1
|
Hurel C, Favier V, de Bonnecaze G, de Gabory L, Patsoura S, Molinier-Blossier S, Carrière M, Daubé P, Dufour X, Fieux M, Carsuzaa F. Transverse Venous Sinus Stenosis in Patients With Nasal Cerebrospinal Fluid Leak and Idiopathic Intracranial Hypertension. Otolaryngol Head Neck Surg 2023; 169:1647-1653. [PMID: 37435619 DOI: 10.1002/ohn.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/29/2023] [Accepted: 05/28/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Spontaneous nasal cerebrospinal fluid (CSF) leaks are frequently linked to idiopathic intracranial hypertension (IIH). The objectives of our study were: (1) to determine the rate of transverse venous sinus stenosis (TVSS) in patients with spontaneous nasal CSF leak and in patients with IIH without CSF (controls), and (2) to study the correlation between spontaneous nasal CSF leak and brain imaging features. STUDY DESIGN A multicenter retrospective case-control study. SETTING Six French tertiary hospitals. METHODS Patients with spontaneous nasal CSF leaks and patients with IIH without nasal CSF leaks (controls) were included. The transverse venous sinus patency was analyzed by magnetic resonance imaging to identify possible stenosis or hypoplasia. RESULTS Thirty-two patients with spontaneous nasal CSF leaks and 32 controls were included. TVSS was significantly more frequent in patients with spontaneous nasal CSF leaks than in controls (p = .029). Univariate analysis indicated that TVSS (odds ratio, OR: 4.2; 95% confidence interval, CI [1.352-14.915]; p = .017) and arachnoid granulations (OR: 3; 95% CI [1.065-8.994]; p = .042) were risk factors for spontaneous nasal CSF leak. In multivariate analysis, TVSS and arachnoid granulations were independent risk factors of nasal CSF leak (OR: 5.577, 95% CI [1.485-25.837], p = .016; and OR: 4.35, 95% CI [1.234-17.756], p = .029, respectively). CONCLUSION This multicenter case-control study shows that TVSS is an independent risk factor for CSF leak in patients with IIH. Stenosis management by interventional radiology may be proposed postoperatively to increase the success of IIH surgical treatment or preoperatively to reduce the need for surgery.
Collapse
Affiliation(s)
- Charles Hurel
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Valentin Favier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Guillaume de Bonnecaze
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Toulouse, Toulouse, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Sophia Patsoura
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | | | - Mathilde Carrière
- Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Pierre Daubé
- Department of Neuroradiology, University Hospital of Poitiers, Poitiers, France
| | - Xavier Dufour
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Maxime Fieux
- Serviced'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université de Lyon, Université Lyon 1, Pierre Bénite, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| |
Collapse
|
2
|
Guilleminault L, Villeneuve T, Didier A, Reber LL, Sigfried A, Serrano E, de Bonnecaze G. Maintained effect of endoscopic sinus surgery in asthma responders to drugs targeting the IL5 pathway with persistent nasal polyposis. Allergy 2023; 78:3031-3034. [PMID: 37650422 DOI: 10.1111/all.15874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Laurent Guilleminault
- Department of Respiratory and Allergic Diseases, Toulouse University Hospital Center, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM U1291, University of Toulouse, CNRS U5051, Toulouse, France
- CRISALIS F-CRIN/INSERM, Toulouse, France
| | - Thomas Villeneuve
- Department of Respiratory and Allergic Diseases, Toulouse University Hospital Center, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM U1291, University of Toulouse, CNRS U5051, Toulouse, France
| | - Alain Didier
- Department of Respiratory and Allergic Diseases, Toulouse University Hospital Center, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM U1291, University of Toulouse, CNRS U5051, Toulouse, France
- CRISALIS F-CRIN/INSERM, Toulouse, France
| | - Laurent L Reber
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM U1291, University of Toulouse, CNRS U5051, Toulouse, France
| | | | - Elie Serrano
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Larrey Hospital, Toulouse, France
| | - Guillaume de Bonnecaze
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Larrey Hospital, Toulouse, France
| |
Collapse
|
3
|
Carsuzaa F, Fath L, Fieux M, Bartier S, de Bonnecaze G, Rumeau C, Michel J, Papon JF, Alexandru M, Favier V. Definition of severity and treatment response in chronic rhinosinusitis with nasal polyps: a Delphi study among French experts. Expert Rev Clin Immunol 2023; 19:1005-1011. [PMID: 37327360 DOI: 10.1080/1744666x.2023.2226869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The introduction of biotherapies has significantly changed the management of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). These drugs are generally reserved for severe or recurrent CRSwNP. Thus, the concepts of severity of the disease and treatment response must be mastered by otorhinolaryngologists. However, a clear definition of these concepts in CRSwNP is missing. METHODS This article focuses on definitions of severity and treatment response in CRSwNP by providing an expert consensus among French rhinologists, using a Delphi study. RESULTS The severity assessment should seek the presence of uncontrolled asthma, olfactory disorders, nasal blockage, impaired quality of life (QOL) and cumulative annual dose of systemic corticosteroids.The treatment response should assess the presence of olfactory disorders, nasal blockage, QOL impairment, response to background therapy, resistance and/or dependence to oral corticosteroids, cumulative annual dose of systemic corticosteroids, response to surgery and to biologics.A failure after polypectomy should not be considered as a failure of surgical management of CRSwNP and must discuss the realization of an extended sinus surgery procedure before the prescription of biologics. CONCLUSION Definitions of severity, control of CRSwNP, as well as therapeutic strategies to improve patients' QOL achieved high level of consensus.
