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Biomedical subjects

O Heymans

Publications and source records attributed to O Heymans.

At least 19 recordsLinked to original sources
PubMed2006

[How I treat...fibroproliferative scars].

Following a skin injury like burn, surgery or a trauma, fibroproliferatives scars are responsible of cosmetic, psychologic and symptomatic disorders. Keloids are benign and occur secondary to an imbalance between the synthesis of extracellular matrix and its degradation. There is a lot of therapeutic modalities available. Despite this, recurrence and sometimes increasing lesions are the major complications. Surgery with adjuvant therapy like steroids injections, radiotherapy, silicone materials seems today the best therapeutic choice. A best physiopatholgy's comprehension is at the base of new treatments, but their efficacity still need to be demonstrate in larger studies.

Humans↗
PubMed2006

[Necrotizing fasciitis: diagnosis and treatments].

The necrotizing fasciitis is a medico-surgical emergency, characterized by the rapid speard of the infection in the subcutaneous tissue, involving fascia superficialis. Peaucity of cutaneous findings early in the course of the disease makes diagnosis a challenge for physician. Pain out of proportion to clinical findings, fever and signs of systemic toxicity are the keys in identification of necrotizing fasciitis. Delayed diagnosis lead to sepsis syndrom and/or multiple organ failure and correlate with poor oucome. Radiolographs, CT-scan or MRI are main radiologic studies, but such procedures should never delay surgical intervention. Intravenous antibiotics, fluid and electrolyte management and analgesia are needed in addition to radical debridment. Clindamycin, hyperbaric oxygen therapy and intravenous immunoglobulins are discussed treatments. Only prompt recognition and immediat care warrant a lower mortality and morbidity for this life-threatening infection.

Amputation, Surgical↗
PubMed2006

[Surgical treatment of chest wall tumors].

The observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or myocutaneous flaps.

Adult↗
PubMed2005

[Smooth or textured implants: what to select?].

Envelope structure has evolved since the seventies. Indeed, low-bleed implants allow an important reduction of capsular contracture for silicone filled implants. Later, textured implants permit an additional reduction of capsular contracture, especially when positioned in a retroglandular pocket. Whereas many studies confirm these findings, the interest of textured implants in the retromuscular plane is not really clear, even if some authors recommend it. Due to the need of a tissular anchorage, anatomical implants are not manufactured with smooth envelopes.

Breast Implants↗
PubMed2005

[Mondor's disease: a complication after breast surgery].

Mondor's disease is a rare but not uncommon complication of breast surgery. This problem is commonly described as the thrombophlebitis of the superficial thoracoabdominal veins. Symptoms combine painful contracture occurring in the sub-mammary region and/or in the axillary region, rising during arm abduction. The contracture located in the axillary region usually join the epitrochlea. Based on a serie of 8 patients, the fascial hypothesis is developed. All the patients were treated by LPG and myo-fascial techiques with a complete relief of pain in 10 days.

Adult↗
PubMed2005

Covering small defects on the weight bearing surfaces of the foot: the free temporal fasciocutaneous flap.

Although defects in the weight bearing area of the heel can be covered by local flaps, radiodermatitis is a contraindication to these flaps. Thin free flaps, as grafted fascial or muscles flaps and thin fasciocutaneous flaps, are usually the option of choice in these particular defects. These reconstructions are prone to shearing strains resulting in ulceration, hypertrophic scars and hyperkeratosis. The authors present a retrospective study of the reconstruction of six small heel defects with the fasciocutaneous temporal free flap performed between 1996 and 2001. The mean size of the defect was 20 cm(2). All arterial anastomoses were performed end to side on the posterior tibial artery. Despite the flap thinness, swelling was present during 12-25 months and one debulking had to be performed. With a mean follow-up of 32 months, all flaps regained protective sensibility after 7 months. No sliding of the flaps could be noted but there was one transient hyperkeratosis. Although the amount of hair on the transferred flaps decreased spontaneously with time, laser hair removal was performed in two patients for psychological reasons. In conclusion, it seems that in selected cases where local flaps are contraindicated, the fasciocutaneous temporal free flap can offer an excellent alternative for heel reconstruction. Due to its particular architecture, it resembles the complex tissue of the sole of the foot resulting in fewer complications and maintenance of flap durability.

