Biomedical subjects
Publications and source records attributed to M Revol.
Without any proof, a governmental agency has decreed that Corticotulle was not enough efficient to be reimbursed by National Health Security. Dealing with treatment of basal cell carcinoma, another governmental agency has published recommendations which even do not follow basic rules of logic. This paper points out that economical and political methods are not scientific or medical ones.
PURPOSE: The purpose of this study was to analyze the evolution of the practice of free flaps in the treatment of tumoral and traumatic pathologies. MATERIALS AND METHODS: This retrospective study was realized on 328 free transfers. The authors compared two periods each of 10 years: series 1 concerns 176 flaps realized from March 12th 1981 to March 13th 1991 (already published); series 2 concerns 152 flaps realized from December 1st 1994 to November 30th 2004. RESULTS: We noticed a decrease of the number of free flaps for lower limbs, a stabilization in the head and neck area and a clear increase in mammary reconstruction. Three donor sites were used in 89% of the cases: latissimus dorsi, forearm and rectus abdominis flaps. Others were used only one to seven times, for specific indications. Some surgical tactics saw their indication decrease (semi-free flap or "apple turnover" technique), others appeared (Y anastomoses). The number of failures decreased from one series to the other (from 5,7 to 2,6%). CONCLUSION: The variety of the flaps remains restricted. The choice is due to the constancy of their vascular anatomy, the size of the pedicles and the reproducibility of their teaching in a University Hospital.
From May 1995 to March 2005 sixty-three consecutive male-to-female gender transformation surgeries were performed at our university center by one author. Our retrospective study collected data from medical records, questionnaire and physical examination. Fifty-nine percent of patients had autologous blood transfusion. Histological examination of testicles found beginning cancer in 1 case. After a-8-year initial period where secondary bilateral Z-plasties were systematically performed, this procedure was abandoned because it left unnatural visible scars. Excluding haematomas (9 cases), we found 8 major complications (12,6%): 1 rectal lesion, 1 leg compression, 5 skin necrosis of the vaginoplasty (total necrosis in 2 cases, partial necrosis in 2 cases, necrosis of full-thickness skin graft in 1 case), and 1 secondary post-traumatic rectovaginal fistula. The questionnaire was completed by 22 patients with a-45-month mean follow-up. Results were graded on a 0 to 10 scale. Mean grades were global satisfaction: 7.6, life quality: 8.4, genitalia appearance: 8.0, clitoris sensitivity: 8.4, urinary function: 8.3, vaginal function: 7.2, sexual function: 7.0. Rate of general satisfaction was high. In a few cases however, patients expressed some disappointment both in being considered as women in their daily living and in having sexual intercourse. These poor results seem clearly related to unfavourable anatomical and morphological initial conditions. Our series demonstrates that surgical treatment of psychiatric disorders meets physical limitations.
Muscle sparing technique is one of the latest improvements of rectus abdominis flaps harvesting. It minimizes donor site morbidity by preserving the abdominal wall. The deep inferior epigastric perforator flap (DIEP) provides reliable tissues for vaginal reconstruction with local low morbidity. We describe the surgical technique and flap-related specific complications. This technique is safe and useful in the vaginal reconstruction especially following a radiotherapy.
OBJECTIVE: Surgical management of the deep nasolabial fold, due to age, genetic diseases or facial lipoatrophy, is difficult and often short-lived. Direct excision seems to improve the long-term results. Clinical illustration and review of literature about the anatomy and physiology of the nasolabial fold are proposed to explain this fact. MATERIALS AND METHODS: Direct excision of the nasolabial fold has been performed on nine patients, three females and six males. The problem was aging midface in two cases, facial lipoatrophy in five cases, cutis laxa in one case and pachydermoperiostosis in one case. The excision was sitting astride the nasolabial fold and the suture preserved a dog-ear at the upper extremity to restore the projection of the cheek. Evaluation items were quality of the scar, durability of the result and personal improvement. RESULTS: Scars were always unnoticeable within six months, projection of the cheek was restored, and results were durable with an average follow-up of eighteen months. All patients were satisfied with the aesthetic or social improvement. CONCLUSION: Direct excision of the nasolabial fold is a simple, reliable and durable method, respecting the physiology of this area of the face. Then, it should be indicated in deepened nasolabial fold, whatever the etiology.
