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Kanlagna A, Oillic J, Verdier J, Perrot P, Lancien U. Prospective assessment of the quality of life and nipple sensation after gender-affirming chest surgery. J Plast Reconstr Aesthet Surg 2024; 94:46-49. [PMID: 38759510 DOI: 10.1016/j.bjps.2024.05.022] [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: 12/27/2023] [Revised: 04/24/2024] [Accepted: 05/05/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND In the existing literature, assessing transgender patients' quality of life after surgery, especially using standardized surveys, is rare. The nipple sensation regarding the operating technique has neither been studied in a prospective nor standardized way. METHODS For one year, we prospectively assessed transgender patients operated on for a gender-affirming chest surgery in our unit. Each patient answered the BREAST-Q© survey and the BODY-Q© chest module survey before and six months after the surgery. In addition, a measure of nipple sensation was performed using Semmes-Weinstein monofilaments pre-and post-operatively to compare surgical techniques. RESULTS Fifty-one patients (102 breasts) were included in our study. The average age was 23.1 years and the average BMI was 24.8 kg/m2. Twenty-one patients (45%) had double incision and free nipple graft mastectomy, 14 (27%) patients had double incision and inferior pedicle mastectomy, while the 14 (27%) other patients had a semi-circular technique. Our study shows an improvement in all the scores of the surveys after surgery (p < 0.0001). Patients with double incision and inferior pedicle mastectomies rated a significantly higher satisfaction with nipples (p = 0.013) and significantly better sexual well-being (p = 0.007) than other techniques. In addition, preservation of nipple sensation was shown in patients operated by semi-circular technique (p < 0.001) and inferior pedicle technique (p < 0.0001). CONCLUSIONS Our prospective study confirms the significant improvement in the quality of life of transgender patients after chest gender-affirming surgery. Double incision with inferior pedicle seems to provide better satisfaction with nipples, higher sexual well-being, and preservation of nipple sensation.
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Affiliation(s)
- Anoujat Kanlagna
- Department of Plastic and Reconstructive Surgery, University Hospital of Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France.
| | - Julien Oillic
- Department of Plastic and Reconstructive Surgery, University Hospital of Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France
| | - Julien Verdier
- Department of Plastic and Reconstructive Surgery, University Hospital of Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France
| | - Pierre Perrot
- Department of Plastic and Reconstructive Surgery, University Hospital of Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France; RMeS: Regenerative Medicine and Skeleton research unit - Inserm, Nantes University, 44000 Nantes, France
| | - Ugo Lancien
- Department of Plastic and Reconstructive Surgery, University Hospital of Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France; RMeS: Regenerative Medicine and Skeleton research unit - Inserm, Nantes University, 44000 Nantes, France
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Bourgeois A, Girardot-Miglierina A, Thomières A, Podevin J, Perrot P, Duchalais E. Technique for treatment of recurrent perianal fistula in Crohn's disease using autologous fat. Tech Coloproctol 2023; 27:1377-1378. [PMID: 37429980 DOI: 10.1007/s10151-023-02836-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023]
Affiliation(s)
- A Bourgeois
- Loire Atlantique, University Hospital of Nantes, Nantes, France.
