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Biomedical subjects

R Legré

Publications and source records attributed to R Legré.

18 recordsLinked to original sources
PubMed1995

[Accidents of chemotherapy involving the upper limb].

Subcutaneous extravation of antimitotic agents in the upper limb is a rare complication of chemotherapy. The functional integrity of the limb can be compromised due to severe skin damage. Extensive soft tissue necrosis is difficult to manage and cannot always be repaired without sequellae. Based on an analysis of a series of patients and a review of the literature, we report the main pathophysiological features and clinical signs of such accidents as well as the still debated therapeutic management. Two points are essential: the emergency situation created by these accidents requiring adequate and rapid treatment despite the apparently benign appearance of the extravation and imperative prevention which is the main therapeutic tool.

Antineoplastic Agents↗
PubMed1994

[Cutaneous flaps].

The use of skin flaps has long been known. Since the beginning of the 20th century, with better knowledge of skin vascularisation and technological development, the plastic surgeon has had at his disposition a wide choice: skin flaps, fasciocutaneous flaps, myocutaneous flaps, blood-carrying flaps and free flaps. The use of a flap for healing should be considered with regard to grafting techniques or directed healing. The criteria for choosing the type of flap are important, in order to obtain a good quality of skin cover with minimum scarring and loss of function.

Dermatologic Surgical Procedures↗
PubMed1994

[Coverage of arterial repair of the upper limb. Choice of a technique apropos of 24 cases].

Twenty-four cases of complex trauma of the upper limb, with soft tissue damage including at least loss of part of an artery and the overlying skin, were recorded and treated in the Hand Emergency Unit at the Timone Hospital in Marseilles. These cases were dealt with globally in a single staged operation with careful wound care, bone stabilisation when this was deemed necessary, arterial shunt and repair of the soft tissues. To cover the exposed arterial shunt, the choice of coverage technique depends on the site of the lesion, on the extent of soft tissue damage, and also on the reliability of the flap and its residual scar. The authors analyse their series and present their indications.

Arm Injuries↗
PubMed1994

[Mandibular reconstruction using an iliac crest free flap vascularized by the deep circumflex iliac vessels. A clinical study apropos of 30 cases].

Thirty cases of mandibular defects were reconstructed with a free iliac flap vascularised by the deep circumflex iliac vessels. Twenty five of these cases involved soft tissue damage with a defect of the mandible. The surgical procedure described by I. Taylor was used. Three anatomical variations of the pedicle were found. The features of the iliac bone are particularly suitable for mandibular reconstruction. The natural shape of the iliac bone does not require complex osteotomies and its healing capacity allows simple osteosynthesis. The thickness of the muscular pedicle, and thus the flap, is determined by the position of the lower edge of the skin components with respect to the iliac crest. This type of flap currently remains very useful in reconstruction of major mandibular and adjacent soft tissue destruction because of the very low incidence of failure (2 cases) and complications.

Adolescent↗
PubMed1994

[Vaginal reconstruction by musculocutaneous flap of the rectus abdominis after pelvic cancer surgery. Apropos of 11 cases].

Surgical treatment of gynecological neoplasms leads to two problems: pelvic defect, and vaginal reconstruction. The authors have been using rectus abdominis musculo-cutaneous flap as described by Tobin. Eleven patients have been treated. A horizontal flap was used in one patient and a vertical one for the 10 other patients. The authors had one failure. In the ten other patients the average healing time was 21 days and 5 patients were able to return to sexual activities. The use of rectus abdominis flap would appear to be an easy and reliable technique for pelvic reconstruction.

Adult↗
PubMed1993

[The diagnostic value of arthrography of the wrist in the evaluation of carpal ligament injuries: radio-surgical correlations. Apropos of 20 cases].

Intra-carpal ligament tears lead to radiocarpal arthritis early diagnosis allows early treatment. Standard and dynamic X rays are not always able to make the diagnosis. In these cases, arthrography of the wrist may give the diagnosis. To establish the specificity of this examination we tried to correlate surgical findings with arthrographic suspicions. Exact diagnosis was established in 12 out of 13 cases of suspected scapholunate ligament tears in 5 out of 6 cases of suspected luno-triquetral ligament tear suspicion and none of the 3 cases of suspected T.F.C.C. rupture suspicion. Wrist arthrography appears to have a good specificity for first row intra-carpal ligament tears. The indication arthrography must be discussed with wrist arthroscopy for the diagnosis of long term wrist pain after clinical examination and standard and dynamic X rays.

Adolescent↗
PubMed1992

[Multicentric study of 143 cases of resection of the proximal carpal bones].

Proximal row carpectomy is an old procedure but the good results published in the literature, it still has bad reputation. The authors conducted a retrospective multicentric study in 143 patients, 128 of whom were post-traumatic cases. And results were good in terms of pain relief. Increase in grip strength was observed in 80% of cases. Wrist range of motion was not improved by resection. The results were not predicted by preoperative status. No prognostic factor could be defined on the basis of study.

Adolescent↗
PubMed1992

[Choice of technique in covering an excision of neoplastic tissue in the inguinal area].

