1
|
Body lift with lateral thigh lift: surgical technique and comparison with the inferior body lift. Plast Reconstr Surg 2024:00006534-990000000-02319. [PMID: 38652856 DOI: 10.1097/prs.0000000000011491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Despite its rarity, cutaneous adipose tissue excess in the trochanteric region following massive weight loss is a surgical challenge. The aim of this work is to propose a surgical technique for lifting the outer thighs by describing its indications and its limitations. METHODS 74 patients were recruited into the study between 2018 2021. Two groups were identified: patients with bodylift combined with lateral thigh lift (n=20) and patients with lower bodylift (n=54). Satisfaction was obtained through the BODY Q questionnaire. The average operating time is 45 minutes longer when an outer thigh lift is performed. The median length of hospitalization is similar. The complication rate is 26% for the bodylift group and 60% for the thigh lift group (p<0.01); the most common complication is dehiscence. RESULTS Data analysis shows that the lateral thigh lift technique does not affect immediate postoperative evolution or hospitalization duration, proving its safety. There was an increase in total complications among patients who underwent lateral thigh lifts. Dehiscence is the most common complication, which is an outpatient treatment. The satisfaction rate is high. Satisfaction is linked to improved quality of life. CONCLUSIONS In our experience, the technique described is an effective means of trochanteric deformities.
Collapse
|
2
|
Vertical Body Lift: Surgical Technique and Comparison with the Inferior Body Lift Technique. Plast Reconstr Surg 2023; 152:507e-517e. [PMID: 36780353 DOI: 10.1097/prs.0000000000010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Patients with massive weight loss have excessive skin laxity along both vertical and transverse axes. Vertical body lift (VBL) is a body-contouring technique addressing both excesses, promoting not only body lifting but also a tightening effect. The aim of this study was to describe the authors' VBL surgical technique and its potential clinical applications. In addition, they present their experience among postbariatric surgery patients to compare surgical aspects and outcomes of VBL and the classic inferior body lift (IBL) technique. METHODS The authors reviewed data on 140 consecutive postbariatric surgery patients who underwent a body lift procedure between January of 2018 and March of 2020. The patients were divided into two groups: the VBL group and the IBL group. Patient demographics, operative details, and postoperative outcomes were compared between groups. RESULTS Of the 140 patients included in the study, 92 underwent IBL and 48 underwent VBL. There were no statistically significant differences between groups for surgical duration (IBL, 192 minutes; VBL, 193 minutes), hemoglobin decrease (IBL, 2.32 g/dL; VBL, 2.11 g/dL), hospital length of stay (IBL, 5.4 days; VBL, 5.7 days), or complication rate (IBL, 32%; VBL, 31%). CONCLUSIONS The authors' study shows comparable operative details and postsurgical outcomes between the VBL and classic IBL techniques. In their experience, VBL is a reliable and reproducible technique that can improve aesthetic and functional outcomes in a subpopulation of approximately one-third of patients with massive weight loss. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
|
3
|
Upper lateral lip flap for the coverage of large superficial labial defect. ANN CHIR PLAST ESTH 2020; 66:159-166. [PMID: 32654842 DOI: 10.1016/j.anplas.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reconstruction of large superficial defects of the upper lip is challenging, as it requires the restoration of both function and morphology. To achieve optimal results, facial features and landmarks should be preserved and similar skin should be used. Moreover, in male patients, upper lip pilosity should be restored. Although myriad of local flaps have previously been described, few address these issues. Herein, we describe our results with an upper lateral lip rotation flap for large upper lip cutaneous defects coverage. PATIENTS AND METHOD A retrospective study was performed including every patient who underwent an upper lateral lip flap between 2010 and 2017. Demographic data, defect dimensions, etiology, type of anesthesia, operative time, postoperative complications, functional and morphological outcomes were recorded. RESULTS A total of 31 patients were included. All procedures were performed under local anesthesia as outpatient procedures. The length of the operative procedure was 48minutes in average. The mean size of the superficial defect was 19mm (ranging from 6 to 30mm). All patients were fully healed after 15 days, and no flap necrosis (partial or total) was reported. No nasal or lip distortion was observed and facial hair was successfully restored in all male patients. CONCLUSION The upper lateral lip flap is a fast, safe, and reproducible procedure to cover defects of the lateral upper lip of up to 3cm. With scars hidden in natural folds and lip defects covered by lip tissues, this technique restores facial cosmetic features with very satisfying aesthetic outcome, especially in men as facial hair is restored.