| | | | - A Thomières
- Loire Atlantique, University Hospital of Nantes, Nantes, France
| | - J Podevin
- Loire Atlantique, University Hospital of Nantes, Nantes, France
| | - P Perrot
- Loire Atlantique, University Hospital of Nantes, Nantes, France
| | - E Duchalais
- Loire Atlantique, University Hospital of Nantes, Nantes, France
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Aubrit J, Lancien U, Ridel P, Perrot P. Breast reconstruction using DIEP flap: The free flap alone be enough? Quality of life and satisfaction analysis after complementary surgeries. J Plast Reconstr Aesthet Surg 2023; 84:223-232. [PMID: 37343423 DOI: 10.1016/j.bjps.2023.05.037] [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: 08/04/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Breast reconstruction using Deep Inferior Epigastric Perforator (DIEP) flap involves complementary surgeries such as lipofilling, symmetrization, and nipple-areolar complex (NAC) reconstruction. Their role and impact have not been explored yet after the DIEP flap use. MATERIAL AND METHODS A retrospective study was performed to evaluate the impact of complementary surgeries on the quality of life of 75 patients after DIEP flap breast reconstruction between 2012 and 2021, comparing the BREAST-Q© score of two groups, patients with DIEP flap only reconstruction and patients with DIEP flap and additional surgeries. Satisfaction for each surgery was assessed using a numeric visual scale on five dimensions (esthetic, self-image, confidence in society, pain, and intimate relationship). Complications and healthcare pathways were also recorded. RESULTS Psychosocial well-being (Q1 BREAST-Q©), satisfaction with medical team (Q9) and with surgeon (Q11) was superior in group 2 (p = 0041, p = 0.001 and p = 0.001 respectively). NAC reconstruction improved BREAST-Q© (p = 0029) by regression analysis and was deemed indispensable by 64% of the patients. An important satisfaction is observed after each surgery (DIEP flap, symmetrization, lipofilling and NAC reconstruction). Complications were uncommon (0-4%) for lipofilling and NAC reconstruction and notable but harmless for symmetrization (wound dressings more than a month in 17%). CONCLUSION Complementary surgeries, especially NAC reconstruction, improved BREAST-Q© score, and have a major impact on satisfaction with minor complications. These surgeries should always be proposed to the patients to assess a satisfactory breast reconstruction using DIEP flap.
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Affiliation(s)
- Jérémy Aubrit
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 Nantes, France.
| | - Ugo Lancien
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), 1 place Alexis Ricordeau, 44000 Nantes, France
| | - Perrine Ridel
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 Nantes, France
| | - Pierre Perrot
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), 1 place Alexis Ricordeau, 44000 Nantes, France
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Thuau F, Lancien U, Tiry E, Crenn V, Perrot P. Impact of surgical first excision delay on function for heat-press hand injury by the Quick-DASH questionnaire: Series over 20 years. Burns 2023; 49:1422-1431. [PMID: 36379823 DOI: 10.1016/j.burns.2022.10.013] [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: 03/11/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Heat-press hand burn leads to complex and severe lesions, with potentiation of thermal burn by the crushing mechanism. Management remains poorly codified, and the surgical strategies found in the literature remain contradictory. The objective of our study is to report our experience and define the first burn excision delay through functional evaluation with a Quick-DASH questionnaire. METHODS We carried out a retrospective study of 20 burned hands by heat-press managed in our burn unit between 2002 and 2021. Following data were collected, at least one year after the accident: Quick-DASH score, which was our primary endpoint, injury assessment according to the Tajima's classification, overall surgical management, and impact on their professional activity. A descriptive statistical analysis of these data was performed followed by a univariate analysis to assess the correlation between delay to first surgical excision and the long-term functional result (Quick-DASH score and time before return to work). RESULTS Burns were Tajima grade 1 (supra-fascial dermal burn) in 35 % of cases, grade 2 (exposure of subfascial structures) in 45 % and grade 3 (bone or joint exposure) in 20 %. There were no cases of bone fractures. We received 18 out of 20 questionnaires with no significant differences between those who send back or not. The median QuickDash score was 7.15 [IQR 0-52.25]. The first surgical excision was performed with a median of 8 days after the accident [min: 0; max: 20]. The median time before return to work was 24 weeks [IQR 17-42.25]. Only 11 patients (55 %) were able to go on the initial employment. Spearman test found a strong trend for a negative correlation between the time to the first excision and the QuickDash score (ρ = -0.46; r2 = 0.087; p = 0.053). CONCLUSION According to observations made in our unit and in agreement with Tajima, who first described heat-press injury, the first surgical excision should be performed approximately one week after the accident. Subsequent excisions may be performed to reassess the lesions and complete the debridement, with reconstruction to follow. Multidisciplinary management is still necessary, including early and intensive physiotherapy, psychological support, and assessment by an occupational physician.
