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Rizzo A, Frega G, Palloni A, Piemontese A, Di Federico A, Ricci A, Carloni R, Fabbri F, Novelli M, Tavolari S, Di Marco M, Ravaioli M, Brandi G. P-69 Intensive follow-up program and oncological outcomes of 278 biliary tract cancer patients after curative intent surgery: A single-center retrospective experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.124] [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] [Indexed: 11/24/2022] Open
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Carloni R, Pechevy L, Postel F, Zielinski M, Gandolfi S. Is there a therapeutic effect of botulinum toxin on scalp alopecia? Physiopathology and reported cases: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2020; 73:2210-2216. [DOI: 10.1016/j.bjps.2020.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/09/2020] [Indexed: 01/04/2023]
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Gandolfi S, Laloze J, Chaput B, Auquit-Auckbur I, Grolleau JL, Bertheuil N, Carloni R. Nostril Surgery: Indications, Surgical Procedures and Outcomes-A Systematic Review of Published Cases. Aesthetic Plast Surg 2020; 44:2219-2229. [PMID: 32812083 DOI: 10.1007/s00266-020-01911-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/18/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To achieve adequate nasal proportions, nostril surgery can be a complementary technique useful in facial surgery. To help surgeons with the decision to realize nostril surgery, we conducted a systematic review to summarize reported cases on surgical procedures with a specific interest on indications, surgical procedures and postoperative outcomes. A therapeutic algorithm is also proposed. METHOD We carried out this review in accordance with the PRISMA criteria. Twenty-two eligible studies were identified using Medical databases, including 1599 patients. A qualitative and quantitative analysis was carried out. DISCUSSION Excision techniques were realized on 728 patients (45.5%), followed by cinching sutures on 642 patients (40%) and combined techniques: excision techniques with flap advancement techniques in 189 cases (12%), excision techniques with flap advancement techniques and cinching suture in 40 patients (2.5%). When excessive alar flaring was present, alar wedge resection was preferred in the 92% of followed by alar and sill resection. Cinching sutures were realized when excessive alar flaring was associated with a vertical alar axis, in cases of wide alar base, of associated orthognathic surgery. When excessive alar flaring was associated with wide alar bases, indications changed basing on the associated deformities. In 795 patients, nostril surgery was conducted simultaneously with rhinoplasty. CONCLUSION Nostril surgery through excision techniques, cinching sutures or flaps advancement techniques, reveals good outcomes and can be complementary to rhinoplasty or orthognathic surgery. Through this systematic review, we tried to orient surgeons to find the best treatment for nostril base surgery. LEVEL OF EVIDENCE III 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)
- S Gandolfi
- Department of Plastic and Reconstructive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - J Laloze
- Department of Maxillo-Facial and Reconstructive Surgery, Dupuytren University Hospital, Limoges, France
| | - B Chaput
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | - I Auquit-Auckbur
- Department of Plastic and Reconstructive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - J L Grolleau
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | - N Bertheuil
- Department of Plastic and Reconstructive Surgery, Rennes University Hospital, Rennes, France
| | - R Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hopital Privé de L'Estuaire, 505 Rue Irène Joliot Curie, 76620, Le Havre, France.
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Carricaburu A, Nseir I, Vanaret J, Auquit-Auckbur I, Carloni R. [Dorsal skin defect: What solutions exist?]. ANN CHIR PLAST ESTH 2020; 66:184-192. [PMID: 32896452 DOI: 10.1016/j.anplas.2020.07.002] [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: 05/29/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
Dorsal subcutaneous or cutaneous defects can be of multiple origin: tumor, congenital malformation, trauma, chronic radiodermitis ulceration, parting of sutures or spine surgery infection, pressure sore, etc. Wound healing of these defects can be really difficult to obtain with simple processes, such as direct sutures or skingrafts, and often implies skin flap surgery. The rarity of recipients vessels from the dorsal area makes free flaps surgery harduous. Various local or locoregional back cover solutions are available: muscular or musculocutaneous flaps (latissimus dorsi, trapezius muscle, spinal muscles, gluteus maximus), perforator flaps (DICAP, DLICAP, SCAP and IGAP…), random flaps. These flaps are really useful and must be mastered in order to propose the best-suited cover solution for each patient after a precise evaluation of their medical and clinical background. Our study, based on the Literature and some clinical cases, aims to draw up a complete table of local, locoregional and microsurgical coverage solutions by anatomical area for median and paramedian back wound defects and thus to produce a decisional algorithm facilitating our care.
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Affiliation(s)
- A Carricaburu
- Service de chirurgie plastique et de la main, centre hospitalier universitaire Charles-Nicolle, Rouen, France.
| | - I Nseir
- Service de chirurgie plastique, clinique mutualiste de Pessac, 45, avenue du Dr-Albert-Schweitzer, 33600 Pessac, France
| | - J Vanaret
- Service de chirurgie plastique et de la main, centre hospitalier universitaire Charles-Nicolle, Rouen, France
| | - I Auquit-Auckbur
- Service de chirurgie plastique et de la main, centre hospitalier universitaire Charles-Nicolle, Rouen, France
| | - R Carloni
- Service de chirurgie plastique, hôpital Jacques-Monod, 29, avenue Pierre-Mendès-France, 76290 Montivilliers, France
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Carloni R, Gandolfi S, Postel F, Bertheuil N, Pechevy L. Reply to: "The effect of intradermal botulinum toxin on androgenetic alopecia and its possible mechanism". J Am Acad Dermatol 2020; 83:e435-e436. [PMID: 32738424 DOI: 10.1016/j.jaad.2020.07.092] [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: 06/09/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Raphael Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Estuaire Private Hospital, Le Havre, France.
| | - Silvia Gandolfi
- Department of Plastic and Reconstructive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Francois Postel
- Department of Plastic and Reconstructive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Nicolas Bertheuil
- Department of Plastic and Reconstructive Surgery, Rennes University Hospital, Rennes, France
| | - Lolita Pechevy
- Department of Plastic, Reconstructive and Aesthetic Surgery, Estuaire Private Hospital, Le Havre, France
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Filippini DM, Grassi E, Palloni A, Carloni R, Casadei R, Ricci C, Serra C, Ercolani G, Brandi G, Di Marco M. Searching for novel multimodal treatments in oligometastatic pancreatic cancer. BMC Cancer 2020; 20:271. [PMID: 32228504 PMCID: PMC7106565 DOI: 10.1186/s12885-020-06718-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/28/2019] [Accepted: 03/05/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. CASE PRESENTATION We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis. CONCLUSIONS Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.
