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Gherle B, Pozner VL, Berkane Y, Watier E, Bertheuil N, Qassemyar Q. Pre-expanded thin DIEP free flap in pediatric upper extremity reconstruction for burn sequelae: A case report. ANN CHIR PLAST ESTH 2024; 69:173-177. [PMID: 38216362 DOI: 10.1016/j.anplas.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 01/14/2024]
Abstract
Deep burns sequelae involving the upper limb are challenging even for experienced surgeons, mainly because local reconstructive options and donor sites are often compromised. The use of free flaps for this type of reconstruction remains difficult due to the small recipient vessel diameter and tendency to vasospasm. Moreover, pediatric cases bring the challenge to another level. We present the case of a 13-year-old girl presenting major retractile sequelae of the upper left limb, including complete wrist immobilization combining wrist hyper-extension, ulnar deviation deformity, and a ulno-carpal dislocation. She was referred to our department where a two-stage reconstruction was performed using a pre-expanded free deep inferior epigastric artery perforator (DIEP) flap. The first surgery consisted of placing two kidney-shaped expanders in a subfascial plane in the hypogastric region. Four months later, after a bi-weekly expansion, an excision of the scar tissue, and the DIEP flap transfer were completed. At the 12-month follow-up evaluation, both aesthetic and functional results were satisfactory, with a good contour and regained mobility of the wrist.
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Affiliation(s)
- B Gherle
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Doctoral School of Biological and Biomedical Sciences, University of Oradea, Oradea, Romania.
| | - V L Pozner
- Private Practice, 66, rue de Lisbone, 75008 Paris, France
| | - Y Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston MA
| | - E Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France.
| | - Q Qassemyar
- Private Practice, 66, rue de Lisbone, 75008 Paris, France
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Beaufils T, Berkane Y, Freton L, Richard C, Watier É, Qassemyar Q, Bertheuil N. A New Surgical Technique for Female-to-Male Top Surgery: The Posterioinferior Pedicle (PIPe) Approach. Aesthetic Plast Surg 2023; 47:2283-2294. [PMID: 37684416 DOI: 10.1007/s00266-023-03552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/23/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Most of the time, female-to-male (FtoM) chest surgery involves mastectomy techniques and free transplantation of the nipple-areola complex. With the increasing prevalence of gender dysphoria and the demand for female-to-male gender reassignment surgery, the need for FtM top surgery is also rising. To meet this demand, we present a new approach: the PIPe technique, based on a fasciocutaneous flap with a posteroinferior pedicle. MATERIALS AND METHODS All patients with FtoM gender dysphoria undergoing surgery using the posteroinferior pedicle flap technique in the Plastic Surgery Department at Rennes University Hospital Center were included. The procedure involved extensive liposuction of the lower internal and external mammary quadrants, followed by liposuction of deep tissues in the upper quadrants, except in the pedicle area. After removing skin from the lower quadrants down to the dermis and de-epithelializing the posteroinferior pedicle flap, the thoracic flap was lowered and the areola transposed. RESULTS From July 2022 to March 2023, fifteen patients underwent surgery, and their results were collected prospectively. The average age was 25 years, the mean weight was 76.6 kg, and the average BMI was 28.1 kg/m2. The average operating time was 102 min, and the mean weight excised was 459.5 g. The average length of hospital stay was 3.3 days, and the drainage duration was 2.4 days. No major complications were reported, and there were no cases of reintervention or recurrence. CONCLUSIONS Our study presents a novel surgical approach utilizing the posteroinferior pedicle technique. Its key benefit lies in the preservation of neurovascular function, which makes it an attractive option for patients seeking to retain nipple sensitivity. This procedure is reliable, reproducible, and recommended as a first-line treatment for grade II and III gynecomastia due to its low rate of major complications and favorable functional and aesthetic outcomes. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Tristan Beaufils
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, 16 Boulevard de Bulgarie, 35200, Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- INSERM U1236, University of Rennes 1, Rennes, France
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France
| | - Lucas Freton
- Department of Urology, Rennes University Hospital Center, Rennes, France
| | - Claire Richard
- Department of Urology, Rennes University Hospital Center, Rennes, France
| | - Éric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | | | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, 16 Boulevard de Bulgarie, 35200, Rennes, France.
- INSERM U1236, University of Rennes 1, Rennes, France.
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France.
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Ghanem W, Qassemyar Q, Julieron M, Kolb F, Leymarie N, Moya-Plana A, Janot F, Temam S, Benmoussa N. Reconstruction of subtotal pharyngolaryngectomy using a fasciocutaneous free flap with cartilage graft: A case series of 17 patients. Head Neck 2023; 45:2335-2343. [PMID: 37482897 DOI: 10.1002/hed.27474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Subcricoid-hemilaryngopharyngectomy (SCHLP) with a reconstruction using a fasciocutaneous free flap armed with cartilage graft (FFACG) aims to avoid permanent tracheostomy while still maintaining the laryngopharyngeal functions. The purpose of this study is to report the outcome of this surgical approach. MATERIALS AND METHODS Retrospective study including 17 men operated between 2001 and 2019. Specific survival rate included death caused by cancer or SCHLP complications. Complications, functional and oncological outcomes were evaluated retrospectively. RESULTS There were no locoregional recurrences. One patient died due to inhalation pneumonia 3 years after surgery. Tracheostomy was closed in 13 patients (76.5%). Mean decannulation time was at six [1-14] months after surgery. CONCLUSION SCHPL with FFACG could avoid total pharyngolaryngectomy with good oncologic results. However, tracheotomy is extended and deglutition recovery is long with high risk of aspirations. These complications justify that such surgery should be realized only on selected patients by experienced surgical teams. Expertise of the surgical team is critical.
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Affiliation(s)
- Wahib Ghanem
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Quentin Qassemyar
- Department of Plastic Surgery, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Morbize Julieron
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Frédéric Kolb
- Department of Plastic Surgery, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Nicolas Leymarie
- Department of Plastic Surgery, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
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Haroun F, Benmoussa N, Bidault F, Lassau N, Moya-Plana A, Leymarie N, Honart JF, Kolb F, Qassemyar Q, Gorphe P. Outcomes of mandibular reconstruction using three-dimensional custom-made porous titanium prostheses. J Stomatol Oral Maxillofac Surg 2023; 124:101281. [PMID: 36084893 DOI: 10.1016/j.jormas.2022.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our aim was to report the long-term outcomes of mandibular reconstruction using CAD-CAM-designed 3D-printed porous titanium implants in patients not amenable to a free vascularized fibula flap reconstruction. METHODS The implants were designed with ProPlan CMF® 2.2 software and manufactured with a Selective Laser Melting (SLM) "layer-by-layer" 3D-printing of pure porous titanium powder beds. Primary endpoints were implant exposure and implant removal calculated using Gray's tests. Secondary endpoints were predictive factors of implant exposure and implant removal, and rates of dental rehabilitation. RESULTS Thirty-six patients were operated between 2015 and 2017 and were included in this study. Reconstruction using a porous titanium 3D-printed implant was proposed due to medical contraindication for a fibula free flap (n = 13), due to the failure of a previous fibula free flap reconstruction (n = 7), or due to refusal of a fibula free flap reconstruction by the patient (n = 16). The medical indications for mandibular reconstruction were a primary tumor requiring mandibulectomy in nine patients, mandibular osteoradionecrosis requiring mandibulectomy in nineteen patients, and secondary reconstruction in eight patients. The 2-year rates of implant exposure and implant removal were 69.4% and 52.8%. Reconstruction of the symphysis was a high-risk exposure variable (OR 30; p = 0.0003). Only one patient underwent a successful dental rehabilitation. CONCLUSION The use of a porous titanium 3D- implant for mandibular reconstruction in head and neck cancer patients resulted in high rates of implant exposure and of implant removal, notably when symphysis involvement.
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Affiliation(s)
- Fabienne Haroun
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France; BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - François Bidault
- BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Nathalie Lassau
- BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Fréderic Kolb
- Plastic and Reconstructive Surgery, UC San Diego, University of California, CA, United States
| | | | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France.