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Affiliation(s)
- F Thuau
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - U Lancien
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France.
| | - E Tiry
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - V Crenn
- Orthopedic and Trauma Surgery department, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - P Perrot
- Plastic and Reconstructive Surgery Department, Adult and pediatric burn unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
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Cavadore N, Lancien U, Crenn V, Verdier J, Perrot P. Knee Joint Rescue in a Traumatic Amputation With Coverage by a Fillet-Free Flap From the Amputated Leg. Cureus 2023; 15:e42917. [PMID: 37664396 PMCID: PMC10474922 DOI: 10.7759/cureus.42917] [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] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Traumatic amputation is a severe injury that requires urgent surgical care. A fillet-free flap from the amputated limb is the most conservative way to ensure proper coverage of the stump when replantation is not possible. We report the case of a male patient who suffered from a traumatic limb amputation in a motorcycle accident. A free fillet flap from the posterior compartment of the leg carrying the posterior tibial pedicle, the soleus muscle, and skin tissue harvested from the amputated limb was performed to cover the amputation stump and thus allow preservation of the knee joint. In our case report, the patient conserved almost maximal knee joint range of motion (130°). He regained the ability to walk only two months after the initial trauma. Prosthetic fitting occurred quickly and without any particular issues throughout the process. Regarding quality of life, after one year, our patient had a five-level EQ-5D version (EQ-5D-5L) score of 21,221, and his 36-Item Short Form Survey (SF-36) score was divided between the five components in 85 points in physical functioning, 100 points in role limitations due to physical health, 100 points in role limitations due to emotional problems, 50 points in energy/fatigue, 68 points in emotional well-being, 75 points in social functioning, 45 points in pain, and 95 points in general health. This technique helped provide good coverage of the stump while preserving a functional knee joint, allowing for effective prosthetic fitting in the future and therefore optimizing our patient's quality of life.
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Affiliation(s)
- Nicolas Cavadore
- Plastic and Reconstructive Surgery, University Hospital of Nantes, Nantes, FRA
| | - Ugo Lancien
- Plastic and Reconstructive Surgery, University Hospital of Nantes, Nantes, FRA
| | - Vincent Crenn
- Orthopaedics and Traumatology, University Hospital of Nantes, Nantes, FRA
| | - Julien Verdier
- Plastic and Reconstructive Surgery, University Hospital of Nantes, Nantes, FRA
| | - Pierre Perrot
- Plastic and Reconstructive Surgery, University Hospital of Nantes, Nantes, FRA
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Lancien U, Goronflot T, Verdier J, Kanlagna A, Perrot P. How to measure vessel caliber in microsurgery and super-microsurgery? Metrological study of three methods applicable in clinical practice. J Plast Reconstr Aesthet Surg 2023; 83:94-97. [PMID: 37271002 DOI: 10.1016/j.bjps.2023.05.014] [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: 04/26/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The microsurgical literature reports the vascular calibers of the vessels studied even though the method of measurement of these vessels is very rarely reported. MATERIAL AND METHOD We performed a metrological study evaluating three methods to measure the external calibers of catheters corresponding to microsurgical and super-microsurgical vessels (1.2 mm, 0.8 mm, and 0.6 mm). Six evaluators measured 15 catheters of three different hidden diameters by each of the three methods applicable in clinical practice: standard graduated ruler, Shinwa® micrometric ruler, and ImageJ® software from a photograph. Accuracy and reliability of the measurements were assessed by studying the inter- and intra-rater and inter-method coefficients (variants of the intra-class coefficient (ICC)) and analysis of the IC95% of the ICCs. RESULTS Intra class correlation ICC "intra-rater" coefficient finds for the standard rule 0.81 [0.65-0.93], Shinwa® rule 0.86 [0.67-0.96], and for the ImageJ® software 0.97 [0.94-0.99]. The "Inter-rater" ICC shows respectively the coefficient 0.51 [0.23 and max 0.93], 0.87 [0.75-0.95], and 0.95 [0.89-0.98]. It appears that the graduated decimeter is the least reliable method of measurement, the Shinwa® ruler presents acceptable reliability but requires the purchase of equipment. The reliability of ImageJ® software is the best and appears to be the most reliable method. CONCLUSION Our original study, with no equivalent in the scientific literature, demonstrates objectively the great accuracy and reliability of a method of measurement of vascular calibers in micro and super microsurgery using intraoperative photography and the use of free computer software.