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Affiliation(s)
- D M Filippini
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - E Grassi
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy.
| | - A Palloni
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - R Carloni
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - R Casadei
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - C Ricci
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - C Serra
- Department of Organ Failure and Transplantation, Ultrasound Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.,General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - G Brandi
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - M Di Marco
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
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Gandolfi S, Carloni R, Mouton J, Auquit-Auckbur I. Finger joint denervation in hand osteoarthritis: Indications, surgical techniques and outcomes. A systematic review of published cases. Hand Surg Rehabil 2020; 39:239-250. [PMID: 32171925 DOI: 10.1016/j.hansur.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/02/2020] [Accepted: 02/08/2020] [Indexed: 10/24/2022]
Abstract
In cases of osteoarthritis with preserved motion, joint denervation can be an effective alternative to arthroplasty or arthrodesis to reduce joint-related pain. Although denervation is a standardized procedure for wrist osteoarthritis, it is used sparingly for finger joints. We conducted a systematic review to summarize reported cases of finger joint denervation in hand osteoarthritis with a specific focus on surgical procedures and postoperative outcomes. PubMed, Cochrane and Science Direct databases were searched from 1998 to 2019 and 13 relevant articles were selected. Three hundred and twenty-five denervations were conducted on 291 patients. Distal interphalangeal (DIP) joint denervation was performed through a dorsal approach; 83% of patients were satisfied with the surgery and complications occurred in 58%. Proximal interphalangeal (PIP) joint denervation was performed through a palmar approach; 90% of patients were satisfied with the surgery; complications were observed in 14%. Good results were observed in 95% of patients who underwent metacarpophalangeal (MCP) joint denervation; complications were observed in 26%; denervation was carried out with dorsal and palmar approaches in all cases. Denervation of the trapeziometacarpal (TMC) joint was achieved through the Wagner approach (61%), multiple incisions (26%), or dorsal approach (13%); satisfaction rate was 91%, with a 6% complication rate. Finger joint denervation in hand osteoarthritis is a simple and effective procedure, providing satisfactory pain relief. Good results are reported in all studies, especially for PIP and TMC joint denervation. Further investigations should be conducted on DIP and MCP joint denervation.
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Affiliation(s)
- S Gandolfi
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France.
| | - R Carloni
- Department of Plastic, Reconstructive Surgery, Hopital Privé de l'Estuaire, 505, rue Irène Joliot-Curie, 76620 Le Havre, France
| | - J Mouton
- Department of Orthopedic Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France
| | - I Auquit-Auckbur
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France
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Carloni R, Gandolfi S, Elbaz B, Bonmarchand A, Beccari R, Auquit-Auckbur I. Dorsal Dupuytren's disease: a systematic review of published cases and treatment options. J Hand Surg Eur Vol 2019; 44:963-971. [PMID: 31184950 DOI: 10.1177/1753193419852171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 02/03/2023]
Abstract
Dorsal lesions in Dupuytren's disease are rare and data concerning their epidemiology and management are sparse. We conducted a systematic review to summarize reported cases of dorsal Dupuytren's disease. Pubmed, Cochrane, and Embase databases were searched from 1893 to 2018, and 17 articles were selected (525 patients). The male to female ratio was 3.8:1. The dorsal disease was bilateral in 225 patients (50%). The index was the most commonly affected finger (48 patients). The proximal interphalangeal joint was the most commonly affected (484 cases). The most frequently reported lesions were knuckle pads (503 patients), dorsal nodules between interphalangeal joints (14 patients), boutonnière deformities (12 patients), and swan-neck deformities (2 patients). Nearly half of the included patients were treated surgically. Postoperative functional result depended on the treated lesion. Most of the included studies had a low level of evidence. Higher-quality studies are necessary to confirm our findings.
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Affiliation(s)
| | - Silvia Gandolfi
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Benedicte Elbaz
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Albane Bonmarchand
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Roberto Beccari
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Isabelle Auquit-Auckbur
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
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Gandolfi S, Auquit-Auckbur I, Poirot Y, Bonmarchand A, Mouton J, Carloni R, Nseir I, Duparc F. Focus on anatomical aspects of soft tissue coverage options in elbow reconstruction: an updating review. Surg Radiol Anat 2018; 40:943-954. [DOI: 10.1007/s00276-018-2066-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/05/2018] [Indexed: 11/30/2022]
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Sticchi C, Alberti M, Artioli S, Assensi M, Baldelli I, Battistini A, Boni S, Cassola G, Castagnola E, Cattaneo M, Cenderello N, Cristina ML, De Mite AM, Fabbri P, Federa F, Giacobbe DR, La Masa D, Lorusso C, Marioni K, Masi VM, Mentore B, Montoro S, Orsi A, Raiteri D, Riente R, Samengo I, Viscoli C, Carloni R. Regional point prevalence study of healthcare-associated infections and antimicrobial use in acute care hospitals in Liguria, Italy. J Hosp Infect 2017; 99:8-16. [PMID: 29253622 DOI: 10.1016/j.jhin.2017.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 08/03/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Given the importance of monitoring healthcare-associated infections (HCAIs) and the consumption of antibiotics, a regional point prevalence survey was conducted in Liguria between March and April 2016. AIM To measure the overall prevalence of HCAI and describe the use of antibiotics in all public hospitals. METHODS Data on risk factors and use of antibiotics were collected for each hospitalized patient. To define the variables significantly associated with HCAI, univariate and multivariate analyses were conducted. Standardized infection ratio and standardized antimicrobial use ratio were measured for each participating hospital. FINDINGS A total of 3647 patients were enrolled. In all, 429 HCAIs were diagnosed in 376 patients, giving a prevalence of HCAI of 10.3%. Respiratory tract (21.7%) and urinary tract (20%) were the most frequent sites of infection. High rates of meticillin-resistant Staphylococcus aureus (47.4%) and Enterobacteriaceae resistant to carbapenems (26.3%) were isolated. Forty-six percent of patients received at least one antibiotic. Combinations of penicillins including β-lactamase inhibitors (24.1%) were the most widely used; the main indication (46.7%) was the treatment of a community-acquired infection. CONCLUSION There was an increase in HCAI prevalence compared to a similar survey conducted in 2007; however, the performance of overlapping investigations will enable more reliable considerations. Nevertheless, data on antimicrobial resistance and use of antibiotics are consistent with the national trend. Despite methodological limitations, prevalence studies are useful to monitor HCAI over time and encourage greater awareness of the problem by all stakeholders.
