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Berkane Y, Tawa P, Guinier C, Bertheuil N, El Batti S, Lellouch AG. Reconstruction of a septic femoral triangle fistula with a pedicled DIEP flap: A case report and mini-review. ANN CHIR PLAST ESTH 2024; 69:233-238. [PMID: 37932173 DOI: 10.1016/j.anplas.2023.10.001] [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: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
Flap-based reconstruction techniques have shown promise in preventing scar contractures and enhancing healing in fold areas by providing vascularized and thick tissue. We report a septic rupture of the superficial femoral artery treated with an arterial allograft and covered with a contralateral pedicled Deep Inferior Epigastric Artery Perforator (DIEP) flap. The patient presented favorable outcomes, including optimal healing at 8 months, with no functional limitation. A literature review also discusses alternative pedicled perforator flaps. These modern techniques present several advantages, including reliability, and can be of great interest in complex vascular surgery cases.
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Affiliation(s)
- Y Berkane
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States; Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes, France.
| | - P Tawa
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States
| | - C Guinier
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes, France
| | - S El Batti
- Department of Vascular Surgery, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm UMRS 1140 Innovation thérapeutique en hémostase, université de Paris, Paris, France
| | - A G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States
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2
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Gherle B, Pozner VL, Berkane Y, Watier E, Bertheuil N, Qassemyar Q. Pre-expanded thin DIEP free flap in pediatric upper extremity reconstruction for burn sequelae: A case report. ANN CHIR PLAST ESTH 2024; 69:173-177. [PMID: 38216362 DOI: 10.1016/j.anplas.2023.11.001] [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: 10/11/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 01/14/2024]
Abstract
Deep burns sequelae involving the upper limb are challenging even for experienced surgeons, mainly because local reconstructive options and donor sites are often compromised. The use of free flaps for this type of reconstruction remains difficult due to the small recipient vessel diameter and tendency to vasospasm. Moreover, pediatric cases bring the challenge to another level. We present the case of a 13-year-old girl presenting major retractile sequelae of the upper left limb, including complete wrist immobilization combining wrist hyper-extension, ulnar deviation deformity, and a ulno-carpal dislocation. She was referred to our department where a two-stage reconstruction was performed using a pre-expanded free deep inferior epigastric artery perforator (DIEP) flap. The first surgery consisted of placing two kidney-shaped expanders in a subfascial plane in the hypogastric region. Four months later, after a bi-weekly expansion, an excision of the scar tissue, and the DIEP flap transfer were completed. At the 12-month follow-up evaluation, both aesthetic and functional results were satisfactory, with a good contour and regained mobility of the wrist.
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Affiliation(s)
- B Gherle
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Doctoral School of Biological and Biomedical Sciences, University of Oradea, Oradea, Romania.
| | - V L Pozner
- Private Practice, 66, rue de Lisbone, 75008 Paris, France
| | - Y Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston MA
| | - E Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France.
| | - Q Qassemyar
- Private Practice, 66, rue de Lisbone, 75008 Paris, France
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3
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Berkane Y, Herlin C, Bertheuil N. Comment on "Surgical management of slightly or non-displaced corporal scaphoid fractures by retrograde percutaneous screw fixation through the anterior trapezium horn: A single-center retrospective French study of 33 patients between January 2015 and January 2019". ANN CHIR PLAST ESTH 2023; 68:385-386. [PMID: 37121848 DOI: 10.1016/j.anplas.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Y Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud (CHU de Rennes), University of Rennes 1, Rennes, France; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - C Herlin
- Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud (CHU de Rennes), University of Rennes 1, Rennes, France; SITI Laboratory, Rennes University Hospital, Rennes, France; Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rouen, Rouen, France
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Espeillac C, Charles T, Donatini G, David R, Bertheuil N, Vallée M, Leclère F. Qualité de vie et évaluation fonctionnelle après gangrène de Fournier : étude rétrospective d’une cohorte de 33 patients. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Freton L, Khene ZE, Richard C, Mathieu R, Alimi Q, Duval E, Vassal L, Bertheuil N, Aillet S, Bonnet F, Ravel C, Guenego A, Travers D, Morel-Journel N, Hascoet J, Peyronnet B. [Self-assessment of healthcare workers regarding the management of trans people in a university hospital]. Prog Urol 2021; 31:1108-1114. [PMID: 34147357 DOI: 10.1016/j.purol.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/13/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Trans people face more barriers when seeking healthcare than the cisgender population probably due to a lack of knowledge, education and comfort of healthcare workers. The purpose of this study was to assess the knowledge and comfort felt by healthcare professionals in managing trans people in a French university hospital. METHODS A self-questionnaire was emailed to healthcare professionals working in departments usually involved in the care of trans people in a French university hospital "not specialized" in medical and surgical gender transition. The questionnaire included demographic questions and Likert scales regarding their knowledge and comfort in taking care of trans people. Responses on the 7-point Likert scales were categorized into "low", "medium" and "high" groups, and responses on the 5-point Likert scales were categorized into "in favour", "neutral" and "against" groups. RESULTS One hundred and two (29%) healthcare professionals answered the questionnaire. Half worked in surgical departments (urology, plastic surgery, gynecology), 24% worked in medical departments (endocrinology, reproductive medicine, cytogenetics) and 26% worked in psychiatry. The majority (60.3%) rated their level of knowledge as "low" and 39.7% as "medium". Sixteen percent rated their level of comfort in managing trans people as "low", 72.5% as "medium" and 11.5% as "high". A majority (77.5%) were in favor of having the costs of gender transition care covered by the national health insurance system, 16.4% were neutral and 6% were against this idea. Feelings about surgical and hormonal gender transition were overwhelmingly (96.4%) in favour or neutral and 91% were willing to get more training and education to manage trans people. CONCLUSION The lack of comfort felt by healthcare professionals in university hospital in managing trans people seems to be related to a lack of knowledge and training in that field and not to a disagreement with the need of transgender healthcare. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- L Freton
- Université de Rennes, urologie, CHU Rennes, Rennes, France.