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Affiliation(s)
- Ugo Lancien
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Place Alexis Ricordeau, 44000 Nantes, France.
| | - Thomas Goronflot
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, 44000 Nantes, France
| | - Julien Verdier
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Place Alexis Ricordeau, 44000 Nantes, France
| | - Anoujat Kanlagna
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Place Alexis Ricordeau, 44000 Nantes, France
| | - Pierre Perrot
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Place Alexis Ricordeau, 44000 Nantes, France
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Lancien U, Charbonnier B, Weiss P, Corre P, Perrot P. Rat Perforator and Skin Vessels Vascular Mapping: An Original Anatomical Study About 140 Vessels and Literature Review. J Surg Res 2023; 288:298-308. [PMID: 37058986 DOI: 10.1016/j.jss.2023.03.015] [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: 11/15/2022] [Revised: 02/21/2023] [Accepted: 03/14/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Recent microsurgical reconstruction techniques benefit from the use of skin and perforator flaps that spare the donor sites. Studies on these skin flaps in rat models are numerous but there is currently no reference regarding the position of the perforators, their caliber, and the length of the vascular pedicles. METHODS We performed an anatomical study on 10 Wistar rats and 140 vessels: cranial epigastric (CE), superficial inferior epigastric (SIE), lateral thoracic (LT), posterior thigh (PT), deep iliac circumflex (DCI) and posterior intercostal (PIC) vessels. The evaluation criteria were the external caliber, the length of the pedicle, and the position of the vessels reported on the skin surface. RESULTS Data from the six perforator vascular pedicles are reported, with figures illustrating the orthonormal reference frame, the representation of the vessel's position, the cloud of points corresponding to the various measurements, and the average representation of the collected data. The analysis of the literature does not find similar studies; the different vascular pedicles are discussed as well as the limitations of our study: evaluation of cadaver specimen, presence of the very mobile panniculus carnosus, other perforator vessels not evaluated as well as the precise definition of perforating vessels. CONCLUSIONS Our work describes the vascular calibers, pedicle lengths, and location of birth and arrival at the skin of the perforator vessels PT, DCI, PIC, LT, SIE, and CE in rat animal models. This work, without an equivalent in the literature, lays the foundation for future studies about flap perfusion, microsurgery, and super microsurgery learning.
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Affiliation(s)
- Ugo Lancien
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France.
| | - Baptiste Charbonnier
- INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
| | - Pierre Weiss
- INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
| | - Pierre Corre
- INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Maxillofacial surgery unit, Nantes University Hospital, Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
| | - Pierre Perrot
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, Nantes, France; INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), Nantes, France; Université de Nantes, UFR Odontologie, Nantes, France
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Thuau F, Aubrit J, Duteille F, Lancien U, Perrot P. ["Junior Doctor" in Plastic Surgery, a new status. Evaluation of the practices after one semester of application of the reform]. ANN CHIR PLAST ESTH 2023; 68:14-18. [PMID: 36096851 DOI: 10.1016/j.anplas.2022.07.014] [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: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The reform of the third cycle of medical studies in 2017 led to the creation of the status of "Junior Doctor", corresponding to the consolidation phase and allowing increasing autonomy and supervision from the intern. In plastic surgery, this status appeared for the first time in November 2021 in French hospitals; it lasts two years and succeeds the first four years of internship. MATERIAL AND METHODS We sent a self-questionnaire by email in May 2022 to the 21 French Junior Doctors. This was interested in their training ground, formation program, consultation activity, operating program, integration into the on-call list, the existence of half-days of availability, and their general opinion on this reform and its implementation. RESULTS We collected 20 questionnaires with a sex ratio of twelve men for eight women. The majority of respondents worked in a university hospital (85 %). 45 % had their consultations, 60 % had their own operating sessions under general anesthesia, and 35 % under local anesthesia. Only 25 % of them considered this reform to be a step forward in terms of training. CONCLUSION The introduction of the status of Junior Doctor is contrasted within the various hospitals. Despite the progressive and supervised autonomy provided by this reform, it is generally perceived neutrally or negatively by Junior Doctors. The establishment of own consultations and operating sessions stands out as a key positive element allowing better application of the reform.
