[The plastic surgeon and the walls: the confinement of surgery].
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Humans↗
Biomedical subjects
J P Chavoin
Publications and source records attributed to J P Chavoin.
[Poland's syndrome: clinic series and thoraco-mammary reconstruction. Report of 27 cases].
The authors evaluate the quality of thoraco-mammary reconstructions in Poland's syndrome. There was 34 patients in our serie, and 27 were operating between 1982 and 2001. There was 19 women and 8 men; the mean age was 19 years (9-40 years). Because of the clinical variability, the authors propose a classification of the malformation's importance in 3 degrees. In our serie, there is 35% of degree I, 53% of degree II and 12% of degree III. Each patient had an average of 2 general anaesthesias (1-6). For the first operation time, men had translation of the homolateral latissimus dorsi muscle flap in 25%, and a thoracic prosthese in 75%. Women had mammary prosthese in 50%, expansion prosthese in 20%, mammary prosthese and thoracic prosthese in 20%, muscle flap in 10%. The same person analysed the results in terms: good, middle or bad. The results are good in 67%, middle in 22%, poor in 11%. In degree 1, the results are always good; in degree II, they are good in 59%, middle in 29% and poor in 12%; in degree III, the results are good, middle and poor in 33%.
Adolescent↗
[Funnel chest: filling technique with deep custom made implant].
Through 97 patients over 9 years, the authors present a surgical treatment for "funnel chest" using custom-made silicone elastomer prothesis which are deeply placed, behind muscle and aponevroses. They justify the choice of this simple and non invasive technique, by the fact that this deformation is only morphological in most cases or even only inaesthetic with exceptional cardiac or pulmonary consequences. Patient's motivation being mainly due to psychological disconfort, the non invasive aspect of the technique leads them to choose surgery, particularly as results are good and complications seldom.
Adolescent↗
[Deflation of breast implants, pre-filled with saline or hydrogel. Results and analysis of 650 treated patients].
SUBJECT: The main mechanical side effect of saline or hydrogel filled implants is deflation. The aim of this study was to analyse the prosthetic deflation rate in the last 7 years in the plastic surgery unit of Toulouse. PATIENTS AND METHODS: We tracked 650 patients operated on between july 1993 and july 2000 (representing 1117 primary implants) which we separated in two groups: the first group contained patients in need of breast reconstruction; the second group contained all the patients with implants placed for aesthetic or breast asymMetry reasons. For each of the two groups we determined the number and the type of implants, as well as the rate and the mean delay after which deflation occurred. RESULTS: During this period, we've determined that: rate of deflation of group 1 (reconstruction) is highest than group 2 (aesthetic), despite sort of implant; rates of deflation of pre-filled hydrogel implants are highest than rates of deflation of pre-filled saline implants. DISCUSSION: Only a few series concerning implants deflation have been described in the literature. We can find a large difference in results which vary from 2 to 76%. We were surprised by the result of our series with a rate of deflation up to 15% with a medium follow-up 5 years in both groups and a mean delay before the fourth year. Deflation's factors are numerous: type of sterilisation, rippling, texture, valve's incompetence, prosthetic patch, guarantee control and iatrogenic causes. Because the silicone gel implants (the one uncomplicated by deflation) were taken off the french market, the saline implants tried to supplant them but without satisfactory results. CONCLUSIONS: With the unacceptable rate deflation of implants in our study, the return in the french market of silicone gel implants seems us an acceptable alternative.
Adolescent↗
[Metabolic problems and nutrition in burns].
Metabolic changes with burns patients are enormous. The loss of skin substance and the necessity of its reconstruction are at the origin of this exceptional situation. In this context of major aggression with important metabolic alteration the nutritional needs are considerable. To assure a tissue reconstruction, nutrition is as important as the fight against infection. The authors make the point on the quantity needs and the quality needs. They raise up the perspectives concerning immunonutriments and note the importance of enteral administration. As a conclusion, they insist on the fundamental role of the clinical aspect, in the survey of nutritional state.
Burns↗
[Skin necrosis after prophylactic treatment with heparin].
The authors present a case of cutaneous necrosis following local injection of heparin. The physiopathology and the clinical aspect are discussed.
Anticoagulants↗
[The tuberous breast: a review].