Collapse
|
4
|
Determinants of the interindividual variability in serum cytidine deaminase activity of patients with solid tumours. Br J Clin Pharmacol 2019; 85:1227-1238. [PMID: 30701582 DOI: 10.1111/bcp.13849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/23/2018] [Accepted: 12/14/2018] [Indexed: 01/30/2023] Open
Abstract
AIMS Cytidine deaminase (CDA) activity in cancer patients' serum has been proposed as a predictive biomarker for efficacy and toxicity of nucleoside analogues. However, discrepant results about its predictive value have been reported due to the high interindividual variability in CDA activity. This study aimed at identifying determinants of this interindividual variability. METHODS From December 2014 to November 2015, 183 patients were prospectively included. Serum CDA activity, biological and clinical characteristics as well as five common single nucleotide polymorphisms (SNPs) in the CDA gene (c.-451C > T, c.-92A > G, c.-33_-31delC, c.79A > C, c.435 T > C) were analysed. Associations between clinical characteristics, pharmacogenetic variants and CDA activity were univariately tested. P < 0.1-candidate variables were analysed through a multivariate analysis. The association between CDA activity and toxicity was assessed for the 56 gemcitabine-treated patients. Intraindividual variability in CDA activity was explored in six pancreatic cancer patients treated with gemcitabine. RESULTS Median CDA activity was 3.97 U mg-1 (range 1.53-15.49 U mg-1 ). A univariate analysis showed that CDA activity was statistically associated with Eastern Cooperative Oncology Group performance status, mild or severe malnutrition, inflammatory syndrome, leucocyte count, neutrophil count, albumin, C-reactive protein and -c.-33_-31delC single nucleotide polymorphism. A multivariate analysis identified that only neutrophil count (P < 0.0001) and severe malnutrition (P = 0.0278) were independently associated with CDA activity. Low CDA activity (<2 U mg-1 ) was not statistically associated with severe gemcitabine-related toxicities (P = 0.16). A decrease in CDA activity was observed during the longitudinal follow-up of six pancreatic cancer patients treated with gemcitabine (P = 0.03). CONCLUSIONS These results suggest that neutrophil count and malnutrition should be considered for the interpretation of pretherapeutic CDA activity.
Collapse
|
5
|
Study of medical education in 3D surgical modeling by surgeons with free open-source software: Example of mandibular reconstruction with fibula free flap and creation of its surgical guides. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:262-267. [DOI: 10.1016/j.jormas.2018.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/15/2018] [Accepted: 02/21/2018] [Indexed: 11/29/2022]
|
6
|
Adjustable selective maxillary expansion combined with one-stage maxillomandibular surgery: A prospective study of osseous widening in fifty-five consecutive patients. J Craniomaxillofac Surg 2018; 46:1408-1420. [PMID: 30001885 DOI: 10.1016/j.jcms.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/29/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE SARME is often considered to be the only available treatment for significant or severe maxillary transverse palatal deficiencies (MTD) in skeletally-mature patients. Despite this observation, the aim of our study was to assess a new type of maxilla distraction osteogenesis. Using two innovative tools, we performed selective expansion: the site to be widened and the amount of increase were both pre-selected. Patients were treated in a single maxillomandibular procedure. Our study focuses primarily on the extent of osseous widening. STUDY DESIGN Post-expansion computed tomography data from 55 non-syndromic patients were included in a prospective study and analyzed in two planes for transverse skeletal widening. Of the 55 patients, 16 underwent isolated posterior distraction for severe posterior endognathia (group I), and 39 were treated in both segments (group II). Diastemas and anterior spaces permitted resolution of crowding and patients with a small, narrow, tapering arch were given a more rounded form. All patients underwent a complete Le Fort I with down fracture. Two novel devices were used: first, an adjustable distractor to achieve an angular opening; and secondly, in group II, new modular plates interlocked for osteosynthesis to provide stability and anterior expansion. RESULTS In group I, analysis of the width of the gain showed significant posterior values decreasing from back to front, a result never achieved with the SARME procedure. The mean osseous gain at first molars was 7.1 mm. When anterior space was required in group II, it was created as wide as needed (mean 4.2 mm, at canine level) with good preservation of the 1st molar space gain (mean 6.8 mm). CONCLUSION Total Le Fort I osteotomy associated with two innovative devices provides a new, segmental and adaptable approach for transverse distraction osteogenesis. We demonstrate a good match with the dental enlargement required. All patients were managed in a single orthognathic procedure for all the anomalies to be treated. Long-term results show good stability.