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Affiliation(s)
- F Thuau
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France.
| | - J Aubrit
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France
| | - F Duteille
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France
| | - U Lancien
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France
| | - P Perrot
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France
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Jacob N, Aubert H, Ridel P, Tsimba V, Perrot P, Barbarot S. Erosive pustular dermatosis of the scalp in 2 children following burns. Ann Dermatol Venereol 2022; 149:296-297. [PMID: 36437123 DOI: 10.1016/j.annder.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/20/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Affiliation(s)
- N Jacob
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - H Aubert
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - P Ridel
- Service de chirurgie plastique, reconstructrice et esthétique/Centre des brûlés adultes et enfants, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - V Tsimba
- Service de rééducation et de réadaptation fonctionnel pédiatrique, Centre mutualiste de Kerpape, lieu-dit Kerpape, 56270 Ploemer, France
| | - P Perrot
- Service de chirurgie plastique, reconstructrice et esthétique/Centre des brûlés adultes et enfants, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - S Barbarot
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Le Floch R, Lancien U, Mauduit N, Mahé P, Perrot P. [Hospitalisations Related To Burns In France. Analyses Of 2019's National Data Base]. Ann Burns Fire Disasters 2022; 35:324-333. [PMID: 38680631 PMCID: PMC11042065] [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] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/11/2022] [Indexed: 05/01/2024]
Abstract
Thanks to the Medical Information Service of our institution, we obtained the data on burns during 2019, saved in the national database. We found 10,913 reports, among them 10,347 metropolitan and 566 overseas. When compared to the French population on January 1st 2020, the incidences were 16 (global population); 15.7 (metropolitan) and 27.1 (overseas)/100,000 inhabitants respectively. The majority (62.95%) of the patients were taken care of in Burn Centres (BCs). However, 4,043 patients were never seen by a burn specialist. Nevertheless 88.54% of skin grafts were performed in BCs and 71.86% of the burns with high seriousness (levels 3 and 4) were in BCs. One hundred and seventy-nine patients (1.64%) died. For the first time, we obtained the intensive care activity, through the scoring actions. Intensive care was held for 958 patients (8.96%), 90.81% of them in a BC. Only 28.57% were associated with major (>30% BSA) burns, but these major burns accounted for 63.78% of the organ failure treatments.
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Affiliation(s)
- R. Le Floch
- Réanimation Chirurgicale et des Brûlés, CHU Nantes, France
| | | | - N. Mauduit
- Service d’Information Médicale, CHU Nantes, France
| | - P.J. Mahé
- Réanimation Chirurgicale et des Brûlés, CHU Nantes, France
| | - P. Perrot
- Service des Brûlés, CHU Nantes, France
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Lancien U, Kanlagna A, Verdier J, Aubrit J, Perrot P. Reverse Lip Lift For Deep Face Burn Sequelae With Bilateral Nostril Stenosis And Lip Contracture: An Original Technique. A Case And Literature Review. Ann Burns Fire Disasters 2022; 35:237-242. [PMID: 37016591 PMCID: PMC10067148] [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] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/23/2021] [Indexed: 04/06/2023]
Abstract
Bilateral nostril stenosis resulting from deep facial burn that occurred on an oxygen-requiring patient with tobacco use is life threatening with obstruction of the airway and impossibility of oxygen supplementation use. We report the case of a deep burn involving the nose and the upper lip during oxygen and tobacco use with a severe bilateral nostril stenosis and upper lip retraction. We did a reverse bullhorn lip lift with bilateral alar base transposition realized in a one-stage surgery with nasal conformer for 4 months. Surgery allowed a significant opening of the nostril stenosis with a 9mm and 11mm major axis on the right and left side respectively. It brought restoration of the ability to nose breath and use an oxygen device, and was considered satisfactory by the patient and the operators. There was no recurrence at 18-month follow-up. Literature provides few examples of management of severe bilateral nostril stenosis following facial deep burn. Nasal conformers with progressive diameter augmentation, rhinoplasty procedure, local plasties, dermal flap, skin and composite grafts can treat this situation but there is no gold standard procedure. Reverse bullhorn lip lift with bilateral alar base transposition makes it possible to correct this severe deep burn sequela. With this clinical case, we show the possibility to treat it in a one-stage procedure through an aesthetic procedure inspiration, with an acceptable scar on the donor site.
