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Biomedical subjects

J Baudet

Publications and source records attributed to J Baudet.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Does surgery promote the development of metastasis in melanoma?].

Surgery, which is currently the only curative treatment for malignant melanoma, is suspected, in particular presentations, to induce adverse effects such as an increase of metastasis spread. A literature review was performed in order to examine the alleged causes of such phenomena. A medline search covering the 1985-1999 period was performed first. The chosen articles and the study of the references of each of them produced additional articles. The hypothesis is based on the alleged existence of tumor dormancy as micrometastates at an early stage of the disease. Surgery could induce metastasis spread directly by increasing the rate of circulating tumor cells and indirectly above all by disturbing complex mechanisms of tumor regulation such as the balance between activating and inhibiting factors of tumor angiogenesis. Surgery itself as well as the surgical stress could also make easier metastasis spread owing to antitumor immune mechanisms disturbance. Currently, there is no adequate evidence to induce a modified approach in the management of cutaneous melanoma. Surgery remains the mainstay of treatment. However, basic research on angiogenesis and immunity must be carried on.

Humans↗
PubMed1999

Reverse dorsal digital and metacarpal flaps: a review of 27 cases.

Reverse dorsal digital and metacarpal flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks of the fingers. These flaps are transposed as reverse island flaps. Dissection of the flap is easy, fast, and preserves the collateral nerve and artery to the fingertip. A series of 27 flaps is reviewed, with more than 6 months of follow-up. Skin defects in all patients were located over or beyond the proximal interphalangeal joint as far as the fingertip and were combined with bone, joint, or tendon exposure. The flaps we used were reliable, and a joint or extensor tendon reconstruction could be performed at the same time. Patients were discharged the day after surgery and allowed to mobilize the finger early. No flap necrosis was observed, and donor site morbidity was minimal; primary closure or a skin graft was used in all patients. These flaps combine the advantages of an extended skin paddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects. When conventional local flaps are inadequate, this fast and simple procedure should be considered for its reliability and low associated morbidity.

Adolescent↗
PubMed1999

The reverse auricular flap: a new flap for nose reconstruction.

In the present article, the authors describe a new chondrocutaneous island flap from the ear helix for nose reconstruction. Anatomic studies showed that helix vascularization depends mainly on the superficial temporal vessels. The presence of vascular communications between the anterior frontal branch of the superficial temporal system and the supraorbital and supratrochlear arterial systems allows this flap to be used in a reverse vascular flow fashion. This new flap has been used successfully in seven cases for reconstructing composite defects of the nasal tip and ala. The donor-site defect is repaired with an advancement and rotation flap from the helical rim, leaving an inconspicuous scar and giving an acceptable cosmetic result of the donor area.

Adult↗
PubMed1999

[Humanitarian plastic surgery missions. Actions and reflections].

After recalling the various possible objectives of humanitarian missions in underprivileged countries, the authors describe the context of their plastic surgery missions, each lasting two to three weeks, with the support of Interplast. These missions have been conducted in India, Pakistan, Thailand, Vietnam and Afghanistan. The organization is now classical: on site supply of anaesthetic and all disposable material, 50 to 100 operations over a fortnight in a local hospital. The diseases most frequently observed were cleft lip and palate and post-burn skin retractions. The authors emphasize the fact that the mission director must be an experienced surgeon in order to select the most reliable and the simplest procedure. They analyse the meaning of their commitment and the way in which this humanitarian action is perceived by the recipient country.

Adult↗
PubMed1999

[Dorsal metacarpal flap with an extensive retrograde pedicle. Anatomic study and 22 clinical cases].