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Luca-Pozner V, Nischwitz SP, Conti E, Lipa G, Ghezal S, Luze H, Funk M, Remy H, Qassemyar Q. The use of a novel burn dressing out of bacterial nanocellulose compared to the French standard of care in paediatric 2nd degree burns - A retrospective analysis. Burns 2021; 48:1472-1480. [PMID: 34924226 DOI: 10.1016/j.burns.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 11/23/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Paediatric burn care is a delicate discipline which benefits from special attention. Despite being highly effective, the current standard of care for second degree burns in the largest paediatric burn center in France - exposure to infrared light - involves long hospital stays, straining economic and professional resources, especially in times of a pandemic. The present study investigated this standard of care and compared it to the use of a bacterial nanocellulose dressing. MATERIALS AND METHODS A retrospective analysis of two groups has been performed: the control group assessed thirty consecutive children treated with the standard of care, and the intervention group assessed thirty consecutive children treated with the bacterial nanocellulose dressing. Parameters evaluated were: healed wounds, additional treatments, rate of infections, hospital length of stay, pain experience and overall satisfaction. RESULTS The two groups did not differ significantly in terms of age and TBSA. A significant reduction in hospital length of stay (p < .001) and pain experience (p < .001) could be observed. In terms of healed wounds, additional treatments and infections, the two groups were equally matched (p > .05) with satisfactory results in both groups. Tendencies towards better results could be seen in the intervention group. CONCLUSION The use of bacterial nanocellulose wound dressings is an important tool in the armamentarium of today's burn surgeons. Satisfying results were achieved, ameliorating burn care for children. Future studies are indicated to further support its value and assess the economic impact.
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Affiliation(s)
- V Luca-Pozner
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France; Sorbonne University, 91-105 Boulevard de l'Hopital, Paris, France
| | - S P Nischwitz
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - E Conti
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - G Lipa
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - S Ghezal
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - H Luze
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - M Funk
- EVOMEDIS GmbH, Graz, Austria
| | - H Remy
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - Q Qassemyar
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France; Sorbonne University, 91-105 Boulevard de l'Hopital, Paris, France
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Tawa P, Brault N, Luca-Pozner V, Ganry L, Chebbi G, Atlan M, Qassemyar Q. Three-Dimensional Custom-Made Surgical Guides in Facial Feminization Surgery: Prospective Study on Safety and Accuracy. Aesthet Surg J 2021; 41:NP1368-NP1378. [PMID: 33480977 DOI: 10.1093/asj/sjab032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Facial feminization surgery (FFS) includes several osseous modifications of the forehead, mandible, and chin, procedures that require precision to provide the patient with a satisfactory result. Mispositioned osteotomies can lead to serious complications and poor aesthetic outcomes. Surgical cutting guides are commonly employed in plastic and maxillofacial surgery to improve safety and accuracy. Yet, to our knowledge, there is no report in the literature on the clinical application of cutting guides in FFS. OBJECTIVES The authors sought to assess the safety and accuracy of custom surgical cutting guides in FFS procedures. METHODS A prospective follow-up of 45 patients regarding FFS with preoperative virtual planning and 3-dimensional custom-made surgical guides for anterior frontal sinus wall setback, mandibular angle reduction, and/or osseous genioplasty was conducted. Accuracy (superimposing preoperative data on postoperative data by global registration with a 1-mm margin of error), safety (intradural intrusion for the forehead procedures and injury of the infra alveolar nerve for chin and mandibular angles), and patient satisfaction were assessed. RESULTS A total 133 procedures were documented. There was no cerebrospinal fluid leak on the forehead procedures or any infra alveolar nerve or tooth root injury on both chin and mandibular angle operations (safety, 100%). Accuracy was 90.80% on the forehead (n = 25), 85.72% on the mandibular angles (n = 44), and 96.20% on the chin (n = 26). Overall satisfaction was 94.40%. CONCLUSIONS Custom-made surgical cutting guides could be a safe and accurate tool for forehead, mandibular angles, and chin procedures for FFS. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Pierre Tawa
- Reconstructive and Aesthetic Surgery Department at Tenon Hospital, Sorbonne University, Paris, France
| | - Nicolas Brault
- Reconstructive and Aesthetic Surgery Department at Tenon Hospital, Sorbonne University, Paris, France
| | - Vlad Luca-Pozner
- Department at Trousseau Hospital, Sorbonne University, Paris, France
| | - Laurent Ganry
- Department at Trousseau Hospital, Sorbonne University, Paris, France
| | - Ghassen Chebbi
- Department at Trousseau Hospital, Sorbonne University, Paris, France
| | - Michael Atlan
- Department of Plastic, Reconstructive and Aesthetic Surgery at Tenon Hospital, Sorbonne University, Paris, France
| | - Quentin Qassemyar
- Reconstructive and Aesthetic Surgery Department at Tenon Hospital, Sorbonne University, Paris, France
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Qassemyar Q, Michel G, Gianfermi M, Atlan M, Havet E, Luca-Pozner V. Sutureless venous microanastomosis using thermosensitive poloxamer and cyanoacrylate: experimental study on a rat model. J Plast Reconstr Aesthet Surg 2021; 75:433-438. [PMID: 34247962 DOI: 10.1016/j.bjps.2021.05.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/08/2021] [Accepted: 05/28/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Sutureless microvascular anastomoses could simplify the microvascular field, shortening operative time and improving the final outcome. The use of thermosensitive poloxamers (TP407) together with the application of cyanoacrylate as an alternative method for conventional sutures was well-documented for arteries, but not for veins. The purpose of our study was to prove the feasibility of this technique for venous anastomoses and compare it with the traditional hand-sewn technique on a rat model. MATERIALS AND METHODS Twenty male Sprague-Dawley rats that weighed between 265 and 310 g were used. In the sutureless group (SG), 20 left external jugular veins (LEJV) end-to-end anastomoses were performed using a T704 and cyanoacrylate glue. They were compared to 20 right external jugular veins (REJV) anastomoses sutured with conventional 10-0 stitches (control group - CG). Diameters of veins, anastomosis time, and patency rate at 15 days were reported. Foreign body reaction was assessed histologically. RESULTS The mean diameter of the LEJV was 0.94 ± 0.1 mm and 0.95 ± 0.09 mm for the REJV. The mean anastomosis time was 11.9 ± 1.37 min for the SG and 27.75 ± 3.31 min for the CG. In the latter group, the immediate patency rate was 95% and 90% at 15 days. For the SG group, 90% of the anastomoses were patent immediately and 85% at 15 days. CONCLUSION TP407 and cyanoacrylate could offer a fast and reliable technique for sutureless venous anastomoses. Before human application, effectiveness of this method remains to be confirmed in larger animals in a long-term follow-up.
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Affiliation(s)
- Q Qassemyar
- Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, 26 avenue du Dr Arnold Netter, 75012 Paris, France; Faculty of Medicine, Sorbonne University, 91 boulevard de l'hôpital, 75013 Paris, France; Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - G Michel
- Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - M Gianfermi
- Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - M Atlan
- Faculty of Medicine, Sorbonne University, 91 boulevard de l'hôpital, 75013 Paris, France; Department of Plastic Surgery, Tenon Hospital, 4 Rue de la Chine, 75020 Paris, France
| | - E Havet
- Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - V Luca-Pozner
- Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, 26 avenue du Dr Arnold Netter, 75012 Paris, France; Faculty of Medicine, Sorbonne University, 91 boulevard de l'hôpital, 75013 Paris, France.
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Gorphe P, Temam S, Moya-Plana A, Leymarie N, Kolb F, Bout-Roumazeilles A, Qassemyar Q, Benmoussa N, Honart JF. Indications and Clinical Outcomes of Transoral Robotic Surgery and Free Flap Reconstruction. Cancers (Basel) 2021; 13:cancers13112831. [PMID: 34204149 PMCID: PMC8201082 DOI: 10.3390/cancers13112831] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022] Open
Abstract
We reviewed the indications, peroperative feasibility, and postoperative clinical outcomes of our first 50 consecutive patients who underwent free flap reconstruction after TORS for complex pharyngeal defects at our institution. We analyzed indications according to previous radiotherapy, the size of the resection, and the transoral exposure of critical structures. We reviewed surgical data, postoperative complications, and functional outcomes comprising tracheostomy and alimentation management. Indications were upfront surgery (34%), a second primary surgery after radiotherapy (28%), or salvage surgery after chemoradiotherapy failure (38%). Localizations were the tongue base (44%), tonsillar fossa (28%), pharyngeal wall (22%), and soft palate (6%). T-classifications were T1 (6%), T2 (52%), T3 (20%), and T4 (22%). The mean length of the surgery was 574 min. Two patients were intraoperatively converted to a conventional approach at the beginning of the learning curve. In conclusion, TORS and free flap reconstruction in complex situations were associated with low rates of postoperative complications and satisfactory functional outcomes. They were, however, associated with a renewed learning curve.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 94800 Villejuif, France; (S.T.); (A.M.-P.); (N.B.)