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Affiliation(s)
- U. Lancien
- Ugo Lancien
Plastic, Reconstructive and Aesthetic Surgery Unit, Nantes University Hospital1 place Alexis Ricordeau, 44000 NantesFrance+33 240087304
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Cavadore T, Lancien U, Barbarot S, Perrot P. Congenital lamellar ichthyosis complicated with erosive pseudo pustulosis: A rare clincal entity. About a case and review of the literature. ANN CHIR PLAST ESTH 2022; 67:176-179. [DOI: 10.1016/j.anplas.2022.03.005] [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] [Received: 02/09/2022] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/01/2022]
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13
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Le Floch R, Mahé P, Perrot P. [Not Available]. Ann Burns Fire Disasters 2022; 35:3-17. [PMID: 35582092 PMCID: PMC9020852] [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] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 06/15/2023]
Abstract
Incidents involving tanker trucks regularly appear in the media. The one in Morogoro (Tanzania) on August 10th 2019 (killing at least 89) attracted our attention. We reviewed medical literature (sparse) and media reports to identify and analyse these incidents. In high income countries isolated accidents may be responsible for a few deaths. In low income countries "double" accidents can occur. A commonplace incident occurs which frequently has no victim. When the incident involves a petrol leak, people gather to scoop up the fuel. A spark ignites the petrol and the ensuing engulfing fire is in itself deadly. Frequently, it triggers a tanker BLEVE, which is responsible for a disaster. Preventing these casualties should include avoiding the initial incident, and also (and above all) discouraging the locals from scooping up fuel they can use or possibly sell in order to survive.
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Affiliation(s)
- R. Le Floch
- Service de réanimation chirurgicale et des brûlés, CHU Nantes, Nantes, France
| | - P.J. Mahé
- Service de réanimation chirurgicale et des brûlés, CHU Nantes, Nantes, France
| | - P. Perrot
- Service des brûlés et de chirurgie plastique, CHU Nantes, Nantes, France
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El Kinani M, Hamel A, Lancien U, Perrot P, Duteille F. Réanimation de l’extension du pouce par transfert de l’extensor indici proprius chez les enfants atteints de pouce flexus adductus congénital. ANN CHIR PLAST ESTH 2022; 67:1-6. [DOI: 10.1016/j.anplas.2021.12.001] [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] [Received: 07/23/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 11/01/2022]
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15
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Thuau F, Lancien U, Crenn V, Perrot P, Duteille F. [The de-epidermized sural flap: An original technique to increase the reliability of the neurocutaneous sural flap]. ANN CHIR PLAST ESTH 2021; 67:93-100. [PMID: 34583875 DOI: 10.1016/j.anplas.2021.08.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/03/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The neurocutaneous sural flap is useful to cover defects of the distal quarter of the lower limb. Nevertheless, severe complications occur in 14% of the cases, and venous congestion is reported in 75% of these cases. This congestion can lead to total necrosis of the flap and a failure of the procedure. We describe a new surgical method aiming to reduce the risk of venous congestion occurrence and failure of the defect coverage. PATIENTS AND METHODS We realized a retrospective study of patients who undergone a de-epidermized distally based neurocutaneous sural flap in our surgery department from 2015 to 2020. The following data were collected: sex, age, vascular risk factors, size of the wound, defect area, etiology, delay between the surgery of the flap and the split-thickness skin graft and complications. RESULTS The cohort is composed of 5 cases. We reported no failure of the coverage of the defect. There were no cases of venous congestion. CONCLUSION The de-epidermized distally based neurocutaneous sural flap could increase the reliability of these flaps by reducing the risk of venous congestion. A larger study comparing the classic technique to the de-epidermized sural flap could confirm these data on a greater number of cases and position this technique in the therapeutic arsenal.
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Affiliation(s)
- F Thuau
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - U Lancien
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - V Crenn
- Service de chirurgie orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Laboratoire PhyOS Inserm UMR 1238, faculté de médecine, 1 rue Gaston-Veil, 44000 Nantes, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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16
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Andre E, Hamel A, Perrot P, Duteille F. [Median nerve compression in the carpal tunnel in children - a delayed diagnosis. About 20 clinical cases]. ANN CHIR PLAST ESTH 2021; 66:298-304. [PMID: 34144846 DOI: 10.1016/j.anplas.2021.04.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/04/2021] [Accepted: 04/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The carpal tunnel syndrome is rare in children. We performed a retrospective study of 10 children. The aim is to show that the diagnosis of carpal tunnel syndrome is difficult in children. PATIENTS AND METHODS We identified all children with median nerve compression in the carpal tunnel between 2010 at 2020, managed in our service. RESULTS Ten children with 20 hands included. There was different etiologies of carpal tunnel syndrome: 5 lysosomal storage diseases, 4 idiopathic carpal tunnel syndrome, 1 genodermatose, 1 Byler syndrome and 1 VACTERL syndrome. Common presenting symptoms were pain (five patients) and under use of fingers (five patients). Two children had opposition deficit of the thumb. We operated 19 hands. Median age at diagnosis was 4 years and 7 months. One children or 2 hands had a reanimation of opposition by tendinous transfer of flexor digitorum superficialis tendon of the ring finger. All children had a complete regression of the painful symptoms, a use improvement of fingers and recovery of the opposition of the thumb. CONCLUSION The diagnosis of carpal tunnel syndrome is difficult in children. It is common to be confronted with an advanced clinical symptoms. The atypical symptoms may cause diagnostic delay. Due to the quality of the clinical results obtained, we recommend open carpal tunnel release even when the diagnosis seems delayed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Andre
- Service de chirurgie orthopédique pédiatrique, CHU de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France.
