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Biomedical subjects

J M Servant

Publications and source records attributed to J M Servant.

At least 37 records · Page 2Linked to original sources
PubMed2000

Ethics and aims of cosmetic surgery: a contribution from an analysis of claims after minor damage.

MAIN OBJECTIVES: Cosmetic surgery raises the ethical problem of the balance of risks and benefits of an operation the benefit of which is psychological and difficult to evaluate. The aim of this study is to improve the understanding of the factors that influence an unsatisfactory outcome. In this context, we have analyzed complaints from patients the alleged damage to whom proved to be ultimately non-existent or minimal. METHODS: Review of the case notes of 20 patients who had sought damages through the French judicial system for minimal or non-existent alleged damage. Data were collected in 1999. FINDINGS: We found fifteen complaints of insufficient results, two for cause and effect relations with pathologies without any connection, and three for lack of information. 5 patients received compensation, the rest having been ruled out of court. The gender ratio (17 F/3 M), the average age (38 years old), the distribution of the operations and the socio-professional categories reflect the characteristics of a standard cosmetic surgery population. The average period of time between an operation and a complaint was 4.3 years (SD = 4.2). Among the medical histories we found two cases of depression, one treatment "for the nerves", one suicide attempt, and two cases of alcoholism without possible interpretation in the framework of this study. In six cases, the surgeon's qualification was not appropriate to the type of operation. The unprofessional conduct of colleagues had an influence on the effect of the procedure as an independent factor. CONCLUSION: These results call for more responsibility from professionals and encourage the undertaking of prospective complementary studies in order to evaluate more precisely the balance of risks and benefits.

Adult↗
PubMed2000

[Effect of brachial-radial and extensor carpi radialis longus tenodesis on elbow flexion-extension movements. Application to tendon transfers in tetraplegia].

The authors show that extension of the elbow produces a traction on brachioradialis (BR) and extensor carpi radialis longus (ECRL): if their tendon is distally freed, it is pulled in the proximal direction when the elbow extends. This phenomenon provides tenodesis effects, especially after tendon transfer in tetraplegia. It has been assessed on 31 upper limbs of patients and fresh cadavers. The mean tendon excursion, between 90 degrees flexion and full extension of the elbow, was 32 mm for BR and 19 mm for ECRL. These tenodesis effects related to the extension of the elbow leads the authors to recommend three practices in tetraplegic patients: active extension of the elbow should be restored before rehabilitation of the hand, and a 90 degrees flexion of the elbow is the position in which BR and ECRL transfers should be set intraoperatively, as well as immobilized postoperatively.

Biomechanical Phenomena↗
PubMed2000

[Microtia: a new chronology for the total external ear reconstruction. A retrospective study of eight cases].

After 14 months of personal training with Professor Ichinose's team in Chiba (Japan), the author reports a new chronology of the total external ear reconstruction for microtia. This approach, proposed by Dr Yoshimoto, subtracts in time spent on creating the cartilaginous framework from the total general anesthesia time. The principles of this technique and its chronology are described. The results of eight patients operated according to this method between February 1994 and October 1999 are analyzed and compared to the 35 previous reconstructions performed by this team. The advantage of this chronology has been established: this method allows a considerable reduction of the general anesthesia time, a rationalization of the cost of these reconstructions, an increased comfort for the patients and an easier learning process for young plastic surgeons.

Cartilage↗
PubMed2000

[Gorlin-Goltz syndrome. Apropos of a maxillary cyst].

We report a case of Gorlin-Goltz syndrome and recall the principle features of this uncommon disease. The syndrome associates multiple skeletal malformations, skin tumors and epidermoid maxillary cyst. We discuss the differential diagnosis of maxillary cysts.

Adult↗
PubMed1999

Biceps-to-triceps transfer in tetraplegia. The medial route.

Eight tetraplegic patients (13 elbows) were treated by biceps-to-triceps transfer. To avoid the risk of radial nerve injury, we chose a medial routing of the biceps. The mean follow-up after surgery was 17.8 months (range, 4-47 months). No complications were encountered. Active extension of the elbow was achieved in each case. The mean postoperative active range of motion of the elbow was 6 degrees extension and 137 degrees flexion. After the biceps-to-triceps transfer mean extension torque of the elbow was 3.7 Nm and mean flexion torque was 10 Nm. In eight elbows in which it was measured, there was a 47% reduction in elbow flexion power. Nevertheless no patient complained about that reduction, and all of them were satisfied.

Adult↗
PubMed1999

Repair of wide coup de sabre without cutaneous excision by means of pericranial-galeal padding flap.

A case of double linear scleroderma of the forehead (coup de sabre) is described. The histopathology of this rare lesion is now well known with a normal epidermis and a sclerotic dermis. The correction was done with an original two-stage procedure: the lesion with alopecia was first treated by excision-suture and a transfer of the involved subcutaneous tissue along the right inner canthus; 1 year later, by a hemicoronal incision, we transferred a galeal-pericranial flap beneath the wider forehead lesion. We think that the use of a filling flap to correct wide coup de sabre lesions without cutaneous excision can be a simple alternative to the classic treatment by complete excision and flap reconstruction. The subcutaneous fascial system of the scalp can provide a good donor site with minimal morbidity.

