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Biomedical subjects

J M Servant

Publications and source records attributed to J M Servant.

At least 19 recordsLinked to original sources
PubMed1997

Surgical treatment of dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans is a rare dermal tumor that recurs after inadequate primary treatment. In a retrospective study, we analyzed the outcomes of 117 patients (mean age 39 years) treated surgically for a dermatofibrosarcoma protuberans. In most cases (107 patients), surgery was performed according to a protocol of taking wide peripheral resection margins of 5 cm and by resecting a disease-free anatomic zone deep to the lesion. The mean follow-up was 61 months. The results suggest a difference in prognosis between patients treated primarily with wide initial resection and those referred secondarily with recurrent disease following previous treatment by narrow resection margins. There was no recurrent disease in the 66 patients treated primarily by wide peripheral (5 cm) and deep resection of the tumor. Of the 41 patients referred secondarily at the time of recurrence, 2 developed further local disease within a year, despite equally aggressive local treatments. Both patients eventually died of metastatic fibrosarcoma. We emphasize the value of a highly aggressive local resection in the primary treatment of dermatofibrosarcoma protuberans to minimize local recurrence and potential malignant transformation. Modern reconstructive techniques provide satisfactory solutions for defects of almost any size and composition. Our findings suggest that radical primary resection of dermatofibrosarcoma protuberans in conjunction with immediate reconstruction of the primary defect provides the best outcome for the patient.

Adult↗
PubMed1996

["Beret" flap and other flaps in the reconstruction of cancer related loss of substance of the ear].

Major tissue loss involving the ears and periauricular area due to carcinologic exeresis is an important problem in reconstructive surgery. We present the "béret" flap, a frontal flap with an occipital pedicle, emphasizing the simplicity of the procedure and its reliability. We present our personal experience and data in the literature and recall the main clinical and histological features of these tumors as well as the clinical course and treatment.

Aged↗
PubMed1994

[Repair and suture of cutaneous wounds].

Suturing is the preferred method for closing a simple wound. The procedure should be preceded by surgical debridement of the wound and carefully done level by level. A number of topographical characteristics should be known and kept in mind. The best technique, in the best possible environment, is a necessary condition, not always sufficient, to reduce the importance of sequelae.

Dermatologic Surgical Procedures↗
PubMed1994

[Microsurgical expanded musculocutaneous flaps of the latissimus dorsi].

Four successful cases of expanded free latissimus dorsi myocutaneous flaps are reported. Expansion of free latissimus dorsi flaps has 2 distinct advantages: moulding of the flap prior to its transfer to a convex surface (cranium); primary closure of the donor site. The latissimus dorsi myocutaneous flap seems to be the flap of choice for pre-transfer expansion.

Adult↗
PubMed1993

Dermatofibrosarcoma protuberans of the chest and the shoulder: wide and deep excisions with immediate reconstruction.

Dermatofibrosarcoma protuberans is a rare malignant tumor of the skin. The only satisfactory treatment is surgical and consists of a wide excision. In our department, we have established the limits of the excision required to be a margin of 5 cm on the surface, whereas in the depth, we excise the first healthy anatomical structure encountered. Latissimus dorsi flap reconstruction was used for the major tissue deficit for 15 patients with dermatofibrosarcoma protuberans of the chest and the shoulder. When compared to skin grafting, this technique results in an improved aesthetic appearance and a stable cover for the periosteumless clavicle. Fourteen patients were followed for an average of 37.6 months and all remained free of disease.

Adolescent↗
PubMed1993

[Use of parascapular semi-free flap in the covering of substance loss of the lower third of the leg and foot. Apropos of 3 cases].

The authors present the use of semi-free parascapular flap for coverage of defects on the distal part of the leg and the foot. 3 cases illustrate this technic. This is a microsurgical cross-leg flap. The flap is temporarily anastomosed on vessels on the opposite leg when local and free flaps are not suitable on the ipsilateral limb. This procedure needs one or two separating operations. The cross-leg fasciocutaneous flap must be discussed.

Adolescent↗
PubMed1992

[Free radial antebrachial flap. A retrospective study of 48 cases. Practical applications].

The authors have studied 48 chinese forearm free flaps operated since 1982 at St-Louis, Hospital Paris. Analysis of early complications and failures shows that the few problems that occurred seem to involve hemodynamics more than technical problems. The results support the hemodynamic theory about radial forearm free flaps: low-flow flap which contrasts with the wide diameter of the radial artery. This kind of free flap may not support interpositional vein graft for arterial bridging (stasis, distension of the graft then thrombosis), which must be taken into account in the operating procedure. When the radial artery needs to be lengthened, we therefore systematically reduce the risk of thrombosis by re-establishing radial artery outflow for safety: either by distal radial artery anastomosis, or with an arteriovenous shunt.

Adolescent↗
PubMed1992

[Free-tissue transfer in plastic surgery (emergencies excluded). Apropos of a 10-year experience].