| | - A Hamel
- Service de chirurgie orthopédique pédiatrique, CHU de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, Centre des Brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, Centre des Brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Condamina M, Penso L, Tran VT, Hotz C, Guillem P, Villani AP, Perrot P, Bru MF, Jacquet E, Nassif A, Bachelez H, Wolkenstein P, Beylot-Barry M, Richard MA, Ravaud P, Viguier M, Sbidian E. Baseline Characteristics of a National French E-Cohort of Hidradenitis Suppurativa in ComPaRe and Comparison with Other Large Hidradenitis Suppurativa Cohorts. Dermatology 2021; 237:748-758. [PMID: 33503635 DOI: 10.1159/000513447] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition substantially impacting patients' quality of life; the pathogenesis remains unclear, and treatment is complex and not yet standardized. Observational data are increasingly being used to evaluate therapeutics in "real-life" interventions, and the development of e-cohorts is offering new tools for epidemiological studies at the population level. OBJECTIVE The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort and to compare these to other cohorts. METHODS We performed a cross-sectional study of the baseline data of HS participants in ComPaRe, an e-cohort of patients with chronic diseases. Data were collected using patient-reported questionnaires about clinical-dem-ographic aspects, quality of life, and treatment history. RESULTS A total of 396 participants (339 females, 57 males) were included (mean age 38 years); 83 (21%) had a family history of HS, 227 (57.3%) were current smokers, and 241 (60.9%) were overweight or obese. Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%). The breast was more frequently affected in women than men (37.5 vs. 5.3%, p < 0.0001), whereas the dorsal region was more frequently affected in men (39.5 vs. 10.9%, p < 0.0001). Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001]). The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics. Most of these results were consistent with previously published cohorts. CONCLUSION Recruitment of participants by such a web platform can be a faster way to get relevant scientific data for a wide variety of patients that could be used for epidemiological studies and to evaluate therapeutics in "real-life" interventions.
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Affiliation(s)
- Morgane Condamina
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Laetitia Penso
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Claire Hotz
- Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Philippe Guillem
- Department of Visceral and Digestive Surgery, Val d'Ouest Clinic, Écully, France.,RésoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation, Dessau, Germany.,Groupe de Recherche en Proctologie de la Société Nationale Française de Coloproctologie, Paris, France
| | | | - Pierre Perrot
- Department of Plastic and Reconstructive Surgery, Hôtel-Dieu Hospital, Nantes, France
| | - Marie-France Bru
- Patient Member of the Scientific Committee of ComPaRe Verneuil Disease, Paris, France
| | - Eric Jacquet
- Department of Visceral Surgery, Beau Soleil Clinic, Montpellier, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, Paris, France
| | - Hervé Bachelez
- Department of Dermatology-Venereology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM U1163, Imagine Institute, Paris, France
| | - Pierre Wolkenstein
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France.,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Marie Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Dermatology Department, University Hospital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Manuelle Viguier
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Emilie Sbidian
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France, .,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France, .,INSERM, Centre d'Investigation Clinique 1430, Créteil, France,
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Bertolotti A, Sbidian E, Join-Lambert O, Bourgault-Villada I, Moyal-Barracco M, Perrot P, Jouan N, Yordanov Y, Sidorkiewicz S, Chazelas K, Bru-Daprés MF, Caumes E, Sei JF, Chosidow O, Beylot-Barry M. Guidelines for the management of hidradenitis suppurativa: recommendations supported by the Centre of Evidence of the French Society of Dermatology. Br J Dermatol 2020; 184:963-965. [PMID: 33278829 PMCID: PMC8247998 DOI: 10.1111/bjd.19710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A Bertolotti
- INSERM CIC1410, CHU Réunion, Saint Pierre, La Réunion, France
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19