| | - Z-E Khene
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - C Richard
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - R Mathieu
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - Q Alimi
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - E Duval
- Réseau de Santé Trans, Rennes, France
| | - L Vassal
- Réseau de Santé Trans, Rennes, France
| | - N Bertheuil
- Université de Rennes, chirurgie plastique et reconstructrice, CHU Rennes, Rennes, France
| | - S Aillet
- Université de Rennes, chirurgie plastique et reconstructrice, CHU Rennes, Rennes, France
| | - F Bonnet
- Université de Rennes, endocrinologie, CHU Rennes, Rennes, France
| | - C Ravel
- Université de Rennes, laboratoire de biologie de la reproduction-CECOS, CHU Rennes, Rennes, France
| | - A Guenego
- Université de Rennes, endocrinologie, CHU Rennes, Rennes, France
| | - D Travers
- Université de Rennes, psychiatrie, CHU Rennes, Rennes, France
| | - N Morel-Journel
- Université de Lyon, urologie, Hospices Civils de Lyon, Lyon, France
| | - J Hascoet
- Université de Rennes, urologie, CHU Rennes, Rennes, France
| | - B Peyronnet
- Université de Rennes, urologie, CHU Rennes, Rennes, France
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6
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Julienne A, Donatini G, Richer JP, Brèque C, Mordon S, Faure JP, Danion J, Bertheuil N, Leclère FM. [Flap harvest training on a new ultrarealistic simulation model: In-training operator feedback about a pulsating reperfused and reventilated cadaver Simlife®]. ANN CHIR PLAST ESTH 2021; 66:126-133. [PMID: 33707027 DOI: 10.1016/j.anplas.2020.12.002] [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: 09/12/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE® model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device. MATERIAL AND METHODS From February 2019 to October 2019, 8 forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE® model. Conditions were as close as possible to the operating room : asepsy, sterile draping, assistant and instrumentation including electrocoagulation. RESULTS The procedure was decomposed in 13 distinct steps. Mean total surgery time was 90,5±11,62minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE® console. Mean intraoperatoy bleeding was 171±108 milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training. CONCLUSION Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.
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Affiliation(s)
- A Julienne
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of Plastic & Reconstructive Surgery, Hand Surgery, Centre of Expertise for Sex Reassignment Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - G Donatini
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - J P Richer
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - C Brèque
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France
| | - S Mordon
- Inserm U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, University Hospital Lille, Lille, France
| | - J P Faure
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - J Danion
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - N Bertheuil
- Department of plastic, reconstructive and aesthetic surgery, hospital Sud, university of Rennes 1, Rennes, France
| | - F M Leclère
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of Plastic & Reconstructive Surgery, Hand Surgery, Centre of Expertise for Sex Reassignment Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Inserm U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, University Hospital Lille, Lille, France
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Gandolfi S, Laloze J, Chaput B, Auquit-Auckbur I, Grolleau JL, Bertheuil N, Carloni R. Nostril Surgery: Indications, Surgical Procedures and Outcomes-A Systematic Review of Published Cases. Aesthetic Plast Surg 2020; 44:2219-2229. [PMID: 32812083 DOI: 10.1007/s00266-020-01911-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/18/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To achieve adequate nasal proportions, nostril surgery can be a complementary technique useful in facial surgery. To help surgeons with the decision to realize nostril surgery, we conducted a systematic review to summarize reported cases on surgical procedures with a specific interest on indications, surgical procedures and postoperative outcomes. A therapeutic algorithm is also proposed. METHOD We carried out this review in accordance with the PRISMA criteria. Twenty-two eligible studies were identified using Medical databases, including 1599 patients. A qualitative and quantitative analysis was carried out. DISCUSSION Excision techniques were realized on 728 patients (45.5%), followed by cinching sutures on 642 patients (40%) and combined techniques: excision techniques with flap advancement techniques in 189 cases (12%), excision techniques with flap advancement techniques and cinching suture in 40 patients (2.5%). When excessive alar flaring was present, alar wedge resection was preferred in the 92% of followed by alar and sill resection. Cinching sutures were realized when excessive alar flaring was associated with a vertical alar axis, in cases of wide alar base, of associated orthognathic surgery. When excessive alar flaring was associated with wide alar bases, indications changed basing on the associated deformities. In 795 patients, nostril surgery was conducted simultaneously with rhinoplasty. CONCLUSION Nostril surgery through excision techniques, cinching sutures or flaps advancement techniques, reveals good outcomes and can be complementary to rhinoplasty or orthognathic surgery. Through this systematic review, we tried to orient surgeons to find the best treatment for nostril base surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- S Gandolfi
- Department of Plastic and Reconstructive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - J Laloze
- Department of Maxillo-Facial and Reconstructive Surgery, Dupuytren University Hospital, Limoges, France
| | - B Chaput
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | - I Auquit-Auckbur
- Department of Plastic and Reconstructive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - J L Grolleau
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | - N Bertheuil
- Department of Plastic and Reconstructive Surgery, Rennes University Hospital, Rennes, France
| | - R Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hopital Privé de L'Estuaire, 505 Rue Irène Joliot Curie, 76620, Le Havre, France.
