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Biomedical subjects

P Paulhe

Publications and source records attributed to P Paulhe.

7 recordsLinked to original sources
PubMed1996

[Skin expansion. Material and technique].

Skin expansion material has progressed and now covers all needs in plastic and reconstructive surgery. Breast reconstruction occupies a special place among expansion techniques and requires specific material. The skin expansion technique was approved by French Social Security in 1995 and is now covered in both the public and private sectors. The skin expansion protocol is rigorous with no room for improvisation. It is only in this way that the quality of the result justifies the use of this technique.

Dermatologic Surgical Procedures↗
PubMed1996

[Expansion in breast surgery].

Skin expansion in breast reconstruction presents several specificities related to mastectomy, retromuscular dissection, and the oncological context. In delayed reconstruction (DR), the local clinical examination is essential to select indications and to eliminate high-risk cases (sequelae of radiotherapy, Halsted, etc.). Immediate reconstruction (IR) must be reserved for motivated patients in whom mastectomy represents the last stage of treatment. The patient must be well informed before the operation. The choice of expander depends on the width of the breast to be reconstructed. Precise drawings are made in the standing position. In the case of DR, the prosthesis is inserted retropectorally superiorly and subcutaneously inferiorly. In IR, a complete retromuscular compartment must be created. Inflation begins after healing at a weekly rhythm until the desired volume has been exceeded. Inflation is performed more slowly in the case of previous irradiation. The second stage is performed three months after the end of inflation. After removal of the expander, the periprosthetic capsule of the compartment can be modified when necessary. The choice of the final prosthesis, preferably with an anatomical shape, is critical in order to obtain the correct volume. When necessary, the inframammary sulcus can be reinforced by internal or external procedures. Other reconstructive procedures (symmetrization, areolar reconstruction) can be associated. The most serious complications are infection and exposure. Serous effusion, thoracic deformity, malposition and capsular retractions can affect the result. Apart from breast reconstruction, expansion of the mammary region is useful in congenital malformations (glandular aplasia, Poland syndrome, severe asymmetry) and in acquired developmental abnormalities. Expansion has several indications in cosmetic surgery for certain cases of augmentation mammoplasty, correction of tuberous breasts and revision of certain mammoplasties.

Breast Diseases↗
PubMed1993

[Forum on tissue expansion. Expansion of the upper limb].

The authors report their experience of skin expansion of the upper limb based on a series of 42 operated patients: shoulder (8 cases), arm (19 cases), forearm (5 cases) and hand (8 cases). The operative protocol must be rigorous in terms of the choice of prosthesis (shape and size) and the type of valve (internal or external) and in terms of the technique of insertion of the expansion prosthesis (short incision in healthy skin) and harvesting of the expanded flap (sliding-draping flap rather than rotation flap). The indications are varied: unsightly scars and sequelae of burns, congenital naevi, syndactyly, resurfacing and preparation for a secondary surgical procedure (implant of a prosthesis, neurolysis, tenolysis). There were few complications with only 2 major complications resulting in failure of this technique.

Adolescent↗
PubMed1993

[Forum on tissue expansion. Are tissue expansion and radiotherapy compatible? Apropos of a series of 50 consecutive breast reconstructions].

Tissue expansion has become a method of choice for immediate or delayed breast reconstruction. The compatibility of radiotherapy and tissue expansion is a growing problem. We analyse a series of 50 breast reconstructions by expansion, 24 without radiotherapy and 26 with radiotherapy. For the 24 patients without radiotherapy, very satisfactory cosmetic results were obtained in 71% of cases with 21% of stage III-IV capsular contractures and 8% of failures. For the 26 patients with a history of radiotherapy, very satisfactory cosmetic results were obtained in 65% of cases with 20% of capsular contractures and 10% of failure. 20% of cases also required a myocutaneous flap to complete the reconstruction. The complications related to radiotherapy are due to radiation lesions of endovasculitis and destruction of the network of elastin fibres. They result in the impossibility of filling the expander, deformation of the thoracic cage, expansion without projection, thinning of the tissues over the prosthesis and necrosis and exposure requiring the use of a myocutaneous flap. In conclusion, signs of radiation dermatitis constitute a contraindication to tissue expansion, which is nevertheless possible, but with a higher risk of complications. Irradiation to an expansion prosthesis is associated with an unacceptable complication rate.

Adult↗
PubMed1991

[Contribution of external valves in skin expansion].

The filling period is a delicate phase of skin expansion procedures. Many of these difficulties are due to problems encountered during puncture of the valves when they are buried in the skin (pain, leaks, loss of the valve, inverted valve). The authors report their experience of the use of external filling valves. Based on a series of 68 valves, they describe the implantation technique, indications and their results.

Adolescent↗
PubMed1991

[Crossed leg expanded flaps].

The authors report their experience of three cases of crossed leg expanded flaps. They describe the operative technique and discuss the advantages and disadvantages. Prior expansion of the crossed leg flap reduces the donor site scar.

Adult↗