The dorsal digitometacarpal flap or extended distal pedicled dorsal metacarpal flap is a new skin flap, useful in reconstructing large distal defects on the dorsal aspect of the digits. It is raised on the dorsum of the hand, over an intermetacarpal space. Its vascularisation is provided by proximal dorsal cutaneous branches of the digital collateral arteries through the rich, anastomotic arterial network of the webspace. This flap is a useful flap compared to others flaps harvested from the dorsum of the hand, such as the reverse metacarpal flaps. The operative procedure preserves the dorsal interosseous muscles aponeurosis, the junctura tendinum and the dorsal metacarpal artery. Its vascularisation depends on the webspace arterial network; it is constant contrary to the dorsal metacarpal arteries of the ulnar spaces. This flap is indicated to cover distal defects on the dorsum of the digits because of its large rotation arc. The anatomical basis and operative technique of the flap are described. Two out of 22 clinical cases were selected to illustrate the ability of this flap for reconstruction of digital defects.

Adult↗
PubMed1999

[The reverse auricular flap. A new flap].

The authors describe a new chondrocutaneous reverse island flap from the ear helix for nose and eyelid reconstruction. Anatomic studies showed that the blood supply of the helix is derived from the superficial temporal system. The presence of vascular communications between the anterior frontal branch of the superficial temporal artery and the supra-orbital and supra-trochlear arterial systems allows this flap to be used in a reverse vascular flow fashion. Three flaps have been successfully used for reconstruction of alar and nose tip defects and in one case for total lower eyelid reconstruction. The donor site is repaired with an advancement and rotation flap from the helical rim giving an acceptable result. In this paper, the authors propose a new pedicle flap for reconstruction of complex nose and eyelid defects.

Adult↗
PubMed1998

Extensor digitorum brevis muscle flap: new refinements.

Two original operative techniques of raising the extensor digitorum brevis muscle flap are presented. These methods allow for covering distal foot defects that are difficult to cover by other reconstructive means. In the first technique, the flap is based on an extended distal pedicle supplied by the dorsal interosseous artery of the first intermetatarsal space. In the second technique, the flap receives its vascular supply from the medial tarsal artery; this procedure may be valuable when the vascular supply of the dorsalis pedis pedicle has been disrupted. To confirm the availability of these vascular pedicles, cadaver dissections were performed and proved that the extended pedicle dissection enhances the rotation arc of the flap. Four selective clinical cases, in which the flap was successfully used, are discussed. Advantages of these techniques, in reconstructing large defects in the distal foot, are delineated.

Adult↗
PubMed1998

[The cervix uteri in pregnancy].

It is during labor that the most dramatic changes to the cervix are apparent, yet the cervix begins its process of adapting early on in pregnancy. From an anatomic perspective, the gravid cervix is changed little in the beginning of pregnancy. It is strikingly less muscular than the rest of the uterus and its connective tissue is comprised essentially of collagen fibers and a matrix rich in proteoglycans. Cervical maturation begins imperceptibly during pregnancy but does not become noticeable until shortly before labor. These changes result from biochemical modifications of the cervical constituents with dissolving of collagen fibers and changes in the respective levels of different proteoglycans. The regulation of this maturation is still poorly understood; steroid hormones, prostaglandins, and collagenases have all been implicated. The effacement and dilatation of the cervix occur with labor. Effacement corresponds with thinning and opening of the internal os and dilatation corresponds with opening of the external os. These phenomena are passive, resulting from physical pressure from fetal engagement under the effects of uterine contractions. Our material understanding of cervical maturation and dilatation are still insufficient, for although we are better and better able to guide the induction and course of labor, it still is impossible for us to arrest premature cervical maturation in the setting of a threatened abortion or premature delivery.

Cervix Uteri↗
PubMed1998

[Role of emergency reconstruction of fingers by the "reposition-flap" technique. Report of eight cases].

Following replantation failure, fingertip reconstruction was performed as an emergency "reposition-flap" procedure in seven patients (eight fingers). This technique was intended for amputations distal to the DIP joint in long fingers, and IP joint in the thumb. Pulp was excised on the amputated segment, and the remaining bone and nail bed were reattached to the proximal stump with Kirschner wires. Pulp was reconstructed with a local advancement and sensitive flap. Trophicity and nail regrowth as well as mobility and strength were satisfactory in five cases. MRI examination showed revascularization of the distal bone fragment in four cases. This procedure is an alternative to amputation after replantation failure when patients do not accept finger shortening. The more distal the amputation, the better is the result.