Cancer surgery of the groin may lead to large skin resection with exposure of the femoral vessels. A reliable coverage technique must be chosen to enable this kind of surgery. Six patients were operated on, and ten flaps were used (3 omentum - 3 rectus abdominis - 1 fascia lata - 1 gracilis - 2 latissimus dorsi free flaps). In the light of our results, omentum must be used when laparotomy is associated with inguinal resection and omentum is available. In the other cases, resection size could prohibit the use of local flaps and a contralateral rectus abdominis flap is chosen which allows coverage of the inguinal area down to the middle third of the thigh.

Abdominal Muscles↗
PubMed1991

[Surgical excision of giant venous angioma of the face under extracorporeal circulation: apropos of a case by a multidisciplinary team].

Because of the risk of haemorrhage related to their resection, deep angiomas of the face are often considered to be inaccessible to treatment. The use of cardiopulmonary bypass with profound hypothermia allows the surgeon to operate in a bloodless field, enabling almost oncological resection of the tumour. The authors report a case of venous angioma of the submaxillary region treated in this way after failure of limited surgery and embolisation. Complete resection of the lesion was achieved and the defect was repaired with a pectoralis major flap and a latissimus dorsi flap. The authors stress the value of a multidisciplinary approach: a cardiac surgeon for CPB, an ENT surgeon for resection and a plastic surgeon for reconstruction.

Extracorporeal Circulation↗
PubMed1990

[Analysis of sequelae of the latissimus dorsi flap removal. Report of 44 cases reviewed and tested].

Since Tanzini, the latissimus dorsi muscle flap has been widely used in plastic surgery. Based on the experience of two plastic surgery units, we decided to try to define the sequelae of this operation. In order to simplify our analysis we only considered free flaps. Out study is based on 42 patients (26 pure muscular flaps and 16 musculo-cutaneous flaps). The sequelae were analysed in terms of aesthetic and functional criteria. The aesthetic sequelae appeared to be minima in the case of pure muscular flaps, but more severe in the case of musculo-cutaneous flaps. Functional sequelae in the shoulder were observed on muscle testing in 30% of cases, although there were no repercussions on sport or work activities. Analysis of spinal posture demonstrated a modification in the frontal plane in 40% of cases although this could not be clearly attributed to the donor site. On the basis of this study, we can conclude that the latissimus dorsi flap retains an important place in the therapeutic arsenal of plastic surgery due to its reliability and its minor cicatricial and functional sequelae at the donor site.

Back↗
PubMed1989

[Evaluation of 106 free flaps. Analysis of the failures and the indications].

Between April 1982 and April 1987, 106 free flaps were performed: 27 in the head and neck, 9 in the upper limbs and 60 in the lower limbs. 4 types of free flaps were essentially used: 42 latissimus dorsi flaps, 30 Chinese flaps, 18 temporalis flaps and 12 gracilis flaps. 14 free flaps were performed as a real emergency to cover defects of the upper limb in 4 cases and of the lower limb in 10 cases. The overall success rate was 87%, but this varied according to the recipient site, as the success rate was only 80% in the lower limb, and according to the type of flap, the latissimus dorsi flap ensured a success rate of 90%. Apart from one case of drepanocytosis, the failures observed could have been prevented. Rigorous intensive care as well as a strategy based on a precise preoperative assessment and appropriate selection of flaps should allow a considerable improvement in the results. Due to its reliability and its possibilities, we consider the latissimus dorsi flap to be the most useful flap. The Chinese flap retains a place in ENT surgery and in the case of emergency by-pass flaps. The gracilis and temporalis flaps may be proposed in certain cases because of their surface area and their minimal scars.

Adolescent↗
PubMed1986

Analysis of sequelae secondary to the radial forearm flap. A study of twenty-six cases.

The radial forearm flap is used extensively in hand and reconstructive surgery. We have performed 31 radial forearm flaps (15 free and 16 pedicled flaps) in 25 adults and 5 children. This series was analyzed in an attempt to minimize the sequelae of the upper limb and provide more specific indications for this flap. Vascular sequelae were assessed by Doppler and thermography examinations. The functional sequelae were appreciated by wrist motion and grasp strength examinations. Cutaneous sequelae were evaluated according to the time of healing and the quality of the scars. Several technical modifications may be proposed in order to try to minimize sequelae. As shown by our study, cutaneous sequelae are the most important and they must always be considered in the indication of this flap.

Adult↗
PubMed1985

[Bilateral lunato-triquetral synostosis with bilateral fracture of the scaphoid bone].

The authors have treated a case of bilateral fracture of the scaphoid bone in a young man who had complete and bilateral lunato-triquetral synostosis, without any other associated congenital condition. Consolidation was obtained by orthopedic treatment on one side, but a Matti-Russe operation was necessary on the other. The authors emphasize but then rule out the hypothesis of a congenital bipartite scaphoid associated with the synostosis. A review of the literature on lunato-triquetral synostoses sums up the main points. The condition is rare in whites and occurs more frequently in blacks. It is sometimes associated with other congenital conditions. Four anatomic and radiologic types have been described. The pathogenic hypotheses, based on embryology, are summarized.

Adult↗