The tuberous breast is one of the most challenging problem in breast surgery. Pediatricians, gynaecologists and plastic surgeons are particularly concerned with the treatment of these young patients. A good assessment of the pathology and a precise knowledge of the surgical procedures are keypoints for a successful treatment. A case report will precede a literature overview of this very complex problem.
Adolescent↗
[Treatment of facial lesions in Parry-Romberg and Barraquer-Simons syndromes: report of 12 clinical cases].
The authors report their personal experience in surgical treatment of facial atrophies. The series present two types of facial atrophy: Parry-Romberg syndrome and Barraquer-Simons syndrome. After reviewing the etiology, pathogenesis and clinical features of these two entities, the authors describe their series of 12 patients: six presenting Parry-Romberg unilateral facial atrophy, six presenting from Barraquer-Simons bilateral facial atrophy. After a review of the literature, they draw conclusions about surgical repair techniques used (free or pedicled flaps, alloplastic grafts, lipofilling) and compare them with those reported in the literature.
Adolescent↗
Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience.
OBJECTIVE: To compare various techniques for the treatment of pilonidal sinus. DESIGN: Retrospective study SETTING: University Hospital of Toulouse, France. SUBJECTS: 246 consecutive patients who presented between 1979 and 1996. The male:female ratio was 2:1, and the mean age 26 years (range 18-69). INTERVENTIONS: 218 one or two stage excision and rotation skin flaps, and 28 simple incisions. RESULTS: 16 sinuses recurred, and no flaps necrosed. CONCLUSION: Excision and rotation skin flaps offers an effective and elegant alternative to the more classic operations for pilonidal sinus as it causes less postoperative pain and shortens convalescence.
Adolescent↗
Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry.
A variety of breast deformities of differing appearances can be grouped together within an extensive syndrome that is characterized by anomalies of the breast base and preferentially involves the lower quadrants. Tuberous breasts are the most typical, but not the only, form of the deformity. The authors studied a series of 37 patients who had breast surgery, and they used a classification of three types: I, II, and III (in increasing order of severity). In type I breasts (minor form), only the lower medial quadrant is deficient; in type II breasts, both lower quadrants are deficient; and in type III breasts, all four quadrants are deficient. The study showed a predominance of minor forms (54 percent of breasts operated on) and of combinations including at least one minor form (81 percent of patients). Seventy percent of women had a breast asymmetry of more than 100 g. Only 27 percent of breasts operated on were hypotrophic, 45 percent were of normal volume, and 28 percent were hypertrophic. The authors propose a procedure to treat the minor forms of the deformity, using a mammaplasty with a superior pedicle and a lower lateral dermoglandular flap to fill the deficient lower medial quadrant. They define the indications of the classic techniques according to the type of deformity and stress the frequent need for secondary revision.
Adolescent↗
[Angiomyoma of the hand: a post-traumatic tumor?].
A 69-year-old woman presented with a tumor of the lateral aspect of the proximal phalanx of the little finger of the right hand. The finger was injured by a ring during a handshake. Excision and histopathological examination revealed the diagnosis of angio-myoma, a benign vascular tumor originating from the smooth muscle cells of arterial or venous walls. Angiomyomas belong to the family of leiomyomas and rare, small tumors (less than one centimeter), preferentially occurring in women between the ages of 40 and 60 years. They may be painful. Only one case of sarcomatous degeneration has been described in the literature. Trauma has never been previously reported as a cause of angio-myoma, but in this case the traumatic origin of the tumor was not in doubt.
Aged↗
[Breast reconstruction after mastectomy for cancer].
In spite of advances in breast cancerology, partial or total mastectomy still has wide indications and remains a mutilative procedure. Since its introduction over thirty years ago, breast reconstruction has become an accepted, codified and efficient procedure. The techniques which can be used can be broadly divided into two categories: reconstructions with implants, which have been greatly improved by skin expansion techniques, and reconstructions using myocutaneous flaps. Whatever method is used, the breast is modeled during the reconstruction procedure and surgery is frequently necessary to obtain a symmetric opposite breast; a good knowledge of plastic surgery is thus a requisite.
Breast Neoplasms↗
A predetermined design for easier aesthetic abdominoplasty.
