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Biomedical subjects

J Baudet

Publications and source records attributed to J Baudet.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Ulnar parametacarpal flap. Experience with 10 clinical cases].

The parametacarpal ulnar flap is raised from the dorsal and ulnar aspect of the hand. It is vascularized by the distal division of the dorsal branch of the ulnar artery. The skin flap is innervated by the dorsal sensory branch of the ulnar nerve helpfull for the reconstruction of skin loss of the palm. At the level of the metacarpo-phalangeal joint of the fifth finger, the medial division is connected by a constant anastomosis with the fifth ulnar collateral artery. This anatomic disposition held the flap to be raised in two manners: as direct flow useful to cover the defects of the palmar aspect of the hand, or as reverse flow covering the defects of the fourth and fifth fingers. In this paper, the authors present an anatomic reminder and the surgical procedure. They report ten clinical cases and precise the indications of this flap in hand reconstruction.

Adolescent↗
PubMed1996

[Osteocartilaginous reconstruction, research and clinical application].

Facing the problem set by losses of osteo-cartilagenous substances around the little bones, the finger- and toe-joints for example, the authors scanned a way different from that of amputation or arthrodesis: the functional rebuilding with the help of substitution grafts. An exploratory research conducted on 21 rabbits in Bordeaux in 1990 allowed to test the coupling of two bio-materials used in surgery here and now, a coupling which has not shown any side-effect and whose benefit is to obtain a non-deformable mass, colonizable by osteoblastic cells. The loss of articular substance suffered by a patient in his fingers in 1992 profited by this bone-rebuilding technique. The use of an external articulated stabilizer was an important provisional support during the colonization of the grafts by the osteoblasts. The difference of time in the osseus rebuilding between the rabbits on the one hand, and the human being on the other, is recorded.

Animals↗
PubMed1995

Bone growth after replantation in children.

Bone growth and the development of epiphyseal plates are disturbed after the replantation of amputated extremities in children, but the potential for continued skeletal growth is almost always maintained in the replanted part. In this reported series of 12 children, all younger than 15 years old, 13 amputated parts of the upper limb have been successfully replanted. After long-term follow-up (from 21 to 216 months), bone growth of the replanted parts was clinically and radiologically evaluated. Two different growing segments were distinguished: the proximal bone segment, directly injured from the initial trauma, and the distal replanted part. Average longitudinal growth recorded was 94.5 percent and 92.7 percent, respectively. Two young patients demonstrated overgrowth of the proximal bone segment, which attained 110 percent and 118 percent of expected growth. Although it is difficult to determine all the parameters affecting the prognosis of post-traumatic reactions in growing cartilaginous plates, the level of amputation is considered to be a significant prognostic factor for the epiphyseal growth of the replanted part.

Adolescent↗
PubMed1995

[Ulnar parametacarpal flap. Anatomical study and clinical application].

The ulnar border of the hand provides a new skin flap which is very useful in the reconstruction of defects of the palm of the hand and ulnar fingers. An anatomical study of the dorsal carpal branch of the ulnar artery and its various branches has led us to propose the ulnar parametacarpal flap either as a pedicle or free microsurgical transfer. The territory of the dorsal carpal branch of the ulnar artery allows harvesting of a simple sensitive skin flap or a composite flap comprising a bone or tendon island flap. Description of the distal communicating vessels with the ulnar collateral artery of the little finger extends the territory of the ulnar parametacarpal flap; based on a retrograde blood supply, it can reach the dorsal and palmar surfaces of the ulnar fingers. The authors present several clinical applications and define the place of this new flap among the various treatment options for the hand.

Hand↗
PubMed1995

[1984-1994: Ten years of skin flaps. Prefabricated flaps].

The term prefabrication of flaps corresponds to completely different technical modalities, often complementary and associated, which share the common feature of extending the indications and potential of pedicle or free flaps. Current methods of prefabrication of flaps can be considered to be based on one or several basic principles of reconstructive surgery. The authors discuss and analyse various modalities: a free flap can be made autonomous or can be expanded prior to transfer. A transfer can be initially prefabricated at its donor site by performing several operative steps in situ. A free transfer can be performed on the main vascular axis of a flap which is subsequently transferred, for example: free scalp transfer to reconstruct an eyebrow on a donor site reconstructing half of the face, but the first in situ operative phase usually consists of performing cutaneous, bone, cartilaginous or even alloplastic material transplants. The transfer is only performed after a sufficiently satisfactory complex anatomical, functional or esthetic unit has been achieved, in order to avoid difficult or dangerous remodeling operations after transfer. The most revolutionary appearance in the area of prefabrications is certainly induction of a pedicle or free neoflap in a so-called random territory. The addition of an arteriovenous pedicle associated with fascia underneath a muscle, underneath a skin cover, in contact with an osteoperiosteal segment allows a perfectly transferable neovascularized unit to be obtained after several weeks. All of the procedures described: autonomization before transfer, expansion before transfer, in situ prefabrication of a complex unit by addition of several tissue units (autologous or alloplastic) in one or several stages and finally vascular induction of a muscular, cutaneous or bone unit, etc. by transfer of a vascular axis in contact with this anatomical structure and combinations of these various modalities obviously open up a new approach which will considerably extend the already remarkable possibilities offered by free tissue transfers.