Adult↗
PubMed2004

Tip of the greater horn of the hyoid bone: a landmark for cervical surgery.

The purpose of this study was to assess the relevance of the tip of the greater horn of the hyoid bone (THB) in the localization of the carotid bifurcation, the superior thyroid and lingual arteries, and the hypoglossal and superior laryngeal nerves. Measurements of these structures with respect to the THB were also made. Thirty perfusion-fixed human cadavers (60 specimens) were studied. Sharp measurements were made along two orthogonal axes crossing exactly on the THB. The vertical axis was parallel to the craniocaudal axis of the body. Taking the THB as a landmark, the five structures were identified in all the specimens. The mean value, standard deviation, and range of measurements for each structure studied are given in the text. This study shows the THB to be a useful landmark which is an aid to locating the aforementioned structures with confidence, and concludes that knowledge of this landmark would be beneficial for the surgeon dealing with the mid neck area.

Aged↗
PubMed2004

Combined reconstruction of the diabetic foot including revascularization and free-tissue transfer.

Diabetic patients, presenting with both peripheral vascular disease and large soft-tissue defects, are too often treated by primary amputation. A combined revascularization and free-tissue transfer procedure can extend limb salvage in these patients. The authors report their experience over 4 years with 19 diabetic patients with peripheral vascular disease and large soft-tissue defects of the foot requiring free-tissue transfer. Although there was a 100 percent flap survival, early local wound problems occurred in three patients (16.6 percent). The recurrence rate was about 18.7 percent, but no complementary flap procedures were mandatory. With a mean follow-up of 38 months (range: 23 to 55 months), the limb salvage rate was 94.4 percent. Although there was one limb loss and one patient with ambulation difficulties, 16 patients (84.2 percent) were fully rehabilitated and were able to function independently. Despite a rather small series, this study confirms that in selected diabetic patients, a combined approach of vascular and reconstructive surgeons can reduce the limb amputation rate with acceptable complication rates. This combined approach offers major benefits to these patients, especially stable coverage and preservation of ambulation, and should always be considered before amputation.

Adult↗
PubMed2004

Breast implants. A review.

Breast implants have been used for about four decades for both reconstructive and aesthetic purposes. In 1963, the quality of the artificial implants was revolutionized by the introduction of the silicone gel-filled implant. Since, this modern prosthesis has gone through an evolution of change and improvement with several types of devices with many variations and styles within each class. Actually, for the last three decades, approximately one million women have received silicone breast implants in the USA. But, in 1992, the American FDA banned silicone from the market, leaving saline implants as the only product generally available as an alternative until now. Other filler materials were introduced, but have never progressed beyond the experimental stage in the USA (in contrast with Europe). The evolution of the different implants through time, with their advantages and disadvantages will be discussed, but also the controversy on silicone implants in the USA and their suspected association with systemic diseases.

Autoimmune Diseases↗
PubMed2004

[Severe paroxysmal drug eruptions].

Some drug reactions showing cutaneous expression exhibit a paroxysmal course. These diseases encompass the toxic epidermal necrolysis, the drug hypersensitivity syndrome, and the acute generalized exanthematic pustulosis. These syndromes are associated with dismal outcome. They represent medical emergencies needing hospitalization in specialized care units.

Acute Disease↗
PubMed2003

[Free flap pedicle loss: clinical study on 8 cases].

