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Sokolow C, Dabos N, Lemerle JP, Vilain R. Bacterial flexor tenosynovitis in the hand. A series of 68 cases. ANNALES DE CHIRURGIE DE LA MAIN : ORGANE OFFICIEL DES SOCIETES DE CHIRURGIE DE LA MAIN 1987; 6:181-8. [PMID: 3426324 DOI: 10.1016/s0753-9053(87)80056-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The authors report 68 cases of bacterial tenosynovitis (BT) that is the largest international series dealing with this pathology since the introduction of antibiotics. Their study stresses the connection between the quality of the final result and the stage at which the condition is treated. The speed at which the tenosynovitis becomes established depends on the mechanism of infection. One can dissociate BT by direct inoculation with violation of the tenosynovial sheath, from the BT by diffusion through an undamaged sheath. The former progress within a few hours to a few days, the latter slowly in a few days to a few weeks, with a slower onset masked by the clinical signs of the initial infection. They propose a new classification which allows the choice of proper surgical therapy taking into account the type of onset of the BT and the intraoperative findings.
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Vilain R. Plastic surgery in a French teaching program. Ann Plast Surg 1986; 17:174-5. [PMID: 3273093 DOI: 10.1097/00000637-198609000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Chachques JC, Mitz V, Zapata R, Moyen EN, Swanson J, Fontaliran F, Vilain R. Risk and consequence of infection at the site of microsurgical repair: an experimental model. Ann Plast Surg 1986; 17:221-7. [PMID: 3273099 DOI: 10.1097/00000637-198609000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The consequences of postoperative infection at the site of microsurgical repair were studied. The experiment used 60 Wistar rats which were divided into 3 groups of 20 each. The femoral artery, vein, and nerve were transected unilaterally and repaired using microsurgical techniques. Staphylococcus aureus was then inoculated into the wound of group 1. Beta-hemolytic Streptococcus was inoculated into the wound of group 2. Group 3 rats served as controls. Clinical, anatomical, bacteriological and histopathological examinations were performed on postoperative days 8 and 30. Wounds in which S. aureus was inoculated demonstrated a significant tendency toward vascular thrombosis with extensive tissue destruction. In the majority of these cases, the necrosis caused by the primary infection engendered an associated, opportunistic infection. Streptococcal inoculations in group 2 demonstrated less severe changes than in group 1. These changes were characterized by injury of the vascular structures themselves with a significant tendency for thickening of the arterial wall, perivascular inflammation, and hematoma formation at the site of the repair. This model allows demonstration of the enzymatic and toxic consequences of bacterial infection in a postoperative site characterized by cellular destruction and interstitial edema surrounding foreign bodies represented by sutures.
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Abstract
Suction lipectomy using a cannula to create multiple tunnels leaves multidirectional subcutaneous scars that, if deep enough, do not modify the appearance of the skin. The postoperative appearance of waves is due to either subcutaneous fat deficiency or to a relative excess of skin. Easy to distinguish clinically, these two kinds of waves may be avoided by a vertical aspiration technique. Fatty defects may be filled with fat obtained from the margins of the defect or from a distant site. The condition of excess skin must be foreseen and the patient warned that a skin resection will be necessary 6 months later.
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Abstract
Aesthetic surgery of the medial thigh is indicated in three instances: excess of skin, localized steatomery, and diffuse obesity after loss of weight. In the first two cases it is possible to limit scarring to the gluteal fold. In obese patients the functional benefits of a combination excision-suction lipectomy outweigh the disadvantages of the scarring over the medial thigh.
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Lafaurie P, Dabos N, Vilain R. [Scalariform incisions. Study of 34 cases]. ANNALES DE CHIRURGIE DE LA MAIN : ORGANE OFFICIEL DES SOCIETES DE CHIRURGIE DE LA MAIN 1986; 5:153-7. [PMID: 3532977 DOI: 10.1016/s0753-9053(86)80032-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The scalaire incisions were indicated in 34 hands with 58 longitudinal palmar contracture which restrict extension and usually result of deep burns. The technique was suggested by the incisions used in Dupuytren's followed by directed cicatrization and wearing dynamic extension splints for 2 months. The functional results are good and fair in 85 percent of cases. The failure usually come from important articular stiffness. The cosmetic result is most often very good especially when comparing with the disadvantage of skin graft pigmentation.