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Dulong J, Loisel S, Verdière L, Bescher N, Bezier I, Latour M, Menard C, Bertheuil N, Roulois D, Tarte K. Activated CD4+ T Cells impact adipose-serived stromal cell function through CD40-dependant activation. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Menardais B, Le Reste PJ, Duisit J, Watier E, Leclère FM, Bertheuil N. Use of a skin perforator flap pedicled by the intercostal muscle for reconstruction of a posterior cervical defect. ANN CHIR PLAST ESTH 2020; 66:76-79. [PMID: 32067755 DOI: 10.1016/j.anplas.2020.01.004] [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: 12/13/2019] [Accepted: 01/20/2020] [Indexed: 11/24/2022]
Abstract
A posterior cervical defect featuring exposed spinal and occipital bone can be covered in various ways. The "ideal" flap should be a low-morbidity, pedicled locoregional flap that can reach the occiput. Cervical adjuvant radiation therapy may limit the coverage options, because many pedicles are located in areas that are often irradiated. Here, we describe a new surgical technique; we used a skin perforator flap pedicled by the intercostal muscle to cover a posterior cervical defect in a patient with metastatic squamous cell lung carcinoma. This technique is a valuable option; the flap originated from outside the irradiated area and reached the occiput. It adds to the options for cervical coverage in patients who require head-and-neck reconstruction. EVIDENCE-BASED MEDICINE: Level V: opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
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Affiliation(s)
- B Menardais
- Department of plastic, reconstructive and aesthetic surgery, hospital Sud, university of Rennes 1, Rennes, France
| | - P J Le Reste
- Department of neurosurgery, university of Rennes 1, Rennes, France
| | - J Duisit
- Department of plastic and reconstructive surgery, cliniques universitaires Saint-Luc, université catholique de Louvain, Brussels, Belgium
| | - E Watier
- Department of plastic, reconstructive and aesthetic surgery, hospital Sud, university of Rennes 1, Rennes, France
| | - F M Leclère
- Department of plastic, reconstructive and aesthetic surgery, CHU of Poitiers, Poitiers, France
| | - N Bertheuil
- Department of plastic, reconstructive and aesthetic surgery, hospital Sud, university of Rennes 1, Rennes, France; Inserm U1236, university of Rennes 1, Rennes, France; SITI laboratory, établissement français du sang Bretagne, Rennes university hospital, Rennes, France.
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10
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Leclère FM, Brèque C, Faure JP, Bertheuil N, Julienne A, Weigert R, Donatini G, Richer JP. [Male to female sex reassignment surgery with a new surgical simulation device using a human perfused cadaver SIMLIFE®: New paradigm in transsexual surgery education ?]. Prog Urol 2020; 30:126-133. [PMID: 31932042 DOI: 10.1016/j.purol.2019.09.011] [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: 04/28/2019] [Revised: 08/23/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In 2015, we reported our experience with the learning curve in genital reassignment surgery and highlighted a four-step learning concept. CLINICAL CASE In this article, we present our first vaginoplasty performed on a humanoid model SIMLIFE®, a human body associated with a pulsating circulation device and a ventilation device. RESULTS The surgical technique included 14 steps. The total surgical time was 182minutes. There was no intraoperative complication, and there was no damage to the urethra or rectum. The intraoperative bleeding measured by the loss of operative fluid was 280mL. We discuss the advantages of this technology perfectly adapted to transsexual surgery. CONCLUSION We demonstrated the feasibility of vaginoplasty performed on a humanoid model SIMLIFE® and highlighted improvement of the surgical skills with this model. This technology could find many other surgical applications. However, it faces cost constraints and legislation on corpses.
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Affiliation(s)
- F M Leclère
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la miletrie TSA-51115, 86073 Poitiers cedex 9, France.