Collapse
Affiliation(s)
- Florent Carsuzaa
- Service ORL, Chirurgie Cervico-Maxillo-Faciale Et Audiophonologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Service d'ORL, de chirurgie cervico faciale, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Léa Fath
- Service d'ORL, de Chirurgie Cervico Faciale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Unité Inserm 1121, Biomatériaux Et Bioingénierie, Centre de Recherche En Biomédecine de Strasbourg, Strasbourg, France
| | - Maxime Fieux
- Service d'ORL, D'otoneurochirurgie Et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite Cedex, France
- Université de Lyon, Université Lyon 1, Lyon, France
- Univ Paris Est Créteil, Inserm, Imrb, Créteil, France
| | - Sophie Bartier
- Univ Paris Est Créteil, Inserm, Imrb, Créteil, France
- Service d'ORL, de Chirurgie Cervico Faciale, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, France
| | - Guillaume de Bonnecaze
- Service d'ORL Et Chirurgie Cervico-Faciale, Pôle Clinique des Voies Respiratoires, Chemin de Pouvourville, France
- Université Paul Sabatier Toulouse III; Laboratoire Center for Anthropobiology and Genomics of Toulouse, Toulouse, France
| | - Cécile Rumeau
- Service d'ORL, de chirurgie cervico faciale, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
- Université de Lorraine, DevAh, Nancy, France
| | - Justin Michel
- Service d'ORL, de chirurgie cervico faciale, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Jean-François Papon
- Univ Paris Est Créteil, Inserm, Imrb, Créteil, France
- Service d'ORL, de Chirurgie Cervico Faciale, Hôpital Kremlin Bicêtre, Assistance Publique des Hôpitaux de Paris, Paris, France
- Université Paris-Saclay, DMU Neuroscience, Le Kremlin-Bicêtre, France
| | - Mihaela Alexandru
- Service d'ORL, de Chirurgie Cervico Faciale, Hôpital Kremlin Bicêtre, Assistance Publique des Hôpitaux de Paris, Paris, France
- Université Paris-Saclay, DMU Neuroscience, Le Kremlin-Bicêtre, France
- Sorbonne Université, Institut National de la Santé Et de la Recherche Médicale, UMR_S933, Hôpital Armand-Trousseau, Paris, France
| | - Valentin Favier
- Service d'ORL, de chirurgie cervico faciale, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
- Research-Team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier (LIRMM), Univ. Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France
| |
Collapse
|
4
|
Carsuzaa F, Béquignon É, Dufour X, de Bonnecaze G, Lecron JC, Favot L. Cytokine Signature and Involvement in Chronic Rhinosinusitis with Nasal Polyps. Int J Mol Sci 2021; 23:ijms23010417. [PMID: 35008843 PMCID: PMC8745309 DOI: 10.3390/ijms23010417] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 02/07/2023] Open
Abstract
Cytokines are well known to play a central role in chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in maintenance of the inflammatory response and the recruitment of eosinophils. The pathophysiological concepts concerning the involvement of inflammatory cytokines in CRSwNP have gradually evolved. Although the Th2 cytokines environment associated with an eosinophilic infiltration has retained a central role in the genesis of polyps, the role of other cytokine subpopulations has also and more recently been detailed, leading to a specific and complex signature in CRSwNP. The purpose of this review is to summarize the current state of knowledge about the cytokine signature in CRSwNP, the role of cytokines in the pathogenesis of this disease and in the intercellular dialog between epithelial cells, fibroblasts and inflammatory cells. Knowledge of this precise cytokine signature in CRSwNP is fundamental in the perspective of potential targeting biotherapies.
Collapse
Affiliation(s)
- Florent Carsuzaa
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, 86000 Poitiers, France; (X.D.); (J.-C.L.); (L.F.)
- Oto-Rhino-Laryngologie et Chirurgie Cervico-Maxillo-Faciale, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France
- Correspondence: ; Tel.: +33-(0)5-49-44-43-28
| | - Émilie Béquignon
- Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, 94010 Créteil, France;
- INSERM U955, Équipe 13, Centre Henri Mondor de Recherche Biomédicale, 94000 Créteil, France
| | - Xavier Dufour
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, 86000 Poitiers, France; (X.D.); (J.-C.L.); (L.F.)
- Oto-Rhino-Laryngologie et Chirurgie Cervico-Maxillo-Faciale, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France
| | - Guillaume de Bonnecaze
- Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France;
| | - Jean-Claude Lecron
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, 86000 Poitiers, France; (X.D.); (J.-C.L.); (L.F.)