- Correspondence:
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 94800 Villejuif, France; (S.T.); (A.M.-P.); (N.B.)
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 94800 Villejuif, France; (S.T.); (A.M.-P.); (N.B.)
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, 94800 Villejuif, France; (N.L.); (A.B.-R.); (J.-F.H.)
| | - Frédéric Kolb
- Plastic and Reconstructive Surgery, UC San Diego, University of California, La Jolla, CA 92121, USA;
| | - Apolline Bout-Roumazeilles
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, 94800 Villejuif, France; (N.L.); (A.B.-R.); (J.-F.H.)
| | - Quentin Qassemyar
- Department of Plastic Surgery, Tenon Hospital, AP-HP, 75020 Paris, France;
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 94800 Villejuif, France; (S.T.); (A.M.-P.); (N.B.)
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, 94800 Villejuif, France; (N.L.); (A.B.-R.); (J.-F.H.)
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Li SS, Mangialardi ML, Nguyen QT, Orosco RK, Honart JF, Qassemyar Q, Kolb FJ. The Chimeric Scapulodorsal Vascularized Latissimus Dorsi Nerve Flap for Immediate Reconstruction of Total Parotidectomy Defects With Facial Nerve Sacrifice: Building a New Program and Preliminary Results From 25 Cases. Ann Plast Surg 2021; 86:S379-S383. [PMID: 33976066 DOI: 10.1097/sap.0000000000002746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Total parotidectomy with facial nerve sacrifice creates 2 challenging reconstructive problems: restoration of facial contour and facial nerve rehabilitation. Strong evidence suggesting that vascularized nerve grafts are superior to nonvascularized nerve grafts motivated our team to develop a chimeric scapulodorsal flap combining the usual harvestable local tissues with the vascularized latissimus dorsi motor nerve (SD-LDVxN). We present our experiences developing a new program at University of California, San Diego, highlighting our first case here, and present preliminary retrospective results focusing on the functional outcomes of facial nerve reanimation. MATERIALS AND METHODS The first case performed in the United States was a 57-year-old woman with stage IVA left parotid adenoid cystic carcinoma and House-Brackmann grade 6 facial palsy. She underwent total parotidectomy with facial nerve sacrifice and a free chimeric SD-LDVxN flap reconstruction. She had an unremarkable postoperative course, and 3- and 6-month follow-up functional results are reported. Preliminary functional results from our total series of 25 patients were reported. RESULTS At her 3-month follow-up, she was a House-Brackmann 5 with a static eFACE score of 37, dynamic eFACE score of 31, and smile eFACE score of 48. At her 6-month follow-up, she was a House-Brackmann 5 with a static eFACE score of 50, dynamic eFACE score of 27, and smile eFACE score of 53. Preliminary results from our total series of 25 patients with an average of 5 years of follow-up were a House-Brackmann 2.5 and eFACE scores of 83.1 for static facial symmetry, 67.5 for dynamic facial symmetry, and 77.7 for smile score. Twenty of the 25 patients had postoperative radiotherapy. No local tumor recurrence had been reported. The average reinnervation time was 9 months and ranged from 3 to 15 months. CONCLUSIONS The SD-LDVxN flap is a highly resourceful solution to reconstruct complex parotid defects, especially those that sacrifice the facial nerve. The vascularized nerve graft allows for primary facial reanimation. Nerve recovery may be superior to what could be expected with a conventional nerve graft.
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Affiliation(s)
- Sean S Li
- From the UC San Diego Division of Plastic Surgery, San Diego, CA
| | | | - Quyen T Nguyen
- UC San Diego Division of Head and Neck Surgery, San Diego, CA
| | - Ryan K Orosco
- UC San Diego Division of Head and Neck Surgery, San Diego, CA
| | - Jean F Honart
- Plastic Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Quentin Qassemyar
- Plastic Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
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Bouaoud J, Temam S, Galmiche L, Cozic N, Bolle S, Belhous K, Kolb F, Qassemyar Q, Bidault F, Couloigner V, Picard A, Le Deley MC, Mahier-Ait Oukhatar C, Gaspar N, Kadlub N. Head and neck Ewing sarcoma: French surgical practice analysis pleads for surgery centralization. J Craniomaxillofac Surg 2021; 50:439-448. [DOI: 10.1016/j.jcms.2021.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 11/07/2020] [Accepted: 01/31/2021] [Indexed: 12/26/2022] Open
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11
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Habibi K, Ganry L, Luca-Pozner V, Atlan M, Qassemyar Q. Thin submental artery perforator flap for upper lip reconstruction: A case report. Microsurgery 2021; 41:366-369. [PMID: 33398906 DOI: 10.1002/micr.30703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/27/2020] [Accepted: 12/16/2020] [Indexed: 11/06/2022]
Abstract
Reconstruction of upper lip defects can be challenging even for experienced surgeons. In order to restore both function and morphology, the use of quality soft tissue is essential. To this effect, the most common solution is the use of local flaps, or, in extreme situations, a free flap. However, a thin cutaneous upper lip defect may require a different approach. Perforator flaps are versatile and may allow an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. We present the case of a 41-year-old female with a 1 × 1.5 cm basal cell carcinoma of the right-side upper lip, initially treated with a full thickness skin graft. Due to poor aesthetic and functional result, a thin submental artery perforator (SMAP) flap reconstruction was performed. Flaps' dimensions were 6 cm long and 4 cm wide and it was based on a perforator arising from the submental artery. Dissection was conducted above the platysma muscle, and the SMAP flap was transferred into the defect through a subcutaneous tunnel created below the mandible and posterior to the anterior belly of digastric muscle. The pedicle length of 6.5 cm was adequate for a tension free inset of the flap. Postoperative course was uneventful and the patient was discharged after 2 days. The 4-month follow-up showed a satisfying functional and aesthetic outcome with a concealed donor site scar. This report points out the coverage potential of the thin SMAP flap, which can be successfully used for a harmonious reconstruction in both color and texture of the upper lip.
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Affiliation(s)
- Koohyar Habibi
- Plastic Reconstructive and Aesthetic Surgery-Microsurgery, Hospital Tenon, Paris, Île-de-France, France
| | - Laurent Ganry
- Plastic and Reconstructive Surgery, Hôpital Armand-Trousseau, Paris, Île-de-France, France.,Sorbonne University, Paris, Île-de-France, France
| | - Vlad Luca-Pozner
- Plastic and Reconstructive Surgery, Hôpital Armand-Trousseau, Paris, Île-de-France, France.,Sorbonne University, Paris, Île-de-France, France
| | - Michael Atlan
- Plastic Reconstructive and Aesthetic Surgery-Microsurgery, Hospital Tenon, Paris, Île-de-France, France.,Sorbonne University, Paris, Île-de-France, France
| | - Quentin Qassemyar
- Plastic Reconstructive and Aesthetic Surgery-Microsurgery, Hospital Tenon, Paris, Île-de-France, France.,Plastic and Reconstructive Surgery, Hôpital Armand-Trousseau, Paris, Île-de-France, France.,Sorbonne University, Paris, Île-de-France, France
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12
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Mangialardi ML, Honart JF, Qassemyar Q, Guyon A, Li SS, Benmoussa N, Beldarida V, Temam S, Kolb F. Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap. J Reconstr Microsurg 2020; 37:282-291. [PMID: 33142333 DOI: 10.1055/s-0040-1719050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cancer involving the parotid gland region may originates from parotid parenchyma itself or from locoregional organs and in rare cases, the facial nerve (FN) has to be sacrificed during tumor resection. In these cases, cancer extension often goes beyond the parotid compartment and requires extensive local resection responsible for complex multitissular defects. The goals of reconstruction may be summarized in the following two components: (1) restoration of the volumetric tissue defect and (2) FN reconstruction. The aim of this study is to describe our surgical technique and our cosmetic results using the chimeric scapulodorsal vascularized nerve (SDVN) flap to reconstruct extensive maxillofacial defects associated with FN sacrifice. METHODS All patients undergone an extensive maxillofacial resection with FN sacrifice and primarily reconstructed with a SDVN flap were included. We classified the maxillofacial defects into six groups based on the type of resection. Intraoperative data including flap composition, topography of FN injury, length of nerve gap, and number of nervous anastomosis were recorded. RESULTS Twenty-nine patients were included. Mean follow-up was 38.7 months. The harvested flaps included the SDVN combined with different components according to the defect group. A satisfactory volumetric restoration was obtained in 93% of cases. The mean number of distal nervous anastomosis was 4.5. The length of the vascularized grafted nerve ranged from 7 to 10 cm. CONCLUSION This is largest series presented in literature on primary FN reconstruction utilizing a vascularized nerve graft. We believe that the chimeric SDVN flap should be highly considered for these cases due to its versatility. The surgeon is able to use single donor site available soft and hard tissues components along with a vascular motor nerve graft, which offers a great length and number of distal branches, and easily matches with the extracranial FN trunk and its peripheral ramifications.