| | - C Brèque
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la miletrie TSA-51115, 86073 Poitiers cedex 9, France
| | - J P Faure
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la miletrie TSA-51115, 86073 Poitiers cedex 9, France
| | - N Bertheuil
- Service de Chirurgie plastique, reconstructrice et esthétique CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - A Julienne
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la miletrie TSA-51115, 86073 Poitiers cedex 9, France
| | - R Weigert
- Service de chirurgie plastique, centre Francois michelet, CHU de bordeaux, 33000 Bordeaux, France
| | - G Donatini
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la miletrie TSA-51115, 86073 Poitiers cedex 9, France
| | - J P Richer
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la miletrie TSA-51115, 86073 Poitiers cedex 9, France
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Choughri H, Bertheuil N, Chaput B, Pélissier P, Dahmam A, Alabdulkareem M, Chasseuil H, Leclère FM. Indications, functional results and patient satisfaction after isolated second ray resection following traumatic injury: A retrospective review of 25 patients. Hand Surg Rehabil 2019; 39:125-130. [PMID: 31866499 DOI: 10.1016/j.hansur.2019.11.007] [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] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 11/16/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022]
Abstract
Amputation of the second ray is a surgical treatment option when reconstruction and/or reimplantation fail. The aim of our study was to review the outcomes after transmetacarpal resection of the second ray following a post-traumatic injury and to assess indications, functional outcomes, and patient satisfaction. Between January 2003 and December 2013, 25 patients (6 women and 19 men with a mean age of 51 years) underwent transmetacarpal resection of their second ray after a post-traumatic injury. Sixteen patients were right-handed and 9 were left-handed. Injuries involved the dominant hand in 14 cases (60%). In order to differentiate patients with preserved index finger length preoperatively from those with a shorter, amputated index finger stump, patients were divided into 2 groups. Group 1 included those with an "intact finger" and Group 2 included patients with an "amputated stump". Data collection, including patient satisfaction and functional outcomes, was performed at 83 months postoperative on average. Average length of follow-up was 7.0±1.0 years (range 5-12 years). Group 1 (intact finger) and 2 (amputated stump) included 15 and 10 patients, respectively. Six patients (24%) had primary ray amputation and 19 (76%) had secondary ray amputation. No surgical revision was necessary. In Group 1, the indications were purely functional in all but two cases, whereas aesthetic indications played a role in all patients in Group 2. The average total time off work was 3 months. There was no difference between Group 1 and 2 (P>0.05). However, patients with primary ray resection averaged 10 weeks of lost work compared to 17 weeks for secondary amputation. There was no functional difference between Groups 1 and 2. Scores for cosmetic appearance and patient satisfaction were higher in Group 2. In certain specific situations after complex hand trauma, transmetacarpal amputation of the second ray is indicated as soon as possible, in order to reduce the time off work. Patient satisfaction following this surgical procedure is high, especially in groups with amputated stumps. A 30% decrease in pinch and grip strength is the rule. No secondary surgery is normally required.
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Affiliation(s)
- H Choughri
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - N Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud, Rennes, France
| | - B Chaput
- Department of Plastic Reconstructive Surgery and Burns, Toulouse Rangueil University Hospital, Toulouse, France
| | - P Pélissier
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Dahmam
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - M Alabdulkareem
- Service de chirurgie plastique, brûlologie, chirurgie de la main, et chirurgie de la réassignation génitale, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France
| | - H Chasseuil
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - F-M Leclère
- Service de chirurgie plastique, reconstructrice et esthétique - brûlés - chirurgie de la main, CHU de Bordeaux, groupe hospitalier Pellegrin, centre François-Xavier Michelet, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Service de chirurgie plastique, brûlologie, chirurgie de la main, et chirurgie de la réassignation génitale, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France
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Isola N, Herlin C, Chaput B, Aillet S, Watier E, Bertheuil N. Upper body lift and breast reshaping with lateral chest wall perforator propeller flap following massive weight loss. ANN CHIR PLAST ESTH 2019; 65:44-53. [PMID: 31350099 DOI: 10.1016/j.anplas.2019.07.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/04/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues. OBJECTIVES To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL). METHODS Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure. RESULTS Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3±10.9kg/m2, with a mean preoperative pre-UBL BMI of 28.7±3.6kg/m2. The average weight loss before surgery was 67.7±22.4kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9±8.4months. The patients' satisfaction with their improved breast shapes and chest wall contours was "good", with an aesthetic outcome mean ranked 3.8±0.8 (out of 5). CONCLUSIONS After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping.
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Affiliation(s)
- N Isola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France
| | - C Herlin
- Department of Plastic Surgery and Burn Surgery, Hopital Lapeyronie, Montpellier University Hospital, 34090 Montpellier, France
| | - B Chaput
- STROMAlab, UMR5273 CNRS, UPS, EFS, INSERM U1031, Rangueil Hospital, 31100 Toulouse, France; Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - S Aillet
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France
| | - E Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35200 Rennes, France; INSERM U1236, University of Rennes 1, 35000 Rennes, France; SITI Laboratory, Rennes University Hospital, 35000 Rennes, France.
