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Biomedical subjects

V Casoli

Publications and source records attributed to V Casoli.

At least 19 recordsLinked to original sources
PubMed2006

[Fibular pedicled proximal vascular island flap for distal femoral bone reconstruction. Anatomical study].

The fibular pedicled proximal vascular island flap for distal femoral bone reconstruction described for the first time by Cariou on 1996, is studied in this article with an anatomical view. This anatomical morphometric study allows to assure the surgeon that this procedure can be done and to precise the surgical technique. The authors showed that, dependent on the length of the lower limb and the level of the fibular artery origin, 10 to 19 cm of femoral bone reconstruction could be done, after 180 degrees flap rotation. The flap can be used, the fibula separated in two parts, for inferior femoral metaphysis reconstruction or for knee joint arthrodesis.

Female↗
PubMed2006

[Filling of a lateral pre-malleolar soft tissue defect with the extensor digitorum brevis flap and the abductor digiti minimi flap].

The authors report the filling of a lateral pre-malleolar soft tissue defect after sub-talar arthrodesis. Four months after surgery the loss of substance measured 2,5 cm in depth, 3 cm diameter at the skin level and 5 cm diameter at the bone level. An autologous tricortical bone graft impacted in the sinus tarsi was also exposed. In this area of the body, soft tissue coverage is difficult because of the lake of local sub-cutaneus tissue and muscle. The authors used two locoregional pedicled flaps: the extensor digitorum brevis flap and the abductor digiti minimi flap. These transfers left a minimum of functional and aesthetic after-effects. The optimal coverage of the exposed structures allowed the patient to walk thirty days after surgery. The way to harvest these flaps, their advantages and disadvantages are detailed.

Adolescent↗
PubMed2005

[Antebrachial flap based on distal perforators of the radial artery: anatomic study of 10 cases].

PURPOSE: The radial forearm flap based on distal perforators of the radial artery is a recent flap, derived from the so-called << chinese-flap >>. The interest of this flap resides in the preservation of the main arteries of the forearm. The aim of this study was to count the distal perforators of the radial artery and to study sub-cutaneous vascular system. MATERIALS AND METHOD: We performed 10 dissections on fresh cadavers, after selective injection of the radial artery with a solution of plasticized resin. The dissection was performed from the palmar flexor fold of the wrist up to 15 cm proximally, allowing to count all of the distal perforators. RESULTS: We determined three different intervals, among which the one located between 2 and 6 cm from the palmar flexor fold of the wrist was the most vascularized. This interval should be considered as the rotation point of the flap. CONCLUSION: This study allowed to make clear and more reliable the operative procedure to raise the flap. This procedure is easy to handle and intended to cover proximal defects of the dorsal aspect of the hand, while sparing the radial artery.

Arm↗
PubMed2005

[<< Reverse >> latissimus dorsi musculocutaneous flap: anatomic study of the secondary pedicles].

PURPOSE: The latissimus dorsi flap based on the secondary segmental vessels, wich is termed << reverse >> or << distally based >> latissimus dorsi flap, has been used to repair major thoraco-lumbar defects, to close myelomeningoceles and to reconstruct congenital diaphragmatic absences. The arc of flap rotation is markedly restricted because the blood supply is segmental. It is the most important factor that limits the flap mobility and so restricts its use. The authors report an anatomic study of these secondary pedicles in order to improve the flap dissection and to extend the arc of flap rotation. MATERIAL AND METHOD: The precise location of the secondary pedicles of the flap was determined by 24 anatomic dissections. RESULTS: The latissimus dorsi has 3, 4 or 5 secondary pedicles respectively in 50%, 25% and 25% of cases in the study. These pedicles take origin from the dorsal branches of the posterior intercostal arteries of the 7th, 8th, 9th, 10th and 11th intercostal spaces. CONCLUSION: The number of secondary pedicles is not constant. The entire flap can be safely based on 2 secondary pedicles when the latissimus dorsi muscle has 3 secondary pedicles. When this muscle has 4 or 5 secondary pedicles, the entire flap should be at least based on 3 secondary pedicles, particularly if the skin island is very far from the origin of these vessels.

Back↗
PubMed2004

Anterior innervation of the proximal tibiofibular joint.