Over a period of ten years the authors have performed 176 elective free tissue transfers. Flaps used were 99 latissimus dorsi, 46 chinese forearm flaps, 12 fibula, 6 toes, 5 omentum, 4 parascapular, and 4 others flaps. Recipient sites were lower limbs in 106 cases, head and neck in 50 cases, forearm and hand in 13 cases, thorax, abdomen, and buttocks in 7 cases. The overall failure rate was 5.7 per cent. Analysis of these failures taught us some original principles. Among these principles, the risk of vascular thrombosis is very important when a venous graft is performed on one end of the artery of a low blood flow flap such as chinese forearm or fibular flaps when the other end of this artery is ligated. When such a graft is done we think that the best way to avoid thrombosis is to suture the other end of the flap artery to a recipient vessel which can be even the distal end of the flap vein itself. Pretransfer expansion of a latissimus dorsi flap was successfully performed in 4 cases. Migrating semi-free flap method, in which the vascular pedicle of a flap is temporarily sutured to recipient vessels located far from the defect, was performed in 12 cases, in most cases on lower limbs where this method constitutes a modern variant of the cross-leg. Folded free-flap method, in which a flap is folded on itself during some days before excision of the recipient site, was performed in 14 cases. Analysis of this series also allowed us to review in detail our usual strategic principles for vascular anastomoses in the head and lower limbs.

Adolescent↗
PubMed1992

[Use of the free latissimus dorsi flap in the reconstruction of extensive orbital exenterations].

The authors present the use of a free latissimus dorsi myocutaneous flap for closure of large orbital exenterations. Five cases illustrate different tumor involvements and coverage possibilities. Several technical details are studied. The vascular anastomoses are performed on cervical vessels: external carotid artery internal jugular vein. The latissimus dorsi myocutaneous flap is particularly suited for reconstruction of large facial soft tissue defects around the orbit when obliteration of the orbital cavity and restoration of deficient facial skin are necessary with correct morphological results.

Anastomosis, Surgical↗
PubMed1992

Tracheobronchial necrosis after caustic ingestion.

Between 1968 and 1988, 679 patients were hospitalized for ingestion of caustic substances, and 87 had severe caustic burns of the entire esophagus, together with panparietal necrosis. Twenty-one of them had tracheobronchial necrosis with perforation. Fifteen have not been operated on; six have had operations, with success in four. We describe an original technique for repairing these tracheobronchial perforations with a pulmonary patch.

Adult↗
PubMed1990

[Experimental study of arterial microanastomoses under tension in the Wistar rat. Morphologic and histologic effects].

An experimental study was performed to evaluate the effects of tension on microsurgical anastomoses. A variable length of the common carotid artery in Wistar rats was resected to give variable degrees of tension and the artery was reanastomosed microsurgically. 42 Wistar rats were divided into 7 groups of 6 rats each according to the relative length resected. Repaired arteries were then compared histologically and functionally with the artery of the contralateral side, submitted to simple section followed by microsurgical anastomosis. Significant histological changes occurred when the length of the resected segment was greater than 13.33% of the vessel's total length. These changes included subendothelial hyperplasia, medial necrosis and thrombosis. The results of this study lead us to conclude that small degrees of tension (less than 13.33% of total vessel length in this study), have no significant effects on patency of microanastomoses. Greater tension results in changes in the laminar flow through vessels that can adversely effect patency. There are also significant histological changes that may have detrimental effects in the long term.

Anastomosis, Surgical↗
PubMed1990

[Analysis of sequelae of the latissimus dorsi flap removal. Report of 44 cases reviewed and tested].

Since Tanzini, the latissimus dorsi muscle flap has been widely used in plastic surgery. Based on the experience of two plastic surgery units, we decided to try to define the sequelae of this operation. In order to simplify our analysis we only considered free flaps. Out study is based on 42 patients (26 pure muscular flaps and 16 musculo-cutaneous flaps). The sequelae were analysed in terms of aesthetic and functional criteria. The aesthetic sequelae appeared to be minima in the case of pure muscular flaps, but more severe in the case of musculo-cutaneous flaps. Functional sequelae in the shoulder were observed on muscle testing in 30% of cases, although there were no repercussions on sport or work activities. Analysis of spinal posture demonstrated a modification in the frontal plane in 40% of cases although this could not be clearly attributed to the donor site. On the basis of this study, we can conclude that the latissimus dorsi flap retains an important place in the therapeutic arsenal of plastic surgery due to its reliability and its minor cicatricial and functional sequelae at the donor site.

Back↗
PubMed1990

[Apropos of a case of infection after esthetic rhinoplasty].

Infection after rhinoplasty is infrequent occurring in less than 1% of cases. When it does occur it may be due to devascularised spicule of bone or in a hematoma. Of much less frequent occurrence is the toxic shock syndrome associated or not with nasal packing and due to staphylococcus aureus. When administering prophylactic antibiotic in nasal surgery one must take into consideration their own hazards: drug reaction, candida infection or resistant staphylococcus aureus.

Adult↗