Adult↗
PubMed1999

[Latissimus dorsi free flap with "Y" anastomoses. Technical variant and use in leg reconstruction].

The authors report a new technique for harvesting and anastomosis of the latissimus dorsi free flap. The latissimus dorsi free flap is elevated with the subscapular and circumflex scapular vessels forming a "Y" pedicle. The recipient artery is sectioned and the arterial tree of the flap is anastomosed to the recipient vessel by two end-to-end anastomoses. This technique is particularly useful in leg reconstructive surgery when only one vessel remains: it simplifies transfer (end-to-end anastomosis), anastomoses are easier because more superficial.

Adult↗
PubMed1999

[Breast reconstruction by inflatable anatomical implant. Retrospective study of 65 cases].

This study reports the first mammary reconstruction series with anatomic saline implants after mastectomy for breast cancer. 65 patients were reviewed with a 10-month follow-up. The authors used Mac Gahn anatomic saline implant style 468 or 363. The contralateral breast mammaplasty for symmetrisation was performed in 53 patients, usually during implantation of the implant. The nipple areola reconstruction was usually performed with full thickness' skin graft and Little's flap. The implants, (average volume of 275 ml before changing), were changed for 17 patients, because of insufficient reconstruction or an excessively high mammary fold. The most frequent complication was pain, despite morphine protocols (19 patients). These were a cases of 9 rippling; but only a small percentage of internal dimple (4 patients). Patient and surgeon satisfaction was rated (1-20) and classified into three levels. In conclusion, the advantages of anatomic saline implants are: to avoid some symmetrisations, reconstruction of a stable breast, to avoid internal dimple. The disadvantages are: persistent rippling, specific learning for their implantation and difficulty of the choice of size.

Adult↗
PubMed1999

[Evaluation of a two-stage surgical strategy for the treatment of skin carcinomas. Retrospective study of 367 cases].

The treatment of skin carcinomas in France is mainly based on surgical resection. However, when the cutaneous surgical defect cannot be sutured, repair by skin graft or skin flap can be either immediate or delayed. The aim of the present study is to evaluate the value of delayed repair. A six-month retrospective study was designed between November 1997 and April 1998, on a total of 367 resections of skin carcinomas and/or premalignant lesions. Two parameters were recorded: management of the skin defect, and the histological results. Out of the 367 resections, there were 275 resections with suture, 42 resections with skin graft, 11 resections with skin flap, and 39 resections without wound closure. In 41 cases further re-excisions were performed because the tumors were incompletely excised. Incompletely excised tumors were found in 6% of sutures, 9% of skin flaps, 24% of skin grafts, and 36% of delayed repairs. The high rate of incomplete surgical resections supports two-step surgery without wound closure when the defect cannot be sutured. This attitude is reinforced by the difficulty of the re-excision when a skin graft or a skin flap has been previously performed.

Basal Cell Carcinoma↗
PubMed1999

[Surgical repair of abdominal wall].

Surgical repair of abdominal wall defects following tumour resection only raises real problems when the nature of the tumour required wide, or even transfixing excision, as in the case of sarcomas or very advanced carcinomas. Superficial repair is performed according to the algorithm of the simplest technique: secondary healing, partial suture, total suture, transplant, or flap (pedicled or free). In the case of transfixing resection, the combination of a biomaterial for reconstruction of the deep plane and a superficial flap is necessary. For very large transfixing defects of the abdomen, a free flap may be required and, in this case, delayed insertion after initial transfer may further reduce the operative risk ("apple turnover" technique). The complications observed in a detailed series of 9 cases operated at Saint-Louis Hospital consisted of one intraoperative cardio-circulatory arrest during second-stage surgery and one late infection at three years. The authors believe that the indications for delayed insertion of a free flap are still very topical in cases in which a very large grafted free flap is necessary in conjunction with a prosthesis. Large abdominal defects after cancer resection can be reconstructed by modern reconstructive surgery.

Abdominal Muscles↗
PubMed1999

[Malignant tumors of the abdominal wall. 10 years of experience at the Saint-Louis Hospital].

The authors present a 10-year retrospective study of 52 patients with dermatofibrosarcomas (33 cases), sarcomas (13 cases) and desmoid tumours (6 cases) operated in their department. All these tumours were located in the abdomen or adjacent regions. Resection margins were 5 cm for dermatofibrosarcomas and 2 cm for sarcomas and desmoid tumours, with a healthy deep anatomical barrier. Dermatofibrosarcomas were repaired by direct suture in 18% of cases, directed healing in 15%, healing and graft in 45% and flap in 31% of cases. 61% of sarcomas were sutured directly, 7% were treated by directed healing and 23% required cover by a flap. All desmoid tumours were closed by primary suture. The quality of the first surgical resection remains the predominant prognostic factor.