Adult↗
PubMed1998

[Abdominoplasty with dissociated intraparietal liposuction. Technical note].

Liposuction has greatly contributed to the improvement of the aesthetic result of abdominoplasties. However, one should consider the high rate of seroma when liposuction is performed via an inferior approach during abdominoplasty. The authors present a new approach to achieve complete liposuction of the abdominal wall during conventional abdominoplasty. This approach is carried out via submammary incision after previous undermining of the abdominal wall. A permanent assessment of the thickness of the wall allows the liposuction to stay strictly in fat tissue. Finally, there is a total independence between liposuction and the undermining procedure which allows minimization of the postoperative seroma. This technic seems particularly useful in a context of extensive abdominal adipose with flaccidity of the abdominal wall, requiring extensive undermining. Thanks to this procedure, the authors have performed a one-stage operation in many cases in which two operations would necessary previously have been.

Abdominal Muscles↗
PubMed1997

[Lateral brachial flaps].

The "extreme" lateral arm flap is a new method for covering the distal upper limb. This flap is a modification of the classical lateral arm flap allowing his transfer as a pedicled flap to cover the forearm and the wrist. This technique is based on a new concept: "the reverse flow VY pedicle advancement". This requires an arterial bifurcation of the deep humeral artery: the medial collateral artery described in this study.

Aged↗
PubMed1997

[Submental island flaps. Surgical technique and possible variations in facial reconstruction].

The submental flap is an island myocutaneous flap supplied by the submental artery divided from the facial artery. Large skin paddles (up to 7 x 18 cm.) can be raised, perfectly matching with facial color. As an island flap it allows coverage of the homolateral oral cavity or the homolateral face (except the medial forehead region). Including the facial vessels in its pedicle allows a safe free transfer. A greater are of rotation is obtained transferring the flap on its distal pedicle. One can include in the flap a segment of internal basilar margin. The resulting scar is perfectly hidden under the mandible. The operative protocol is now well defined and makes the flap easy to use. 21 flaps have been transferred, resulting in a single partial necrosis of a flap extremity.

Face↗
PubMed1997

Reconstruction of the hand with forearm island flaps.

From all of the flaps reviewed, it is important to know how to select the most suitable choice in each case. Aside from the technical expertise of the surgeon, the indication depends on the size and the location of the substance loss. For large defects in any location, the radial forearm flap remains the most reliable and safest choice. For children and women, the authors prefer distant pedicled transfers or free flaps to minimize cosmetic donor site morbidity. For small or medium defects that cannot be managed by a local transposition flap, the indication is based on the location of the wound. Palmar defects, if proximal and ulnar, may be covered using the dorsal ulnar flap, with little morbidity in the donor area. The anterior interosseous flap seems a better choice whenever vascularized tendon, nerve, or bone are needed also. For the first web space and neighboring radial defects, the posterior interosseous flap provides a reasonable alternative. Dorsal defects of the hand can be reconstructed with a posterior interosseous flap, provided there is no suspicion of injury to the anastomotic dorsal system of the wrist. The anterior interosseous flap is a good choice for composite osteocutaneous transfers. For complex composite defects, the ulnar artery forearm flap distally based may be indicated for reconstructive problems requiring vascularized flexor tendons. The anterior interosseous flap is able to provide excellent quality vascularized bone. Indications depend above all on the surgeon's experience and on the different schools. As always, the better flap is that which is performed by the surgeon who has mastered the particular surgical technique. In conclusion, this article is devoted to an update on forearm flaps and illustrates the innovative strength of this specialty. It also points out that, through in depth knowledge of the anatomy, flaps may be raised from many anatomic regions of a limb without disturbing the main vascular axis of that extremity. Minimizing the donor site morbidity while maximizing the quality of the reconstruction is the primary concern when indications are established for reconstructive hand surgery, which is where one of the authors' main research efforts resides.

Forearm↗
PubMed1997

[Update mid-term review of the pedicular extension in reverse YV flow. Review of a 7-year experience].