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Affiliation(s)
- Maria L Mangialardi
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Fracois Honart
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Quentin Qassemyar
- Faculty of Medicine, Sorbonne Université, Paris, France.,Department of Plastic, Reconstructive and Burn Surgery, Hopital Armand-Trousseau, Paris, France
| | - Alice Guyon
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sean S Li
- Department of Plastic Surgery, UCSD, San Diego, California
| | - Nadia Benmoussa
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Vincent Beldarida
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Frédéric Kolb
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France.,Department of Plastic Surgery, UCSD, San Diego, California
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13
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Ganry L, Ettinger KS, Rougier G, Qassemyar Q, Fernandes RP. Revisiting the temporal artery posterior auricular skin flap with an anatomical basis stepwise pedicle dissection for use in targeted facial subunit reconstruction. Head Neck 2020; 42:3153-3160. [PMID: 32686883 DOI: 10.1002/hed.26362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/26/2020] [Accepted: 06/16/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study demonstrates the anatomy of the pedicled temporal artery posterior auricular skin (TAPAS) flap, its variable arc of rotation based on stepwise dissection, and case reports demonstrating clinical use. This flap provides excellent color match and ultrathin tissue for targeted reconstruction of small- to medium-sized facial subunit defects. METHODS Twenty-six cadaver dissections were performed. The authors measured the reach and rotation limits of the flap in a pedicled fashion depending on a stepwise approach for vascular pedicle dissection. Two clinical cases demonstrating maximum arc of rotation are seen. RESULTS The pedicled TAPAS flap maximal rotation limits allow for reconstruction of facial subunits encompassing nearly the entire ipsilateral face. No venous congestion, wound complications, or partial/total flap loss were encountered with extreme clinical applications. CONCLUSION The pedicled TAPAS flap has extensive versatility for reconstruction of a variety of facial subunit defects. The flap also has, in theory, multiple applications for intraoral reconstruction.
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Affiliation(s)
- Laurent Ganry
- Faculté de Médecine, Sorbonne Université, Paris, France.,Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, Paris, France
| | - Kyle S Ettinger
- Section of Head and Neck Oncologic Surgery and Reconstruction, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, Minnesota, USA
| | - Guillaume Rougier
- Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, Paris, France.,Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - Quentin Qassemyar
- Faculté de Médecine, Sorbonne Université, Paris, France.,Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, Paris, France
| | - Rui P Fernandes
- Head and Neck Oncologic Surgery and Microvascular Fellowship Program, Division of Head and Neck Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.,Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
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14
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Luca-Pozner V, Qassemyar Q. The place of pedicled perforator flaps in humanitarian reconstructive surgery. J Plast Reconstr Aesthet Surg 2020; 73:1775-1784. [PMID: 32580921 DOI: 10.1016/j.bjps.2020.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- V Luca-Pozner
- Department of Plastic and Reconstructive Surgery, Armand-Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012 Paris, France.
| | - Q Qassemyar
- Department of Plastic and Reconstructive Surgery, Armand-Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012 Paris, France; Faculty of Medicine, Sorbonne University, 91-105 Boulevard de l'Hôpital, 75013 Paris, France
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15
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Schmidt M, Cristofari S, Al Madani O, Romano G, Qassemyar Q, Pascal‐Moussellard H, Atlan M. Bipedicled dorsal intercostal artery propeller flaps for reconstruction of extensive cervicothoracic midline defects. Microsurgery 2020; 40:656-662. [DOI: 10.1002/micr.30595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/13/2020] [Accepted: 04/17/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Magali Schmidt
- Department of Plastic, Reconstructive, and Esthetic SurgeryTenon Hospital, Sorbonne University Paris France
| | - Sarra Cristofari
- Department of Plastic, Reconstructive, and Esthetic SurgeryTenon Hospital, Sorbonne University Paris France
- Sorbonne University Paris France
| | - Omar Al Madani
- Department of Plastic, Reconstructive, and Esthetic SurgeryTenon Hospital, Sorbonne University Paris France
| | - Golda Romano
- Department of Plastic, Reconstructive, and Esthetic SurgeryTenon Hospital, Sorbonne University Paris France
| | - Quentin Qassemyar
- Department of Plastic, Reconstructive, and Esthetic SurgeryTenon Hospital, Sorbonne University Paris France
- Sorbonne University Paris France
| | - Hugues Pascal‐Moussellard
- Sorbonne University Paris France
- Department of Orthopedic Surgery and TraumatologyPitié‐Salpêtrière Hospital, Sorbonne University Paris France
| | - Michael Atlan
- Department of Plastic, Reconstructive, and Esthetic SurgeryTenon Hospital, Sorbonne University Paris France
- Sorbonne University Paris France
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16
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Ruiz F, Brault N, Ouar N, Atlan M, Qassemyar Q. Anterolateral thigh free flap with extended pedicle for the secondary reconstruction of a large thoracolumbar wall defect. ANN CHIR PLAST ESTH 2020; 65:163-166. [PMID: 32278492 DOI: 10.1016/j.anplas.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 11/18/2022]
Affiliation(s)
- F Ruiz
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
| | - N Brault
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - N Ouar
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - M Atlan
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - Q Qassemyar
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
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17
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Tawa P, Lévy J, Brault N, Madar Y, Qassemyar Q. [Superficial circumflex iliac artery perforator free flap in pediatric reconstruction: A case report]. ANN CHIR PLAST ESTH 2020; 65:338-342. [PMID: 32220489 DOI: 10.1016/j.anplas.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 10/24/2022]
Abstract
The dorsalis pedis reconstruction requires to bring a thin tissue to recover every noble structure of the foot including tendons, nerves and vessels while resisting the stress induced on these structures when walking or wearing shoes. We report the case of a thirteen year-old child who presented a third-degree burn sequelae on the dorsalis pedis with scar retraction and chronic ulceration on the fifth metatarsal despite multiple skin grafts. He couldn't put on his shoes because of the pain and walking was difficult. We performed a SCIP flap (Superficial Circumflex Iliac Artery Perforator) to reconstruct this defect. The flap measuring 12×7cm has been harvested on the right groin and anastomosed with the pedicle of the first intermetatarsal space. At 3 months postoperatively, the child can put on his shoes again and walk without pain. The donor site is discrete in the inguinal crease, hidden in the underwear. The SCIP flap is a thin and pliable flap with a discrete donor site. It is suitable for reconstructions of distal extremities of limbs, both in adults and children.
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Affiliation(s)
- P Tawa
- Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France
| | - J Lévy
- Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France
| | - N Brault
- Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - Y Madar
- Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - Q Qassemyar
- Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France.
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18
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Bedarida V, Qassemyar Q, Temam S, Janot F, Kolb F. Facial functional outcomes analysis after reconstruction by vascularized thoracodorsal nerve free flap following radical parotidectomy with facial nerve sacrifice. Head Neck 2020; 42:994-1003. [PMID: 31976612 DOI: 10.1002/hed.26076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parotid spread tumor may occasion wide defect with facial nerve sacrifice. We report our one time reconstruction experience of this defect using a thoracodorsal artery perforator and nerve flap (TAPN). METHODS Eight patients underwent a radical parotidectomy with facial nerve sacrifice between February 2010 and June 2016. A single time reconstruction was performed using a thoracodorsal artery perforator and nerve flap, with skin or fat paddle. The thoracodorsal nerve vascularized was harvested and used to reconstruct the facial nerve from the trunk to four until six distal branches. Patients underwent physiotherapy for 3 months at least. Facial outcomes were assessed using House-Brackmann scale and eFACE application. OUTCOMES Mean follow-up was 30 months. No complication occurred on donor site. All patients recovered a complete soft eye closure. No Frey syndrome occurred. CONCLUSION TAPN is adapted to wide and complex parotid defects.