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Affiliation(s)
- C Sticchi
- Infectious Diseases, Epidemiology and Prevention, Health Regional Agency, Liguria, Italy.
| | - M Alberti
- International Evangelical Hospital, Genoa, Italy
| | | | | | - I Baldelli
- IRCCS Giannina Gaslini Institute, Genoa, Italy
| | | | - S Boni
- ASL 5 Spezzino, La Spezia, Italy
| | - G Cassola
- Infectious Diseases Unit, Galliera Hospital, Genoa, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, Giannina Gaslini Institute, Genoa, Italy
| | | | | | | | | | | | | | - D R Giacobbe
- Infectious Diseases Unit, San Martino Polyclinic Hospital, University of Genoa, Italy
| | - D La Masa
- IRCCS Giannina Gaslini Institute, Genoa, Italy
| | | | | | - V M Masi
- International Evangelical Hospital, Genoa, Italy
| | | | | | - A Orsi
- San Martino Polyclinic Hospital, Genoa, Italy
| | - D Raiteri
- Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - R Riente
- San Paolo Hospital, Savona, Italy
| | | | - C Viscoli
- Infectious Diseases Unit, San Martino Polyclinic Hospital, University of Genoa, Italy
| | - R Carloni
- Infectious Diseases, Epidemiology and Prevention, Health Regional Agency, Liguria, Italy
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Affiliation(s)
- Audrey Patoué
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
- Department of Plastic, Reconstructive and Aesthetic Surgery, Trousseau Hospital, University of Tours, Tours, France
| | - Antoine De Runz
- Department of Maxillofacial, Plastic, Reconstructive and Cosmetic Surgery, Nancy University Hospital, Nancy, France
| | - Raphael Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Charles Nicolle Hospital, Rouen, France
| | - Sylvie Aillet
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
- INSERM U917, University of Rennes 1, Rennes, France
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France
- STROMAlab, UMR5273 CNRS/UPS/EFS-INSERM U1031, Rangueil Hospital, Toulouse, France
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Pechevy L, Carloni R, Guerid S, Vincent PL, Toussoun G, Delay E. Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures. Aesthet Surg J 2017; 37:665-677. [PMID: 28171481 DOI: 10.1093/asj/sjw258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate. OBJECTIVES We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF. METHODS Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed. RESULTS Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001). CONCLUSIONS The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Lolita Pechevy
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Raphael Carloni
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Samia Guerid
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Pierre-Luc Vincent
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Gilles Toussoun
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Emmanuel Delay
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
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Pechevy L, Carloni R. Reply to: A systematic review of complications associated with direct implants vs. tissue expanders following wise pattern skin-sparing mastectomy. J Plast Reconstr Aesthet Surg 2017; 70:1200-1201. [PMID: 28412034 DOI: 10.1016/j.bjps.2017.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Lolita Pechevy
- Department of Plastic, Reconstructive and Aesthetic Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Raphael Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Charles Nicolle University Hospital, Rouen, France.
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Chaput B, Bertheuil N, Grolleau JL, Bekara F, Carloni R, Laloze J, Herlin C. Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: A prospective study. Microsurgery 2017; 38:177-184. [DOI: 10.1002/micr.30162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Benoit Chaput
- Department of Plastic and Reconstructive Surgery; Rangueil University Hospital; Toulouse France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery; Hospital Sud, University of Rennes 1; Rennes France
| | - Jean-Louis Grolleau
- Department of Plastic and Reconstructive Surgery; Rangueil University Hospital; Toulouse France
| | - Farid Bekara
- Department of Plastic and Reconstructive Surgery; Lapeyronie University Hospital; Montpellier France
| | - Raphael Carloni
- Department of Plastic and Hand Surgery; CHU Charles Nicolle; Rouen France
| | - Jerome Laloze
- Department of Plastic and Reconstructive Surgery; Rangueil University Hospital; Toulouse France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery; Lapeyronie University Hospital; Montpellier France
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Chaput B, Herlin C, de Bonnecaze G, Carloni R, Laloze J, Bertheuil N. One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation. Plast Reconstr Surg 2017; 139:807e-808e. [PMID: 28234880 DOI: 10.1097/prs.0000000000003101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Benoit Chaput
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital Toulouse, France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Guillaume de Bonnecaze
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Raphael Carloni
- Department of Plastic and Hand Surgery, CHU Rouen, Rouen, France
| | - Jerome Laloze
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
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Bekara F, Bertheuil N, Carloni R, Dast S, Sinna R, Chaput B, Herlin C. Venous Supercharging Reduces Complications and Improves Outcomes of Distally Based Sural Flaps. J Reconstr Microsurg 2017; 33:343-351. [DOI: 10.1055/s-0037-1598620] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background The use of distally based neurocutaneous sural flaps (DBNCSF) is one of the most common methods of reconstructing the distal lower leg. However, they have developed a bad reputation because of their propensity for venous engorgement. Venous congestion that can lead to distal necrosis can be prevented by venous supercharging. Using a prospective comparative study, we thus explored the effect of venous supercharging on the reliability of these useful workhorse flaps.
Methods We prospectively included 38 patients who received a conventional DBNCSF and 38 patients who received a supercharged version of this flap (sDBNCSF) between January 2012 and July 2016.
Results No significant difference was identified between the groups in terms of age, sex, comorbidity, or defect origin. The main reconstruction etiology was traumatic (open fracture, scar disunion, and chronic osteitis). The flap size was noticeably larger in the sDBNCSF group, albeit without significance. The length-width ratio was significantly greater in the sDBNCSF group (6.08 vs. 5.53, p = 0.022). Venous congestion was significantly more common in the non-supercharged group (28.6 vs. 2.6%, p = 0.01), as was coverage failure (23.7 vs. 2.6%, p = 0.035).
Conclusion There are significant benefits to using venous supercharging of DBNCSF, when technically feasible. In our experience, venous supercharging increases reliability, allows the raise of larger skin paddles with much narrower pedicles limiting the morbidity of the procedure, and improves the functional and esthetic results.
