Biomedical subjects
P Pelissier
Publications and source records attributed to P Pelissier.
Role of progesterone in peripheral nerve repair.
Progesterone is synthesized in the peripheral nervous system in glial cells. The functions of progesterone are indicated by the findings that it stimulates neurite outgrowth from dorsal root ganglia sensory neurones in explant cultures, accelerates the maturation of the regenerating axons in cryolesioned sciatic nerve, and enhances the remyelination of regenerated nerve fibres. The formation of myelin sheaths around axons is a sexually dimorphic process, as the sheaths are thicker in female than in male regenerating nerves. The progesterone-induced myelination is probably mediated by progesterone receptors, as it is impaired by mifepristone (RU486), a progesterone antagonist. The stimulation of neurite growth in the peripheral nervous system may be mediated by a progesterone metabolite, 5alpha-tetrahydroprogesterone, through GABA(A) receptors.
[The iliac crest. Perspective on a donor site of exceptional free flaps, 20 years after its initial description].
The iliac crest represents the principle 'reservoir' for the cortico-spongy bone. After having been used for a long time in the form of a conventional graft, it has been the object, in the last 20 years, of increasingly sophisticated transfers, making it possible to extract it in vascularized form. The authors present the anatomical bases of these transfers, which can be conceived on four different vascular axes: the superficial circumflex iliac axis, which was the first used, the deep circumflex iliac axis, the superior gluteal axis, and the lateral femoral circumflex axis. After having presented the various techniques of extraction of the anterior and posterior crests, the authors attempted to delineate the indications of each variant in the reconstruction of the members and the cervico-facial sphere. A comparison with the fibula flap will be finally carried out in order to parallel the advantage and respective disadvantages of these two transfers.
[The technique and location of secondary donor sites of vascularized bone grafts in the therapeutic arsenal of the plastic surgeon].
Most of the donor sites for conventional bone grafts can also provide vascularised bone grafts. Increased progress in vascular research has enabled the harvesting of grafts that are increasingly reliable and versatile. This work does not give emphasis to classic vascularised bone transfers like the iliac crest, the fibula or the lateral border of the scapula but highlights 'secondary' sites which are often underutilized. Several donor areas are studied; the upper limb including the clavicle, the lower limb, the thorax and the cranium. The hands and toes, which constitute a specific entity, are excluded. In each chapter the authors have emphasised the fundamental points relating to the anatomy, the technique of harvesting and the indications.
[Engineering of osseous cells and bioartificial tissues].
The association of osteogenic stem cells to a synthetic carrier makes possible the elaboration of bioartificial tissue. Numerous phosphocalcic ceramics does not trigger a foreign body reaction when implanted in bone tissue and thus, a number of materials are available osteogenic stem cell carriers to replace the bone tissue. Several methods can be used to harvest these cells. Their multiplication in vitro can lead to the appearance of anomalies of their metabolism or their karyotype. The culture method also seems to have a major influence on their appearance. The presence of these anomalies could explain the variability of results in terms of bone extracellular matrix synthesis after cell reimplantation. The surgical technique used for the implantation is also of influence. A method suppressing the in vitro period has been developed to avoid any cell metabolism modification. This method allows for a very reproducible bone synthesis in ectopic site. The availability of human embryonic stem cells could help to develop cell graft techniques for bone reconstruction.
[Vascular Ehlers-Danlos syndrome. Diagnosis 17 years after first digestive manifestations].
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Reverse dorsal digital and metacarpal flaps: a review of 27 cases.
Reverse dorsal digital and metacarpal flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks of the fingers. These flaps are transposed as reverse island flaps. Dissection of the flap is easy, fast, and preserves the collateral nerve and artery to the fingertip. A series of 27 flaps is reviewed, with more than 6 months of follow-up. Skin defects in all patients were located over or beyond the proximal interphalangeal joint as far as the fingertip and were combined with bone, joint, or tendon exposure. The flaps we used were reliable, and a joint or extensor tendon reconstruction could be performed at the same time. Patients were discharged the day after surgery and allowed to mobilize the finger early. No flap necrosis was observed, and donor site morbidity was minimal; primary closure or a skin graft was used in all patients. These flaps combine the advantages of an extended skin paddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects. When conventional local flaps are inadequate, this fast and simple procedure should be considered for its reliability and low associated morbidity.
[Role of emergency reconstruction of fingers by the "reposition-flap" technique. Report of eight cases].
Following replantation failure, fingertip reconstruction was performed as an emergency "reposition-flap" procedure in seven patients (eight fingers). This technique was intended for amputations distal to the DIP joint in long fingers, and IP joint in the thumb. Pulp was excised on the amputated segment, and the remaining bone and nail bed were reattached to the proximal stump with Kirschner wires. Pulp was reconstructed with a local advancement and sensitive flap. Trophicity and nail regrowth as well as mobility and strength were satisfactory in five cases. MRI examination showed revascularization of the distal bone fragment in four cases. This procedure is an alternative to amputation after replantation failure when patients do not accept finger shortening. The more distal the amputation, the better is the result.
[Abdominoplasty with dissociated intraparietal liposuction. Technical note].
Liposuction has greatly contributed to the improvement of the aesthetic result of abdominoplasties. However, one should consider the high rate of seroma when liposuction is performed via an inferior approach during abdominoplasty. The authors present a new approach to achieve complete liposuction of the abdominal wall during conventional abdominoplasty. This approach is carried out via submammary incision after previous undermining of the abdominal wall. A permanent assessment of the thickness of the wall allows the liposuction to stay strictly in fat tissue. Finally, there is a total independence between liposuction and the undermining procedure which allows minimization of the postoperative seroma. This technic seems particularly useful in a context of extensive abdominal adipose with flaccidity of the abdominal wall, requiring extensive undermining. Thanks to this procedure, the authors have performed a one-stage operation in many cases in which two operations would necessary previously have been.