- Service Immunologie et Inflammation, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France
| | - Laure Favot
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, 86000 Poitiers, France; (X.D.); (J.-C.L.); (L.F.)
| |
Collapse
|
5
|
Berthier C, Arthozoul M, Taizou M, Grolleau JL, de Bonnecaze G, Chaput B. Is the dorsal vascular system sufficient to vascularize the entire teguments of the thumb? Surg Radiol Anat 2021; 43:397-403. [PMID: 33392700 DOI: 10.1007/s00276-020-02627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Simultaneous lesions of both proper digital arteries of the thumb are common in hand trauma surgery. The purpose of this anatomical study was to determine if the dorsal arterial network could be sufficient to ensure the vascularization of the thumb skin sheath. METHODS We carried out a cadaveric study on 22 hands. The ulnar and radial proper digital arteries of the thumb were ligated at the base of the first phalanx. Red dye was injected into the radial artery and blue dye into the ulnar artery at the wrist level. Visual evaluation of skin staining and systematic photographs was done at 1, 3 and 10 min after injection of dyes. RESULTS Staining of the thumb sheath was obtained in 100% of the dissections and complete in 91.91% of cases. Staining originated from mixed radial and ulnar artery origins in 81.82% of cases. It was incomplete in 9.09% of cases with a missing on the dorsoradial edge of the proximal phalanx. In one dissection, the whole hand skin was only stained red, and in another dissection only stained blue. CONCLUSION The dorsal vascular network ensures the substitution of the skin vascularization in more than 90% of cases when ligating the proper digital arteries of the thumb. A clinical impression of good skin vascularization after injury of both proper digital arteries might lead the surgeon not to perform systematic revascularization, but the risk of variable damages of adjacent tissues due to an interruption of one major arterial system requires a palmar arterial anastomosis whenever possible.
Collapse
Affiliation(s)
- Charline Berthier
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France.
| | - Marion Arthozoul
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Mohcine Taizou
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Jean-Louis Grolleau
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Guillaume de Bonnecaze
- Department of Otorhinolaryngology Head and Neck Surgery, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France.,Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France
| | - Benoit Chaput
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| |
Collapse
|
6
|
Lemaire E, Schultz P, Vergez S, Debry C, Sarini J, Vairel B, de Bonnecaze G, Takeda-Raguin C, Cabarrou B, Dupret-Bories A. Risk Factors for Pharyngocutaneous Fistula After Total Pharyngolaryngectomy. Ear Nose Throat J 2020; 100:746S-752S. [PMID: 32098492 DOI: 10.1177/0145561319901035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the risk factors of pharyngocutaneous fistula after total pharyngolaryngectomy (TPL) in order to reduce their incidence and propose a perioperative rehabilitation protocol. MATERIALS AND METHODS This was a multicenter retrospective study based on 456 patients operated for squamous cell carcinoma by total laryngectomy or TPL. Sociodemographic, medical, surgical, carcinologic, and biological risk factors were studied. Reactive C protein was evaluated on post-op day 5. Patients were divided into a learning population and a validation population with patients who underwent surgery between 2006 and 2013 and between 2014 and 2016, respectively. A risk score of occurrence of salivary fistula was developed from the learning population data and then applied on the validation population (temporal validation). OBJECTIVE To use a preoperative risk score in order to modify practices and reduce the incidence of pharyngocutaneous fistula. RESULTS Four hundred fifty-six patients were included, 328 in the learning population and 128 in the validation population. The combination of active smoking over 20 pack-years, a history of cervical radiotherapy, mucosal closure in separate stitches instead of running sutures, and the placement of a pedicle flap instead of a free flap led to a maximum risk of post-op pharyngocutaneous fistula after TPL. The risk score was discriminant with an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI] = 0.59-0.73) and 0.70 (95% CI = 0.60-0.81) for the learning population and the validation population, respectively. CONCLUSION A preoperative risk score could be used to reduce the rate of pharyngocutaneous fistula after TPL by removing 1 or more of the 4 identified risk factors.