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Bertheuil N, Mocquard C, Pluvy I, Watier E, Bergeat D. Risk Factors for Postoperative Complications After Abdominal Panniculectomy and the Contribution of Plastic Surgeons on Reconstruction Following Massive Weight Loss. Obes Surg 2019; 29:1659-1660. [DOI: 10.1007/s11695-019-03807-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bertheuil N, Chaput B, Ménard C, Varin A, Laloze J, Watier E, Tarte K. Adipose mesenchymal stromal cells: Definition, immunomodulatory properties, mechanical isolation and interest for plastic surgery. ANN CHIR PLAST ESTH 2019; 64:1-10. [DOI: 10.1016/j.anplas.2018.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
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de Runz A, Boccara D, Bertheuil N, Claudot F, Brix M, Simon E. Three-dimensional imaging, an important factor of decision in breast augmentation. ANN CHIR PLAST ESTH 2018; 63:134-139. [DOI: 10.1016/j.anplas.2017.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/26/2017] [Indexed: 10/18/2022]
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Laloze J, Varin A, Gilhodes J, Bertheuil N, Grolleau J, Brie J, Usseglio J, Sensebe L, Filleron T, Chaput B. Cell‐assisted lipotransfer: Friend or foe in fat grafting? Systematic review and meta‐analysis. J Tissue Eng Regen Med 2017; 12:e1237-e1250. [DOI: 10.1002/term.2524] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 01/07/2023]
Affiliation(s)
- J. Laloze
- Department of Plastic, Reconstructive and Aesthetic Surgery, Department of Plastic and Reconstructive SurgeryRangueil Hospital Toulouse France
- STROMALabUniversité de Toulouse, EFS, ENVT, INSERM U1031 Toulouse France
| | - A. Varin
- STROMALabUniversité de Toulouse, EFS, ENVT, INSERM U1031 Toulouse France
| | - J. Gilhodes
- Biostatistic UnitInstitut Universitaire du Cancer Toulouse Toulouse France
| | - N. Bertheuil
- SITI Laboratory, Etablissement Français du Sang BretagneRennes University Hospital Rennes France
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital SudUniversity of Rennes 1 Rennes France
| | - J.L. Grolleau
- Department of Plastic, Reconstructive and Aesthetic Surgery, Department of Plastic and Reconstructive SurgeryRangueil Hospital Toulouse France
| | - J. Brie
- Service de Chirurgie Maxillo‐Faciale, réparatrice et stomatologieCHU de Limoges Toulouse France
| | - J. Usseglio
- Service de Chirurgie Maxillo‐Faciale, réparatrice et stomatologieCHU de Limoges Toulouse France
| | - L. Sensebe
- STROMALabUniversité de Toulouse, EFS, ENVT, INSERM U1031 Toulouse France
| | - T. Filleron
- Biostatistic UnitInstitut Universitaire du Cancer Toulouse Toulouse France
| | - B. Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, Department of Plastic and Reconstructive SurgeryRangueil Hospital Toulouse France
- STROMALabUniversité de Toulouse, EFS, ENVT, INSERM U1031 Toulouse France
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Laloze J, Varin A, Bertheuil N, Grolleau J, Vaysse C, Chaput B. Cell-assisted lipotransfer: Current concepts. ANN CHIR PLAST ESTH 2017; 62:609-616. [DOI: 10.1016/j.anplas.2017.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/27/2017] [Indexed: 01/04/2023]
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Huguier V, Paulus E, Fradet J, Rousseau P, Bertheuil N. [Light sources usable by the plastic surgeon in the absence of photographic studio]. ANN CHIR PLAST ESTH 2017; 62:314-321. [PMID: 28285884 DOI: 10.1016/j.anplas.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/13/2016] [Accepted: 02/08/2017] [Indexed: 11/19/2022]
Abstract
Medical photography is an important part of the medical file and is widely used in medical communication, especially in our discipline. His practice has to be the most standardized and reproducible as possible, which distinguishes it from artistic photography. Photography fix the light reflecting from a subject, so surgeon have to control of the light source in any environment. In the absence of dedicated studio, using external cobra or ring flashes with special diffusers allow the surgeon to have light sources adapted to the different conditions encountered in daily practice.
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Affiliation(s)
- V Huguier
- Service de chirurgie plastique, CHU, 2, rue de la Milétrie, CS 90577, 86021 Poitiers cedex, France.
| | - E Paulus
- Service de chirurgie plastique, CHU, 2, rue de la Milétrie, CS 90577, 86021 Poitiers cedex, France
| | - J Fradet
- Service de chirurgie plastique, CHU, 2, rue de la Milétrie, CS 90577, 86021 Poitiers cedex, France
| | - P Rousseau
- Service de chirurgie plastique, CHU, 4, rue Larrey, 49100 Angers, France
| | - N Bertheuil
- Service de chirurgie plastique, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France
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Bertheuil N, Carloni R, Bekara F, Laloze J, Herlin C, Chaput B. Propeller Perforator Flaps of Extremities Seem Less Reliable. J Reconstr Microsurg 2017; 33:603-604. [DOI: 10.1055/s-0036-1597991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- N. Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - R. Carloni
- Department of Plastic and Hand Surgery, CHU Charles Nicolle, Rouen, France
| | - F. Bekara
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - J. Laloze
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | - C. Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - B. Chaput
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
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Vitse J, Bekara F, Bertheuil N, Sinna R, Chaput B, Herlin C. Perforator-based propeller flaps reliability in upper extremity soft tissue reconstruction: a systematic review. J Hand Surg Eur Vol 2017; 42:157-164. [PMID: 27671797 DOI: 10.1177/1753193416669262] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 02/03/2023]
Abstract
UNLABELLED Current data on upper extremity propeller flaps are poor and do not allow the assessment of the safety of this technique. A systematic literature review was conducted searching PubMed, EMBASE, and the Cochrane Library electronic databases, and the selection process was adapted from the preferred reporting items for systematic reviews and meta-analysis statement. The final analysis included ten relevant articles involving 117 flaps. The majority of flaps were used for the hand, distal wrist, and elbow. The radial artery perforator and ulnar artery perforator were the most frequently used flaps. The were 7% flaps with venous congestion and 3% with complete necrosis. No difference in complications rate was found for different flaps sites. Perforator-based propeller flaps appear to be an interesting procedure for covering soft tissue defects involving the upper extremities, even for large defects, but the procedure requires experience and close monitoring. LEVEL OF EVIDENCE II.