Collapse
|
7
|
Three-dimensional surgical modelling with an open-source software protocol: study of precision and reproducibility in mandibular reconstruction with the fibula free flap. Int J Oral Maxillofac Surg 2017; 46:946-957. [DOI: 10.1016/j.ijom.2017.02.1276] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/09/2017] [Accepted: 02/28/2017] [Indexed: 11/29/2022]
|
8
|
Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:197-202. [PMID: 28365396 DOI: 10.1016/j.jormas.2017.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/25/2016] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support. PROCEDURE Four successive specialised Open-source software were used to perform our 3D modelling: OsiriX®, Meshlab®, Netfabb® and Blender®. Digital Imaging and Communications in Medicine (DICOM) data on patient skull and fibula, obtained with a computerised tomography (CT) scan, were needed. The 3D modelling of the reconstructed mandible and its surgical guides were created. CONCLUSIONS This new strategy may improve surgical management in Oral and Craniomaxillofacial surgery. Further clinical studies are needed to demonstrate the feasibility, reproducibility, transfer of know how and benefits of this technique.
Collapse
|
9
|
Calvarial metastasis of renal cell carcinoma. BMJ Support Palliat Care 2017; 8:436-438. [DOI: 10.1136/bmjspcare-2016-001216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/14/2016] [Accepted: 01/17/2017] [Indexed: 11/03/2022]
Abstract
The calvarium is an extremely unusual site of metastasis of renal cell carcinoma. We report a 62-year-old man who was enrolled for palliative medical management for an exophytic calvarial metastasis. His quality of life was greatly compromised with everyday local care and bandages due to recurrent events of infection and bleeding, limiting his social life. Surgical palliative surgery was carried out to improve the patient's quality of life. After tumour resection, the resultant defects of the calvarium and the scalp were covered by a muscular latissimus dorsi free flap and a fascia lata graft as dural substitute. There was no evidence of local recurrence or distant metastasis during the 3 years follow-up. Consequently, resection of solitary metastasis in the early stage is the treatment of choice with a chance to cure the metastasis and avoid associated morbidity that may occur if the lesion is left untreated.
Collapse
|
10
|
Prevalence and factors associated with persistent pain following body contouring surgery. J Plast Reconstr Aesthet Surg 2016; 69:700-5. [PMID: 26923660 DOI: 10.1016/j.bjps.2016.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/21/2015] [Accepted: 01/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Persistent postsurgical pain (PPP) has been reported by patients following various surgeries. Body contouring procedures are being performed more frequently, but no data are available regarding the effects of these procedures. Long-term disability occurring after performing "functional" procedures on healthy subjects is a particular concern. The aim of this study was to describe the risk factors, prevalence, characteristics, and effects of persistent pain after body contouring procedures. METHODS Patients who underwent body contouring surgery (e.g., abdominoplasty, lower body lift, medial thigh lift, brachioplasty, and abdominal liposuction) between January 1 2009 and December 31 2013 were included in this retrospective, monocentric cohort study. Pain evaluation was performed using a visual analog pain scale (VAS) and the Douleur Neuropathique 4 (DN4) questionnaire. Major risk factors previously identified in the literature were evaluated. RESULTS The study included 199 patients. Pain was reported by 42 patients (21%). Seventy-one percent (n = 30) of these 42 patients presented with neuropathic pain. Risk factors that were significantly associated with PPP were acute postoperative pain (p = 0.0003), medical history of bariatric surgery (p = 0.002), longer period of hospitalization (p = 0.04), depressive status during the operative period (p = 0.03), substantial stress before surgery (p = 0.03), and major complications after surgery (p = 0.03). CONCLUSION Persistent chronic pain is frequent after body contouring procedures. Preemptive approaches and early postoperative diagnosis are important measures that can be used to limit the effects of this complication on the patient's quality of life.