Collapse
Affiliation(s)
- Emilien Lemaire
- Department of Otorhinolaryngology, Centre Hospitalo-Universitaire de Hautepierre, Strasbourg, France
| | - Philippe Schultz
- Department of Otorhinolaryngology, Centre Hospitalo-Universitaire de Hautepierre, Strasbourg, France
| | - Sébastien Vergez
- Department of Otorhinolaryngology, Hôpital Larrey, Institut Universitaire du Cancer Toulouse Oncopôle, Toulouse, France
| | - Christian Debry
- Department of Otorhinolaryngology, Centre Hospitalo-Universitaire de Hautepierre, Strasbourg, France
| | - Jérome Sarini
- Department of Otorhinolaryngology, Head and Neck Surgery, 443157Instititut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopôle, Toulouse, France
| | - Benjamin Vairel
- Department of Otorhinolaryngology, Hôpital Larrey, Institut Universitaire du Cancer Toulouse Oncopôle, Toulouse, France
| | - Guillaume de Bonnecaze
- Department of Otorhinolaryngology, Hôpital Larrey, Institut Universitaire du Cancer Toulouse Oncopôle, Toulouse, France
| | - Catherine Takeda-Raguin
- Department of Geriatric Medicine, Hôpitaux Universitaires de Toulouse, Hôtel Dieu Saint Jacques, Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Unit, 443157Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopôle, Toulouse, France
| | - Agnès Dupret-Bories
- Department of Otorhinolaryngology, Head and Neck Surgery, 443157Instititut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopôle, Toulouse, France
| |
Collapse
|
7
|
Benbassat B, Cambronne C, Gallini A, Chaynes P, Lauwers F, de Bonnecaze G. The specific branches leading to the genioglossus muscle: three-dimensional localisation using skin reference points. Surg Radiol Anat 2019; 42:547-555. [PMID: 31820050 DOI: 10.1007/s00276-019-02390-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/21/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Supra-selective stimulation of the branches destined for the horizontal part of genioglossus muscle (GGh) could be a target of choice in the treatment of mild-to-severe obstructive sleep apnea syndrome. The main aim of our study was to assess a percutaneous method for the three-dimensional localisation of the terminal branches destined to GGh. MATERIALS AND METHODS Twenty cadaveric hypoglossal nerves were dissected and included in the injection protocol. The distance between the posterior edge of the mandibular symphysis and the hyoid bone on the sagittal midline as the approximated distance of the geniohyoid muscle (dGH) was measured before any dissection. Methylene blue mixed with a thickening agent, was injected. The injection point was defined in relation to dGH, in an orthonormal coordinate system. For each dissection, we recorded the theoretical and the real (X, Y, Z) coordinates of GGh motor points and measured their distance to each other. RESULTS X was accurately estimated. Y and Z were overestimated by + 5.34 ± 5.21 mm ([Formula: see text]) and + 4.79 ± 3.99 mm ([Formula: see text]) on average, respectively. We found a more significant difference between the theoretical and real Y and Z coordinates in the subgroup BMI < 25 kg/m2 (8.6 ± 4.5 mm and 6.9 ± 2.5 mm, respectively, p = 0.0009), and of Z in subgroup with dGH ≥ 50 mm (6.89 ± 3.26 mm, p = 0.0494). CONCLUSIONS X can be estimated accurately using the relationship [Formula: see text]. Y seems to be related to BMI and Z may be estimated with the relationship [Formula: see text]. This three-dimensional localisation could be very helpful to facilitate placement of cuff electrodes to manage refractory sleep apnea.
Collapse
Affiliation(s)
- Bastien Benbassat
- Otolaryngology, Head and Neck Surgery Department, University Rangueil-Larrey Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - Clément Cambronne
- Department of Oral Surgery, University of Toulouse, 31000, Toulouse, France
| | - Adeline Gallini
- UMR1027, INSERM-University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, 37 Allées Jules Guesdes, 31073, Toulouse, France
| | - Patrick Chaynes
- Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France
- Department of Neurosurgery, Pierre-Paul Riquet Hospital, University of Toulouse, 31059, Toulouse, France
| | - Frédéric Lauwers
- Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France
- Department of Maxillofacial Surgery, Pierre-Paul Riquet Hospital, University of Toulouse, 31059, Toulouse, France
| | - Guillaume de Bonnecaze
- Otolaryngology, Head and Neck Surgery Department, University Rangueil-Larrey Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France.
- Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France.
| |
Collapse
|
8
|
de Bonnecaze G, Chaput B. An innovative reconstruction procedure of total nasal resurfacing with a bipedicled propeller perforator flap. Head Neck 2019; 41:3049-3055. [PMID: 31038813 DOI: 10.1002/hed.25790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A forehead frontal flap is the treatment of choice for complex nasal defects. However, in patients with contra indications for such frontal flaps, few alternatives are available. METHODS We developed a three-stage, nasal reconstruction procedure using a bipedicled, propeller perforator flap based on the modiolus perforators. Here, we describe the flap, the harvesting thereof, and the 6-month outcomes after placement. RESULTS The flap did not exhibit any sign of necrosis or congestion. Six months after reconstruction, the patient had not suffered any esthetic or functional sequela. CONCLUSION Although the indications for our new flap are less numerous than those for a frontal flap, our flap is a useful alternative when frontal flap placement is not feasible (or the patient refuses such a flap) and when placement of a free flap is too risky.