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Affiliation(s)
- J Vitse
- 1 Departments of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France
| | - F Bekara
- 1 Departments of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France
| | - N Bertheuil
- 2 Department of Plastic, Reconstructive and Aesthetic Surgery, CHRU Rennes, Rennes, France
| | - R Sinna
- 3 Department of Plastic, Reconstructive and Aesthetic Surgery, CHRU Picardie, Amiens, France
| | - B Chaput
- 4 Department of Plastic, Reconstructive and Aesthetic Surgery, CHRU Rangeuil, Toulouse, France
| | - C Herlin
- 1 Departments of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France
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Ellart J, Grolleau JL, Gangloff D, Meresse T, Garrido I, Bertheuil N, Carloni R, Chaput B. [Morbidity of bodylift. Evaluation of 111 patients over 5 years]. ANN CHIR PLAST ESTH 2016; 61:820-826. [PMID: 27666182 DOI: 10.1016/j.anplas.2016.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/05/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The management of patients with weight loss sequelae, sometimes major, is increasingly well standardized. However, this surgery is not without risk. Complications of bodylift are more frequent than those of conventional abdominoplasties. The objective of this study was to evaluate the morbidity associated with this surgery through a retrospective, single-center study. MATERIALS AND METHODS One hundred and eleven circular abdominaloplasties were conducted between June 2011 and September 2015 in the plastic surgery department of the university hospital of Toulouse. Minor and major complications were identified and analyzed. RESULTS Frequency of postoperative complications was 44.1% in our series. Major complications have involved 15.3% of patients. Blood transfusions (9%) and hematoma requiring reoperation (7.2%) were the most frequent major complications. We found significantly more major complications in patients with important fat resection with a cut off at 3200 g (P=0.02). Men experienced significantly more major complications than women (P=0.005). The average delta-BMI (before and after weight loss) was significantly higher in the group of patients with the highest percentage of minor complications (P=0.045). Indeed, a high delta-BMI (greater than 19.5) was associated with an excess risk of minor complications in our population. CONCLUSION Democratization and progress in the field of bodylift should not obscure the fact that it is, in reality, a procedure at risk. While we manage increasingly better cosmetic results and thromboembolic complications, it still persists many complications.
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Affiliation(s)
- J Ellart
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Lille, rue Émile-Laine, 59037 Lille, France
| | - J-L Grolleau
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - D Gangloff
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - T Meresse
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - I Garrido
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - N Bertheuil
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Sud, université de Rennes 1, 2, rue Henri-Le-Guillax, 35000 Rennes, France
| | - R Carloni
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, centre hospitalier universitaire de Toulouse, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
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Herlin C, Bertheuil N, Bekara F, Boissiere F, Sinna R, Chaput B. Leech therapy in flap salvage: Systematic review and practical recommendations. ANN CHIR PLAST ESTH 2016; 62:e1-e13. [PMID: 27427444 DOI: 10.1016/j.anplas.2016.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 02/03/2016] [Accepted: 06/12/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Medicinal leeches have been part of the therapeutic armamenterium of plastic surgeons for more than 50 years. While their use in hand surgery is a matter of course, their use in salvage of flaps with venous congestion remains facultative depending on teams. MATERIALS AND METHODS We conducted a systematic review of leech therapy for flap salvage between 1960 and 2015, analyzing 121 articles and subsequently taking into consideration 41 studies. In parallel, we collected data from 43 patients for whom leach therapy had recently been applied in treatment of venous insufficiency in pedicled or free flaps after revision surgery had failed to improve flap vascularization, or in cases where flap revision was not appropriate. The data collected pertained to relevant indications, treatment procedure, efficacy, adjuvant therapies, side effects and complications. RESULTS For this indication, the success rate of leech therapy ranged from 65 to 85% (83.7% in our series) according to the situations encountered. Optimal frequency of application ranged from 2 to 8hours, while average overall duration ranged from 4 to 10 days. The number of leeches to be applied can be determined depending on volume of the flap. In 50% of the cases reported in the literature, the patients required transfusion. Antibiotic prophylaxis against Aeromonas is highly advisable. A ciprofloxacin and trimethoprim-sulfametoxazole combination currently appears as the most relevant prophylactic antibiotherapy. CONCLUSION Hirudotherapy is a reliable treatment in cases of patent venous insufficiency of pedicled or free flaps (or when revision surgery is not recommended). Even though the relevant literature is highly heterogeneous, we have attempted to put forward a specific protocol bringing together dosage, delivery route, frequency of administration and appropriate prophylactic antibiotherapy. An algorithm for treatment and management of venous congestion and a practical information sheet have been placed at the disposal of plastic surgery teams.