Collapse
|
11
|
Adjustable selective maxillary expansion combined with maxillomandibular surgery: A case report. Int Orthod 2015; 13:320-31. [PMID: 26277457 DOI: 10.1016/j.ortho.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgically assisted rapid maxillary expansion (SARME) is usually considered the gold standard for maxillary transverse expansion in adults. However, a second surgical procedure is needed in cases of associated sagittal or vertical discrepancies. We describe the use of two new innovative devices for the correction of discrepancies in all dimensions during a single surgical procedure, thus reducing treatment duration. MATERIAL We report the case of a 21-year-old female patient, referred to our department for skeletal Class III malocclusion associated with right-side laterognathism and transverse maxillary deficiency. The patient underwent one-stage surgery, using sliding osteosynthesis plates and an adjustable bone-borne distractor. Pre-surgical orthodontics consisted in leveling and aligning the mandibular arch; maxillary leveling was initiated 3 months before surgery. Postoperative palatal distraction combined with orthodontic finishing enabled complete correction of dental and bony discrepancies after 3 months. CONCLUSION In our experience, treatment of transverse, sagittal and vertical discrepancies has been possible in a single surgical procedure, using two innovative techniques: sliding osteosynthesis and an adjustable bone distractor. Two years post-surgery, the correction is stable in all dimensions.
Collapse
|
12
|
[The "two positions" lipoabdominoplasty]. ANN CHIR PLAST ESTH 2015; 60:268-75. [PMID: 25937127 DOI: 10.1016/j.anplas.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUNDS Lipoabdominoplasty is a way to improve morphological outcomes by treating the areas not accessible to resection during classical abdominoplasty, especially hips. However, patients can present a lateral and posterior fat extension, not accessible to an anterior liposuction. This situation is managed by a first step with liposuction in the prone position. The aim of this study was to determine whether lipoabdominoplasty performed in two positions increases morbidity compared with lipoabdominoplasty in supine position only. METHODS This was a retrospective study of 137 patients who underwent lipoabdominoplasty between 2009 to 2013. Eighty-five patients underwent a one position lipoabdomynoplasty and 52 a two positions lipoabdomynoplasty. Medical records were reviewed to collect data regarding patient demographics, operative technique, volume of liposuction and complications. RESULTS The posterior liposuction has significantly increased the length of procedure (mean: 43.3 minutes). The volume of liposuction was significantly higher when the procedure was performed with prone and supine position (2789.6 mL versus 1373.8 mL, P<0.001). There was no significant difference between the two groups regarding complications and blood loss. CONCLUSION Lipoabdominoplasty in two positions is an effective technique with the same morbidity as a lipoabdominoplasty in supine position only. The procedure finds its indication, between classic abdominoplasty and bodylift, for patients with lateral and posterior fat extension without posterior skin excess.