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Affiliation(s)
- Farid Bekara
- Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, South University Hospital, Rennes, France
| | - Raphael Carloni
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle Hospital, Rouen, France
| | - Sandy Dast
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Picardie, Amiens, France
| | - Raphael Sinna
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Picardie, Amiens, France
| | - Benoit Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rangueil, Toulouse, France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
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Bertheuil N, Carloni R, Bekara F, Laloze J, Herlin C, Chaput B. Propeller Perforator Flaps of Extremities Seem Less Reliable. J Reconstr Microsurg 2017; 33:603-604. [DOI: 10.1055/s-0036-1597991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- N. Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - R. Carloni
- Department of Plastic and Hand Surgery, CHU Charles Nicolle, Rouen, France
| | - F. Bekara
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - J. Laloze
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | - C. Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - B. Chaput
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
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Carloni R, Naudet F, Watier E, Bertheuil N. Comments on "What is Wrong With Systematic Reviews and Meta-Analyses: If You Want the Right Answer, Ask the Right Question!". Aesthet Surg J 2017; 37:NP22-NP23. [PMID: 28052907 DOI: 10.1093/asj/sjw230] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Raphael Carloni
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France.
| | - Florian Naudet
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
| | - Eric Watier
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
| | - Nicolas Bertheuil
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France
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Patoué A, Herlin C, Carloni R, Chaput B, Watier E, Bertheuil N. Modified Lipoabdominoplasty: Updating Concepts-Our Postbariatric Experience. Plast Reconstr Surg 2016; 139:1021e-1022e. [PMID: 28002280 DOI: 10.1097/prs.0000000000003221] [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] [Indexed: 11/25/2022]
Affiliation(s)
- Audrey Patoué
- Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France, Department of Plastic, Reconstructive, and Aesthetic Surgery, Trousseau Hospital, University of Tours, Tours, France
| | - Christian Herlin
- Department of Plastic Surgery and Burn Surgery, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Raphael Carloni
- Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France, Department of Plastic, Reconstructive, and Aesthetic Surgery, Charles Nicolle Hospital, Rouen, France
| | - Benoit Chaput
- STROMAlab, UMR5273 CNRS/UPS/EFS-INSERM U1031, Rangueil Hospital, and, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France
| | - Eric Watier
- Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes, France, STROMAlab, UMR5273 CNRS/UPS/EFS-INSERM U1031, Rangueil Hospital, Toulouse, France, INSERM U917, University of Rennes 1, Rennes, France, SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France
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Herlin C, Bekara F, Bertheuil N, Frobert P, Carloni R, Chaput B. Deep burns caused by electronic vaping devices explosion. Burns 2016; 42:1875-1877. [DOI: 10.1016/j.burns.2016.08.015] [Citation(s) in RCA: 12] [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: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
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Bosc R, Hersant B, Carloni R, Niddam J, Bouhassira J, De Kermadec H, Bequignon E, Wojcik T, Julieron M, Meningaud JP. Mandibular reconstruction after cancer: an in-house approach to manufacturing cutting guides. Int J Oral Maxillofac Surg 2016; 46:24-31. [PMID: 27815013 DOI: 10.1016/j.ijom.2016.10.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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: 06/04/2016] [Revised: 07/15/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
The restoration of mandibular bone defects after cancer can be facilitated by computer-assisted preoperative planning. The aim of this study was to assess an in-house manufacturing approach to customized cutting guides for use in the reconstruction of the mandible with osteocutaneous free flaps. A retrospective cohort study was performed, involving 18 patients who underwent mandibular reconstruction with a fibula free flap at three institutions during the period July 2012 to March 2015. A single surgeon designed and manufactured fibula and mandible cutting guides using a computer-aided design process and three-dimensional (3D) printing technology. The oncological outcomes, production parameters, and quality of the reconstructions performed for each patient were recorded. Computed tomography scans were acquired after surgery, and these were compared with the preoperative 3D models. Eighteen consecutive patients with squamous cell carcinoma underwent surgery and then reconstruction using this customized in-house surgical approach. The lengths of the fibula bone segments and the angle measurements in the simulations were similar to those of the postoperative volume rendering (P=0.61). The ease of access to 3D printing technology has enabled the computer-aided design and manufacturing of customized cutting guides for oral cancer treatment without the need for input from external laboratories.
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Affiliation(s)
- R Bosc
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France.
| | - B Hersant
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - R Carloni
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - J Niddam
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - J Bouhassira
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
| | - H De Kermadec
- Department of Head and Neck Surgery, Intercity Hospital of Creteil, Creteil, France
| | - E Bequignon
- Department of Head and Neck Surgery, Intercity Hospital of Creteil, Creteil, France
| | - T Wojcik
- Department of Head and Neck Surgery, Oscar Lambret Cancer Centre, Lille, France
| | - M Julieron
- Department of Head and Neck Surgery, Oscar Lambret Cancer Centre, Lille, France
| | - J-P Meningaud
- Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Créteil, France
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Carloni R, Naudet F, Chaput B, de Runz A, Herlin C, Girard P, Watier E, Bertheuil N. Are There Factors Predictive of Postoperative Complications in Circumferential Contouring of the Lower Trunk? A Meta-Analysis. Aesthet Surg J 2016; 36:1143-1154. [PMID: 27402788 DOI: 10.1093/asj/sjw117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The massive weight loss patient may require a circumferential contouring of the lower trunk. OBJECTIVES To summarize the complication rates and explore the possibility of predictive risk factors for complications. METHODS We performed a systematic review using the PubMed and Cochrane databases to identify published articles on the topic. Random effects meta-analyses and meta-regression were conducted to synthesize the data gathered. RESULTS The analysis included 28 studies and 1380 patients. All but one were retrospective cohorts or case studies. Circumferential contouring of the lower trunk resulted in 37% [95%-CI 30%; 44%] overall complications; 17% [95%-CI 12%; 24%] wound dehiscences; 4% [95%-CI 3%; 5%] skin necrosis; 5% [95%-CI 3%; 9%] infections; 3% [95%-CI 2%; 4%] hematomas; 13% [95%-CI 9%; 18%] seromas; 12% [95%-CI 7%; 21%] scar irregularities; 3% [95%-CI 2%; 5%] thromboembolism; and 5% [95%-CI 3%; 8%] revisions for complications. Lower body lift-related techniques were associated with a higher rate of overall complications than belt lipectomy-related techniques (P = .002). No difference in complication rate was shown when performing a gluteal augmentation with flap. Due to insufficient data reported in the studies, risk factors for postoperative complications could not be assessed. CONCLUSIONS The whole literature provides very low reliable information. Confusion factors could not be ruled out to explain the increased complications rate for the lower body lift compared to the belt lipectomy. This finding needs to be confirmed in randomized trials. Collaborative efforts must be made to improve the evidence level of our practices and to serve patients in an optimal way. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Raphael Carloni