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Affiliation(s)
- Vincent Bedarida
- Head & Neck Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Quentin Qassemyar
- Faculty of Medicine, Sorbonne Université, Paris, France.,Department of Plastic, Reconstructive and burn surgery, Hopital Armand-Trousseau, Paris, France
| | - Stéphane Temam
- Head & Neck Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - François Janot
- Head & Neck Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Frédéric Kolb
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
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19
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Lancien U, Brault N, Ouar N, Atlan M, Qassemyar Q. Bilateral pure adipose free flap for aesthetic purposes replacing infected malar implants: About a case and review of the literature. ANN CHIR PLAST ESTH 2019; 65:171-175. [PMID: 31421923 DOI: 10.1016/j.anplas.2019.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- U Lancien
- Department of Plastic, Reconstructive and Aesthetic Surgery, Microsurgery, Tissue Regeneration, centre hospitalier Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - N Brault
- Department of Plastic, Reconstructive and Aesthetic Surgery, Microsurgery, Tissue Regeneration, centre hospitalier Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Ouar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Microsurgery, Tissue Regeneration, centre hospitalier Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M Atlan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Microsurgery, Tissue Regeneration, centre hospitalier Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne university, medical school, 91-105, boulevard de l'hôpital, 75013 Paris, France
| | - Q Qassemyar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Microsurgery, Tissue Regeneration, centre hospitalier Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne university, medical school, 91-105, boulevard de l'hôpital, 75013 Paris, France
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20
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Podeur F, Peyrachon B, Nokovitch L, Dammacco MA, Qassemyar Q, Deneuve S. Predictive value of the milking patency test when performing the arterial microanastomosis in head and neck surgery. Head Neck 2019; 41:3328-3333. [PMID: 31228303 DOI: 10.1002/hed.25841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/10/2019] [Accepted: 06/04/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The milking patency test (MPT) is widely used to assess the patency of microanastomosis, despite it being proven to be a traumatic test. METHODS We performed microanastomoses with intentional two-wall stitches and asked senior microsurgeons to evaluate the permeability of the anastomoses by looking first at the results of the MPT, then according to artery pulsation. RESULTS Microsurgeons were all accurate in evaluating normal or clamped anastomoses. But in anastomoses with defects, the MPT was considered normal 94%, 85%, and 73%. MPT has a positive predictive value of 100% but with a negative predictive value of 27.5%. Observation of the artery pulsation distal to the anastomosis gave similar results. CONCLUSIONS Our experiment shows that the two-wall stitches on arterial anastomoses are hardly detected by an MPT. The observed pulsation of the artery gives the same results and could be used instead, without damaging the vessels.
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Affiliation(s)
- Fabien Podeur
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | | | - Lara Nokovitch
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | | | | | - Sophie Deneuve
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
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21
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Tawa P, Foirest C, Tankéré F, Ouar N, Brault N, Atlan M, Qassemyar Q. [Tongue reconstruction by thoracodorsal perforator flap: A new harvesting technique to reduce morbidity]. ANN CHIR PLAST ESTH 2019; 64:368-373. [PMID: 30827573 DOI: 10.1016/j.anplas.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
The thoracodorsal artery perforator flap is increasingly used in head and neck reconstructions. One of its multiple advantages is the low donor site morbidity compared to the other free flaps usually used for this type of surgery, such as the radial forearm free flap and the anterolateral flap of the thigh. However, the current harvesting technique of the thoracodorsal artery free perforator flap needs a vertical incision rising high in the axillary hollow for the dissection of the pedicle, thus impeding optimal discretion of the donor site, especially for women. We describe an original technique to harvest a pure transversal skin paddle on its own perforator, leaving a horizontal scar thoroughly hidden in the bra and preserving the thoracodorsal pedicle. We detail the requirements for this new type of harvesting.
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Affiliation(s)
- P Tawa
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - C Foirest
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Tankéré
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - N Ouar
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - N Brault
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - M Atlan
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - Q Qassemyar
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France; Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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Nail-Barthelemy R, Stroumza N, Qassemyar Q, Delage M, Nassif A, Atlan M. Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis. ANN CHIR PLAST ESTH 2019; 64:68-77. [DOI: 10.1016/j.anplas.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/04/2018] [Indexed: 01/12/2023]
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Hufschmidt K, Camuzard O, Balaguer T, Baqué P, de Peretti F, Santini J, Bronsard N, Qassemyar Q. The infraorbital artery: From descriptive anatomy to mucosal perforator flap design. Head Neck 2019; 41:2065-2073. [PMID: 30684276 DOI: 10.1002/hed.25653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/06/2018] [Accepted: 01/03/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The terminal and perforating branches of the infraorbital artery (IOA) are poorly described. Its anatomical situation and mucosal component could provide an interesting donor site for mucosal reconstruction. The aims of the following study were to establish an anatomical description and to assess the feasibility of mucosal perforator flaps for eyelid and nasal reconstruction. METHODS Twenty-three fresh cadaver hemifaces were studied in order to perform an IOA anatomical classification by recording the artery's characteristics, its course, number, type, and diameter of terminal branches. We also examined the feasibility of local flaps for facial reconstruction. RESULTS We highlighted five different types of courses. All cadavers had at least one superior vestibular branch with a caliber of ≥0.4 mm. A pedicled flap arising from the vestibular branch was raised in all dissections. CONCLUSION The vestibular perforator flap based on the IOA seems to be a reliable flap in reconstruction of mucosal defects.
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Affiliation(s)
- Katharina Hufschmidt
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Olivier Camuzard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Thierry Balaguer
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Patrick Baqué
- Department of General and Emergency Surgery, University Hospital Nice, Nice, France
| | - Fernand de Peretti
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Joseph Santini
- Department of Head and Neck Surgery, University Hospital of Nice, Nice, France
| | - Nicolas Bronsard
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Quentin Qassemyar
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Tenon, Paris, France
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Brault N, Qassemyar Q, Bouthors C, Lambert B, Atlan M, Missenard G. [A giant sacral chordoma resection and reconstruction with a gluteal perforator flap, a case report and literature review]. ANN CHIR PLAST ESTH 2018; 64:271-277. [PMID: 30509683 DOI: 10.1016/j.anplas.2018.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sacral chordomas are rare primary bone tumors and represent more than half of all primary malignant sacral tumors. Surgical resection is the only treatment with close to 50% of remission at 10 years, with or without radiotherapy. This tissue removal can be very extensive and morbid, particularly for evolved tumors. The reconstruction mostly uses myocutaneous flaps, notably the gluteus maximus flap and the latissimus dorsi flap, increasing morbidity of the surgical procedure. To avoid a muscular sacrifice and reduce the post-surgical morbidity, we describe the case of a patient who underwent a giant sacral chordoma resection and a reconstruction with a superior gluteal artery perforator flap. CASE REPORT A 57-y.o. patient with a voluminous sacral chordoma had undergone a partial sacrectomy and abdomino-perineal resection. Firstly, a laparoscopy was realized to create a colostomy, to dissect an omental flap and to prepare the monobloc resection. In a prone position, the resection of the tumor was achieved and a de-epithelialized superior gluteal artery perforator flap was performed to fill the space and to support pelvic organs. CONCLUSION For resections of sacral chordomas, coelioscopy has considerably reduced the surgical morbidity. However, the majority of reconstructions use myocutaneous flaps, specifically gluteus maximus and latissimus dorsi, which their postural function is considerable. Muscular sacrifice can lead to functional impotence with difficulty walking and standing up and run contrary to the diminution morbidity initiated by oncologic surgeons.