Collapse
Affiliation(s)
| | - Benoit Chaput
- Plastic and Reconstructive Surgery Department, University Hospital of Toulouse, Toulouse, France
| |
Collapse
|
9
|
Costa N, Mounié M, Bernard G, Bieler L, Molinier L, Serrano E, de Bonnecaze G. Cost-effectiveness of trans-nasal endoscopic sphenopalatine artery ligation vs arterial embolisation for intractable epistaxis: Long-term analyses. Clin Otolaryngol 2019; 44:511-517. [PMID: 30720918 DOI: 10.1111/coa.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/04/2018] [Accepted: 01/26/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trans-nasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolisation both provide excellent success rates for intractable epistaxis. Recent economic models suggest that TESPAL could be a cost-saving strategy. Our main aim was to perform cost-effectiveness analyses on TESPAL compared with embolisation to treat patients with epistaxis. DESIGN We performed retrospective, monocentric, comparative analyses on patients referred to our centre and treated with embolisation or TESPAL. SETTING This economic evaluation was carried out from a payer's perspective (ie French National Health Insurance) within a time horizon of 12 months. PARTICIPANTS Thirty-seven TESPAL procedures and thirty-nine embolisation procedures to treat intractable epistaxis were used in the analyses. MAIN OUTCOME MEASURES The primary outcome is presented as the cost per 1% of non-recurrence. Effectiveness was defined as avoiding recurrence of epistaxis during the 1-year follow-up. Cost estimates were performed from the payer's perspective. RESULTS Hospitalisation costs were higher for embolisation compared with TESPAL (5972 vs 3769 euros). On average, hospitalisation costs decreased by 41% when a patient was treated by TESPAL compared with an embolisation strategy (P = 0.06). The presence of comorbidities increased hospitalisation costs by 79% (P = 0.04). TESPAL enabled 1867€ to be gained in intractable epistaxis. CONCLUSIONS The outcomes from our decision model confirm that TESPAL is more cost-effective for patients with intractable epistaxis.
Collapse
Affiliation(s)
- Nadège Costa
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France
| | - Michael Mounié
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France.,University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Toulouse Cedex 9, France
| | - Geraldine Bernard
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France
| | - Laurent Bieler
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France
| | - Laurent Molinier
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France.,University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Toulouse Cedex 9, France
| | - Elie Serrano
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - Guillaume de Bonnecaze
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| |
Collapse
|
10
|
Bastier PL, Dunion D, de Bonnecaze G, Serrano E, de Gabory L. Renal cell carcinoma metastatic to the sinonasal cavity: A review and report of 8 cases. Ear Nose Throat J 2019; 97:E6-E12. [PMID: 30273434 DOI: 10.1177/014556131809700902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Renal cell carcinoma (RCC) metastatic in the sinonasal cavity is rare. In many cases, it represents the initial presentation of RCC. We conducted a retrospective chart review to report the clinical presentation, imaging, and treatment of RCC metastases in the sinonasal cavity at two tertiary care referral centers. Our population was made up of 8 patients-6 men and 2 women, aged 55 to 86 years (mean: 66.9; median: 63.5)-who had been diagnosed with cancer in the sinonasal cavity. The most common complaints were epistaxis, nasal obstruction, and diplopia. Cancers were located in the ethmoid sinus (n = 3), nasal cavity (n = 2), sphenoid sinus (n = 2), and maxillary sinus (n = 1). Local treatment involved resection and adjuvant radiotherapy in 4 patients, surgery alone in 2 patients, and radiotherapy alone in the other 2. The lesion was embolized before surgery in 4 cases. We also performed a critical review of similar published cases. Our literature review covered 53 cases of RCC metastatic to the sinonasal cavity, including ours. Metastases were the first presentation of RCC in 24 of these cases (45.3%); in our series, the metastases led to the diagnosis of the primary RCC in 3 cases (37.5%). In the 53 reported cases, metastatic resection was performed on 35 patients (66.0%). Survival data were available for 22 of these operated patients, and 17 of them achieved a complete local response. Adjunctive radiotherapy was not associated with a better local response. Overall survival was significantly better in patients who had an isolated metastasis rather than multiple metastases (p = 0.013). There was no difference in overall survival between patients whose metastasis represented the initial presentation of RCC and those whose metastasis did not (p = 0.95). We recommend that sinonasal metastasis be suspected in the event of unilateral nasal bleeding or nasal obstruction in patients diagnosed with RCC. Embolization may prevent abundant bleeding during removal. Surgery may improve the quality of life of these patients while decreasing nasal obstruction and bleeding.
Collapse
Affiliation(s)
- Pierre-Louis Bastier
- Department of Otorhinolaryngology-Head and Neck Surgery, Bordeaux University Hospital, Place Amélie Raba-Leon, 33000 Bordeaux, France.