Adult↗
PubMed1994

[Replantation of the hand and fingers].

Using microsurgical techniques to replant an amputated hand or digit is one of the most important progress in the field of hand surgery during the last three decades. The result of a replantation depends on: the mechanism and the level of amputation, the length and the type of ischaemia of the amputated segment, the surgical techniques, the postoperative care, the rehabilitation and so on. Although the success of a replantation is first judged on the survival of the replanted segment, it nevertheless should be assessed on the function achieved. Thanks to the 30-year clinical experience, the final functional result of a replantation can now be anticipated at initial examination; thus indications can be better established by patient selection criteria. The replantation of the hand and the digits is henceforth reasonable only if there is a possibility of a useful functional result.

Amputation, Traumatic↗
PubMed1994

Clinical and histological patterns of dermatofibromas of the nail apparatus.

True fibromas develop as painless slow-growing nodular tumours. They may appear in any portion of the nail apparatus. The clinical features vary according to their anatomical site. In contrast, the histological features, consisting of a dermal hypocellular reticular nodule with ill-defined demarcation, were similar in all our patients, and factor XIIIa was negative.

Histiocytoma, Benign Fibrous↗
PubMed1994

[Anterior interosseous flap].

An anatomical study which was carried out on 44 upper limbs of fresh cadavers has enabled us to describe a new flap based on the superior perforating branch of the anterior interosseous artery: "the anterior interosseous flap". The anterior interosseous artery participates in the vascularization of the dorsal aspect of the distal two-third of the forearm by providing two perforating branches, "the superior and the inferior perforating branches". The superior perforating branch of the anterior interosseous artery, pedicle of the flap, perforates the interosseous membrane 10 +/- 2 cm above the radio-carpal joint and runs in the septum between the extensor pollicis longus and brevis muscles accompanied by two venae comitantes. The calibre of the artery at its origin varies from 0.9 to 1.5 mm. During its course, the artery gives 5 to 7 septocutaneous branches to reach the overlying skin in the posterior aspect of the distal two-thirds of the forearm. It also gives 3 to 5 osseous branches spreading over the dorsal aspect of the distal third of the radius and several muscle branches to the abductor pollicis longus, extensor pollicis longus and brevis, extensor indicis and extensor digitorum muscles. The inferior perforating branch of the anterior interosseous artery generally perforates the interosseous membrane 4 to 5 cm above the radio-carpal joint. After giving a medial branch which anastomoses with the posterior interosseous artery (in 42 out of 44 cases) the inferior perforating branch of the anterior interosseous artery always runs distally to join the dorsal vascular network of the wrist which is rich enough to produce a retrograde arterial blood flow. This flap can be used as an island flap (with a retrograde or a direct blood flow) or a free flap. The surgical procedure of the retrograde island flap consists in raising the cutaneous or compound flap based on the superior perforating branch, division of the interosseous membrane and ligature of the anterior interosseous trunk proximally. The flap is vascularized by a retrograde blood flow through the dorsal (or volar or both) vascular network of the wrist. Theoretically, the most distal point of rotation of the flap is located at the level of the luno-capitate joint and the pedicle is long enough to allow the most distal point of the flap to reach the DIP joint of the finger.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[The "extreme" brachial flap: a distal pedicled use of an external brachial flap. Preliminary report].

The authors present a new application of the procedure they called the "reverse flow YV pedicle extension" which allows a very distal pedicled mobilisation of the lateral arm flap. Until now, only the distally based lateral arm flap and the ulnar recurrent fascicutaneous island flap could to be transferred distally but reached only the proximal third of the forearm. In our experience these flaps did not seem to be very reliable. Lengthening of the lateral arm flap pedicle using the lateral triceps artery (branch arising from the profunda brachii artery) allows the lateral arm flap to be transferred beyond the distal third of the forearm. This so-called "extreme" lateral arm flap has advantages and disadvantages which are discussed in this paper. We consider cutaneous or osteocutaneous reconstructions of the forearm to be the best indication for this flap. Our first clinical case is reported.

Accidents, Traffic↗
PubMed1994

[Reverse flow YV pedicle extension: a method of doubling the arc of rotation of a flap under certain conditions].