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Affiliation(s)
- N Brault
- Service de chirurgie plastique, reconstructive, esthétique, microchirurgie et régénération tissulaire, faculté de médecine, Sorbonne université, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Q Qassemyar
- Service de chirurgie plastique, reconstructive, esthétique, microchirurgie et régénération tissulaire, faculté de médecine, Sorbonne université, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - C Bouthors
- Service de chirurgie orthopédique et traumatologie, chirurgie du rachis, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - B Lambert
- Service de chirurgie digestive et oncologique, université Paris-Sud, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - M Atlan
- Service de chirurgie plastique, reconstructive, esthétique, microchirurgie et régénération tissulaire, faculté de médecine, Sorbonne université, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Missenard
- Service de chirurgie orthopédique et traumatologie, chirurgie du rachis, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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Struk S, Qassemyar Q, Leymarie N, Honart JF, Alkhashnam H, De Fremicourt K, Conversano A, Schaff JB, Rimareix F, Kolb F, Sarfati B. The ongoing emergence of robotics in plastic and reconstructive surgery. ANN CHIR PLAST ESTH 2018; 63:105-112. [DOI: 10.1016/j.anplas.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/02/2018] [Indexed: 12/25/2022]
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26
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Gorphe P, Auperin A, Honart JF, Ton Van J, El Bedoui S, Bidault F, Temam S, Kolb F, Qassemyar Q. Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer. Laryngoscope Investig Otolaryngol 2018; 3:121-126. [PMID: 29721545 PMCID: PMC5915826 DOI: 10.1002/lio2.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/05/2018] [Accepted: 03/01/2018] [Indexed: 12/25/2022] Open
Abstract
Objective We analyzed the outcomes for patients with a retropharyngeal internal carotid artery (ICA) who underwent a transoral robotic surgery (TORS) procedure involving a cervical‐transoral robotic oropharyngectomy course with free flap reconstruction. Methods Patients were included in the prospective multicentric trial NCT02517125. These patients were scheduled to undergo surgery for an oropharyngeal localization. By pre‐operative CT scan and MRI it was determined that they had a retropharyngeal internal carotid artery. Results Three patients had a retropharyngeal ICA: a patient with a 35 mm synovial sarcoma of the tonsillar fossa, a patient with a T2N2b squamous‐cell carcinoma (SCC) of the glossotonsillar sulcus, and a patient with a T3N0 SCC of the tonsillar fossa in a previously irradiated field. These patients encountered neither preoperative nor postoperative complications. Conclusions In our experience, TORS for oropharyngeal cancers appears to be feasible in patients with a retropharyngeal ICA, provided that the procedure has been adapted for complex situations. Level of evidence 4.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Anne Auperin
- Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean Ton Van
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - François Bidault
- Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Stéphane Temam
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Frédéric Kolb
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Quentin Qassemyar
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
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Ouar N, Qassemyar Q, Boccara D, Atlan M. Three-stage post-oncological reconstruction of the scalp using a dermal-assisted skin graft, adipose tissue graft and follicular graft: A clinical case. ANN CHIR PLAST ESTH 2018; 64:86-88. [PMID: 29566953 DOI: 10.1016/j.anplas.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Affiliation(s)
- N Ouar
- Microsurgery Department, Plastic Reconstructive and Aesthetic Surgery, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - Q Qassemyar
- Microsurgery Department, Plastic Reconstructive and Aesthetic Surgery, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - D Boccara
- Burns Unit, Plastic and Reconstructive Surgery, Hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - M Atlan
- Microsurgery Department, Plastic Reconstructive and Aesthetic Surgery, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Qassemyar Q, Assouly N, Madar Y, Temam S, Kolb F. Total nasal reconstruction with 3D custom made porous titanium prosthesis and free thoracodorsal artery perforator flap: A case report. Microsurgery 2018; 38:567-571. [PMID: 29464784 DOI: 10.1002/micr.30302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 01/05/2018] [Accepted: 01/24/2018] [Indexed: 12/24/2022]
Abstract
Total nasal reconstruction is a challenging surgical procedure which usually involves a free flap, forehead flap, and cartilage grafts. In certain failure situations where patients do not accept the idea of anaplastology, possibilities become very limited. We report the case of a patient who underwent several reconstruction steps with multiple failures including free and local flaps and cartilage harvests which showed recurrent episodes of necrosis and infection leading to melting and collapse of reconstructed structures. Furthermore, the patient did not want any anaplastological rehabilitation. We proposed to the patient an innovative method that consists to print a three-dimensional custom-made porous titanium prosthesis, based on the original shape of his nose, to replace the cartilage support. This implant was first inserted in a thoracodorsal artery perforator flap for primary integration before the free transfer of the complete structure, two months later. The free transfer was successful without any complication. A stable reconstruction and satisfying result was obtained. The patient did not want additional surgical improvement 24 months post-operatively, and resumed his professional activities. The possibility of using three-dimensional custom titanium prostheses to replace the bone and cartilage support seems to be an interesting alternative for patients in the failure situation of nasal reconstruction.
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Affiliation(s)
- Quentin Qassemyar
- Department of Head & Neck Surgery, Gustave Roussy, Cancer Campus Grand-Paris, Villejuif, F-94805, France
| | - Nathaniel Assouly
- Department of Head & Neck Surgery, Gustave Roussy, Cancer Campus Grand-Paris, Villejuif, F-94805, France
| | - Yoni Madar
- Department of Head & Neck Surgery, Gustave Roussy, Cancer Campus Grand-Paris, Villejuif, F-94805, France
| | - Stéphane Temam
- Department of Head & Neck Surgery, Gustave Roussy, Cancer Campus Grand-Paris, Villejuif, F-94805, France
| | - Frédéric Kolb
- Department of Head & Neck Surgery, Gustave Roussy, Cancer Campus Grand-Paris, Villejuif, F-94805, France
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Gorphe P, Temam S, Kolb F, Qassemyar Q. Cervical-transoral robotic oropharyngectomy and thin anterolateral thigh free flap. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:71-74. [DOI: 10.1016/j.anorl.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Struk S, Honart JF, Qassemyar Q, Leymarie N, Sarfati B, Alkhashnam H, Mazouni C, Rimareix F, Kolb F. Utilisation du vert d’indocyanine en chirurgie sénologique et reconstruction mammaire. ANN CHIR PLAST ESTH 2018; 63:54-61. [DOI: 10.1016/j.anplas.2017.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
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Struk S, Schaff JB, Qassemyar Q. [The sural medial perforator flap: Anatomical bases, surgical technique and indications in head and neck reconstruction]. ANN CHIR PLAST ESTH 2017; 63:117-125. [PMID: 29203066 DOI: 10.1016/j.anplas.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The medial sural artery perforator (MSAP) flap is defined as a thin cutaneo-adipose perforator flap harvested on the medial aspect of the leg. The aims of this study were to describe the anatomical basis as well as the surgical technique and discuss the indications in head and neck reconstructive surgery. MATERIAL AND METHODS We harvested 10 MSAP flap on 5 fresh cadavers. For each case, the number and the location of the perforators were recorded. For each flap, the length of pedicle, the diameter of source vessels and the thickness of the flap were studied. Finally, we performed a clinical application of a MSAP flap. RESULTS A total of 23 perforators with a diameter superior than 1mm were dissected on 10 legs. The medial sural artery provided between 1 and 4 musculocutaneous perforators. Perforators were located in average at 10.3cm±2cm from the popliteal fossa and at 3.6cm±1cm from the median line of the calf. The mean pedicle length was 12.1cm±2.5cm. At its origin, the source artery diameter was 1.8mm±0.25mm and source veins diameters were 2.45mm±0.9mm in average. There was no complication in our clinical application. DISCUSSION This study confirms the reliability of previous anatomical descriptions of the medial sural artery perforator flap. This flap was reported as thin and particularly adapted for oral cavity reconstruction and for facial or limb resurfacing. Sequelae might be reduced as compared to those of the radial forearm flap with comparable results.
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Affiliation(s)
- S Struk
- Département de chirurgie plastique et reconstructrice, Gustave-Roussy, Cancer Campus Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - J-B Schaff
- Département de chirurgie plastique et reconstructrice, Gustave-Roussy, Cancer Campus Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Q Qassemyar
- Service chirurgie plastique, reconstructrice et esthétique, hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
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Stroumza N, Nail Barthelemy R, Majoulet L, Delchet O, Qassemyar Q, Atlan M. Endoscopic DIEP flap dissection (eDIEP): An experimental cadaveric study. J Plast Reconstr Aesthet Surg 2017; 70:1149-1151. [DOI: 10.1016/j.bjps.2017.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 04/12/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
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Atlan M, Qassemyar Q, Lkah C. [Earlobe reconstruction in one step by the Gavello's procedure: Surgical technique and a case report]. ANN CHIR PLAST ESTH 2017; 62:340-343. [PMID: 28385569 DOI: 10.1016/j.anplas.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/26/2017] [Indexed: 11/15/2022]
Abstract
The earlobe because of its anatomical position is subject of defects secondary to multiple and varied etiologies. Although its functional role appears negligible, its aesthetic and social importance makes its reconstruction a delicate surgery because it must be discreet but also the simplest possible. Many methods have been described but some require several operating times. The aim of this article is to present a simple procedure with a bilobed flap based on a reliable vascularization and which requires only one operative time. We describe the technique through a clinical case and review the literature to discuss the other methods described.