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Affiliation(s)
- C Herlin
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHRU Lapeyronie, 325, avenue du doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Service de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France; Unité de plaies et cicatrisation, CHRU Lapeyronie, 34295 Montpellier, France.
| | - N Bertheuil
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Rennes, 35000 Rennes, France
| | - F Bekara
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHRU Lapeyronie, 325, avenue du doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Service de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France; Unité de plaies et cicatrisation, CHRU Lapeyronie, 34295 Montpellier, France
| | - F Boissiere
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHRU Lapeyronie, 325, avenue du doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Service de chirurgie plastique et craniofaciale pédiatrique, CHRU Lapeyronie, 34295 Montpellier, France; Unité de plaies et cicatrisation, CHRU Lapeyronie, 34295 Montpellier, France
| | - R Sinna
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Picardie, 80080 Amiens, France
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Rangueil, 31400 Toulouse, France
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Bertheuil N, Carloni R, De Runz A, Herlin C, Girard P, Watier E, Chaput B. Medial thighplasty: Current concepts and practices. ANN CHIR PLAST ESTH 2016; 61:e1-7. [PMID: 26433317 DOI: 10.1016/j.anplas.2015.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/30/2015] [Indexed: 12/18/2022]
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Eburdery H, Grolleau J, Berthier C, Bertheuil N, Chaput B. Management of Large Sternal Wound Infections With the Superior Epigastric Artery Perforator Flap. Ann Thorac Surg 2016; 101:375-7. [DOI: 10.1016/j.athoracsur.2015.06.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 11/16/2022]
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Bertheuil N, Chaput B, Ménard C, Varin A, Garrido I, Grolleau J, Sensébé L, Watier E, Tarte K. Les cellules stromales mésenchymateuses du tissu adipeux : historique, isolement, propriétés immunomodulatrices et perspectives cliniques. ANN CHIR PLAST ESTH 2015; 60:94-102. [DOI: 10.1016/j.anplas.2014.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/25/2014] [Indexed: 12/15/2022]
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Carloni R, Pechevy L, Isola N, Vidal L, Goga D, Watier E, Bertheuil N. [Fournier's gangrene: Cervical and facial extension. A very rare case]. ANN CHIR PLAST ESTH 2015; 61:84-9. [PMID: 25766003 DOI: 10.1016/j.anplas.2015.02.003] [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: 11/25/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
Fournier's gangrene is a fearsome disease with a bad prognosis and a mortality rate ranging between 10 and 80% according to the literature. It is extensive in 13 to 54% of cases. Up to date, cervico-facial extension has never been reported. We describe the case of a 51-year-old overweighed woman with a history of type 2 diabetes and a narrow lumbar canal who was referred to our institution for significant fatigue and increasingly painful legs. A diagnosis of Fournier's gangrene was made after correlating the physical findings with the results of a full body scan. Diffuse subcutaneous emphysema involving the face, neck, mediastinum, abdominal wall, right buttock, perineum and the right thigh was identified. Treatment included multiple surgical debridements, admission to intensive care unit, and an efficient antibiotic therapy that enabled preservation of the patient's life. To our knowledge, this is the first case of cervical and mediastinal extension of Fournier's gangrene to be reported. No clear guidelines exit on the management of this complication (cervico-facial and mediastinal drainage). We share our experience of this unusual case.
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Affiliation(s)
- R Carloni
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France.
| | - L Pechevy
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - N Isola
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - L Vidal
- Institut de recherches médicales A.-Lanari, université de Buenos-Aires, C1427ARO Buenos-Aires, Argentine
| | - D Goga
- Service de chirurgie plastique et reconstructrice, centre des brulés, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - E Watier
- Service de chirurgie plastique et reconstructrice, hôpital Sud, CHU de Rennes, boulevard de Bulgarie, 35200 Rennes, France
| | - N Bertheuil
- Service de chirurgie plastique et reconstructrice, hôpital Sud, CHU de Rennes, boulevard de Bulgarie, 35200 Rennes, France; Inserm U917, université de Rennes 1, 35033 Rennes, France; Laboratoire SITI, établissement français du sang Bretagne, CHU de Rennes, 35033 Rennes, France; STROMAlab, UMR5273 CNRS/UPS/EFS - Inserm U1031, hôpital Rangueil, 31059 Toulouse, France
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Bertheuil N, Sulpice L, Levi Sandri G, Lavoué V, Watier E, Meunier B. Inguinal lymphadenectomy for stage III melanoma: A comparative study of two surgical approaches at the onset of lymphoedema. Eur J Surg Oncol 2015; 41:215-9. [DOI: 10.1016/j.ejso.2014.10.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022] Open
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Bigot N, Guérillon C, Loisel S, Bertheuil N, Sensebé L, Tarte K, Pedeux R. ING1b negatively regulates HIF1α protein levels in adipose-derived stromal cells by a SUMOylation-dependent mechanism. Cell Death Dis 2015; 6:e1612. [PMID: 25611387 PMCID: PMC4669774 DOI: 10.1038/cddis.2014.577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/18/2014] [Accepted: 12/03/2014] [Indexed: 12/16/2022]
Abstract
Hypoxic niches help maintain mesenchymal stromal cell properties, and their amplification under hypoxia sustains their immature state. However, how MSCs maintain their genomic integrity in this context remains elusive, since hypoxia may prevent proper DNA repair by downregulating expression of BRCA1 and RAD51. Here, we find that the ING1b tumor suppressor accumulates in adipose-derived stromal cells (ADSCs) upon genotoxic stress, owing to SUMOylation on K193 that is mediated by the E3 small ubiquitin-like modifier (SUMO) ligase protein inhibitor of activated STAT protein γ (PIAS4). We demonstrate that ING1b finely regulates the hypoxic response by triggering HIF1α proteasomal degradation. On the contrary, when mutated on its SUMOylation site, ING1b failed to efficiently decrease HIF1α levels. Consistently, we observed that the adipocyte differentiation, generally described to be downregulated by hypoxia, was highly dependent on ING1b expression, during the early days of this process. Accordingly, contrary to what was observed with HIF1α, the absence of ING1b impeded the adipogenic induction under hypoxic conditions. These data indicate that ING1b contributes to adipogenic induction in adipose-derived stromal cells, and thus hinders the phenotype maintenance of ADSCs.