The authors have presented a predetermined design of cutaneous resection for abdominoplasty without relocation of the umbilicus. The design is characterized by two lateral tips, pointing upward, and a central dome. The upper and lower edges of the cutaneous incision are of the same length, which prevents puckers and allows optimal evolution of the scar. The median cutaneous resection removes the horizontal base of the triangular area of pubic hair, producing a lower final scar and giving the mons pubis a more youthful appearance. The lateral cutaneous resections allow transverse redraping of the abdominal skin, and the oblique scars, placed in the natural folds, are easily concealed even under brief attire. Unlike individual resection techniques that require practice and experience, this technique is perfectly codified and can be carried out by less experienced surgeons.
Abdomen↗
["Saphenous vascular loop" technique in the treatment of lower limb defects. Report of five cases].
Five patients with high energy trauma of the lower limb with tissue defect located in the knee or the proximal third of the leg underwent reconstruction with a free latissimus dorsi flap. This flap was connected to a vascular saphenous loop which initially creates an arterioveous shunt between proximal femoral vessels. This was performed in a single operation with two teams of surgeons. This technique was chosen because a healthy recipient pedicle was not available in the vicinity of the defect. Application of vein grafts is not the usual procedure but there are situations in which it becomes necessary. Our aim in this paper is to discuss these situations, to describe the technique used in our Hospital and to analyze the advantages and disadvantages of a one or two-stage operation.
Adult↗
[Morphological anomalies of breasts in adolescent girls and their surgical correction].
BACKGROUND: Morphological anomalies of the breast in adolescent girls cause considerable psychological distress. Plastic and reconstructive surgery offer the possibility of improving such conditions. The aims of this work were to define and illustrate the various types of anomalies, clarify their distribution and present the repair methods that can be used and the results obtained. POPULATION AND METHODS: A consecutive series of 33 girls under the age of legal majority, admitted over a 1-year period for surgical modifications of breast shape, was studied. The basic anomalies were classified as mammary hypertrophy, hypotrophy, asymmetry, and abnormal shape, among which were Poland's syndrome, tuberous breasts, thelorism and pute ptosis. The basic techniques used were reduction, augmentation with placement of an implant and breast remodeling. Distribution of anomalies was as follows: symmetrical bilateral hypertrophy, 33%; asymmetric bilateral hypertrophy, 30%; unilateral hypertrophy, 6%; combined hyper- and hypotrophy, 3%; unilateral hypotrophy with abnormal shape, 9%; abnormal shape with normal size, 15% and bilateral hypotrophy, 0.3%. Mean hospital stay was 3 days and there were no serious postoperative complications. DISCUSSION: Bilateral hypertrophy was the most frequent disorder and the main drawback was residual scaring. Bilateral hypotrophy was rarely seen since only congenital absence of mammary glands is surgically treated before legal coming of age. The main problem of implants was formation and contraction of fibrous capsules around the implants in 5% of cases. Asymmetry and anomalies of shape were more difficult to treat because each breast requires a different procedure. At the present time, because of the cost/benefit ratio of such procedures, they are reimbursed by health services. CONCLUSION: Although the results are not perfect, the psychological impact of such treatment is highly positive, suggesting that the requests of adolescent girls for this type of surgery may be encouraged.
Adolescent↗
[Imaging of abdominal wall eventration: role and value of x-ray computed tomography].
The role of imaging in preoperative investigation of incisional hernia was studied in a series of 332 operated patients. CT scan (220 patients) remains the reference investigation. Magnetic resonance imaging (8 patients) does not provide any supplementary information at the present time. The classical features of median and lateral incisional hernia are described and the importance of evaluation of the elasticity and strength of the abdominal wall is stressed. In the authors' experience, this evaluation has implications for pre- and intraoperative strategy.
Abdominal Muscles↗
[Effect of irradiation fields on the results of breast reconstruction with skin expansion after radiotherapy].
Deferred prosthetic breast reconstruction after skin expansion is considered to be difficult after radiotherapy. The authors report a series of 14 cases of reconstruction after radiotherapy, compared with 6 cases of reconstruction without radiotherapy. They reported a similar quality of results after radiotherapy not including irradiation of the chest wall and in the absence of radiotherapy (p = 0.742). On the other hand, a significant deterioration of the results was observed when radiotherapy included chest wall irradiation (p = 0.0015). Finally, no direct correlation was observed between the macroscopic appearance of the skin and presence or absence of a history of irradiation of the chest wall. They conclude that the indications for reconstruction by tissue expansion after radiotherapy must be based more on the irradiation protocol than on the macroscopic appearance of the skin.
Adult↗