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Florian Naudet
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Benoit Chaput
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Antoine de Runz
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Christian Herlin
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Paul Girard
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Eric Watier
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
| | - Nicolas Bertheuil
- Drs Carloni, Watier, and Bertheuil are Plastic and Reconstructive Surgeons, and Dr Girard is a Fellow, Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes, Rennes, France. Dr Naudet is a Psychiatrist and Methodologist, Department of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France. Dr Chaput is a Plastic and Reconstructive Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University, Toulouse, France. Dr de Runz is a Plastic and Reconstructive Surgeon, Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France. Dr Herlin is a Plastic and Reconstructive Surgeon, Department of Plastic Surgery and Burn Surgery, Hospital Lapeyronie, Montpellier University Hospital, Montpellier, France
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Carloni R, De Runz A, Chaput B, Herlin C, Girard P, Watier E, Bertheuil N. Erratum to: Circumferential Contouring of the Lower Trunk: Indications, Operative Techniques, and Outcomes-A Systematic Review. Aesthetic Plast Surg 2016; 40:669. [PMID: 27439535 DOI: 10.1007/s00266-016-0677-y] [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] [Indexed: 10/21/2022]
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Ellart J, Grolleau JL, Gangloff D, Meresse T, Garrido I, Bertheuil N, Carloni R, Chaput B. [Morbidity of bodylift. Evaluation of 111 patients over 5 years]. ANN CHIR PLAST ESTH 2016; 61:820-826. [PMID: 27666182 DOI: 10.1016/j.anplas.2016.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/05/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The management of patients with weight loss sequelae, sometimes major, is increasingly well standardized. However, this surgery is not without risk. Complications of bodylift are more frequent than those of conventional abdominoplasties. The objective of this study was to evaluate the morbidity associated with this surgery through a retrospective, single-center study. MATERIALS AND METHODS One hundred and eleven circular abdominaloplasties were conducted between June 2011 and September 2015 in the plastic surgery department of the university hospital of Toulouse. Minor and major complications were identified and analyzed. RESULTS Frequency of postoperative complications was 44.1% in our series. Major complications have involved 15.3% of patients. Blood transfusions (9%) and hematoma requiring reoperation (7.2%) were the most frequent major complications. We found significantly more major complications in patients with important fat resection with a cut off at 3200 g (P=0.02). Men experienced significantly more major complications than women (P=0.005). The average delta-BMI (before and after weight loss) was significantly higher in the group of patients with the highest percentage of minor complications (P=0.045). Indeed, a high delta-BMI (greater than 19.5) was associated with an excess risk of minor complications in our population. CONCLUSION Democratization and progress in the field of bodylift should not obscure the fact that it is, in reality, a procedure at risk. While we manage increasingly better cosmetic results and thromboembolic complications, it still persists many complications.
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Affiliation(s)
- J Ellart
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Lille, rue Émile-Laine, 59037 Lille, France
| | - J-L Grolleau
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - D Gangloff
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - T Meresse
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - I Garrido
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - N Bertheuil
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Sud, université de Rennes 1, 2, rue Henri-Le-Guillax, 35000 Rennes, France
| | - R Carloni
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
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Mojallal A, Bertheuil N, Carloni R, Grolleau J, Sinna R, Bekara F, Herlin C, Chaput B. Free-Flap Reconstruction: What Do Microsurgeons Prefer for Themselves? J Reconstr Microsurg 2016; 32:639-42. [DOI: 10.1055/s-0036-1584807] [Citation(s) in RCA: 4] [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] [Indexed: 10/21/2022]
Affiliation(s)
- Ali Mojallal
- Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Raphael Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Jean Grolleau
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | - Raphael Sinna
- Department of Plastic and Reconstructive Surgery, Nord University Hospital, Amiens, France
| | - Farid Bekara
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Benoit Chaput
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
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Bertheuil N, Carloni R, De Runz A, Herlin C, Girard P, Watier E, Chaput B. Medial thighplasty: Current concepts and practices. ANN CHIR PLAST ESTH 2016; 61:e1-7. [PMID: 26433317 DOI: 10.1016/j.anplas.2015.08.006] [Citation(s) in RCA: 12] [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: 07/27/2015] [Accepted: 08/30/2015] [Indexed: 12/18/2022]
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Boureaux E, Chaput B, Bannani S, Herlin C, De Runz A, Carloni R, Mortemousque B, Mouriaux F, Watier E, Bertheuil N. Eyelid fat grafting: Indications, operative technique and complications; a systematic review. J Craniomaxillofac Surg 2016; 44:374-80. [PMID: 26880013 DOI: 10.1016/j.jcms.2015.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 09/08/2015] [Revised: 11/24/2015] [Accepted: 12/23/2015] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Many recent studies concerning autologous fat grafting in the eyelids have been published, mostly consisting of case reports and retrospective case series. However, no study on the overall complication or satisfaction rate associated with the various grafting techniques exists. We performed a comprehensive literature review to determine the outcomes and complications of eyelid fat grafting, as well as patient satisfaction. METHODS A systematic review of the literature using the PRISMA criteria was conducted. This protocol was registered at the Prospective Register of Systematic Reviews at the National Institute for Health Research. RESULTS Sixteen studies, representing 1,159 patients and published between June 2004 and December 2014, were included. Satisfactory results, judged by clinical examination, were observed in all studies. Few postoperative complications were reported. CONCLUSIONS We demonstrated that the procedures were easy to perform, and achieved satisfactory and sustainable results with few complications in both reconstructive and cosmetic surgery. However, a wide disparity exists in the various fat harvesting, fat purification, and reinjection techniques. Further studies are required to assess the long-term outcomes. Our conclusions should be accepted cautiously due to the small number of articles and the lack of evidence in published studies.
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Affiliation(s)
- Elodie Boureaux
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France; Department of Ophthalmology, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| | - Benoit Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Sahar Bannani
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie Burn Center, CHU of Montpellier, Montpellier, France
| | - Antoine De Runz
- Department of Maxillofacial, Plastic, Reconstructive and Cosmetic Surgery, CHU of Nancy, Nancy, France
| | - Raphael Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Bruno Mortemousque
- Department of Ophthalmology, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| | - Frederic Mouriaux
- Department of Ophthalmology, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France; INSERM U917, University of Rennes 1, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France; INSERM U917, University of Rennes 1, Rennes, France; SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France; Stromalab Laboratory, UMR5273 CNRS/UPS/EFS - INSERM U1031, Rangueil Hospital, Toulouse, France.