| | | | | | | | | |
Collapse
|
11
|
de Gabory L, Escabasse V, Boudard P, de Bonnecaze G, Rumeau C, Jankowski R, Debry C, Morinière S, Merino B, Mortuaire G, Malard O, Bordenave L. Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy. Eur Arch Otorhinolaryngol 2018; 276:447-457. [PMID: 30536161 PMCID: PMC6394433 DOI: 10.1007/s00405-018-5232-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/28/2018] [Indexed: 12/01/2022]
Abstract
Purposes The purpose of this study was to compare the efficacy of a mineral-rich solution vs normal saline solution (0.9% NaCl) following endoscopic complete bilateral ethmoidectomy. Methods This was a prospective, multicenter, randomized, controlled, open-label trial in subjects suffering from steroid-resistant sinonasal polyposis. Adults performed 4 nasal irrigations of mineral or saline solutions daily for 28 days. Evaluations included subject-reported RHINO quality of life (QoL) and NOSE scores, tolerability, and satisfaction, the Lund–Kennedy endoscopic score and assessments of crusting, secretions and mucociliary clearance (rhinoscintigraphy). Results A total of 189 subjects were randomized. Clinically relevant improvements (> 20 points) in RhinoQOL and NOSE scores were measured in both groups without any significant inter-group difference. Among the subjects with impaired RhinoQOL at pre-inclusion, the change in Impact-RhinoQOL score was significantly superior in mineral-rich vs saline solution at day 21 (p = 0.028) and day 28 (p = 0.027). The Lund–Kennedy score continuously improved in both groups earlier with the mineral-rich solution. Crusts were significantly fewer in number and less severe/obstructive in patients receiving mineral-rich vs saline solution at day 7 (p = 0.026) and day 14 (p = 0.016). Furthermore, secretions disappeared significantly more quickly and were less thick/purulent with mineral-rich solution at day 14 (p = 0.002) and day 21 (p = 0.043). Less epistaxis was reported in the mineral vs saline solution (p = 0.008 at day 21). Conclusions Our findings indicate that the composition of a nasal irrigation solution influences endoscopic scores and QoL after sinus surgery for patients over 60, those with an initially poor QoL and higher symptom score, and smokers.
Collapse
Affiliation(s)
- Ludovic de Gabory
- ENT Department, CHU Bordeaux, 33000, Bordeaux, France. .,CHU Bordeaux, CIC 14-01 IT, 33000, Bordeaux, France. .,Univ. Bordeaux, 33000, Bordeaux, France. .,ENT Department, University Hospital of Bordeaux, Hôpital Pellegrin, Centre F-X Michelet, Place A. Raba-Léon, 33076, Bordeaux Cedex, France.
| | | | - Philippe Boudard
- ENT Department, Saint-Augustin Private Hospital, Bordeaux, France
| | | | - Cécile Rumeau
- ENT Department, University Hospital of Nancy, Nancy, France
| | | | - Christian Debry
- ENT Department, University Hospital of Strasbourg, Strasbourg, France
| | | | - Bertrand Merino
- Nuclear Medicine Department, Saint-Augustin Private Hospital, Bordeaux, France
| | | | - Olivier Malard
- ENT Department, University Hospital of Nantes, Nantes, France
| | - Laurence Bordenave
- CHU Bordeaux, CIC 14-01 IT, 33000, Bordeaux, France.,Univ. Bordeaux, 33000, Bordeaux, France.,Nuclear Medicine Department, CHU Bordeaux, 33000, Bordeaux, France
| |
Collapse
|
12
|
de Bonnecaze G, Verillaud B, Chaltiel L, Fierens S, Chapelier M, Rumeau C, Malard O, Gavid M, Dufour X, Righini C, Uro-Coste E, Rives M, Bach C, Baujat B, Janot F, de Gabory L, Vergez S. Clinical characteristics and prognostic factors of sinonasal undifferentiated carcinoma: a multicenter study. Int Forum Allergy Rhinol 2018; 8:1065-1072. [PMID: 29935059 DOI: 10.1002/alr.22143] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is a very rare entity with a poor prognosis. Due to the lack of studies on the subject, evidence is lacking concerning its management. METHODS A multicenter collaborative study was conducted to assess treatment strategy, oncological outcome, and prognostic factors. RESULTS Definitive analyses focused on 54 patients with a majority of advanced stage; the 3-year overall survival (OS) and 3-year recurrence-free survival (RFS) rates were, respectively, 62.4% and 47.8%. During the follow-up, 18 patients (33.3%) died, 10 (18.5%) developed metastases, 7 had lymph-node involvement (13%), and 12 (22.2%) showed recurrence or local progression. In univariate analyses, treatment modalities associated with improved RFS were induction chemotherapy (p = 0.02) and intensity-modulated radiotherapy (p = 0.007). In the multivariate analyses, only induction chemotherapy (p = 0.047, hazard ratio [HR] = 0.39) was significantly associated with improved RFS. CONCLUSION Multimodal therapies including induction chemotherapy and intensity-modulated radiotherapy may improve the prognosis of SNUC; surgery might improve local control. Further multicenter studies are required.
Collapse
Affiliation(s)
- Guillaume de Bonnecaze
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Lariboisière, Paris, France
| | - Leonor Chaltiel
- Biostatistics Department, L'Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-Oncopole), Cancer Institute, Toulouse, France
| | - Sylvestre Fierens
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Pellegrin, Bordeaux, France
| | - Mark Chapelier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France
| | - Cécile Rumeau
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Nancy, Nancy, France
| | - Olivier Malard
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Nantes, Nantes, France
| | - Marie Gavid
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Xavier Dufour
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Poitiers, Poitiers, France
| | - Christian Righini
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Grenoble, Grenoble, France
| | | | - Michel Rives
- Radiation Oncology Department, IUCT-Oncopôle, Cancer Institute, Toulouse, France
| | - Christine Bach
- Department of Otorhinolaryngology-Head and Neck Surgery, Hopital Foch, Suresnes, France
| | - Bertrand Baujat
- Department of Otorhinolaryngology-Head and Neck Surgery, Tenon Hospital, Paris-Est University, Paris, France
| | - François Janot
- Department of Otorhinolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France
| |
Collapse
|
13
|
de Bonnecaze G, Gallois Y, Chaynes P, Bonneville F, Dupret-Bories A, Chantalat E, Serrano E. Intractable epistaxis: which arteries are responsible? An angiographic study. Surg Radiol Anat 2017; 39:1203-1207. [PMID: 28508924 DOI: 10.1007/s00276-017-1856-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/14/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. METHODS Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. RESULTS Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. CONCLUSIONS A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.