Melanoma is a malignant tumor, with dominant lymphatic extension. Sentinel lymph node is the first lymph node touched by melanoma. Our retrospective and monocentric study is about 87 patients, between July 1999 and July 2003. The inclusion criteria were malignant melanoma with Breslow level superior or equal 1.5 mm, and/or Clark level superior or equal IV, and/or ulcerated, and/or in regression. Sentinel lymph node has been negative on histological analysis in 75 patients (86.2%). About these 75 patients, we found five metastatic lymph node recurrence (6.66%) in a short notice (median 10.2 months). For the five patients with recurrence, the original slides and tissue blocks were available for reexamination. Then, we found micrometastasis in two patients (40% of occult metastasis). Our rate of lymph node recurrence in patients with sentinel lymph node negative is about 6.66%. Our analysis make us believe that early recurrence are essentially linked to histological analysis limits, and maybe to skip metastasis existence.
Epidermolysis bullosa (EB) is a heterogeneous group of genetically determined skin fragility disorders in which minor trauma leads to blister formation on the skin. One of the most severe forms is Hallopeau-Siemens recessive dystrophic EB which main cause of mortality is squamous cell carcinoma (SCC). Exeresis of SCC leads to a difficult problem about treating the surgical wound. Most of the time, achieving a split-thickness skin graft on these severely affected EB patients is either too difficult or gives poor quality results. In some cases, flaps could be performed but they represent a too aggressive solution. However cutaneous pinch grafting is really adapted to the healing of these wounds. We have reported 4 cases of patients with recessive dystrophic EB complicated with SCC from 30 mm to 270 mm. After surgical excision of these SCC, dressings have been applied until obtaining a good enough floor for achieving a skin graft. The four patients have been treated by cutaneous pinch grafting. Airway management and monitoring have required particular precautions for avoiding anaesthetic related morbidity. We have noticed no adverse effect. A complete healing of good quality has been obtained in all cases (3 to 16 months of follow-up). No recurrence of SCC has been noticed and donors sites have had got a good healing. Relating to the healing of wounds after exeresis of SCC in case of dystrophic EB, cutaneous pinch grafting represents the most reliable solution with a minimum of physical traumatism.
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OBJECTIVE: Development of upper limb functional surgery in tetraplegics in the last 50 years. METHODS: The literature review relating to the years 1950-2002 was carried out with 3 data bases: Medline, Pascal, Embase. This review also involved a thorough study of non-indexed references. RESULTS: A large number of surgical procedures are described. Two priorities are stressed by the authors: safety of these procedures and duration of postoperative immobilization. CONCLUSION: This review of literature shows that the prospects for restoring upper limb function in tetraplegics are greater than ever, offering a larger number of patients the possibility to increase their independence in daily life. Functional surgery remains, nevertheless, demanding in terms of length of immobilization and presupposes requiring a multidisciplinary approach requiring rehabilitation teams to be up to date with surgical procedures.
To assess the results of surgical resection and chest wall reconstruction we reviewed our experience with the complete chest wall reconstruction after en bloc excisions according to an original algorithm based on the location of the thoracic defect. The 14 reconstructions were performed by the senior author. We found 5 central, 6 lateral and 3 borders locations. In the central locations with a total resection of the sternum the reconstruction was realized by Gore-tex's mesh in depth, metal hooks (staples) and Marlex's mesh under a musculocutaneous flap of coverage. In case of lateral location the reconstruction was realized by Gore-tex's mesh covered with a musculocutaneous flap, the borders locations were reconstructed by Marlex's mesh and flap of coverage. The histological diagnoses were: one desmoid tumor, eight sarcomas, a recurrence of hepatocarcinoma and four recurrences of breast cancer. The superficial coverage performed by latissimus dorsis flap 12 for cases and rectus abdominis flap for two cases. All the patients were able to produce a spontaneous breath after surgery. Two deaths at distance and an infection were to regret. On the whole the algorithm of reconstruction according to the location of the defect allows a simplification of the indications.