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Carloni R, Hersant B, Bosc R, Bertheuil N, Meningaud JP. Re: 'Reconstructive approach to hostile cranioplasty: A review of the University of Chicago experience'. J Plast Reconstr Aesthet Surg 2015; 68:1616-7. [PMID: 26162994 DOI: 10.1016/j.bjps.2015.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/20/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Raphael Carloni
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
| | - Barbara Hersant
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Romain Bosc
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Jean-Paul Meningaud
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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Carloni R, Hersant B, Bosc R, Le Guerinel C, Meningaud JP. Soft tissue expansion and cranioplasty: For which indications? J Craniomaxillofac Surg 2015; 43:1409-15. [PMID: 26189146 DOI: 10.1016/j.jcms.2015.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 03/16/2015] [Revised: 05/19/2015] [Accepted: 06/15/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this study was to better define indications for scalp tissue expansion before cranioplasty, and to describe our methodology for calculate the surface of tissue needed, by combining a preoperative analysis of both the size of the defect and the quality of skin above. MATERIAL AND METHODS A retrospective analysis of patients who underwent expansion before cranioplasty between 2009 and 2015 was conducted. Information was collected on the etiology, size and location of the defect, and reasons of skin contracture. Data concerning expansion and cranioplasty were reviewed. RESULTS Among 47 patients who underwent operation for cranioplasty, five (10.6%) required previous scalp tissue expansion. The etiology of the bone defect was tumoral in three cases, posttraumatic in one case, and a decompressive craniectomy in one case. The mean surface of the bone defect was 69.6 ± 18.7 cm(2). The locations of the defects were fronto-temporo-parietal, frontal, temporo-frontal, on the vertex, and occipital. The cause associated with the skin contracture was an infection in four cases and a delayed cranioplasty in one case. A round-profile expander and a custom-made porous hydroxyapatite implant were used for all patients. CONCLUSIONS The accurate assessment of tissue needed before cranioplasty is as essential as the choice of the material used for bone reconstruction. After previous infected cranioplasty or delayed reconstruction of large defects, scalp tissue expansion should be proposed.
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Affiliation(s)
- R Carloni
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
| | - B Hersant
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - R Bosc
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - C Le Guerinel
- Department of Neurosurgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - J P Meningaud
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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Carloni R, Pechevy L, Isola N, Vidal L, Goga D, Watier E, Bertheuil N. [Fournier's gangrene: Cervical and facial extension. A very rare case]. ANN CHIR PLAST ESTH 2015; 61:84-9. [PMID: 25766003 DOI: 10.1016/j.anplas.2015.02.003] [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: 11/25/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
Fournier's gangrene is a fearsome disease with a bad prognosis and a mortality rate ranging between 10 and 80% according to the literature. It is extensive in 13 to 54% of cases. Up to date, cervico-facial extension has never been reported. We describe the case of a 51-year-old overweighed woman with a history of type 2 diabetes and a narrow lumbar canal who was referred to our institution for significant fatigue and increasingly painful legs. A diagnosis of Fournier's gangrene was made after correlating the physical findings with the results of a full body scan. Diffuse subcutaneous emphysema involving the face, neck, mediastinum, abdominal wall, right buttock, perineum and the right thigh was identified. Treatment included multiple surgical debridements, admission to intensive care unit, and an efficient antibiotic therapy that enabled preservation of the patient's life. To our knowledge, this is the first case of cervical and mediastinal extension of Fournier's gangrene to be reported. No clear guidelines exit on the management of this complication (cervico-facial and mediastinal drainage). We share our experience of this unusual case.
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Affiliation(s)
- R Carloni
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France.
| | - L Pechevy
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - N Isola
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - L Vidal
- Institut de recherches médicales A.-Lanari, université de Buenos-Aires, C1427ARO Buenos-Aires, Argentine
| | - D Goga
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - E Watier
- Service de chirurgie plastique et reconstructrice, hôpital Sud, CHU de Rennes, boulevard de Bulgarie, 35200 Rennes, France
| | - N Bertheuil
- Service de chirurgie plastique et reconstructrice, hôpital Sud, CHU de Rennes, boulevard de Bulgarie, 35200 Rennes, France; Inserm U917, université de Rennes 1, 35033 Rennes, France; Laboratoire SITI, établissement français du sang Bretagne, CHU de Rennes, 35033 Rennes, France; STROMAlab, UMR5273 CNRS/UPS/EFS - Inserm U1031, hôpital Rangueil, 31059 Toulouse, France
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Unal R, Klijnstra F, Burkink B, Behrens SM, Hekman EEG, Stramigioli S, Koopman HFJM, Carloni R. Modeling of WalkMECH: a fully-passive energy-efficient transfemoral prosthesis prototype. IEEE Int Conf Rehabil Robot 2014; 2013:6650406. [PMID: 24187225 DOI: 10.1109/icorr.2013.6650406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this paper we present the port-based model of WalkMECH, a fully-passive transfemoral prosthesis prototype that has been designed and realized for normal walking. The model has been implemented in a simulation environment so to analyze the performance of the prosthetic leg in walking experiments and so to enhance the mechanics of the system. The accuracy of the model has been validated by experimental tests with a unilateral amputee participant.
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Carloni R, Delay E, Gourari A, Ho Quoc C, Tourasse C, Balleyguier C, Forme N, Goga D. Preoperative imaging prior to breast reconstruction surgery: benchmarking bringing together radiologists and plastic surgeons. Proposed guidelines. ANN CHIR PLAST ESTH 2014; 59:e13-9. [PMID: 24556529 DOI: 10.1016/j.anplas.2013.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/04/2013] [Accepted: 07/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prescription of preoperatory imaging assessment prior to planned breast reconstruction surgery (reduction or augmentation mastoplasty, correction of congenital breast asymmetry) is poorly codified. The objective of this study was to analyze the attitudes of French radiologists and plastic surgeons with regard to prescription of preoperative imaging in the framework of non-oncologic breast surgery. MATERIAL AND METHODS This is a descriptive and comparative observational study involving two groups, one consisting of 50 plastic surgeons (P) and the other of 50 radiologists (R) specialized in breast imaging. A questionnaire was handed out to radiologists during a conference on breast imaging at the Institut Gustave-Roussy in Paris (France) held on 17th December 2012. The same questionnaire was handed out to plastic surgeons at the National Congress of the French Society of Plastic and Reconstructive Surgery (SOFCPRE) held on 19th, 20th and 21st November 2012, also in Paris (France). The questionnaire focused on prescription of preoperative and postoperative imaging evaluation for non-oncologic breast surgery in patients with no risk factors for breast cancer or clinically identified indications. RESULTS Forty-six percent of the plastic surgeons considered an imaging exam to be recent when it had been carried out over the previous 6 months, while 40% of the radiologists set the figure at 1 year. Clinical breast density exerted no influence on 92% of the plastic surgeons and 98% of the radiologists. A majority of the plastic surgeons would prescribe a preoperative exam regardless of age (57% for breast reduction, 61% for breast implant placement and 61% for surgical correction of asymmetry) while the radiologists would prescribe exams mainly for patients over 40 years (50% for reduction, 44% for augmentation, 49% for asymmetry correction). The plastic surgeons would prescribe either ultrasound or mammograms (59% for reduction, 72% for augmentation, 66% for asymmetry correction) while radiologists would usually prescribe mammograms (64%, 57%, 64%). Most of the radiologists, along with the plastic surgeons, did not think that postoperative examination is justified (58% of P and 62% of R for reduction, 56% P and 68% of R for augmentation, 52% of P and 64% of R for asymmetry correction). CONCLUSION In 2012, there existed no French consensus on prescription of a preoperative imaging assessment in the framework of non-oncologic breast surgery in patients without risk factors for breast cancer. Active cooperation bringing together radiologists and plastic surgeons is likely to facilitate the harmonizing of their respective practices. In this paper, we propose guidelines that could help them to synchronize their efforts.