The authors present a new surgical procedure which allows the transfer of pedicled flaps distally to the origin of their vascular pedicle. They call this procedure the "reverse-flow YV pedicle extension of a flap". The idea is to raise a flap distally on a branch of a Y-like vascular bifurcation. The section of the trunk of the bifurcation turns the Y-into a V-vascular pattern, which allows distal mobilisation of the flap on the remaining branch of the V. The distal range of transposition of the flap can reach twice the length of one bifurcation of the flap. The arterial blood supply is provided by reverse-flow through the attached remaining branch of the V. Venous drainage is ensured as in a distally based pedicled flap. Up until now, the authors have performed six different applications of this procedure: arterial lengthening of a latissimus dorsi flap pedicled on the circumflex scapular artery for coverage of the vertex (a venous anastomosis is required in this case; lengthening of the submental vein in very distal transfers of a submental flap; lengthening of an arteriovenous pedicle: transfer of the anterior interosseous flap which can reach the PIP joint of long digits, transfer of an amputated digit on to the adjacent stump, distal transfer of a medial plantar flap allowing it to reach the tip of the toes, transfer of the lateral arm flap on to the triceps branch of the profunda brachii artery. This flap can reach the metacarpal area of the hand. This procedure seems to very usefully replace microsurgical techniques in many circumstances in which, until now, they would have been necessary. Further applications will be discussed.

Female↗
PubMed1994

[Concentration of amoxicillin in neonates after infusion to the mother during labor].

Amoxicillin is effective against S. agalactiae (MIC 50 = 0.03 mg/l). Neonatal prophylaxis of GBS infection had already been studied but very few data are available regarding pharmacokinetic of these antibiotics. In this study, 58 pregnant women with GBS colonisation and/or with epidemiologic risk factors received intrapartum antibiotic infusion at the beginning of the labor (1 g amoxicillin every 6 hours until the delivery). At delivery, cord blood and gastric fluid were taken in delay from 0.5 to 6 hours after the beginning of the infusion. Dosages were done in triplicate with a microbiological method using Bacillus subtilis ATCC 6633 as test strain. In cord blood amoxicillin appeared as early as the first half hour. Concentration were from 5 to 7 mg/l between 1 hour and 4 hours after the beginning of the infusion, and from 3 to 4 mg/l after 4 hours. In gastric fluid, concentrations obtained were over 1 mg/l after 1.5 hour and over 3 mg/l after 2.5 hours with good efficiency even after the sixth hour. The protocol using a slow intrapartum amoxicillin infusion (1 g) gave concentrations in gastric fluid and cord blood over S. agalactiae MIC.

Adult↗
PubMed1994

[Transsexualism: surgical aspects. An experience of the plastic surgical unit's in Bordeaux].

After briefly reviewing the history of transsexual surgery, the authors explain their technical choices and present their experience based on a series of 19 patients, 11 male transsexuals and 8 female transsexuals. The results are analysed. The potential complications of surgery in female transsexuals are those of microsurgical techniques aggravated by treatment with testosterone, as well as urethral fistulae and strictures. In addition to prevention of thromboses, the authors palliate these complications by ulnar elongation of the radial forearm flap in order to minimise the factors responsible for urethral fistulae, combined with enlargement of this flap to decrease the risk of stricture. The complications in male transsexuals essentially consist of rectoneovaginal fistulae. Problems of the depth of the neovagina are also important. Two rectoneovaginal fistulae were observed in this series of 11 patients, both treated medically. The unit's experience in this field will be continued in order to further improve the results.

Adult↗
PubMed1993

The osteocutaneous upper arm flap for mandibular reconstruction.

The authors present the osteocutaneous upper arm flap as useful in segmental microsurgical mandibular reconstructions. This flap presents several advantages: easy and rapid dissection; a long and reliable pedicle; excellent segmental blood supply to the bone, allowing multiple osteotomies; remarkable mobility of the skin paddle relating to the underlying bone; and minimal donor-site morbidity. Among its few disadvantages are that the bone is predominantly cortical, and the bone shaft cannot exceed 11 x 2 cm. Nevertheless, this flap is an excellent alternative to conventional procedures, when a segmental reconstruction, requiring short bone segments and skin, is required. Eight consecutive clinical cases have been successfully treated and are reported.

Adult↗
PubMed1993

[Forum: reconstruction of the traumatic thumb. Reconstruction of the thumb by osteocutaneous flaps of the forearm].

The authors present different techniques of thumb reconstruction using osteocutaneous retrograde island forearm flaps. They describe an original thumb reconstruction technique by using the anterior interosseous osteocutaneous retrograde island flap and present two clinical cases. The advantages and disadvantages as well as the indications of this kind of thumb reconstruction procedure are discussed.

Adult↗
PubMed1993

The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap.

This paper describes the use of a new island flap based on the submental artery. Previously described cervical flaps have inherent problems ranging from limited mobility to unacceptable donor-site scars, to unpredictable outcomes. The flap design and technique were studied on 20 fresh cadavers and 8 patients who underwent radical neck dissections. The flap was then used successfully for reconstruction of orofacial defects in 8 patients. The flap has a long (up to 8 cm), reliable pedicle, and cutaneous dimensions can reach up to 7 x 18 cm. It can be used as a cutaneous, musculofascial (cervicofascial and platysma), or osteocutaneous flap. This flap has an excellent skin color match and a wide arc of rotation, and can extend to the whole homolateral face, except for a part of the forehead and the whole oral cavity. The anatomy, the technique, and clinical experiences are presented.

Adult↗