</p><p><strong>Conclusions: </strong>The postoperative pain management program for pediatric liver transplantation effectively alleviates postoperative pain through multimodal analgesia, shortens recovery time, and improves family satisfaction. This approach shows substantial clinical value and may serve as a reference for standardizing pain management in children post-liver transplantation.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1162-1171"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Septotomy During Thoracic Endovascular Aortic Repair for Chronic Dissection-Related Aneurysm: All That Glitters Is Not Gold.","authors":"Marco Franchin, Luca Bertoglio, Francesca Mauri, Federico Fontana, Gabriele Piffaretti","doi":"10.62713/aic.4521","DOIUrl":"10.62713/aic.4521","url":null,"abstract":"<p><p>Although endovascular repair is preferred over open techniques for chronic dissection-related thoracoabdominal aneurysms, specific adjunctive maneuvers are frequently required to optimize the distal landing zone of the thoracic endovascular aortic repair (TEVAR) or to enlarge the narrowed true lumen to deploy a branched endograft. Recently, transcatheter endovascular septotomy (TES) has gained attention as an evolving minimally invasive technique to optimize complex TEVAR procedures creating a better apposition of the endograft to the native aortic wall with the primary aim to block the retrograde perfusion of the false lumen. Initial results have been described satisfactory, but not negligible rates of intraprocedural complications in the form of lamella prolapse/migration leading to branch vessels occlusion have been described too. Herein we describe a complication that occurred after TEVAR with TES, causing static malperfusion of the reno-visceral vessels.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1131-1136"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging Crohn's Disease: Surgical Complexity and Outcomes in Colonic vs Non-Colonic Resections in a Large Single-Centre Cohort.","authors":"Andrea Micalef, Gloria Zaffaroni, Anna Fortini, Francesco Colombo, Andrea Bondurri, Piergiorgio Danelli, Anna Maffioli","doi":"10.62713/aic.4538","DOIUrl":"10.62713/aic.4538","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;The surgical management of colonic Crohn's disease (CD) remains controversial, with segmental resections possibly associated with a higher rate of recurrence and postoperative complications, while total proctocolectomy reduces recurrence but increases the risk of permanent stoma formation. This study compares surgical outcomes and complications in CD patients undergoing colonic resections (any colectomy with or without concomitant ileal/ileocaecal surgery) vs non-colonic resections (ileal or ileocaecal resections and/or small-bowel strictureplasties without colectomy), with particular emphasis on intra-abdominal septic complications (IASC), non-IASC events, and length of stay (LOS) in hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This monocentric observational study analysed consecutive adult patients with histologically confirmed CD who underwent intestinal surgery between January 2012 and April 2024 at Luigi Sacco University Hospital. Patients were divided into two groups according to the index operation. Group A included patients undergoing colonic resection, with or without concomitant ileal or ileocaecal resections and/or small-bowel strictureplasties. Group B included patients undergoing ileal or ileocaecal resection and/or small-bowel strictureplasties without any associated colonic resection. Outcomes included 30-day postoperative complications, LOS, and readmission rates. Statistical analysis was performed using chi-square, Wilcoxon rank-sum tests, and regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 461 patients, 90 (19.5%) underwent colonic resections (Group A), while 371 (80.5%) had non-colonic resections (Group B). Overall, complications occurred in 36.2% of patients, with significantly higher rates in Group A than in Group B (48.9% vs 33.2%; &lt;i&gt;p&lt;/i&gt; = 0.005). IASC were more frequent in Group A (18 out of 90 patients, 20.0%) than in Group B (37 out of 371 patients, 10.0%) (&lt;i&gt;p&lt;/i&gt; = 0.008). The median LOS was 11 days overall, with a statistically significant difference between the groups (Group A: 12 days; Group B: 11 days, &lt;i&gt;p&lt;/i&gt; = 0.012). In addition, we observed a significantly higher 30-day reoperation rate in Group A compared with Group B (14.4% vs 6.5%; &lt;i&gt;p&lt;/i&gt; = 0.012). Thirty-day readmission rates were low and did not differ significantly between the groups (3.3% vs 1.3%, &lt;i&gt;p&lt;/i&gt; = 0.365). Colonic resection, disease phenotype, and American Society of Anesthesiologists score were identified as independent risk factors for postoperative complications and prolonged LOS. There were no significant differences in the 30-day readmission rates among the groups, and no 30-day mortality cases were observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this large single-centre cohort, colonic resections were associated with higher postoperative complication rates, increased IASC and longer LOS compared with non-colonic resections. These differences likely reflect greater baseline disease complexity and operativ","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 7","pages":"1308-1316"},"PeriodicalIF":0.8,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Application of Surgical Methods Based on Different Lung Segments and Pathological Subtypes in the Treatment of T1b Lung Adenocarcinoma.","authors":"Zhanqiang Zhai, Youcai Zhu, Gang Lan, Lichao Huang, Yong Gao, Puen Chen, Yonghua Min, Huafei Chen, Xiaofeng Li, Ye Ye","doi":"10.62713/aic.4485","DOIUrl":"https://doi.org/10.62713/aic.4485","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the clinical application of surgical methods based on different lung segments and pathological subtypes in the treatment of T1b lung adenocarcinoma.