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Affiliation(s)
- R Carloni
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - E Delay
- Plastic and reconstructive surgery, centre régional Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - A Gourari
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France; Plastic and reconstructive surgery, centre régional Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - C Ho Quoc
- Plastic and reconstructive surgery, centre régional Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - C Tourasse
- Hôpital privé Jean-Mermoz, 55, avenue Jean-Mermoz, 69008 Lyon, France
| | - C Balleyguier
- Imaging unit, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - N Forme
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - D Goga
- Plastic and reconstructive surgery unit, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
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Behrens SM, Unal R, Hekman EEG, Carloni R, Stramigioli S, Koopman HFJM. Design of a fully-passive transfemoral prosthesis prototype. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:591-4. [PMID: 22254379 DOI: 10.1109/iembs.2011.6090111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this study, we present the mechanical design of a prototype of a fully-passive transfemoral prosthesis for normal walking. The conceptual working principle at the basis of the design is inspired by the power flow in human gait, with the main purpose of realizing an energy efficient device. The mechanism is based on three elements, which are responsible of the energetic coupling between the knee and ankle joints. The design parameters of the prototype are determined according to the human body and the natural gait characteristics, in order to mimic the dynamic behavior of a healthy leg. Hereby, we present the construction details of the prototype, which realizes the working principle of the conceptual mechanism.
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Affiliation(s)
- S M Behrens
- Faculty of Engineering Technology, MIRA Institute, University of Twente, The Netherlands
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Amicizia D, Cremonesi I, Carloni R, Schiaffino S. The response of the Liguria Region (Italy) to the pandemic influenza virus A/H1N1sv. J Prev Med Hyg 2011; 52:120-123. [PMID: 22010539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Influenza is a cause of acute respiratory disease. It has a typical epidemic nature during the winter season, but may also assume a pandemic pattern when a completely new virus spreads among humans. Influenza places a heavy economic and healthcare burden on both the National Health Service and society. During the 2009/2010 influenza pandemic season, the Liguria Region drew upon the specific skills of the various sectors of the Department of Health and Social Services. In collaboration with the Department of Health Sciences of the University of Genova, the Regional Health Agency (RHA) and other public organizations, steps were taken to address the issues of technical and scientific updating and the coordination of all the departments of Local Healthcare Units in Liguria. The main activities conducted at the regional level provided an adequate response to the influenza pandemic. These activities focused on Local and National Influenza Surveillance Systems, the regional Pandemic Plan, vaccination strategies for seasonal and pandemic influenza, and the communication of data from monitoring programs (sentinel physicians--syndromic surveillance). The prevention of influenza transmission and containment of epidemics and pandemics require effective communication strategies that should target the whole population.
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Affiliation(s)
- D Amicizia
- Department of Health Sciences, University of Genoa, Italy
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Unal R, Carloni R, Hekman EG, Stramigioli S, Koopman HM. Biomechanical conceptual design of a passive transfemoral prosthesis. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:515-8. [PMID: 21095657 DOI: 10.1109/iembs.2010.5626020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we present the conceptual design of a fully-passive transfemoral prosthesis. The proposed design is inspired by the analysis of the musculo-skeletal activity of the healthy human leg. In order to realize an energy efficient device, we introduce three storage elements, which are responsible of the energetic coupling between the knee and the ankle joints. Simulation results show that the power storage of the designed conceptual prosthesis is comparable with the human gait.
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Affiliation(s)
- R Unal
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, The Netherlands.
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Visser LC, Carloni R, Klijnstra F, Stramigioli S. A prototype of a novel energy efficient variable stiffness actuator. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2010:3703-6. [PMID: 21096859 DOI: 10.1109/iembs.2010.5627424] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this work, we present a proof of concept of a novel variable stiffness actuator. The actuator design is based on the conceptual design proposed in earlier work, and is such that the apparent output stiffness of the actuator can be changed independently of the output position and without any energy cost. Experimental results show that the behavior of the prototype is in accordance with the theoretical results of the conceptual design, and thus show that energy efficient variable stiffness actuators can be realized.
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Affiliation(s)
- L C Visser
- Department of Electrical Engineering, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, 7500 AE Enschede, The Netherlands.
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Orsi A, Alicino C, Patria AG, Parodi V, Carloni R, Turello V, Comaschi M, Moscatelli P, Orengo G, Martini M, De Florentiis D. Epidemiological and molecular approaches for management of a measles outbreak in Liguria, Italy. J Prev Med Hyg 2010; 51:67-72. [PMID: 21155408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since March 2010 a measles outbreak has been occurred in Genoa, Liguria, an administrative Region in Northern Italy. Epidemiological and molecular data on the outbreak, obtained from the passive mandatory notification system, the laboratory surveillance and an innovative syndrome surveillance system, were investigated. Overall 39 cases were reported in the urban area. Information about demography, vaccination status, hospitalization and geographic distribution of measles cases are available. 19 cases (48.7%) were laboratory-confirmed and were characterized by sequence analysis: 18 strains belonged to genotype D8, so identifying a new measles variant within the Liguria population. Adopted control measures seem to have limited viral circulation. The outbreak allowed to test the efficacy of the 3 surveillance systems active in Liguria, highlighting their advantages and some important limitations. More efforts are needed to collect and integrate any epidemiological and virological available data in order to better describe the local measles transmission dynamics.
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Affiliation(s)
- A Orsi
- Department of Health Sciences, University of Genoa, Italy.