Collapse
|
13
|
[Horizontal V-Y advancement flap for lower eyelid reconstruction in young patients]. J Fr Ophtalmol 2014; 38:7-12. [PMID: 25542445 DOI: 10.1016/j.jfo.2014.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The reconstruction of lower eyelid defects is a complex issue because of the thinness of eyelid tissues and the need for protection of the globe. The surgery must address two requirements: a functional goal, avoiding eyelid malposition, and a cosmetic goal, limiting aesthetic compromises. In young patients, direct closure is rarely possible if the defect is superior to 1cm. The horizontal V-Y advancement flap is a simple and reliable method but is hardly ever reported. The purpose of this study is to review the surgical technique and report our experience with this flap in the reconstruction of younger patients. PATIENTS AND METHODS Nine patients, 5 men and 4 women, with a mean age of 54 years, underwent a lower eyelid reconstruction by horizontal V-Y advancement flap between 2011 and 2014. In every case, the initial pathology was a basal cell carcinoma and the surgical margins were uninvolved. The mean diameter of the surgical defect was 1.9 centimeters and the average procedure duration was 40 minutes. RESULTS All patients were managed as outpatients. Functional and aesthetic results were judged satisfactory or very satisfactory by all the patients and their surgeon. No flap necrosis and no ectropion or scleral show were reported. In one patient, lower lid edema lasted until the third postoperative month. CONCLUSION The horizontal V-Y advancement flap enables to repair lower eyelid defects using nearby skin of similar characteristics. Aesthetic results are very satisfactory, and scars, concealed in the eyelid creases, are nearly invisible in the long term. The lack of tension on the eyelid margin limits the risk of eyelid position. This simple and reliable one-step procedure, possible under local anesthesia, is appropriate for young, active patients, limiting the cosmetic sequelae and social ramifications.
Collapse
|
14
|
Outcomes of Panniculectomy after Bariatric Surgery: A Comparative Study and Review of the Literature. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
15
|
Modified Antia-Buch flap for the reconstruction of helical rim defects. J Plast Reconstr Aesthet Surg 2014; 67:1659-62. [PMID: 25193398 DOI: 10.1016/j.bjps.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/28/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Antia-Buch flap is a sophisticated one-stage procedure using two chondrocutaneous flaps to reconstruct the ear helix. Because tissue laxity is largely conferred by the inferior flap, relative to the less mobile superior flap, chondrocutaneous resection of scapha is required for closure. This results in loss of ear height and limits morphologic outcome. We describe a modification of the Antia-Buch flap, which may avoid such drawbacks. PATIENTS AND METHOD We conducted a retrospective review of patients (n = 15), each undergoing our modified Antia-Buch flap between 2010 and 2014. All procedures were performed under local anesthesia as outpatient procedures. Data on magnitude of resections, procedure durations, related complications, and aesthetic outcomes were collected. RESULTS The mean size of resection was 25 mm (range, 20-30 mm). The modification improved the mobility of the upper chondrocutaneous flap, eliminating the need to resect the scapha. All wounds healed uneventfully, with no skin necrosis. The morphologic outcome was satisfactory or very satisfactory in all patients, preserving the shape, height, and width of the ear. CONCLUSIONS Our modification changes the upper flap from an advancement flap to a transposition flap, enhancing its mobility and preempting the resection of the scapha. Thus, anatomic landmarks, aesthetic subunits of the pinna, and ear height are maintained for highly satisfactory morphologic results. LEVEL OF EVIDENCE 4.
Collapse
|
16
|
|
17
|
[An adjustable distractor for transverse maxillary distraction osteogenesis]. ACTA ACUST UNITED AC 2013; 114:170-4. [PMID: 23827271 DOI: 10.1016/j.revsto.2013.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 11/18/2012] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The posterior skeletal widening in conventional distractions (Surgical Assisted Rapid Maxillary Expansion) is often modest, in contrast with a predominant anterior expansion. Until recently, it was not possible to consider transverse palatal distraction osteogenesis and Le Fort I impaction or advancement in the same procedure, as the osteosynthesis plates impeded maxillary anterior opening. We developed new sliding osteosynthesis plates allowing to perform an advancement or impaction Le Fort I osteotomy associated with a low-resistance bipartite palatal distraction osteogenesis. We had for aim to describe the device and to determine its clinical applications. MATERIAL This new palatal distractor is made up of two independent stainless steel jacks allowing for an adjustable distraction in the anterior or posterior area as needed. Bone-borne and tooth-borne versions are available. DISCUSSION This new distractor can be adjusted sagittally. The distraction can be angular or parallel, and the distraction mode can be modified during post-operative distraction. This device should be adapted to all clinical presentations. It can be used in combination with sliding osteosynthesis to perform a Le Fort 1 osteotomy and at the same time a complete correction of vertical, horizontal, and sagittal deficiencies.