Since 1990, the authors use a surgical procedure called reverse flow YV pedicle extension to transfer a flap distally to its donor site. Their clinical experience, based on of 8 different applications and more than 80 clinical cases, demonstrates the reliability of the procedure. Nevertheless, the latissimus dorsi transfer, based on scapular vessels, must be an exceptional indication due to the need to achieve a venous microanastomosis. Moreover, the "extreme lateral arm flap" is considered to require a precise preoperative anatomical assessment because of the variants of the pedicle bifurcation. The authors are convinced that further applications will extend their experience of this procedure.

Humans↗
PubMed1997

[Distal extensor digitorum brevis muscle flap. Report of 2 cases].

The authors describe an original technical modification of the extensor digitorum brevis muscle flap. As described, its use in a classical reverse flow manner allows the flap to reach only the metatarsophalangeal joints. The presence of the first dorsal interosseous pedicle offers the possibility to sacrifice the plantar anastomoses of the pedis pedicle and raise the flap on the vascular network of the first metatarsal space. The point of rotation is moved distally from the apex of the first metatarsal space to its base. The length of the vascular pedicle is substantially enhanced and enables the flap to cover all dorsal and palmar defects of the toes. Two clinical cases are showed. The advantages of this flap are discussed, particularly its indication in reconstructive surgery of the foot.

Adult↗
PubMed1996

Laparoscopically assisted vaginal hysterectomy for non-malignant disease of the uterus. Report on a personal series of 126 cases.

OBJECTIVE: A report is given of a series of 126 laparoscopically-assisted vaginal hysterectomies (LAVH) for benign lesions, carried out between September 1990 and December 1995. MATERIALS AND METHOD: The mean age of the patients was 50.3 years, and the main indications for hysterectomy were metrorrhagia (88). The main reasons why LAVH was chosen from among other hysterectomy techniques were a large uterus (55), associated ovarian surgery (45), and a difficult vaginal approach (35). The surgical technique always began with a laparoscopic stage followed by a vaginal stage. The laparoscopic stage generally finished at the lower part of the broad ligament. The vagina was opened and the uterine arteries were ligatured by a vaginal approach (116). Only 10 total laparoscopic hysterectomies were performed. RESULTS: The mean duration of the operation was 72 +/- 28 min, mean blood loss was 1.89 g/dl, and mean uterus weight was 224 g (maximum = 1093 g). Operative complications consisted of two bladder wounds and two switches to abdominal hysterectomy. Postoperative complications were urinary infections (17), hemorrhages needing second-look operations [2] and abscess of the vaginal section requiring evacuation [3]. CONCLUSION: LAVH should never be carried out instead of vaginal hysterectomy (VH), since VH is the best procedure when it is easy to perform. The authors use LAVH when VH is difficult or contraindicated (the aim being to avoid laparotomy) and actually carry out less than 5% of hysterectomies for benign lesions by laparotomy.

Blood Loss, Surgical↗
PubMed1996

[Boomerang flap. A true single-stage pedicled cross finger flap].

The indications for cover of long fingers have been considerably modified over recent years as a result of the concept of retrograde flow flaps. However, in some cases in which the dorsal digital networks cannot be used, cross-finger flaps are still indicated for cover of long fingers beyond the PIP joint. The authors present a new flap eliminating the need for this rather complicated procedure. The donor site takes advantage of the rich dorsal collateral arterial network of P1 of an adjacent healthy finger. The flap can be raised due to the constant existence of a bifurcation between the collateral dorsal digital arterial networks and the anastomoses situated at various levels between the dorsal and palmar collateral networks of the long fingers, which are constant as far as the PIP joint. A dorsolateral flap can therefore be raised from a healthy finger and transferred to the injured finger by raising the fatty connective tissue, including the dorsal collateral pedicles, in the shape of a boomerang. This flap covers distal defects from the PIP joint to the fingertip. The authors describe the anatomical basis for raising of the flap, the operative technique and report six clinical cases with a mean follow-up of 11 months.

Arteries↗