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Affiliation(s)
- M Atlan
- Service de chirurgie plastique reconstructrice et esthétique, université Pierre-et-Marie-Curie Paris VI, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
| | - Q Qassemyar
- Service de chirurgie plastique reconstructrice, institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - C Lkah
- Clinique de chirurgie plastique et esthétique, 42, boulevard Driss-Slaoui-Val-d'Anfa, Casablanca, Maroc
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Gorphe P, Von Tan J, El Bedoui S, Hartl DM, Auperin A, Qassemyar Q, Moya-Plana A, Janot F, Julieron M, Temam S. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi. J Robot Surg 2017; 11:455-461. [PMID: 28064382 DOI: 10.1007/s11701-017-0679-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/02/2017] [Indexed: 11/26/2022]
Abstract
The latest generation Da Vinci® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| | - Jean Von Tan
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Dana M Hartl
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Anne Auperin
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Quentin Qassemyar
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Morbize Julieron
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Stephane Temam
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
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Qassemyar Q, Aguilar P, Temam S, Kolb F, Gorphe P. [The thin ALT perforator flap for oropharyngeal robotic-assisted reconstruction]. ANN CHIR PLAST ESTH 2017; 62:1-7. [PMID: 28041765 DOI: 10.1016/j.anplas.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/18/2022]
Abstract
Since a few years, the transoral robotic surgery reduced the morbidity of oropharyngeal tumors excision. Large posterior tumors can now be removed without any scar visible on the face. In this context and to respect the thinness required for reconstructions at the junction of the upper aerodigestive tract, the free radial forearm flap still remains the solution of choice. However, if the transoral robotic surgery respects the anatomy and the aesthetics of patients at the visible and social area that represents the face, the forearm flap provides visible scars on the other region of social interaction that represents the upper limb. The aim of our work was to prove the feasibility and the benefits in terms of reducing sequelae when using a thin anterolateral perforator flap harvested above the plane of the superficial fascia. We present this new original method in detail and the advantages it offers to patients after surgery.
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Affiliation(s)
- Q Qassemyar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - P Aguilar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - S Temam
- Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - F Kolb
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - P Gorphe
- Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Abstract
Head and neck reconstruction in pediatric oncology, even if it is based on adult experience, presents important characteristics including age-related growth, the type of tumor and donor sites features. Indications of free flaps are rare but required care that should be codified, taking into account the details specific to context, and not giving place for improvisation as it is important that surgical outcomes must be as simple as possible. The objective of this article is not to present the technical details of free flaps harvesting in children because it is what is certainly the least different with adults. The aim is to share our experience of the specificities and singularities of pediatric head and neck reconstruction in order to focus attention to everything that makes this surgery demanding. We present the most common indications, the types of free flaps used for reconstruction, facial location modalities of reconstruction and the perioperative management.
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Affiliation(s)
- Q Qassemyar
- Département de chirurgie plastique et reconstructrice, institut Gustave-Roussy, Cancer campus, Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - F Kolb
- Département de chirurgie plastique et reconstructrice, institut Gustave-Roussy, Cancer campus, Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Deneuve S, Qassemyar Q, Blancal JP, Couloignier V, Sainte-Rose C, Janot F, Kolb F. Thoraco dorsal artery perforator flap for trismus release in a young girl. Int J Pediatr Otorhinolaryngol 2015; 79:1949-51. [PMID: 26363893 DOI: 10.1016/j.ijporl.2015.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
Trismus is a frequent complication occurring after treatment of tumors of the pterygomaxillary fossa. Local flaps and full-thickness skin grafts fail to release it because they usually lead to scar contracture in previously irradiated tissues. We propose to release it with a thoracodorsal artery perforator flap, which is feasible in children like other perforator flaps. It is interesting because it is thinner than the anterolateral thigh flap and its scar may be less disgraceful and easier to hide.
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Foy JP, Qassemyar Q, Assouly N, Temam S, Kolb F. [Harvesting technique of chimeric multiple paddles fibular flap for wide oromandibular defects]. ANN CHIR PLAST ESTH 2015; 61:292-7. [PMID: 26497269 DOI: 10.1016/j.anplas.2015.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/07/2015] [Indexed: 10/22/2022]
Abstract
Carcinological head and neck reconstruction still remains a challenge due to the volume and varied tissues needed. Large and wide oromandibular defects require, not just the bone but also soft tissues for the pelvilingual reconstruction and therefore, a second free flap may become necessary in addition to a fibular flap. The option of an unique chimeric flap based on the fibular artery and its branches is less known whereas it offers the advantage of a unique flap with bone, muscle and multiple skin paddles, independent of each other. The aim of this technical note is to present step by step the surgical procedure of this chimeric flap and share this method that avoids a second free flap.
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Affiliation(s)
- J-P Foy
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervicofaciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Q Qassemyar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervicofaciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - N Assouly
- Département de carcinologie cervicofaciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - S Temam
- Département de carcinologie cervicofaciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - F Kolb
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervicofaciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Qassemyar Q, Boulart L. A 4-task skills examination for residents for the assessment of technical ability in hand trauma surgery. J Surg Educ 2015; 72:179-183. [PMID: 25498883 DOI: 10.1016/j.jsurg.2014.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/24/2014] [Accepted: 10/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate a 4-task skills examination model for surgical trainees as a method of assessment of the different technical skills essential in hand trauma surgery. DESIGN Using established validation methodology, construct validity was assessed by comparing the performance of 2 groups of residents in surgery (group A: residents with any formation in microsurgery and hand surgery and group B: residents with specific formation in hand or microsurgery or both). PARTICIPANTS AND SETTING Overall, 19 residents in surgery with different degree of formation in hand and microsurgery participated in the study. All the residents performed 4 tasks on synthetic models consecutively: task 1-Z-plasty, task 2-metacarpal fracture fixation, task 3-tendon repair, and task 4-end-to-end anastomosis. The running order was awarded in a random drawing and 4 independent observers scored each resident. RESULTS There was a significant difference in performance in the overall score between groups A and B and particularly for tasks 1 and 4. All participants felt the 4 tasks were good models to learn the procedure and recommended this approach to younger residents. CONCLUSION This approach was based on a 4-tasks examination is the first model of evaluation of the different technical skills required for hand trauma surgery for residents. The results show a good differentiation between residents that have microsurgical and hand formation and those who do not have. This easy model can be easily integrated in the curriculum of residents, who want to specialize in hand surgery.
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Affiliation(s)
- Quentin Qassemyar
- Division of Plastic & Reconstructive Surgery, Gustave Roussy Cancer Campus, Villejuif, France; Department of Anatomy, University of Picardie, Amiens, France.
| | - Louise Boulart
- Division of Plastic & Reconstructive Surgery, Gustave Roussy Cancer Campus, Villejuif, France
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Qassemyar Q, Michel G. A new method of sutureless microvascular anastomoses using a thermosensitive poloxamer and cyanoacrylate: An experimental study. Microsurgery 2015; 35:315-9. [DOI: 10.1002/micr.22381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Q. Qassemyar
- Division of Plastic and Reconstructive Surgery; Gustave Roussy Cancer Campus; Grand Paris, 114 Rue Edouard Vaillant Villejuif France
- Department of Anatomy; University of Picardie; Rue Des Louvels Amiens France
| | - G. Michel
- Department of Anatomy; University of Picardie; Rue Des Louvels Amiens France
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Qassemyar Q, Gianfermi M. Supermicrosurgery and hyaluronic acid: experimental feasability study of a new method. ANN CHIR PLAST ESTH 2014; 60:e59-65. [PMID: 25447214 DOI: 10.1016/j.anplas.2014.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION As a technique of anastomosis for vessels of less than 0.8mm in diameter, supermicrosurgery has aroused renewed interest on account of its potential clinical applications. The technical difficulty of surgery at such a small scale necessitates exploration of new methods likely to render the anastomoses accessible and reliable. The aim of this article is to present the results of an experimental study on the feasibility of anastomoses (arterial diameter ≤0.5mm), assisted by the injection of hyaluronic acid (HA). MATERIALS AND METHODS Ten end-to-end arterial anastomoses of the inferior epigastric artery (diameter ≤0.5mm) were performed in 5 rats. An injection of HA had previously been carried out in the vessel lumen and the sutures were made with 12-0 nylon. Immediate and 3-day permeability were controlled and anastomosis times were measured. RESULTS Average diameter of the arteries was 0.42 mm (range 0.29-0.48 mm). Mean anastomosis duration was 19.5 min (range 15-23 min). The average number of stitches was 6. Immediate patency was 100% with a success rate of 80% at 3 days. CONCLUSIONS The properties of HA seem to effectively facilitate anastomoses of arteries with a diameter ≤0.5mm. HA provides comfort and promotes safety in performance of exceedingly small-scale surgery. While the results appear promising, but further studies are needed in order to determine the potential toxicity of this method on tissues.
