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Biomedical subjects

D Montandon

Publications and source records attributed to D Montandon.

At least 37 records · Page 2Linked to original sources
PubMed1993

Frontoethmoidal cephaloceles: transcranial and transfacial surgical treatment.

In the treatment of frontoethmoidal cephaloceles (FEC), three aims should be pursued: (1) to provide good exposure for a safe neurosurgical correction, (2) to obtain the best cosmetic result with minimal scarring, and (3) to inflict on the child the least surgical trauma. Between 1986 and 1991, 6 children were operated on in our unit for FEC. In this study, we compare the advantages of the transcranial surgical approach versus the transfacial surgical approach. Because most of the facial anomalies presented by these patients are represented by modifications in the position and shape of the medial orbital walls, as well as elongation of the nose, we feel more comfortable using the transcranial approach. It permits safer translocation of the medial orbital walls and recreation of the dorsum of the nose with a calvarial bone graft, and provides wide access for neurosurgical correction. In our experience, the most difficult part of the operation remains correction of the length of the nose. The transfacial approach, with planned skin resection, may thus represent an advantage in these cases. Therefore, our purpose is not to oppose these two surgical procedures, but often to combine them for safer treatment and better cosmetic results.

Child↗
PubMed1991

Sensibility and cutaneous reinnervation after breast reconstruction with musculocutaneous flaps.

Sensibility and sensory reinnervation were investigated in 19 patients who underwent, after mastectomy, a breast reconstruction using myocutaneous flaps. A comparative study in reinnervation of the flaps has been performed either after surgery with a latissimus dorsi flap with prosthesis or after surgery with a simple or double pedicle transverse rectus abdominal flap. Ten patients with latissimus dorsi flaps and 9 patients with transverse rectus abdominal flaps were tested. The tests included stimulation with touch, pressure, pin prick, and temperature. The patients were also interviewed regarding their impressions, a subjective sensibility. These results show that the recovery of sensibility by patients who underwent surgery with the transverse rectus abdominal flap technique is superior, objectively and subjectively.

Adult↗
PubMed1991

Extrinsic eyelid ectropion.

Extrinsic ectropion is caused by loss of skin around the orbital margins. Every patient with cicatricial ectropion should be assessed thoroughly to determine if the cause is intrinsic, extrinsic, or both. This assessment is extremely important when dealing with severe deformities after burns, cancer, or noma, for example. The assessment allows a proper planning of surgery. As a rule, the original size and location of the missing tissues should be recreated and the defect replaced by homologous tissues.

Cicatrix↗
PubMed1991

The surgical treatment of noma.

Noma is a gangrenous stomatitis affecting children from developing countries. It may leave dreadful mutilations around the mouth, with amputation of the lips, cheek, nose, lids, maxilla, palate, or mandibula. Reconstruction should take into account the size of the defect, the presence of trismus or constriction of the mandible, the age of the child, and the child's general condition. During the last 3 years, eight patients were treated at the Unit of Plastic and Reconstructive Surgery of the Hôpital Cantonal Universitaire. Except in one case, tracheostomy was avoided, thanks to intranasal intubation by fibroscopy. These children, aged 2 to 9 years, underwent 31 general anesthesias and complex reconstructive procedures, including latissimus dorsi musculocutaneous pedunculated and free flaps, cranial flaps with galea, cranial bone and skin grafts, and retroauricular temporal skin flaps. All patients were able to return to Africa with dramatic functional and cosmetic improvements. However, satisfactory mouth opening and mandibular function were not always obtained.

Child↗
PubMed1991

[The infected sternotomy].

In the presence of a wound infection following a sternotomy, an active surgical treatment is currently the method of choice. Large debridement followed by an effective wound closure is advised by most authors. In our experience, most cases will respond to this treatment whateither flap is used: omentum, rectus abdominis, latissimus dorsi, pectoralis major musculocutaneous flaps. However, a few patients have had repeated attempt to close the sternal defect without success. In these cases a proper surgical treatment is a life-saving procedure. Thorough debridement and closure with bipedicled pectoralis major and rectus fascio-cutaneous flaps with drainage of the mediastinum is advised. Stabilisation of thoracic wall and filling of the dead space are not mandatory.

Aged↗
PubMed1991

The reversed fasciosubcutaneous flap in the leg.

A reversed fasciosubcutaneous tissue flap in the leg is described. This distally based flap is vascularized by the perforating cutaneous branches of the peroneal and tibialis posterior arteries. It must carry all its subcutaneous tissue. A study on the vascularization of the subcutaneous tissue reveals the predominance of the vascular network in this layer with regard to the dermal or fascial plane. The dermal vascular network at the donor site is sufficient to let the skin survive without its underlying subcutaneous vascular support. The flap can reach the malleolar and heel region. The advantages of this technique are (1) easy dissection, (2) preservation of the major vascular pedicles of the lower limb, (3) skin preservation at the donor site, thus preserving the shape of the limb, and (4) versatility (it is supple and can adapt to every surface, and it can be grafted on the deep or the superficial side). The addition of this technique to the armamentarium of the reconstructive surgeon has proved to be very useful in repairing soft-tissue defects in the lower limb. Often it can replace the classical fasciocutaneous flap or even a free flap.

Fasciotomy↗
PubMed1990

[Congenital malformations of the eyelids].