Breast reconstruction with latissimus dorsi myocutaneous flap is a reliable technique. Its width is limited to between 10 and 12 cm if direct closure of the donor site defect is required. We report a study with assessment of the dorsal skin laxity in 25 women, simulating vertical, horizontal and reverse oblique flap. The average width was 12.5 cm (11.6 to 14 cm) for reverse oblique flap, 9.4 cm (8 to 11 cm) for vertical and 9.2 cm (8 to 10.6 cm) for horizontal flap. Our study suggests that the reverse-oblique flap provides a wider flap and reduces the donor site morbidity.
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INTRODUCTION: Many risk factors of nosocomial infection may be met with tetraplegic patients. The objective of this work was to study the prevalence of colonization by 3 multiresistants bacteria (methicillin resistant staphylococcus aureus (MRSA), Klebsiella pneumoniae with widened spectrum beta lactamase or multi-resistant Acinetobacter baumannii) on this population. MATERIAL AND METHODS: It was about a prospective study for which we included 20 consecutive patients coming from a rehabilitation of long stay center to have a surgical operation of palliative reanimation of the upper limb. For each patient, the first morning of his hospitalization, many sites cultures were carried out for bacteriological analysis whose results were returned in 48 h to the operator. No patient was excluded. RESULTS: Five patients (25%) showed the presence of SARM. One patient (5%) showed the presence of Klebsiela pneumoniae. One of the patients carrying a SARM was also carrying Acinetobacter baumannii. Overall 6 patients were contaminated (30%) but no postoperative infection occurred, neither at the time of the hospitalization nor after the exit of the service. DISCUSSION: The various risk factors of nosocomial infection appearance met in tetraplegic patient were analyzed. This study showed that the cares of tetraplegic patients limited to the maximum the risk of nosocomial infection appearance (no one in this series) in spite of an important contamination met in this type of population which presents long durations of hospitalization, main risk factor regularly met.
INTRODUCTION: The cup and cone technique, first described by Carrol and Hill is very simple. It affords excellent contact between bones, and allows all possible adjustments of the arthrodesis in three planes before its final fixation. MATERIAL AND METHODS: Fifty seven cup and cone arthrodesis of the thumb were performed in 41 adult tetraplegic patients. Level of arthrodesis was i.p. in 28 cases, TM in 25 cases and MP in 4 cases. Distribution in Giens classification was 3 group 1, 14 group 2, 9 group 3, 23 group 5, 2 group 6, 1 group 7, 2 group 10. Mean follow-up was 51 months. Three criteria were retrospectively studied: the clinical strength of arthrodesis, its position, and the potential existence of complications. RESULTS: Clinical fusion was obtained in 8 week in all cases, without any infection. No delayed union was observed. In only one case, a surgical revision was required, due to initial bad setting of TM arthrodesis and an intermetacarpal arthrodesis was performed with a bony graft. In all other cases, position of arthrodesis was correct. In a few cases, only minor or non specific drawbacks were observed: TM arthrodesis were sometimes painful during the first 6 months postoperatively; transient dystrophy of the thumb nail occurred two times in i.p. arthrodesis; the worst drawback was the shortening of the thumb, which impaired the key-grip in cases where the thumb was preoperatively short. DISCUSSION: In tetraplegic patients, stabilization of the thumb can be obtained either by split distal FPL tenodesis or by an arthrodesis at TM, MP or i.p. level of the thumb. When the provided thumb length is adequate arthrodesis is preferred. The cup and cone technique is very simple and effective. It is fit particularly in tertraplegic patients, whatever the level of the thumb arthrodesis.