Collapse
|
18
|
[Sliding osteosynthesis: a new technique for transverse palatal distraction osteogenesis associated with advancement and/or impaction Le Fort I osteotomy]. ACTA ACUST UNITED AC 2013; 114:19-23. [PMID: 23711212 DOI: 10.1016/j.revsto.2012.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 06/02/2012] [Accepted: 12/16/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND The orthopedic and surgically assisted maxillary expansion is often followed by maxillary advancement osteotomy. The posterior width gain is often small. The expansion is often more extended anteriorly. It impairs posterior correction. The authors describe a new device, ensuring both transversal and sagittal maxillary correction in a single procedure. MATERIAL AND SURGICAL TECHNIQUE The sliding internal fixation device is in titanium, 0.8mm thick. It is made up of two plates (Deltex(®), Paris cedex 15, France): an inferior plate with a 45°-angulated slide, a superior plate with a spur. The surgical technique is a Le Fort 1 segmented osteotomy. The distractor is activated between the fifth and 10th postoperative day. Contention is maintained for 1 year after the end of activation. DISCUSSION This sliding osteosynthesis technique allows stabilizing the advancement and/or impaction as well as transversal expansion for large transversal deficits in adult patients. This technique avoids performing a second procedure.
Collapse
|
19
|
Split-thickness skin graft harvested from the scalp for the coverage of extensive temple or forehead defects in elderly patients. ACTA ACUST UNITED AC 2012; 14:137-9. [PMID: 22431817 DOI: 10.1001/archfacial.2011.1345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To review our experience of facial reconstruction with split-thickness skin grafts (STSGs) harvested from the scalp. METHODS We included all patients undergoing STSG harvested from the scalp for the reconstruction of extensive forehead or temple defects after cancer resection. We recorded the size of resection before surgery and after healing, and we calculated the resulting contraction rate. Time of healing and occurrence of complication were also recorded. RESULTS Forty patients were included. Their mean age was 87 years, and the mean size of resection was 26 cm(2). The duration of healing at the donor site was shorter than 12 days, and pain levels were low. The rate of contraction at the recipient site was 11% after healing. Good morphologic outcomes were reported by both patients and surgeon. CONCLUSION Extensive forehead and temple defects can be covered in this way with a low morbidity; rapid, painless healing; and a high success rate, making this procedure particularly suitable for elderly patients.
Collapse
|
20
|
Semi-free radial forearm flap for head and neck reconstruction in vessel-depleted neck after radiotherapy or radical neck dissection. Microsurgery 2012; 32:269-74. [PMID: 22371166 DOI: 10.1002/micr.21945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 11/05/2011] [Accepted: 11/10/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Venous thrombosis is the main cause of radial forearm flap failure, especially when recipient vessels are compromised by prior radiation therapy or neck dissection. In such conditions, semi-free radial forearm flap (SF-RFF) can be performed to reduce this risk. PATIENTS AND METHOD We reviewed all SF-RFF procedures performed in our institution for head and neck reconstruction. The flap was harvested as a conventional radial forearm flap but the cephalic vein was dissected along the arm up to the deltopectoral crease and used as the sole drainage vein. RESULT Seven SF-RFFs were harvested for head and neck reconstructions. The dissection of the cephalic vein lasted less than 25 min in all cases. No flap loss or thrombosis was observed. CONCLUSION The SF-RFF is a reliable and versatile procedure for facial, oral, or larynx reconstruction. This hybrid version of the radial forearm free flap is particularly appropriate when no suitable recipient veins are available as a result of radiation or prior surgery.