Mucoid cysts compressing the common peroneal nerve have been reported. Whether these cysts are schwannoma or are synovial in nature is the subject of controversy in the medical literature. To contribute to this debate, the present study was designed to detail the anterior innervation of the proximal tibiofibular joint. We dissected 10 knees of five fresh cadavers after staining the tibiofibular joint under fluoroscopic guidance. Through a lateral approach near the fibular head, the common peroneal nerve was isolated then dissected distally to determine whether it or its branches ramified over the proximal tibiofibular joint. In all 10 legs, only one collateral branch was observed on the common peroneal nerve proximal to its terminal division. This collateral sent a branch to the proximal tibiofibular joint before penetrating the tibialis anterior muscle. The articular branch coursed in a superior and posterior direction approximately 1 cm to attain the tibiofibular joint. In no specimen did the deep or superficial peroneal nerves send a twig to the tibiofibular joint. This study confirms and clarifies prior descriptions of the innervation of the anterior aspect of the proximal tibiofibular joint. It clarifies the mechanisms of compression of the common peroneal nerve by synovial cysts that originate from the proximal tibiofibular joint and provides anatomical landmarks that should facilitate complete resection of these cysts.

Cadaver↗
PubMed2004

The middle collateral artery: anatomic basis for the "extreme" lateral arm flap.

The vascularization of the posterolateral area of the arm is supplied by the terminal branches of the deep brachial artery [middle collateral artery (MCA) and posterior radial collateral artery]. Their anatomy has been a field of confusion for a long time. An extended lateral arm flap, named the "extreme" lateral arm flap, supplied by these branches and dissected as a retrograde island flap has been proposed as an alternative for large compound defects of the distal forearm. We carried out an extensive anatomic study of the "extreme" lateral arm flap on 69 upper limbs: 54 fresh injected with colored latex, 10 embalmed and 5 radiographed after Micropaque injection. Two origin levels of the MCA were found: a proximal one (37%) above the radial groove, and a distal one (63%) at the level of the groove. The deep brachial artery always bifurcated after the origin of the MCA into a posterior radial collateral artery (PRCA) and anterior radial collateral artery (ARCA). Indeed in our dissections, after the origin of the MCA from the deep brachial artery, there was always a common trunk named the radial collateral artery (RCA) which bifurcated into the ARCA and PRCA. In all dissected arms we always found the MCA anastomosed in a transverse pattern with the inferior ulnar collateral artery (IUCA), contributing to the anastomotic circle of the elbow. This circle represents the unique vascularization source of the reverse "extreme" lateral arm flap.

Aged↗
PubMed2003

The retrograde neurocutaneous island flap of the dorsal branch of the ulnar nerve: anatomical basis and clinical application.

It is well known that a cutaneous artery is constantly located near a cutaneous peripheral nerve, forming a vascular plexus around it. This vascular axis can be either a true artery or an interlacing network, ensuring the vascularization of the nerve and giving off several neurocutaneous perforators to the skin. The anatomy of the accompanying arteries of the dorsal branch of the ulnar nerve (DBUN) and their relationships with the dorsal branch of the ulnar artery (DBUA) were investigated in 22 fresh upper limbs injected with colored neoprene latex. A constant perineural vascularization of the terminal branch of the DBUN was observed in the fourth web space, connected distally with the corresponding dorsal metacarpal or palmar digital arteries. Our findings therefore provide anatomical bases for a new neurocutaneous island flap. Moreover, they allow us to describe a precise surgical technique in order to raise this flap over the larger branch of the DBUN, in the fourth intermetacarpal space. The flap is harvested on the medial aspect of the dorsum of the hand, and its point of rotation is located in the fourth web space, 1 cm proximal to the metacarpophalangeal joint. It is supplied by a reversed flow originating from distal anastomoses of the perineural vessel with the dorsal metacarpal and digital palmar arteries in the fourth web space. This flap does not involve in its pedicle the distal course of the DBUA. It represents a pure neurocutaneous flap.

Aged↗
PubMed2001

[Terminal-lateral nerve anastomoses. Preliminary clinical report of two cases].

Nerve regeneration is based on three phenomenons of critical importance: neurotropism, nerve guidance and neurotrophis. These principles allow understanding the mechanisms of nerve suture and grafting, but also the newly described end-to-side nerve anastomoses. In this procedure, the distal stump of a severed nerve is anastomosed on the lateral side of an intact nerve, with or without removal of the perineurium. Authors report their beginning experience with this procedure (ten cases) and discuss the early results. End-to-side anastomosis seems to be a useful and reliable technique for clinical nerve repair. Even if nerve grafting remains the gold standard to bridge nerve defects, one has nothing to loose if a few minutes, anastomosing the severed nerve on the lateral side of an intact nerve, rather than doing nothing.

Adolescent↗
PubMed2001

Limits and indications of the dorsal transposition flap: critical evaluation of 15 cases.

