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Biomedical subjects

J P Loddé

Publications and source records attributed to J P Loddé.

6 recordsLinked to original sources
PubMed1998

[Facial epitheliomas: general considerations, surgical techniques and indications].

Carcinoma of the face is the skin disease most frequently encountered by plastic surgeons in everyday practice. Although basal cell carcinomas and squamous cell carcinomas are generally easy to recognize, their treatment remains subject to various schools of thought, or even individual practices, which are often difficult to define. This article defines a general plan of management of these tumours; their histological duality corresponds to a therapeutic duality. Resection of a basal cell carcinoma requires safety margins of 3 to 4 mm, versus at least 5 mm for a squamous cell carcinoma. In a high-risk subject, with a sclerodermiform carcinoma or undifferentiated squamous cell carcinoma, this safety margin may be as much as 10 mm or more. Frozen section examination is preferable in these situations. Six anatomical regions are studied selectively to define the main rules of reconstruction: nasal region, orbitopalpebral region, labial region, malar region, frontal region and auricular region. Each region will be subdivided into several subterritories, each requiring different strategies. The objectives, methods and indications of each reconstruction are selectively defined. The final strategy proposed is based not only on the author's personal experience, but also on the results of the national survey on carcinomas. As a complement to these therapeutic guidelines, the authors raise the problem of incomplete resection, which requires the definition of a peripheral infiltration index predictive of the recurrence rate. Surgery obviously cannot constitute exclusive treatment carcinomas, hence the value of presenting other methods currently available in the therapeutic armamentarium. Surveillance is essential in every case, determined by the patient's risk of recurrence or even metastatic dissemination.

Basal Cell Carcinoma↗
PubMed1998

[Sclerodermiform basal cell carcinoma. Apropos of a study of 83 cases].

The authors present a study of 83 cases of sclerodermiform basal cell carcinoma. This series constitutes 2.3% of all skin cancers treated in the authors' unit from 1981 to 1996. The predominant site of these carcinomas is the centrofacial region with 46% of tumours involving the nose. In the majority of cases, treatment consisted of cover by a flap (52.6% of cases). Full-thickness skin grafts were used in 29% of cases and excision-suture was performed in 18.4% of cases. The authors emphasize the need to perform large resection with safety margins determined by the macroscopically visible tumour diameter. As frozen section pathological examination is not contributive, they prefer to defer reconstruction until the final pathology results are obtained. The only exception is the need to cover a vital region, such as the eye. These carcinomas must be followed in the long-term, as 20% of recurrences were detected in this series, comprising many orbitopalpebral sites, associated with difficult staging, and which always have a reserved prognosis. The authors therefore propose the use of epitheses in so-called high-risk sites. The three main guidelines in this disease, one of the most worrying forms of skin cancer, are surgical aggressiveness, modesty in terms of the cosmetic result and alertness in the follow-up.

Basal Cell Carcinoma↗
PubMed1995

[Biomaterials in plastic and maxillofacial surgery].

The major progress in biomaterials over recent years have concerned osteosynthesis, reconstruction and creation of the shapes of bones and soft tissues and gluing. In the authors' field of osteosynthesis, "pure" medical titanium, particularly T40, is perfectly adapted to situations (face, hand) in which the bone constraints are much lower than those encountered in hip and long bone surgery. Two improvements can be recommended: reheated titanium T40 due to its improved ductility; cermets (ceramo-metallic biomaterials) which have an excellent biocompatibility and which allow bone-implant liaisons, particularly for the bony fixation of epithesis supports. Ceramics and coral can be safely used to fill bone defects, in situations with low constraints. Numerous products are available and improve each year. For an equal quality, it is preferable to use the least expensive. Numerous products are available for reconstruction or creation of soft tissues, but present various disadvantages such as collagen, which is not resorbed, collagen-bioceramic, bone-collagen, hydroxyapatite-gelatin composites have a promising future, but the follow-up is too short at the present time. Fluorinated polymers, of which Gore-Tex is the leader, have been used for about thirty years in multiple applications, and certainly have a great future. The technology of biological glues is difficult, but this line of research is very interesting and promising for glues derived from non-living substances.

Biocompatible Materials↗
PubMed1978

Mandibular osteosynthesis by miniature screwed plates via a buccal approach.

The modified Michelet's (1973) technique of mandibular osteosynthesis, which consists of monocortical juxta-alveolar and sub-apical osteosynthesis, without compression and without inter-maxillary fixation, is described. This technique can be used in many types of mandibular fracture, single or multiple, associated or isolated, except in the case of a fracture of the condylar neck and in the presence of pre-existing infection. Infected fractures are treated by orthopaedic methods. Materials used (plates and screws) and particulars of the method have been tested by multi-disciplinary experimentation, particularly by anatomical verification and biomechanical studies. The ideal line of osteosynthesis is described. For the author, this technique is a routine treatment of any type of mandibular fracture.

Bone Plates↗