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Vilain R. [Veins and cellulitis]. PHLEBOLOGIE 1985; 38:653-9. [PMID: 4095152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is no relation between what French women call "cellulitis" and the venous problems of genetic origin. It may be that cellulitis is the name given to those extra kilos, to mild obesity, to fatty deposits on the thighs and buttocks (sub-trochanteric and crural steatomeries: "jodhpurs"); the point is that cellulitis is apparent, either immediately or on pinching the skin, as an orange-peel pitting. This problem exteriorises the lobular structure of the surface fat. This derives from excessively large lobules, cutaneous relaxation, or excessive pressure on the walls separating the lobules into compartments. Slimming reduces the large areas of deposit at the base of the buttocks. Musculation of the thighs can improve their appearance. More people think they have cellulitis than are really afflicted with it; this is just one of the many deceptions associated with it.
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Chachques JC, Mitz V, Hero M, Arhan P, Gallix P, Fontaliran F, Vilain R. Experimental cardioplasty using the latissimus dorsi muscle flap. THE JOURNAL OF CARDIOVASCULAR SURGERY 1985; 26:457-62. [PMID: 4030877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study was undertaken to examine the possibility of using the latissimus dorsi muscular flap, divided in two parts thus covering the surfaces of the heart, and inserting it into the thoracic cavity by means of a segmental resection of the second rib. After cadaver case studies, 15 operations were performed on 5 Beagle dogs. The first group of 5 operations consisted of a latissimus dorsi flap graft over the heart. The second group and third group of operations (3 and 6 months later) consisted of reoperating for muscular and cardiac biopsies and electrical stimulation tests on the heart-muscle complex. The latissimus dorsi flap provided a sizable mass of contractile tissue. The haemodynamic studies showed no compressive or constrictive phenomenon of the muscle on the heart and revealed the preservation of an appropriate cardiac output for short intervals of time (2 hours), through phasic electrostimulation of the flap. The histopathological studies showed conserved muscular structure. The technical feasibility, histological adaptability and electrophysiological properties of this muscular flap makes it appropriate to develop a functional stimulation programme and perhaps adequate for the treatment of dysplasic, ischemic, tumoral and other acquired or congenital myocardial diseases.
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Dardour JC, Vilain R, Castro D. [Evaluation of 10 years of surgical treatment for decubitus ulcer]. LA SEMAINE DES HOPITAUX : ORGANE FONDE PAR L'ASSOCIATION D'ENSEIGNEMENT MEDICAL DES HOPITAUX DE PARIS 1984; 60:1051-6. [PMID: 6326292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The authors report a series of 67 patients presenting with 103 decubitus ulcers, treated between 1969 and 1977, and with a follow-up of one year or more. The majority of the patients were paraplegics, other etiologies being present in smaller numbers and raising different problems. They first studied the importance of the pre-and post-operative treatment. This was followed by study of the importance of different surgical techniques for each of the three localizations (sacral, ischial and trochanteric). They demonstrated the absolute need for surgical management, especially with paraplegic patients. Surgery alone allows rapid healing with a high success rate. While it does not, however, preclude any possibility of recurrence (whatever the technique used), it does at least allow the patient to live a normal life. The authors further emphasize the importance of the preoperative treatment, using the nutripump, and the postoperative treatment, using the pulsating air bed (in preference to the water bed). They consider the nutripump to be the most important breakthrough in this field, in recent years. As regards the different localizations, they consider muscle or musculocutaneous flaps to be the treatment of choice for ischial ulcers, but stress the need for wide ischiectomy and the excision of the bursa. In their experience, insufficient excision is a source of failure, even if the flap is good. Similarly, musculocutaneous flaps offer the best solution for trochanteric ulcers, but again, only accompanied by excision of the bursa. Recognition of coxofemoral arthritis is also essential, and no flap will take until this has been remedied. In the case of sacral ulcers, however, they prefer large rotation skin flaps, which allow further advancement in the event of recurrence. The association of two or three ulcers makes surgical management imperative because of the frequently severe undermining of the patient's general state of health. The treatment of two locations in a single stage is always preferable whenever it is feasible.