</p><p><strong>Methods: </strong>A total of 207 patients with T1b lung adenocarcinoma admitted to the hospital between December 2019 and December 2022 were included in a retrospective analysis. According to the different surgical treatment strategies, all patients were divided into two groups: control group (n = 117) and experimental group (n = 90). The surgical methods for the control group were based on consolidation-to-tumour ratio (CTR), and the experimental group were according to lung segments and pathological subtypes. All patients were followed up for three years. Kaplan-Meier curve and Cox proportional hazard analysis were adopted to analyze the 3-year overall survival (OS) and recurrence-free survival (RFS) of two groups.</p><p><strong>Results: </strong>Compared with the control group, the proportion of lobectomy, lymph node management strategy, total nodes retrieved, number of stations, blood loss and operation time in the experimental group were decreased (<i>p</i> < 0.05), and the forced expiratory volume in 1 second (FEV₁) after surgery was increased. During the 3-year follow-up, there were 15 cases of recurrence (12.82%) and 6 cases of death (5.13%) in the control group; there were 9 cases of recurrence (10.00%) and 4 cases of death (4.44%) in the experimental group. There was no significant difference in recurrence or mortality between the two groups (<i>p</i> > 0.05). Kaplan-Meier curves showed no significant differences in 3-year disease-free survival (DFS) rate or 3-year overall survival (OS) rate between the two groups (<i>p</i> = 0.456, 0.623). Cox univariate analysis showed that the risk factors affected RFS were micropapillary pathological subtype (hazard ratio (HR) = 4.125, 95% confidence interval (CI) = 1.241-13.709, <i>p</i> = 0.021) and middle and lower lobes (HR = 2.633, 95% CI = 1.092-6.350, <i>p</i> = 0.031).</p><p><strong>Conclusions: </strong>For T1b lung adenocarcinoma, incorporating tumor location and pathological subtype into surgical decisions may be beneficial to patient outcomes. This study may provide a reference for personalized treatment of small-sized lung cancer.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 6","pages":"1034-1041"},"PeriodicalIF":0.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Study on Nicotinic Acid for Injection as Adjuvant Therapy to Improve Microcirculatory Perfusion After Digital Replantation.","authors":"Yuan Yang, Yang Zhao, Xuhong Wang","doi":"10.62713/aic.4466","DOIUrl":"https://doi.org/10.62713/aic.4466","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to evaluate the impact of injectable nicotinic acid as adjuvant therapy on microcirculatory perfusion and digit survival rate after digital replantation.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 200 patients who underwent digital replantation. Based on the treatment regimen, patients were divided into two groups: the nicotinic acid group (n = 102) and the control group (n = 98). The primary outcome was the relative perfusion ratio (PU ratio), calculated by normalizing the perfusion value of the replanted digit to that of an intact and uninjured reference digit from the same patient, measured using a laser Doppler flowmeter. Secondary outcomes included the incidence of vascular crisis, digit survival rate, postoperative hospital stay, and adverse reactions.</p><p><strong>Results: </strong>On postoperative day 1, the perfusion ratio did not differ between the two groups. However, on postoperative days 3, 5, and 7, the perfusion ratios in the nicotinic acid group were significantly higher than those in the control group (all <i>p</i> < 0.001). In the nicotinic acid group, the total incidence of vascular crisis was significantly lower (<i>p</i> = 0.029), and the digit survival rate was significantly higher (<i>p</i> = 0.030), along with shorter postoperative hospital stay compared with the control group (<i>p</i> < 0.001). Subgroup analysis indicated that the therapeutic benefit of nicotinic acid was particularly pronounced in the subgroup with more severe \"crush/avulsion\" injuries. The incidence of facial flushing was higher in the nicotinic acid group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Adjuvant use of injectable nicotinic acid, in addition to conventional therapy, was associated with improved microcirculatory perfusion, reduced incidence of vascular crisis, and increased digit survival rate. The treatment was generally well tolerated with no serious safety concerns identified. Due to the retrospective and non-randomized nature of this study, these findings should be interpreted as associations rather than definitive treatment effects.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 6","pages":"1080-1087"},"PeriodicalIF":0.