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Biomedical subjects

M Costagliola

Publications and source records attributed to M Costagliola.

At least 19 recordsLinked to original sources
PubMed2000

[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↗
PubMed1999

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↗
PubMed1999

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↗
PubMed1998

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↗
PubMed1998

["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↗
PubMed1997

[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↗
PubMed1997

[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↗
PubMed1997

[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↗
PubMed1997

[Severe cutaneous necrosis after ultrasound lipolysis. Medicolegal aspects and review].

The authors report the case of a young patient who developed extensive skin necrosis after ultrasound liposuction of the medial surface of the thigh. These lesions required excision, split-skin graft and installation of an expansion prosthesis. The medicolegal aspects of this case are discussed, in particular the responsibility of the doctor who performed this damaging procedure, from three points of view: damage, fault, causality. In this case, the damage corresponded to necrosis which can be due to a chemical, infectious or thermal mechanism. It is responsible for serious damages due to the number of operations, the length of hospital stay, immobilization, rehabilitation and the time off work. The aesthetic damage, the pretium doloris, and the inconvenience are certainly considerable, but was there fault in this case? Fault by clumsiness if the equipment was used abnormally; fault by negligence or imprudence when the equipment was not approved or when the operator was not a qualified physician, submitting his patient to undue risks. The causality is envisaged in the case of chemonecrosis and burns. It would be strongly presumed in a civil procedure in case of non-approved equipment. The authors are in favour of a hypothesis of a burn and review the current state of ultrasound liposuction, which was the subject of an intense media campaign several years ago.

Adult↗
PubMed1996

[Reconstruction of the anterior chest wall by a sandwich-type combination of a synthetic support and a muscle flap from the latissimus dorsi. Apropos of a case].

Reconstruction of the chest wall after balistic or other trauma requires good and muscle cover and creation of a new, stable and airtight wall. The authors present a case of balistic trauma of the right anterolateral chest wall which was urgently debrided and subsequently reconstructed by sandwich combination of a latissimus dorsi muscle flap and synthetic material composed of a sheet of PTFE and creation of two methylmethylacrylate ribs. The advantage of this technique is that it avoids the use of autologous tissue from an already weakened chest wall and confers a new chest stability in several sites corresponding to the wall defect with easily available and easy-to-use materials.

Adult↗
PubMed1996

[Reconstruction of the shape of the shoulder after scapulothoracic amputation].

Few papers have been published in the international literature on reconstruction of the shape of the shoulder stump after scapulothoracic amputation. The authors report a case of reconstruction using a solid silicone implant after prior skin expansion. The essential objective of this reconstruction is to eliminate the need for an external prosthesis, which constitutes a major handicap for these patients.

Adult↗
PubMed1996

[Occipital forehead pedicle for one-stage repair of defects of the upper third of the face].

The authors describe a reconstruction technique for defects of the superior third of the face using a fascio-cutaneous flap with a forehead paddle supplied by an occipital pedicle. This flap has been successfully used in three cases to cover defects of the temporo-zygomatic area indeed, the superior part of the cheek. Our three patients presented recurrent cutaneous carcinoma, a local and general poor condition. This process suits reliability and easiness to a good carcinologic, functional and aesthetic result.

Aged↗
PubMed1995

[An unusual complication of cervicofacial lift: paralysis of the external branch of the accessory spinal nerve].

Paralysis of the lateral branch of the accessory nerve is an extremely rare lesion during cervico-facial facelift. Based on 3 detailed and published personal cases observed over a period of 15 years, the authors review the literature, revealing a total of 9 cases over a period of 30 years, but other cases have probably not been published. Their review reveals the following points. This is an exceptional lesion. However, the nerve can be damaged as it emerges from the posterior border of the sternocleidomastoid muscle during slightly deep dissection and the electrical scalpel must be used cautiously. Even, partial paralysis of the trapezius muscle induces pain and considerable functional impairment with partial permanent disability. The natural history of this paralysis is very long and may be followed by regression after several years. Although there is an obvious cause-and-effect relationship between the operation and accessory nerve paralysis, it is always difficult to attribute this lesion to a possible surgical error, as the exact mechanism of the nerve lesion remain hypothetical and once again raises the problem of therapeutic risk.

Accessory Nerve Injuries↗
PubMed1994

[Continuous administration of vancomycin in patients with severe burns].

OBJECTIVES: In the severely burned patient, a marked, rapid fall in serum concentrations is often observed after intermittent infusion of vancomycin at the usual dose of 30 mg/kg. This specific "jagged" pharmokinetic course with inadequate residual concentrations raises the problem of the efficacy of this time-dependent antibiotic. Studies in patients in general resuscitation units have shown the interest of vancomycin administration in continuous infusion. METHODS: We analyzed variations in serum concentrations of vancomycin during continuous infusion in 18 patients with burns involving a mean of 40% total body surface and reported the doses necessary to maintain serum vancomycin at therapeutic levels; the possible correlations between serum vancomycin concentrations, burn parameters, age and renal function; and clinical and biological tolerance. RESULTS: Higher initial doses were required in burn patients (40 mg/kg in patients aged under 60) than in other patients. Impairment of renal function is a contra-indication of continuous infusion. CONCLUSION: This mode of administration has the advantage of ensuring greater efficacy by preventing fluctuations in serum concentrations.

Adult↗
PubMed1994

[Merkel cell carcinoma of the skin].

This study reports five cases of Merkel-cell carcinoma of the skin. Then the authors review the present state of the art from the data already available in the literature concerning this malignant primary skin tumor. A part from local excision, no standard procedures are described. The literature provides a lot of discrepancies concerning the additional treatments such as lymph mode excision, radio and chemotherapy. The prognosis of this tumor remains poor because of a high incidence of local recurrence, a frequent spread to regional lymph modes and the development metastases.

Aged↗
PubMed1994

[Difficult diagnosis of a hypervascularized tumor: "angiomatous epulis"].

Based on a case presented by the patient himself, the authors describe the difficult management of a very large, recurrent epulis arising in a context of flat angioma of one half of the face according to a vascular mode. After a brief review of the clinical and aetiopathogenic aspects, the authors discuss the value of complete surgical treatment and raise the question of the possible relation, in this particular case, between angioma and this recurrent so-called angiomatous epulis.

Adult↗