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Ansaldi F, Sticchi L, Durando P, Carloni R, Oreste P, Vercelli M, Crovari P, Icardi G. Decline in pneumonia and acute otitis media after the introduction of childhood pneumococcal vaccination in Liguria, Italy. J Int Med Res 2009; 36:1255-60. [PMID: 19094434 DOI: 10.1177/147323000803600612] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The effect of the pneumococcal conjugate vaccine immunization programme on pneumococcal-associated or potentially pneumococcal-associated hospital admissions in the Italian region of Liguria was assessed. Hospital admission rates were compared in subjects belonging to birth cohorts before and after the introduction of widespread immunization for 0 - 2-year old children with a seven-valent conjugate vaccine (PCV7). Significant reductions in hospitalization rates for all-cause and pneumococcal pneumonia and for acute otitis media were observed in subjects born after widespread uptake of the vaccine. The preventive fraction (a measure of vaccine effectiveness) ranged from 15.2% for all cause pneumonia to 70.5% for pneumococcal pneumonia. This study contributes to the growing body of information that supports the beneficial effect of PCV7 vaccination.
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Affiliation(s)
- F Ansaldi
- Department of Health Sciences, University of Genoa, Italy
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Ansaldi F, Orsi A, Altomonte F, Bertone G, Parodi V, Carloni R, Moscatelli P, Pasero E, Oreste P, Icardi G. Emergency department syndromic surveillance system for early detection of 5 syndromes: a pilot project in a reference teaching hospital in Genoa, Italy. J Prev Med Hyg 2008; 49:131-135. [PMID: 19350960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Early detection is fundamental for achieving effective control of infectious disease outbreaks. We described the development of a local chief complaint emergency department (ED)-based syndromic surveillance system to improve public health response in Genoa, Italy. The five syndromes under investigation by the syndromic surveillance system were influenza-like illness (ILI), low-respiratory tract illness (LRTI), not-haemorrhagic gastroenteritis, acute hepatitis, fever-with-rash (maculo-papular or vescicular) syndrome. Syndrome coding, data capture, transmission and processing, statistical analysis to assess indicators of disease activity and alert thresholds, and signal response were operatively described. Preliminary results on ILI syndromic surveillance showed that new system allowed the activation of the alert state with a specificity of 90.3% and a sensitivity of 72.9% in predicting epidemiological relevant events, such as > or = 10 accesses to ED for ILI in 3 days. The new syndromic surveillance system allowed to alert the public health institutions 2.5 days before than the local surveillance system based on sentinel physicians and paediatricians, permitting the early activation of the necessary measures for the containment and for burden reduction of the epidemic event. It is noteworthy that the syndromic surveillance epidemic cut-off was overcome once before and 4 times after influenza outbreak detected by sentinel-based surveillance system: all episodes were contemporary with Respiratory Syncytial Virus and Parainfluenza Virus circulation, as detected by regional reference laboratory.
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Affiliation(s)
- F Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy.
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Ansaldi F, Marensi L, Puppo S, Rosselli R, Turello V, Zoppi G, Carloni R, Oreste P, Riente R, Valle L, Orsi A, Sticchi L, Durando P, Icardi G. Molecular epidemiology and case-control approaches for management of an outbreak of hepatitis A in Liguria, Italy. J Prev Med Hyg 2007; 48:103-108. [PMID: 18274347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION AND METHODS Hepatitis A remains an important public health problem in low endemicity areas, because of the social and economic high burden of cyclical outbreaks. In this study we described an outbreak of HAV infection occurred in the city of Genoa and in its proximity and the viral circulation in the post-epidemic period. In order to identify risk factors associated to the illness and to determine the source of infection and the dynamics of virus evolution, we conducted an epidemiological and molecular investigation by a case-control study and by sequence analysis of high variable regions of the genome. RESULTS From May to October 2005, 58 HAV hepatitis cases were notified. The case-control study showed that beach establishment attending is strongly associated with HAV hepatitis (OR = 24.5, p-value < 0.01), at multivariate analysis. The profile of epidemic curve, the clinical onset of primary cases who occurred in few weeks and the geographic distribution of cases clearly indicated a common exposure to a point source: the outbreak can be probably associated with a contaminated food product dispensed in the affected area. The outbreak has been mainly caused by a single variant, confirming the common exposure to a point source; this variant previously circulated within homosexual man (MSM) network in Northern Europe. During the outbreak and in the following months, different variants originating from Southeast Asia, Southern America and Northern Africa, have co-circulated: all these cases were related to international travel and none of these had determined secondary cases. DISCUSSION The epidemiological picture of hepatitis A in Liguria is characterized by a wide heterogeneity of circulating HAV strains. This pattern could be associated with the increase of imported cases and transmission within network of persons with similar risk factors. Molecular approach coupled to descriptive and analytical epidemiological studies appeared un-replaceable tools for management and control of HAV outbreaks, because of their capacity to recognize infection origin, transmission patterns and dynamics of virus evolution.
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Affiliation(s)
- F Ansaldi
- Department of Health Sciences, University of Genoa, Italy.
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Ansaldi F, Bertone A, Carloni R, Gasparini R, Icardi G, Marensi L, Mastroianni F, Oreste P, Riente R, Sasso L, Turello V, Valle L, Zoppi G. Molecular epidemiology of measles in Liguria, Italy: a tool for the elimination of the infection. J Prev Med Hyg 2007; 48:39-42. [PMID: 17713136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Bruscoli F, Corsi A, Cavicchi C, Carloni R, Ferioli I, Gemmani A, Crociati M, Pompili A. [Therapeutic objectives and strategies in NBIA 1 (Hallovorden-Spatz syndrome)]. Minerva Anestesiol 1998; 64:529-34. [PMID: 9951272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
A 10 years old male patient, DG, was admitted in the ICU because of continuous uncontrolled movements due to a neurologycal degenerative disease (Hallervorden-Spatz syndrome) able to determine reduction of spontaneous breathing efficacy. At admission he presented acute ventilatory failure, because of a Staphylococcus aureus broncopneumonia, so he had a tracheal tube and mechanical ventilation (pressure support). During hospitalization (4 months in ICU and 2 months in Pediatric Department) DG received tracheotomy and percutaneous gastrostomy, to obtain adequate spontaneous ventilation and artificial enteral nutrition; a satisfactory pharmacological control of choreo-athetosic movements, with not great interference with original sleep-awake cycle, was obtained. Actually DG is living in his family (9 months follow-up); he has tracheotomy and percutaneous gastrostomy; he can relate with the environment; in a few months, he'll go to school again. He need 30 daily administrations of 8 different drugs; family, supported by an integrated multidisciplinary équipe, takes care of him. The role of Intensivist is essential not only in the management of acute phases in chronic diseases, but also in the longterm management of a homely care.
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Affiliation(s)
- F Bruscoli
- Servizio di Anestesia, Rianimazione e Terapia Antalgica, AUSL Rimini, Presidio Ospedaliero di Rimini
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