Collapse
Affiliation(s)
- Guillaume de Bonnecaze
- Department of Otorhinolaryngology Head and Neck Surgery, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France.
- Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France.
| | - Y Gallois
- Department of Otorhinolaryngology Head and Neck Surgery, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France
| | - P Chaynes
- Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France
- Department of Neurosurgery, Pierre-Paul Riquet Hospital, University of Toulouse, Toulouse, France
| | - F Bonneville
- Department of Neuroradiology, Pierre-Paul Riquet Hospital, University of Toulouse, Toulouse, France
| | | | - E Chantalat
- Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France
| | - E Serrano
- Department of Otorhinolaryngology Head and Neck Surgery, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France
| |
Collapse
|
14
|
Chaput B, Herlin C, de Bonnecaze G, Carloni R, Laloze J, Bertheuil N. One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation. Plast Reconstr Surg 2017; 139:807e-808e. [PMID: 28234880 DOI: 10.1097/prs.0000000000003101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Benoit Chaput
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital Toulouse, France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Guillaume de Bonnecaze
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Raphael Carloni
- Department of Plastic and Hand Surgery, CHU Rouen, Rouen, France
| | - Jerome Laloze
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| |
Collapse
|
15
|
de Bonnecaze G, Chaput B, Woisard V, Uro-Coste E, Swider P, Vergez S, Serrano E, Casteilla L, Planat-Benard V. Adipose stromal cells improve healing of vocal fold scar: Morphological and functional evidences. Laryngoscope 2016; 126:E278-85. [PMID: 27075408 DOI: 10.1002/lary.25867] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/23/2015] [Accepted: 12/15/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS Adipose derived stromal cells (ASCs) are abundant and easy to prepare. Such cells may be useful for treating severe vocal disturbance caused by acute vocal fold scars. STUDY DESIGN Prospective animal experiments with controls. METHODS Twenty New-Zealand white rabbits were used in the present study. We evaluated vocal fold healing, with or without injection of autologous ASCs, after acute scarring. A defined lesion was created and the ASCs were immediately injected. Vocal fold regeneration was evaluated histomorphometrically and via viscoelastic analysis using an electrodynamic shaker. RESULTS Six weeks after ASC injection, vocal folds exhibited significantly less inflammation than control folds (P < 0.005). In addition, hypertrophy of the lamina propria and fibrosis were significantly reduced upon ASC injection (P < 0.02). The decrease in viscoelastic parameters was less important in the ASC injected group compared to the noninjected group (P = 0.08). CONCLUSION Injection of autologous ASCs improved vocal fold healing in our preclinical model. Further studies are needed, but this method may be useful in humans. LEVEL OF EVIDENCE NA. Laryngoscope, 126:E278-E285, 2016.
Collapse
Affiliation(s)
- Guillaume de Bonnecaze
- CNRS UMR5273 STROMALab, University of Toulouse, Toulouse Cedex, France.,Université Paul Sabatier de Toulouse, University of Toulouse, Toulouse Cedex, France.,Department of Ear, Nose and Throat Head and Neck Surgery, University of Toulouse, Toulouse Cedex, France
| | - Benoit Chaput
- CNRS UMR5273 STROMALab, University of Toulouse, Toulouse Cedex, France.,Université Paul Sabatier de Toulouse, University of Toulouse, Toulouse Cedex, France.,INSERM U1031, University of Toulouse, Toulouse Cedex, France.,EFS Pyrénées-Méditerranée, University of Toulouse, Toulouse Cedex, France.,Department of Plastic Reconstructive and Aesthetic Surgery, University of Toulouse, Toulouse Cedex, France
| | - Virginie Woisard
- Department of Ear, Nose and Throat Head and Neck Surgery, University of Toulouse, Toulouse Cedex, France
| | | | - Pascal Swider
- Biomechanics Group, IMFT UMR CNRS 5502, Toulouse Cedex, France
| | - Sebastien Vergez
- Department of Ear, Nose and Throat Head and Neck Surgery, University of Toulouse, Toulouse Cedex, France
| | - Elie Serrano
- Department of Ear, Nose and Throat Head and Neck Surgery, University of Toulouse, Toulouse Cedex, France
| | - Louis Casteilla
- CNRS UMR5273 STROMALab, University of Toulouse, Toulouse Cedex, France.,Université Paul Sabatier de Toulouse, University of Toulouse, Toulouse Cedex, France.,INSERM U1031, University of Toulouse, Toulouse Cedex, France.,EFS Pyrénées-Méditerranée, University of Toulouse, Toulouse Cedex, France
| | - Valerie Planat-Benard
- CNRS UMR5273 STROMALab, University of Toulouse, Toulouse Cedex, France.,Université Paul Sabatier de Toulouse, University of Toulouse, Toulouse Cedex, France.,INSERM U1031, University of Toulouse, Toulouse Cedex, France.,EFS Pyrénées-Méditerranée, University of Toulouse, Toulouse Cedex, France