INTRODUCTION: The extensor tenodesis is a direct dynamic tenodesis which is activated by wrist flexion due either to hand weight or flexor carpi radialis. This tenodesis is usually performed to the distal radius, but it is possible to fix EDC (extensor digitorum communis) to the retinaculum extensorum. MATERIAL AND METHODS: Biomechanical study concerned 12 anatomical subjects (24 wrists). The biometric and radiological analysis of retinaculum displacement distalwards was made under low (1 kg) and moderate (6 kg) pulling. Surgical clips were placed on the proximal and distal limits of the retinaculum in order to study their positions on roentgenograms. RESULTS: Average width of the retinaculum was 19 mm. Average movement under 1 kg drive was 6 mm and 8.6 mm under 6 kg drive. X-rays showed that the proximal border of the retinaculum was always located proximally to the wrist rotate centre, whatever the traction. DISCUSSION: We found the same anatomical features described by different authors, except for the width of the retinaculum. Our study suggests that the retinaculum is strong enough to support a surgical tenodesis.
The aim of our study was to prove that endoscopic-assisted harvest of the medial gastrocnemius muscle is as effective as the conventional technique. We performed endoscopic dissection on 10 fresh human cadavers, and found that the medial gastrocnemius muscle was easily harvested through a minor donor-site incision, because of its topography and constant dominant proximal vascular pedicle. The operative technique is described.
BACKGROUND: Thrombotic vascular occlusion is one of the main complications that can occur during microsurgical anastomosis and is frequent when the blood becomes turbulent. The aim of this ex vivo study was to test the use of nonlinear mathematical tools to detect turbulence flow upstream and downstream of an arterial stenosis and of a microsurgical anastomosis technique in arteries with diameters in the range of microsurgical practice. MATERIALS AND METHODS: Rat carotid arteries (0.8 to 1.2 mm diameter) were transferred to a flow chamber and perfused with Krebs solution. An oscillated vascular flow was initiated with a peristaltic pump and a transit time flowmeter was used to measure flow with two probes. An arterial stenosis was created by a ligature and progressively increased ranging from 0 to 95%. For each flow signal three nonlinear analytical procedures were applied: time-delayed procedures, correlation dimension, and computing of the largest Lyapunov exponent. RESULTS: Our results indicated that the level of turbulence flow is correlated with the area reduction stenosis. In the range of 60-95% area reduction stenosis, we noted an experimental increase of turbulence flow. We also founded that a classical end-to-end anastomosis technique induced an increase of the turbulence flow in comparison with a control artery. CONCLUSIONS: Thus nonlinear analysis can be useful in characterizing the complexity of an oscillated flow in small arteries submitted to stenosis or microsurgical anastomosis and may have clinical uses in detecting high level turbulent flow after microsurgery.
The utility of mammary prosthesis texturing in the prevention of capsular contracture was established some 20 years ago. Various models of implant texturing are currently on the market. We decided to study two of the most popular implants with two different surface texturings: the Biocell RTV and the Mentor 1600 Siltex. An observation at the electron microscopic level of the implants' surfaces was achieved. At the time of a prospective survey on 10 patients, the capsule fragments corresponding to these two prostheses have been analyzed at the electron microscopic level. All prostheses were removed from the patients because of asymmetry or bad positioning. The aim of our study was to establish a correlation between these two frequent texturing surfaces and their corresponding capsules. Our results showed that only the Biocell's capsules present a mirror image with correspondence of the depressions on the prosthesis and contacts on the capsule. This phenomenon seems linked to the existence of a critical size of the pores constituting the implant surface. This observation leads us to the hypothesis of an adhesive effect between the prosthesis and its capsule. If this last is not directly linked to the prevention of capsular contracture, it can have an effect on implant stabilization in the primary mammary reconstruction and in the secondary corrections of asymmetry or bad position.