[Submental island flaps. Surgical technique and possible variations in facial reconstruction].
The submental flap is an island myocutaneous flap supplied by the submental artery divided from the facial artery. Large skin paddles (up to 7 x 18 cm.) can be raised, perfectly matching with facial color. As an island flap it allows coverage of the homolateral oral cavity or the homolateral face (except the medial forehead region). Including the facial vessels in its pedicle allows a safe free transfer. A greater are of rotation is obtained transferring the flap on its distal pedicle. One can include in the flap a segment of internal basilar margin. The resulting scar is perfectly hidden under the mandible. The operative protocol is now well defined and makes the flap easy to use. 21 flaps have been transferred, resulting in a single partial necrosis of a flap extremity.
[Update mid-term review of the pedicular extension in reverse YV flow. Review of a 7-year experience].
Since 1990, the authors use a surgical procedure called reverse flow YV pedicle extension to transfer a flap distally to its donor site. Their clinical experience, based on of 8 different applications and more than 80 clinical cases, demonstrates the reliability of the procedure. Nevertheless, the latissimus dorsi transfer, based on scapular vessels, must be an exceptional indication due to the need to achieve a venous microanastomosis. Moreover, the "extreme lateral arm flap" is considered to require a precise preoperative anatomical assessment because of the variants of the pedicle bifurcation. The authors are convinced that further applications will extend their experience of this procedure.
Staged approach to phallic construction and penile reconstruction.
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[1984-1994: Ten years of skin flaps. Prefabricated flaps].
The term prefabrication of flaps corresponds to completely different technical modalities, often complementary and associated, which share the common feature of extending the indications and potential of pedicle or free flaps. Current methods of prefabrication of flaps can be considered to be based on one or several basic principles of reconstructive surgery. The authors discuss and analyse various modalities: a free flap can be made autonomous or can be expanded prior to transfer. A transfer can be initially prefabricated at its donor site by performing several operative steps in situ. A free transfer can be performed on the main vascular axis of a flap which is subsequently transferred, for example: free scalp transfer to reconstruct an eyebrow on a donor site reconstructing half of the face, but the first in situ operative phase usually consists of performing cutaneous, bone, cartilaginous or even alloplastic material transplants. The transfer is only performed after a sufficiently satisfactory complex anatomical, functional or esthetic unit has been achieved, in order to avoid difficult or dangerous remodeling operations after transfer. The most revolutionary appearance in the area of prefabrications is certainly induction of a pedicle or free neoflap in a so-called random territory. The addition of an arteriovenous pedicle associated with fascia underneath a muscle, underneath a skin cover, in contact with an osteoperiosteal segment allows a perfectly transferable neovascularized unit to be obtained after several weeks. All of the procedures described: autonomization before transfer, expansion before transfer, in situ prefabrication of a complex unit by addition of several tissue units (autologous or alloplastic) in one or several stages and finally vascular induction of a muscular, cutaneous or bone unit, etc. by transfer of a vascular axis in contact with this anatomical structure and combinations of these various modalities obviously open up a new approach which will considerably extend the already remarkable possibilities offered by free tissue transfers.
[Transsexualism: surgical aspects. An experience of the plastic surgical unit's in Bordeaux].
After briefly reviewing the history of transsexual surgery, the authors explain their technical choices and present their experience based on a series of 19 patients, 11 male transsexuals and 8 female transsexuals. The results are analysed. The potential complications of surgery in female transsexuals are those of microsurgical techniques aggravated by treatment with testosterone, as well as urethral fistulae and strictures. In addition to prevention of thromboses, the authors palliate these complications by ulnar elongation of the radial forearm flap in order to minimise the factors responsible for urethral fistulae, combined with enlargement of this flap to decrease the risk of stricture. The complications in male transsexuals essentially consist of rectoneovaginal fistulae. Problems of the depth of the neovagina are also important. Two rectoneovaginal fistulae were observed in this series of 11 patients, both treated medically. The unit's experience in this field will be continued in order to further improve the results.
[Triple anastomotic disunion with infection of a total aorto-bifemoral prosthesis successfully treated by axillo-bifemoral bypass].
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[Heterogenic goiter, right recurrent paralysis and nodule of the homolateral carotid bifurcation. A difficult diagnosis].
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[Aneurysmal development of aorto-iliac medial dystrophies. Apropos of 12 cases].
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Dystrophy of the media with aneurysmal tendency in the abdominal aorta-iliac segments (13 cases).
The authors report 13 cases of aneurysm of the abdominal aorta and common iliac arteries similar to those described by Leriche. The main morphological abnormality was major dystrophy involving the media, giving a special pathological appearance to these structures, long considered a mere morphological anomaly. In this part of the arterial system at least, they seem to evolve towards aneurysm and rupture (thin-walled aneurysm). This course requires echotomographic supervision of cases not submitted to immediate surgery, owing to the widespread nature of the process and the fact that some lesions resemble large arteries rather than aneurysms. The classic surgical technique of aortic and iliac aneurysms should often also include special technical devices. First, unilateral by-pass operation before the resection stage, and secondly aortic suture on a prosthesis to avoid tearing the arterial wall which is affected by media-spongiosis. The ten cases operated here all had a favourable course with a follow-up period of 1 to 9 years.