Congenital malformations of the eyelids have been classified in many ways, considering their various origins. The author proposes hereby a simplified classification concentrated on the therapy: 1. isolated malformations of one or two eyelids 2. palpebral anomalies associated with a more extensive craniofacial malformative syndrome 3. congenital tumors On this basis the author examines the most frequent malformations: blepharoptosis, coloboma, epicanthus, blepharophimosis, microblepharism and some congenital tumors. For each of these lesions, a surgical treatment is proposed and illustrated.

Blepharoptosis↗
PubMed1989

[Reconstruction following an orbital tumor in children].

Tumors of the orbital region which may develop during infancy and childhood have multiple origins and a specific treatment should be applied to each lesion as regards the degree of malignancy, the extent of the tumor and the age of the child. The plastic surgeon is usually called when the surgical treatment or the radiotherapy have been mutilating. It is then necessary to offer the most satisfactory reconstruction to the child, taking into account the possibility of a recurrent disease or the future development of the orbital cavity. The following priorities should be observed: 1) The tumoral resection should be as complete and as curative as possible. 2) The sight of the eye should be saved if possible; 3) The skeletal reconstruction should be performed if possible with autologous bone graft taken from the skull area. 4) The soft tissue reconstruction is performed by a series of plastic surgery methods. The use of the temporal muscle is common. 5) The final esthetic result often depends on the choice and the quality of additional corrections (canthopexy, mucosal graft, correction of enophthalmos, etc). The surgery of orbital tumors is a team work (neurosurgery, ophthalmology, otolaryngology, plastic surgery). The presence of the plastic surgeon during the initial treatment is highly recommendable and often permits an immediate reconstruction.

Child↗
PubMed1989

Myofibroblasts from diverse pathologic settings are heterogeneous in their content of actin isoforms and intermediate filament proteins.

We examined by immunofluorescence the distribution of vimentin, desmin, alpha-smooth muscle actin and alpha-sarcomeric actin in normal human soft tissues and in pathologic tissues containing myofibroblasts, including normally healing granulation tissue, hypertrophic scar, and fibromatosis. The pattern of actin isoforms was also documented biochemically by two-dimensional gel electrophoresis. Fibroblastic and/or myofibroblastic cells in each setting always expressed vimentin and never alpha-sarcomeric actin. Moreover, these cells showed an heterogeneous cytoskeletal composition which defined four phenotypes: (a) cells expressing only vimentin; (b) cells expressing vimentin, alpha-smooth muscle actin and desmin; (c) cells expressing vimentin and alpha-smooth muscle actin; and (d) cells expressing vimentin and desmin. Given this, two groups of lesions are distinguished: the first contains only vimentin cells and consists of normally healing granulation tissue, eschars and normally healed scars; the second contains vimentin cells admixed with variable proportions of vimentin, alpha-smooth muscle actin and desmin, vimentin and alpha-smooth muscle actin, and vimentin and desmin cells and consists of hypertrophic scars and fibromatoses. Immunogold electron microscopy showed that alpha-smooth muscle actin was present in a proportion of cells with ultrastructural features of myofibroblasts. Our findings suggest that contrary to myofibroblasts of normally healing granulation tissue and normally healed scars, myofibroblasts of pathologic conditions characterized by chronic retraction express always immunochemical features indicative of smooth muscle differentiation.

Actins↗
PubMed1989

[Long term results of 68 cases of breast reduction performed at a university surgical service].

The authors have analyzed long-term (4.2 years) results of 68 cases of breast reductions, defined as an excision of 300 g or more per side, operated in the Plastic Surgery Unit of the University Hospital of Geneva. After a brief historical review of breast reductions both subjective and objective results are analyzed and discussed. The subjective results were obtained by analyzing a standard questionnaire sent to the 68 patients. Objective results were obtained by a physical analysis of 35 patients who came for the check-up by a single examiner. 87% of all the patients were satisfied with the results, would repeat the operation again and would recommend it. Although there are still some problems with scar length, width and postoperative glandular function, it is hoped that the newer techniques will solve these.

Adolescent↗
PubMed1987

Blood supply of the subcutaneous tissue of the upper limb and its importance in the subcutaneous flap.

Vascularization of the subcutaneous tissue of the upper extremity is described. Injection of coloured latex or India ink and gelatine solution showed the principal sources of the blood supply. Microdissection and transclarification of Spalteholz allowed for the study of the direct and indirect arterial branches which form the principal network of the subcutaneous tissue. The findings are of practical importance since the subcutaneous tissue can be used as a separate flap for covering soft tissue defects of the forearm and hand.

Adult↗
PubMed1986

Craniofacial operations and specialised centres: should they have a monopoly?

Contrary to several recent statements craniofacial operations should not be the monopoly of large specialised centres but may be handled successfully by well trained surgeons working in a good medical environment. The experience of the Geneva University Hospital is reviewed in this paper; there has been no death or major complication and the cosmetic results compare favourably with other series.

Adolescent↗
PubMed1986

Surgical treatment of congenital fronto-orbitomalar asymmetries.

Congenital fronto-orbital asymmetries can be of various origin. Correction of these malformations, whether due to maldevelopment of the foetus or to a congenital tumour, generally require a combined intracranial and extracranial approach. In recent years, a working group of plastic surgeons and neurosurgeons in the French-speaking part of Switzerland have been particularly interested in these problems. Some of their results are presented here.

Bone Transplantation↗