The authors report on 8 cases of free flaps with vascular pedicle disruption that were encountered between postoperative days 8 to 18. In one case, the inflow disappeared 18 months after the transfer without any trouble. This resulted in 2 partial and one complete flap losses. The 4 other flaps survived completely. This complete survival is related to the angiogenesis process coming from the surrounding tissues. The most obvious causal factor responsible for the 2 partial losses was the coverage of large, non viable areas, such as a prosthetic material and bone deprived of periosteum. The only causal factor that could be assessed in the case of total necrosis was the presence of an immunosuppressive treatment. Variables participating in the installation of an adequate angiogenic response are then discussed in accordance to this experience and to the literature. Limited contact with viable tissue, ischemia-reperfusion or drugs limiting the angiogenesis seems to promote failure when the pedicle is quickly disrupted. Hypoxia seems to be the most important cellular mechanism promoting the angiogenesis in this context.

Aged↗
PubMed2003

[Coverage of defects: principles].

The coverage of defects is a broad field with which the plastic surgeon is confronted daily within traumatic, tumoral or other context. The various techniques used are skin graft and flaps, forming both heterogeneous groups. Indeed, there are various types of skin graft although a common denominator is the need for a good recipient site in order to allows an adequate "take". On the other hand, flaps carry their own vascularization. Thus, they are not dependent of the recipient site for their survival. Those are divided into three groups: local flaps, pedicled flaps and free flaps. The choice of the adequate technique with respect to the defect to be covered depends on the characteristics of the defect, its localization, the functional requirements of the area, the exposed structures, the medical status of the patient. The possible morbidity left on the donor site the aesthetic and functional goals are taken into consideration. For each case, there are often several good options as well as others less optimal solutions. The existing solutions are often so numerous that the plastic surgeon is frequently able to solve all the types of defects.

Congenital Abnormalities↗
PubMed2002

Use of the medial adipofascial flap of the leg for coverage of full-thickness burns exposing the tibial crest.

Bone exposure constitutes a frequent and difficult problem in burn patients. Where free flaps remain indicated in tibial osteomyelitis, a pedicled fascial or adipofascial flap provides an excellent alternative for coverage of simple tibial crest exposure. In fact, the adipofascial tissue of the anteromedial aspect of the leg can be mobilized over the whole length of the tibia. It is vascularized by the saphenous artery and the posterior tibial artery perforators. This pattern of blood supply allows a wide range of use for any size of burn defect in this area. Therefore, this local pedicled flap provides an excellent solution for coverage of the exposed tibia after severe burns.

Burns↗
PubMed2002

[Systemic infections of dental origin].

Microorganisms harbored in the oral cavity have long been recognized to cause systemic disease with a well known mechanism of spread via the blood stream. Different factors, including the presence of periodontal disease, the number of dental extractions or the duration of dental surgery have an influence on the risk of bacteremia. Infectious endocarditis is classically cited, but there are other potential problems including brain abscess, meningitis, lung or lie abscess, and even for some authors, a risk of thrombotic heart disease. It is important to keep in mind that some of these focal infections may be possible complications of dental (or buccal) infection. Prevention is crucial.

Bacteremia↗
PubMed2002

[Arterial revascularization with free tissue transfer for salvage of ischemic limbs with extensive tissue loss: an alternative to amputation].

Severe limb ischemia is a common problem encountered in medical practice. Aggressive attempts at revascularization have extended the limits of limb salvage. However, in certain cases, extended tissue loss compromises the healing process. It often results in amputation despite bypass graft patency. Microvascular free tissue transfer combined with arterial revascularization allows healing of these wounds and limb preservation. This combined approach is the ultimate alternative to amputation.

Amputation, Surgical↗
PubMed2002

[Deep vein thrombosis in a burn patient].

Association between deep venous thrombosis (DVT) and pulmonary embolism is probably an underestimated problem in the thermally injured patients. However, those patients display important risk factors according to Virchow's triad. This article reports on three unrecognised DVT's accompanying burns which were characterized by absence of healing or edema. The pathophysiology of this issue is then discussed with respect to the specific area of the thermally injured patient. It is our belief that local inflammatory phenomenon play a major part in the genesis of DVT associated with chronic non-healing burns.

Adult↗