Collapse
|
21
|
Reconstruction mammaire par lambeau de superior gluteal artery perforator (SGAP) sans changement d’installation. À propos de huit cas. ANN CHIR PLAST ESTH 2010; 55:539-46. [DOI: 10.1016/j.anplas.2010.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 09/09/2010] [Indexed: 10/18/2022]
|
22
|
Sauvetage de prothèses en reconstruction mammaire : à propos de sept cas consécutifs. ANN CHIR PLAST ESTH 2010; 55:578-82. [DOI: 10.1016/j.anplas.2010.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 07/01/2010] [Indexed: 11/28/2022]
|
23
|
[Increasing the reliability of SIEA flap using peroperative fluorescent angiography with indocyanine green in breast reconstruction]. ANN CHIR PLAST ESTH 2010; 55:531-8. [PMID: 20863606 DOI: 10.1016/j.anplas.2010.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED The lower abdominal skin and fat have become a standard for breast reconstruction. For 30 years, techniques have evolved, seeking to reduce the morbidity while increasing the reliability of the flap. The Superficial Inferior Epigastric flap Artery (SIEA) spares the abdominal fascia and provides a very satisfying autologous breast reconstruction. However, the pedicle of this flap and its angiosome exhibit a considerable variability, making its use less reliable than other abdominal flaps. MATERIAL The Indocyanine green (ICG) is soluble dye. When illuminated by an near-infrared light, the ICG emits fluorescence that is not trapped by the skin. A single device (Photo Dynamic Eye(®)) provides the emission of the near-infrared light and the reception of the fluorescence. It provides therefore a simple and efficient intraoperative real-time surface angiographic imaging. SURGICAL PROTOCOL: After dissecting the superficial inferior epigastric vessels, the abdominal flap was harvested from the abdominal wall preserving one perforator arising from the deep inferior epigastric vessels. The perforator was then clamped, and the vascular territory of the SEIA artery was visualized using laser-induced fluorescence of the indocyanine green. The surgical technique was modified depending on the indication for surgery and the result of perfusion measurements. RESULTS The authors present four clinical cases of breast reconstruction with SIEA to illustrate this procedure. CONCLUSION The SIEA flap is another surgical technique to achieve autologous breast reconstruction without abdominal morbidity or muscular dissection. Intraoperative angiographic imaging with ICG makes this flap more reliable.
Collapse
|
24
|
[Current role of laparoscopy in the diagnosis and treatment of ovarian cysts]. REVUE FRANCAISE DE GYNECOLOGIE ET D'OBSTETRIQUE 1992; 87:248-52. [PMID: 1385655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Between October 1986 and March 1990, 220 patients underwent surgical treatment for ovarian cysts. 156 of these patients underwent an initial celioscopy and could potentially benefit from celiosciopic treatment. The group mean age was 33.3 years. The circumstances under which the cysts were discovered usually consisted of pelvic pain or diagnosis during a routine examination. Twenty-four patients underwent laparotomy immediately after coelioscopy either due to a suspect macroscopic diagnosis either due to technical difficulties. 84.6 percent of the patients in the group were able to undergo celioscopic treatment only, essentially consisting of intraperitoneal cystectomy. The main advantages were the reduction in adherent sequelae in these women of a sexually active age, but also some financial savings related to the reduced duration of hospitalization and of sick leave. The theoretical reservations consist of the risk of malignancy and macroscopic diagnosis following coelioscopic exploration must be very restricted, with laparotomy whenever there is any doubt. No malignant tumor was escaped detection in this group.
Collapse
|
25
|
[Sites of endometriosis]. LA REVUE DU PRATICIEN 1990; 40:1091-6. [PMID: 2345851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endometrious may be located in many parts of the body which are not limited to the pelvic region. While the classical theory of menstrual reflux easily accounts for the genital locations, other theories, notably metaplasia, have been propounded to explain more remote locations. Among the sites of implantation of the disease, the most common is the ovary followed, in order of frequency, by the anterior and posterior parts of the vaginal fornix, the broad ligament of the uterus and the uterosacral ligaments. Endometriosis of the digestive or urinary tract may create problems of differential diagnosis with cancer. External locations are much less frequent.
Collapse
|