The dorsal transposition flap was used in 15 cases of distal fingertip amputation. The amputations were either oblique ulnar, oblique radial, oblique palmar, or transverse. Two flaps developed partial necrosis. Flat nail growth always occurred, but the nail was considered short in 4 cases due to a proximal amputation through the nail bed. The mean 2-point discrimination test result was 8 mm. Distal interphalangeal joint range of motion was normal in 5 cases. Four cases lacked 10 degrees from full extension, 9 cases lacked up to 20 degrees from full flexion, and 1 case lacked 35 degrees. Even if this procedure is simple, reliable, and fast, due to its limited size and arc of rotation, as well as its poor sensibility, this flap may only be indicated for oblique ulnar fingertip amputations.

Adolescent↗
PubMed2001

Dorso-ulnar osteocutaneous reverse flow flap of the thumb.

Three cases of distal thumb reconstruction with a reverse pedicled osteocutaneous flap taken from the dorso-ulnar aspect of the first metacarpal are presented. Even though the indications are rare, this flap is useful for the reconstruction of distal osteocutaneous defects of the thumb where more complex procedures are not feasible or considered as excessive.

Adult↗
PubMed2001

Internal use of n-butyl 2-cyanoacrylate (Indermil) for wound closure: an experimental study.

n-Butyl 2-cyanoacrylate glue (Indermil) was used for the closure of dorsal wounds on rabbits. A 4-cm-long and 1-cm-wide laceration was created bilaterally on the back of 15 rabbits. One side was closed with absorbable 2-0 subcutaneous sutures and fast absorbable 3-0 skin sutures, whereas the other side was closed with cyanoacrylate glue applied on both deep and superficial tissues. A partial wound dehiscence occurred on the glue side in one animal at 2 weeks. The animal was killed at this time and considered a bad result in the glue group. In all other animals, no seroma, partial dehiscence, or wound infection occurred. Histopathologic analysis revealed that Indermil induced edema and a mild acute inflammatory reaction and resorbed almost completely within 2 months when applied to well-vascularized tissues. The application of glue on the cutaneous wound edges is a fast and easy procedure that does not seem to delay or inhibit the healing process or its quality.

Animals↗
PubMed2000

Soleus-fibula free transfer in lower limb reconstruction.

Free-fibula transfer has been widely used since 1975. Many modifications have been described; one of them, association of the lateral part of the soleus muscle to the fibula, is reported here through a 14-case series. This composite flap is intended for extensive defects of the lower limbs involving bone and soft tissues. The flap is considered by the authors to be reliable, with a constant vascularization. A 20-cm length offibula may be harvested associated either with the lateral part of the soleus muscle or with the whole muscle. Moreover, the soleus muscle represents a vascular security inasmuch as it preserves both medullar and periosteal bone supply. Fourteen cases have been performed by the authors since 1978 and could be reviewed with a minimum 2-year follow-up. Average length of bone defect was 12 cm, and average length offibula harvested was 18.6 cm. Soft-tissue defect was always associated and ranged from 8 x 4 cm to 20 x 30 cm. The fibula was harvested with the lateral part of the soleus muscle in 10 cases and with the whole soleus muscle in 4 cases. One total treatment failure was reported and was related to intimal degenerative lesions on veins used for arteriovenous bypass. In other patients, mean time for bone healing was 11 months. Patients could walk again, on average, 17 months after reconstruction. Sequelae at the donor site were minimal.

Adolescent↗
PubMed1999

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.

Adolescent↗
PubMed1999

[Humanitarian plastic surgery missions. Actions and reflections].

After recalling the various possible objectives of humanitarian missions in underprivileged countries, the authors describe the context of their plastic surgery missions, each lasting two to three weeks, with the support of Interplast. These missions have been conducted in India, Pakistan, Thailand, Vietnam and Afghanistan. The organization is now classical: on site supply of anaesthetic and all disposable material, 50 to 100 operations over a fortnight in a local hospital. The diseases most frequently observed were cleft lip and palate and post-burn skin retractions. The authors emphasize the fact that the mission director must be an experienced surgeon in order to select the most reliable and the simplest procedure. They analyse the meaning of their commitment and the way in which this humanitarian action is perceived by the recipient country.

Adult↗
PubMed1998

[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.

Adult↗
PubMed1998

[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.

Abdominal Muscles↗
PubMed1997

[Lateral brachial flaps].

The "extreme" lateral arm flap is a new method for covering the distal upper limb. This flap is a modification of the classical lateral arm flap allowing his transfer as a pedicled flap to cover the forearm and the wrist. This technique is based on a new concept: "the reverse flow VY pedicle advancement". This requires an arterial bifurcation of the deep humeral artery: the medial collateral artery described in this study.

Aged↗