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Mitz V, Meriaux JL, Vilain R. Functional sequelae after ulnar nerve repair. Study of forty-nine cases. ANNALES DE CHIRURGIE DE LA MAIN : ORGANE OFFICIEL DES SOCIETES DE CHIRURGIE DE LA MAIN 1984; 3:193-205. [PMID: 6529296 DOI: 10.1016/s0753-9053(84)80034-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The full picture of functional ulnar deficiency, following suture or grafting, was studied and analyzed by two of the authors, who followed this series of patients on a long-term basis. The patients were tested using sphygmometric rubber bulbs in other to determine the overall closing force of the hand (making a fist), and the force of the pinch between the thumb and index ("energetic pinch"). Moreover, radionuclide vascular tests were used in order to find an eventual etiology of the "cold" disease, present in 2/3 of these injured hands. The principal functional deficiencies which bothered the patients and which we were able to demonstrate are as follows: deficient adduction of the thumb: the pinch between the thumb and index is diminished by approximately 50%, impairment, in the spreading of fingers, impairment in the overall force of the grasp, ulnar clawing which may embarrass function of the hand one year after the operation in one fourth of the cases. Therefore it appeared logical to propose an adduction plasty at the same time of repair, whether it was a primary suture or a secondary nerve graft. This adduction plasty uses the flexor digitorum sublimis of the ring finger which is rerouted and passed behind the profondus tendons and brought over to the lateral sesamoid bone of the thumb. This transfer is prolonged and tacked to the extensor pollicis longus in order to prevent the hyperflexion of the proximal phalanx of the thumb of which patients hardly ever complain but which denotes the severeness of ulnar nerve injury. An excellent correlation exists between the severeness of the functional deficiency and the importance of Froment's sign. The study of the other residual deficiencies shows that the restoration of the first dorsal interosseus, the reinforcement of the force of the flexores digitorum profundus of the middle and fourth fingers and of the intrinsics does not seem to be justified on an emergency basis. Zancolli's operation, which has been advocated by certain authors as an emergency procedure, does not seem to be necessary at this stage of repair, but remains a very interesting palliative procedure one year after the nerve repair if still judged necessary. Several clinical examples illustrate the value of long-term follow-up of these operated patients.
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Mitz V, Vilain R. [Esthetic lifting of skin grafts]. ANNALES DE CHIRURGIE 1983; 37:649-54. [PMID: 6370085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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37
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Saffar P, Vilain R. [Sprains and dislocations of the fingers]. LA REVUE DU PRATICIEN 1983; 33:423-8. [PMID: 6844836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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38
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Vilain R. [Hospital hygiene: science or derision]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1983; 109:631-637. [PMID: 6661976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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39
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Vilain R. [Families, I love you, or, a good understanding of hygiene]. REVUE DE L'INFIRMIERE 1982; 32:10-1. [PMID: 6926134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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40
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Vilain R. [Microbial diffusion and antibiotherapy]. PHLEBOLOGIE 1982; 35:825-32. [PMID: 7156192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cleaning leg ulcers depends on tissular and microbial enzymes, the production of which depends on good vascularization. When an aetiological treatment is started, the microbes ensure sufficient cleaning, leading to granulation and epidermization. Antibiotherapy is pointless. Sometimes it can be detrimental, replacing a natural growth with alien strains which cause diffusion. Very exceptionally, a short course of antibiotherapy may be necessary to cope with signs of diffusion, usually signifying a Group A streptococcal infection, with seasonal recrudescence. The Blue Pus Microbe has no special pathological significance. It merely indicates that the case has become chronic.