| |
Collapse
|
16
|
Riot S, de Bonnecaze G, Garrido I, Ferron G, Grolleau JL, Chaput B. Is the use of negative pressure wound therapy for a malignant wound legitimate in a palliative context? "The concept of NPWT ad vitam": A case series. Palliat Med 2015; 29:470-3. [PMID: 25524962 DOI: 10.1177/0269216314560009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of malignant wounds remains particularly difficult. They are often malodorous, highly exuding, and painful. In this context, the use of negative pressure wound therapy is usually not recommended. It is, however, an effective procedure for maintaining a good quality of life in certain palliative situations. CASE PRESENTATION Five patients underwent negative pressure wound therapy for a malignant wound in our unit. Three had sarcomas, one patient had a parietal recurrence of breast carcinoma, and one patient had melanoma. They were in a metastatic palliative situation and were no longer receiving specific treatment. CASE MANAGEMENT AND OUTCOMES The patients reported a decrease in odor and exudates with negative pressure wound therapy, compared with conventional dressings. No patients complained of pain associated with the suction system itself. Fewer dressing changes reduced the pain and encouraged the resumption of social interactions. The average duration of negative pressure wound therapy before the death of the patients was 49 days. No complications or bleeding were observed. The duration of the patients' stay was shortened by implementing negative pressure wound therapy at home. CONCLUSION We report on our experiences with five patients for whom manufacturers and health authorities contraindicated the use of negative pressure wound therapy because of its potential to encourage tumor growth, although it was considered to be beneficial for all of these patients. This procedure may offer an alternative to conventional wound dressings at the end of life and improve the quality of life of patients by controlling the three most disabling elements: the odor, exudate, and pain associated with changing the dressings. Miniaturization and lower costs could promote the systematic use of negative pressure wound therapy.
Collapse
Affiliation(s)
- Samuel Riot
- Department of Plastic and Reconstructive Surgery, University of Toulouse CHU Rangueil, Toulouse, France
| | - Guillaume de Bonnecaze
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Toulouse CHU Rangueil-Larrey, Toulouse, France
| | - Ignacio Garrido
- Department of Plastic and Reconstructive Surgery, University of Toulouse CHU Rangueil, Toulouse, France Universitary Institute of Cancer, Toulouse, France
| | | | - Jean-Louis Grolleau
- Department of Plastic and Reconstructive Surgery, University of Toulouse CHU Rangueil, Toulouse, France
| | - Benoit Chaput
- Department of Plastic and Reconstructive Surgery, University of Toulouse CHU Rangueil, Toulouse, France Department of Otorhinolaryngology, Head and Neck Surgery, University of Toulouse CHU Rangueil-Larrey, Toulouse, France Universitary Institute of Cancer, Toulouse, France
| |
Collapse
|
17
|
Michot A, Chaput B, Gobel F, Menez T, de Bonnecaze G, Pelissier P. Chronic ischaemia does not appear to hinder healing with Integra(®) : implementation at a tibial artery bypass site. Int Wound J 2015; 13:1003-5. [PMID: 25586165 DOI: 10.1111/iwj.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/10/2014] [Indexed: 12/01/2022] Open
Abstract
Wounds with exposed vessels, especially in artery bypass procedures, can pose a barrier to adequate skin healing. Skin grafts or flaps are sometimes difficult to perform in the face of the ischaemia that is often present in such cases. We report a case of a 73-year-old man who presented with grade IV peripheral arterial disease necessitating salvage of the lower limb using artery bypass surgery. Immediate exposure of femorotibial artery secondary to skin necrosis following the bypass led us to propose an innovative means of wound coverage using Integra(®) , a well-known dermal regeneration template. The wound healed uneventfully with an appearance similar to that of the adjacent skin. Integra(®) seems to be less demanding in terms of the vascular wound bed and the degree of oxygenation than a conventional skin graft. This finding could support further indications for this dermal regeneration template.
Collapse
Affiliation(s)
- Audrey Michot
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Bordeaux Segalen, Bordeaux, France.
| | - Benoit Chaput
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
| | - Fabienne Gobel
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Bordeaux Segalen, Bordeaux, France
| | - Tiphaine Menez
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Bordeaux Segalen, Bordeaux, France
| | - Guillaume de Bonnecaze
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
| | - Philippe Pelissier
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Bordeaux Segalen, Bordeaux, France
| |
Collapse
|