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Affiliation(s)
- Q Qassemyar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Laboratoire d'anatomie et d'organogenèse, université de Picardie Jules-Verne, rue des Louvels, 80000 Amiens, France.
| | - M Gianfermi
- Laboratoire d'anatomie et d'organogenèse, université de Picardie Jules-Verne, rue des Louvels, 80000 Amiens, France
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Qassemyar Q. Perforantes, branches et rameaux. Commentaires sur l’article « Étude radio-anatomique tridimensionnelle de l’artère faciale et de ses perforantes cutanées » Ann Chir Plast Esthet 2014;59:22–8. ANN CHIR PLAST ESTH 2014; 59:298-9. [DOI: 10.1016/j.anplas.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 04/02/2014] [Indexed: 11/25/2022]
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Qassemyar Q, Gianfermi M, Sarfati B, Leymarie N, Kolb F. Super-microdissected local flaps for the coverage of temporal defects. Microsurgery 2014; 34:554-7. [PMID: 24895327 DOI: 10.1002/micr.22284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/18/2014] [Accepted: 05/21/2014] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Skin graft is still a method of choice for the coverage of temporal defects. But there are some disadvantages like a "patch" appearance, the need of dressing or longer healing time. Numbers of local flaps have been described for closing skin defects on temporal region. Yet, they may cause distortion of the surrounding tissues, especially in the temporal hairline and eyebrow. We present a series of seven local flaps based on small branches (SB) of the superficial temporal artery (STA) for the coverage of temporal defects, and discuss their advantages. PATIENTS AND METHODS Supermicrodissection of SB of the STA was performed to obtain local flaps for reconstruction of temporal defects after skin cancer excisions in seven patients. Patient's age ranged from 70 to 88 years old and the diameter of defects ranged from 4 to 6 cm. All procedures were performed under local anesthesia except one. In all cases, defects were obtained after skin cancer excisions. RESULTS The operative time ranged from 55 to 75 min. All flaps survived with an average follow-up of 8 months, reconstructions have maintained a cosmetically pleasing result. CONCLUSION We believe that SB flaps may be a new option for reconstruction of temporal defects with the advantages of local flaps, without the inconvenience of a skin pedicle. Moreover, these flaps raise the question of the use of SB based flaps for the coverage of moderate-sized skin defects anywhere in the body, and open new fields in reconstructive surgery.
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Affiliation(s)
- Q Qassemyar
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Cancer Campus, Grand Paris, 114 Rue Edouard Vaillant, F-94805, Villejuif, France; Department of Anatomy, University of Picardie, rue des Louvels, 80000, Amiens, France; Department of Plastic Surgery, Amiens Hospital, place Victor Pauchet, 80000, Amiens, France
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Mirghani H, Leymarie N, Amen F, Qassemyar Q, Leclère FM, Kolb F. Pharyngotracheal fistula closure using the internal mammary artery perforator island flap. Laryngoscope 2013; 124:1106-11. [DOI: 10.1002/lary.24372] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Haïtham Mirghani
- Department of Head and Neck Surgery; Institut de Cancérologie Gustave Roussy; Villejuif Amiens France
| | - Nicolas Leymarie
- Department of Plastic Surgery; Institut de Cancérologie Gustave Roussy; Villejuif Amiens France
| | - Furrat Amen
- Department of Head and Neck Surgery; Institut de Cancérologie Gustave Roussy; Villejuif Amiens France
| | - Quentin Qassemyar
- Department of Maxillofacial Surgery; Amiens North Hospital; Amiens France
| | - Franck Marie Leclère
- Department of Plastic Surgery; Institut de Cancérologie Gustave Roussy; Villejuif Amiens France
| | - Frederic Kolb
- Department of Plastic Surgery; Institut de Cancérologie Gustave Roussy; Villejuif Amiens France
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Sinna R, Alharbi M, Assaf N, Perignon D, Qassemyar Q, Gianfermi M, Deguines JB, Regimbeau JM, Mauvais F. Management of the perineal wound after abdominoperineal resection. J Visc Surg 2013; 150:9-18. [PMID: 23434360 DOI: 10.1016/j.jviscsurg.2013.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although many options are available for the management of perineal wounds after abdominoperineal resection, ranging from direct closure to flap reconstruction, treatment remains challenging. A better understanding of the aims, drawbacks and progress in perineal wound management after abdominoperineal rectal resection can help the surgeon make better choices for each patient, but it is very difficult to propose a single, optimal, evidence-based procedure for the management of pelvic exenteration. Recent progress provided by the extralevator abdominoperineal resection technique and perforator flap concepts have changed our conception of reconstruction leading to the different technical options highlighted in this review.
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Affiliation(s)
- R Sinna
- Department of Plastic, Reconstructive and Aesthetic Surgery, Amiens University Medical Center, Hôpital Nord, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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Qassemyar Q, Sinna R. De la microchirurgie à la « supermicrochirurgie » : étude expérimentale de faisabilité et perspectives. ANN CHIR PLAST ESTH 2011; 56:518-27. [DOI: 10.1016/j.anplas.2010.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
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Qassemyar Q, Browet F, Robbe M, Verhaeghe P, Regimbeau JM. Dynamic parietal closure: initial experience of an original parietal closure procedure for treatment of abdominal wound dehiscence. ACTA ACUST UNITED AC 2011; 146:762-4. [PMID: 21690458 DOI: 10.1001/archsurg.2011.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Moure C, Qassemyar Q, Dunaud O, Neiva C, Testelin S, Devauchelle B. Skeletal stability and morbidity with self-reinforced P (L/DL) LA resorbable osteosynthesis in bimaxillary orthognathic surgery. J Craniomaxillofac Surg 2011; 40:55-60. [PMID: 21514172 DOI: 10.1016/j.jcms.2011.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 12/31/2010] [Accepted: 01/13/2011] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION We present a retrospective study of 30 consecutive cases of bimaxillary orthognathic surgery with biodegradable self-reinforced poly-L/DL-lactide plates and tacks, for the same indication of Angle class III malocclusion. We reported the skeletal stability and morbidity at 1 year after surgery. PATIENTS AND METHODS All patients underwent bimaxillary procedure. We used self-reinforced poly-L/DL lactic acid copolymer. Stabilization of Lefort I osteotomy was achieved by four plates L-shaped. Sagittal split osteotomies were fixed by two straight-plates. Lateral cephalograms were taken before (T0), soon after (T1) and more than 1 year after surgery (T2). Eight standard landmarks and four angular measurements were taken into account. All differences of the landmarks and angles were measured at T1 and T2. The regular clinical follow-up was scheduled for a minimum period of 1 year. RESULTS The mean advanced maxillary was 3.33 mm and the mean mandibular setback was 6.13 mm. The mean mandibular relapse was 2.2 mm (non-significant). Horizontal maxilla mean variation was 0.8 mm at 1 year at A-point. Vertical maxilla stability depends on maxillary movements: impaction stability is better as an isolated advancement or associated with pull-down movement. We found six inflammatory reactions and two of them need the removal of the plates. CONCLUSION Bimaxillary orthognathic procedure with bioresorbable osteosynthesis is a reliable and reproducible method. Angle class III malocclusions could be entirely and successfully managed with bioresorbable osteosynthesis. The stability and suites at 1 year are comparable to titanium osteosynthesis.
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Affiliation(s)
- Christophe Moure
- Department of Maxillo-Facial Surgery, Amiens North Hospital, University of Picardie Jules Verne, Place Victor Pauchet, F-80054 Amiens cedex 01, France
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