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Mitz V, Leviet D, Vilain R. [Carpal tunnel syndrome. Cosmetic incision (author's transl)]. LA NOUVELLE PRESSE MEDICALE 1982; 11:2353-4. [PMID: 7111001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The median nerve compressed in the carpal tunnel can be released by an incision in the "line of life", a natural fold along the axis of the third metacarpal bone. By sectioning the carpal tunnel in the palm of the hand, on the cubital side of the median nerve, division of the external branch and of the sensory cutaneous rami of the nerve can be avoided. Hypertrophic scars are prevented. The part of the carpal tunnel situated in the forearm can be freed by a subcutaneous incision if needed, but compression at that level is much less frequent than in the palm of the hand.
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Mitz V, Vilain R. [Retromuscular implantation of mammary prosthesis for reconstruction of the breast: report on 56 cases (author's transl)]. JOURNAL DE CHIRURGIE 1982; 119:381-8. [PMID: 7107737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Though retromuscular implantation of mammary prosthesis for breast reconstruction presents certain advantages, a retrospective study of the results of 56 such prostheses implanted in 38 patients demonstrated certain complications related to this procedure. These included: ectopy, secondary migration, poor aesthetic appearance during muscle contractions, formation of a hard shell (33 p. cent of cases), and residual mammary asymmetry. However, the advantages related to the retromuscular site of implantation are sufficiently marked for this technique, described in detail, to be employed in certain chosen indications: sequelae to subcutaneous fatty mammectomies ("benign" breast), mammary reconstruction after resection for cancer or radiodermatitis, and perhaps after the use of musculocutaneous flap from the large dorsal muscles ("malignant" breast), and to increase mammary size in cases of agenesis or total aplasia (Poland's syndrome, "unesthetic"" breast).
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Vilain R, Richard JC, Avril JL. [Management of bites]. REVUE DE L'INFIRMIERE. INFORMATIONS 1981:16-8. [PMID: 6910131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Vilain R. [Severe emergencies involving the limbs. Therapeutic problems]. LA NOUVELLE PRESSE MEDICALE 1981; 10:219-21. [PMID: 7465356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Richard JC, Latouche X, Lemerle JP, Leviet D, Mitz V, Vilain R. [External fixation in emergency treatment of severe open trauma of the hand. An original technique (author's transl)]. ANNALES DE CHIRURGIE 1980; 34:699-701. [PMID: 7447327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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47
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Mitz V, Leviet D, Vilain R. [Replantation of seven torn-off thumbs (author's transl)]. ANNALES DE CHIRURGIE 1980; 34:667-73. [PMID: 7447322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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48
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Vilain R. [The treatment of minor burns by the practitioner]. LA REVUE DU PRATICIEN 1980; 30:547-51. [PMID: 7361052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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49
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Vilain R. [Skin and subcutaneous tissue in prolonged immobilization: an ongoing prevention]. LA REVUE DU PRATICIEN 1979; 29:3793-9. [PMID: 547405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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50
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Mitz V, Leviet D, Vilain R. [When should peripheral nerves be grafted? (author's transl)]. LA NOUVELLE PRESSE MEDICALE 1979; 8:2815-8. [PMID: 388341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the presence of peripheral nerve damage, the only acceptable procedure is suture without tension, carried out under excellent conditions of fascicular approximation. In the case of loss of substance, immediate or secondary suture should never be performed. In the experience of "S.O.S. Main" secondary suture has led to the most disastrous results. Nerve graft, as an emergency, is legitimate in the case or reimplantations, in view of the high degree of technical competence of the teams, and the experience acquired. Deffered nerve graft is envisaged at about the end of the second month:--either in the absence of suture,--or in the absence of recovery. When there is any doubt, further examination at the 4 th or 5 th month ensures that treatment is not delayed too long. At all events, examinations must be repeated every two months in order to study nerve regrowth and to determine the need for possible though difficult reoperation if it stops.
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