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Affiliation(s)
- N Bigot
- 1] INSERM U917, Microenvironnement et Cancer, Rennes, France [2] Université de Rennes 1, Rennes, France [3] Etablissement Français du Sang Bretagne, Rennes, France
| | - C Guérillon
- 1] INSERM U917, Microenvironnement et Cancer, Rennes, France [2] Université de Rennes 1, Rennes, France [3] Etablissement Français du Sang Bretagne, Rennes, France
| | - S Loisel
- 1] INSERM U917, Microenvironnement et Cancer, Rennes, France [2] Université de Rennes 1, Rennes, France [3] Etablissement Français du Sang Bretagne, Rennes, France
| | - N Bertheuil
- 1] Université de Rennes 1, Rennes, France [2] Service ITeCH, CHU Pontchaillou, Rennes, France
| | - L Sensebé
- 1] Etablissement Français du Sang Pyrénées Méditerranée [2] Université Paul Sabatier, Toulouse, France [3] UMR5273-INSERM U1031, Toulouse, France
| | - K Tarte
- 1] INSERM U917, Microenvironnement et Cancer, Rennes, France [2] Université de Rennes 1, Rennes, France [3] Etablissement Français du Sang Bretagne, Rennes, France [4] Service ITeCH, CHU Pontchaillou, Rennes, France
| | - R Pedeux
- 1] INSERM U917, Microenvironnement et Cancer, Rennes, France [2] Université de Rennes 1, Rennes, France [3] Etablissement Français du Sang Bretagne, Rennes, France
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Dellière V, Bertheuil N, Harnois Y, Thiénot S, Gérard M, Robert M, Watier E. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia. Indian J Plast Surg 2015; 47:436-40. [PMID: 25593436 PMCID: PMC4292128 DOI: 10.4103/0970-0358.146650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.
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Affiliation(s)
- Vincent Dellière
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - Y Harnois
- Department of General Surgery, Rennes University Hospital, Rennes, France
| | - S Thiénot
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - M Gérard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - M Robert
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - E Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
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Beuzeboc Gérard M, Aillet S, Bertheuil N, Delliere V, Thienot S, Watier E. Surgical management of subcutaneous fat necrosis of the newborn required due to a lack of improvement: a very rare case. Br J Dermatol 2014; 171:183-5. [PMID: 24359190 DOI: 10.1111/bjd.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 12/01/2022]
Abstract
Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon and transient disease characterized by defined areas of fat necrosis and overlying cutaneous nodule lesions. It usually becomes apparent within the first 6 weeks of life in full-term or post-term infants. It is caused by generalized and/or local tissue hypoperfusion. The skin lesions of ScFN tend generally to improve spontaneously in a few weeks. We present a full-term newborn with birth distress. After therapeutic hypothermia, she presented voluminous and numerous subcutaneous fat necrosis with extensive calcifications. Surgical management was decided at her ninth month because of a total lack of regression. Hypercalcaemia, the most threatening complication, appeared only after this delayed surgery.
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Affiliation(s)
- M Beuzeboc Gérard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud - University of Rennes 1, 16 Boulevard de Bulgarie, Rennes, 35200, France
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Lavoué V, Lemarrec A, Bertheuil N, Henno S, Mesbah H, Watier E, Levêque J, Morcel K. Quality of life and female sexual function after skinning vulvectomy with split-thickness skin graft in women with vulvar intraepithelial neoplasia or vulvar Paget disease. Eur J Surg Oncol 2013; 39:1444-50. [DOI: 10.1016/j.ejso.2013.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/17/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022] Open
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Huguier V, Bertheuil N, Parry F, Robiolle C, Dagrégorio G. [Post-traumatic reconstruction of the lower lip after total or subtotal amputation using the Webster's modification of the Bernard cheiloplasty -- advantages, disadvantages and limitations: three cases]. ANN CHIR PLAST ESTH 2013; 58:166-74. [PMID: 23333301 DOI: 10.1016/j.anplas.2012.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 12/18/2012] [Indexed: 11/18/2022]
Abstract
Webster's modification of the Bernard cheiloplasty is a well-known technique, usually applied to the reconstruction of total or subtotal amputations of the lower lip following oncological resection. We present three cases of post-traumatic reconstructions with interesting results.
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Affiliation(s)
- V Huguier
- Service de chirurgie plastique, CHU de Poitiers, BP 577, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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