Abdominal Neoplasms↗
PubMed1999

[Main abdominal flap donor sites].

The main flaps derived from the abdominal wall are described, indicating the following points for each one: vascular anatomy, the cutaneous and/or muscle territory of the flap, the arc of rotation, the main applications and finally comments concerning certain specific anatomical or technical points. Rectus abdominis flaps are by far the most frequently used in routine clinical practice for mammary reconstruction and cover of the thorax, abdomen or groin areas. Groin flaps are also frequently used, either as pedicled flaps to cover defects of the upper extremity or abdomen, or as free flaps, especially for mandibular reconstructions.

Abdominal Muscles↗
PubMed1999

[Anatomical study of the distal tendon of the brachial biceps muscle. Application to biceps-triceps transfer in tetraplegic patients].

In some cases of biceps-to-triceps transfer the muscle fibres of the biceps are inserted very distally, preventing correct setting of the transfer. A knowledge of the anatomy of the intramuscular part of the distal tendon of the biceps is useful to lengthen this tendon proximally. A study of 40 specimens showed that the intramuscular part of the distal tendon of the biceps is a large flattened lozenge-shaped aponeurosis located in a frontal plane. It receives muscle fibre insertions on both aspects. The length of the invisible part of the tendon can be estimated by a simple formula: 0.55 a + 4 cm, where "a" represents the length of the tendon between the most proximal tendinous point visible, and the most distal muscle point visible.

Cadaver↗
PubMed1999

[Position of venous outflow: a crucial aspect in flaps with 2 opposed pedicles. Application to the cutaneous delay phenomenon. Experimental study with rats].

In the present study, the authors decided to focus on the effect of the venous outflow location in the survival of a flap with a choke vessels barrier by means of a rat bipedicled ventral island flap. In a first experiment, the extent of flap necrosis was examined in three experimental groups: group 1, alternate vein and artery ligation (n = 5); group 2, unilateral artery ligation (n = 5); group 3, unilateral pedicle ligation (n = 5). Less than 10% necrosis occurred in group 1; 28% in group 2 and 33% in group 3. In a second experiment we applied the first results to the delay phenomenon. 10 rats were divided into 2 groups: group 4, primary ligation of a complete pedicle on one side; group 5, primary alternate vein and artery ligation and the flaps were raised 21 days later. We observed 20% necrosis in group 4 and only 4% in group 5. The data of the first experiment indicate that a vein remaining near the artery can be a dramatic obstacle to the efficiency of choke vessels. The second experimental study shows the superiority of primary selective ligation in the delay phenomenon.

Animals↗
PubMed1998

External-internal oblique reverse blood supply musculocutaneous flap for chest wall reconstruction.

A defect resulting from resection of advanced breast tumor can be quite large, posing a difficult reconstructive challenge. A significant number of such patients are found to have local recurrences after receiving beam radiation therapy and chemotherapy. The external oblique musculocutaneous flap is now considered a reliable option, with segmental blood supply from the posterior intercostal arteries. We report a 57-year-old man with local recurrence of breast tumor after external beam therapy. We faced a difficult challenge in performing reconstruction because of (1) several previous operations that used most of the usual options and (2) the absence of recipient vessels for microsurgery. We performed an external-internal oblique musculocutaneous flap with a reverse blood supply from the lateral branches of the inferior epigastric artery. Our use of a reverse-flow external-internal oblique flap supports the concept of rotating the muscles as a unit to encourage viability of the denervated and relatively devascularized component.

Arteries↗
PubMed1998

[Epithelioid sarcoma manifesting as chronic plantar arch ulceration].

BACKGROUND: Epitheloid sarcoma is an uncommon malignant soft tissue tumor observed in the distal extremities of young men. We report a case of long standing ulceration of the sole which was found to be an epithelioid sarcoma. CASE REPORT: A 78-year-old woman had an indolent ulceration of the left sole for several months. Physical examination disclosed a well demarcated 3-cm ulcerated lesion with a red center and flat edges. Skin sections confirmed the diagnosis of epithelioid sarcoma. Cells stained positively for anti-vimentin, anti-cytokeratin and anti-epithelial membrane antigen, but not for anti-S100 protein and anti-actin antibodies. Wide local excision was performed. DISCUSSION: Epithelioid sarcoma is an uncommon malignant tumor which apparently differentiates from mesenchymatous cells. It is usually observed in the distal extremities in young males, predominantly the hands and forearms. The tumor presents a firm, flesh-colored indolent nodule. Ulceration usually develops and involves the subcutis and deeper soft tissue, particularly fascial planes, aponeuroses and tendon sheaths. Treatment is wide surgical excision with or without radiotherapy. The case reported here on the sole of the foot in a 78-year-old women is unusual. Clinicians should be aware that the initial biopsy may not be contributive and that repeated biopsies may be necessary for positive diagnosis.

Aged↗