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accessory Soleus Muscle and Persistent Posterior Ankle Pain: Report of Three Cases.","authors":"Francesco Pogliacomi, Salvatore Battaglia, Fabrizio Quattrini, Francesco Ceccarelli, Filippo Calderazzi","doi":"10.62713/aic.4588","DOIUrl":"10.62713/aic.4588","url":null,"abstract":"<p><strong>Aim: </strong>Posterior ankle pain is a nonspecific symptom that can result from various pathologies. Rare accessory muscle variants, including the accessory soleus muscle, may cause overlapping clinical conditions due to mass effect, dynamic impingement, chronic compartment syndrome, or tibial nerve compression. Limited familiarity with this anatomical variant often leads to diagnostic delay, misdiagnosis, or inappropriate treatment. The authors report three cases of chronic posterior ankle pain in athletes caused by the accessory soleus muscle with the aim to highlight the importance of considering the accessory soleus muscle (ASM) as a possible cause of this symptomatology. The diagnostic and therapeutic management, and clinical-functional outcomes are analysed.</p><p><strong>Case presentation: </strong>All patients reported posterior ankle pain for more than one year, exacerbated by sports activity and forced plantar flexion, with relief at rest. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) demonstrated the presence of ectopic muscle tissue compatible with an accessory soleus muscle. Clinical data, imaging findings, treatment modalities, and clinical-functional outcomes were retrospectively collected for each case. Preoperative, one year postoperative, and final follow-up assessments included the Visual Analog Scale (VAS) for pain evaluation, 17-Item Italian Foot Function Index (17-IFFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score validated in Italian. All patients underwent surgical excision of the accessory soleus muscle through a posteromedial approach.</p><p><strong>Results: </strong>Surgical excision was the definitive treatment for each patient, resulting in pain relief, clinical and functional improvement, and return to sports activity. No complications or recurrences were observed.</p><p><strong>Conclusions: </strong>The accessory soleus muscle is a potential cause of chronic posterior ankle pain and must be considered in the differential diagnosis to avoid diagnostic delays or misdiagnosis. Surgical excision has represented the effective and definitive treatment of the three reported cases.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 6","pages":"992-998"},"PeriodicalIF":0.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Critical Risk Factors and Development of a Predictive Model for Surgical Site Infection in Type 2 Diabetic Patients Undergoing Oral and Maxillofacial Surgery.","authors":"Ting Sun, Junxia Gong, Wenqing Zhu, Chaojuan Wu","doi":"10.62713/aic.4470","DOIUrl":"https://doi.org/10.62713/aic.4470","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study aims to explore the critical risk factors associated with surgical site infection (SSI) in patients with type 2 diabetes mellitus (T2DM) undergoing oral and maxillofacial surgery, and to develop a predictive model to support early risk stratification and guide targeted preventive approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective, case-control study enrolled patients with T2DM who underwent oral surgery at Nanjing Stomatological Hospital, Nanjing University between June 2022 and June 2025. A total of 110 patients who developed postoperative SSI were included in the infection group. A total of 110 patients without SSI were selected as the control group, matched 1:1 according to age and sex. Detailed demographic and clinical data, including patient history, perioperative blood glucose control levels, surgical type, oral environment, and antibiotic usage, were collected from both groups. Risk factors associated with SSI were analyzed and compared between groups, and a nomogram prediction model was developed. Internal validation was performed using 5000 bootstrap resamples, and model performance was assessed via the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plots.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 110 patients who developed SSI after oral surgery, microbiological assessment identified Gram-negative bacteria as the predominant pathogens (62.73%), with Pseudomonas aeruginosa accounting for 18.18% and Klebsiella pneumoniae for 14.55% of the isolates. This was followed by Gram-positive organisms, which account for 34.55% of the pathogens, predominantly Staphylococcus aureus (10.91%). Multivariable logistic regression analysis showed that a surgical incision classified as Type II or III (vs Type I; Odds Ratio [OR] = 3.789), severe periodontal calculus in the oral environment (Grade III vs Grade I-II; OR = 4.092), poor blood glucose control (vs good; OR = 3.347), and elevated serum C‑reactive protein (CRP) levels (per unit increase; OR = 1.627) were independently associated with postoperative surgical site infection. A nomogram was constructed based on the equation: Logit (P) = 1.402 + 1.332 × (incision type) + 1.409 × (oral environment) + 1.208 × (blood glucose control) + 0.487 × (CRP). The maximum total score on the nomogram was 225 points, corresponding to a 90% predicted probability of postoperative SSI. The Hosmer-Lemeshow test (χ&lt;sup&gt;2&lt;/sup&gt; = 2.088, &lt;i&gt;p&lt;/i&gt; = 0.230 &gt; 0.05) demonstrated no significant difference between the observed and predicted outcomes of the nomogram model. The nomogram demonstrated excellent predictive performance, with an AUC of 0.897 (95% Confidence Interval [CI]: 0.855 to 0.939).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The oral environment, perioperative glycemic control, CRP levels, and surgical incision type are independent risk factors associated with postoperative SSI. Establishing a prediction model based on these factors and im","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 6","pages":"1069-1079"},"PeriodicalIF":0.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}