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Aubert H, Pere M, Bellier Waast F, Perrot P, Barbarot S. Management of Congenital Melanocytic Naevi in Children: A French National Survey Using Clinical Vignettes. Acta Derm Venereol 2020; 100:adv00341. [PMID: 33205825 PMCID: PMC9309711 DOI: 10.2340/00015555-3695] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Management of congenital melanocytic naevi in childhood may vary depending on the habits and experience of the treating clinician. The aim of this study was to assess current practice and determinants of surgical excision decision-making among French physicians. A national survey was conducted among dermatologists, paediatricians and surgeons, using clinical vignettes illustrating 29 scenarios. The primary outcome was the decision to perform surgical excision in each vignette. Of the 11,310 decisions made by the 390 participants (257 dermatologists, 35 surgeons, and 98 paediatricians) surgical excision was chosen in 33% of cases. The stated motivations for performing surgical excision were: melanoma risk, aesthetic/psychosocial risk, or both, in 39%, 34% and 27% of cases, respectively. Physicians with a higher level of experience in oncodermatology were more likely to opt for surgical excision. The age of the child, the size of the congenital melanocytic naevi, and the visibility of the lesion had no influence on the decision to perform surgical excision.
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Affiliation(s)
- Hélène Aubert
- Department of Dermatology, Nantes University Hospital, FR-44100 Nantes, France. E-mail:
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20
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Condamina M, Tran VT, Penso L, Hotz C, Guillem P, Villani A, Perrot P, Bru MF, Jacquet E, Nassif A, Bachelez H, Wolkenstein P, Beylot-Barry M, Richard MA, Ravaud P, Viguier M, Sbidian E. Caractéristiques cliniques des patients atteints d’hidradénite suppurée participants à la e-cohorte ComPaRe et comparaison avec les données de la littérature. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.318] [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: 11/26/2022]
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21
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Duteille F, Oillic J, Pouzet L, Perrot P, Hamel A, Dautel G. Management of loss of tissue substance in children's limbs. What are the salient peculiarities? A proposed algorithm. ANN CHIR PLAST ESTH 2020; 65:479-495. [PMID: 32891460 DOI: 10.1016/j.anplas.2020.05.010] [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: 04/29/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
Loss of tissue substance in children's limbs has the same etiologies and in many cases, the same severity as in adults' limbs, and the means placed at the disposal of a surgeon are likewise comparable. It may nonetheless prove difficult to strategically position the different treatment methods in a decision-making tree. After all, a child presents numerous peculiarities: high quality of vascularization (both microcirculation and macrocirculation), better ability to achieve nerve regeneration and durable bone consolidation and, last but not least, a pronouncedly superior overall functional prognosis. Moreover, a child's future needs to be taken into account ; it is not only cicatrization per se, but also the quality of healing that should dictate therapeutic choices, which will consequently be determined in view of avoiding functional disorders during the growth process. On the basis of their experience and following a review of the literature, the authors have assessed the interest of each relevant technique and drawn up a decision-making tree.
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Affiliation(s)
- F Duteille
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France.
| | - J Oillic
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France
| | - L Pouzet
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France
| | - P Perrot
- Plastic, reconstructive and esthetic surgery unit, burn treatment center, CHU of Nantes, Nantes, France
| | - A Hamel
- Pediatric surgery unit, CHU of Nantes, Nantes, France
| | - G Dautel
- Plastic and reconstructive surgery unit of the musculoskeletal system, CHU of Nancy, France
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22
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Pouzet L, Lancien U, Hamel A, Perrot P, Duteille F. Negative Pressure Wound Therapy in children: A 25 cases series. ANN CHIR PLAST ESTH 2020; 66:242-249. [PMID: 32665064 DOI: 10.1016/j.anplas.2020.06.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/22/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022]
Abstract
Negative Pressure Wound Therapy is a device applied to a wound that causes local depression. There are a few series showing the effectiveness of this treatment in Pediatric. The objective of this work is to try to clarify the indications in children. This is a retrospective series of 25 children between 2004 and 2019. The inclusion criteria were all children with a wound treated with Negative Pressure Wound Therapy. The characteristics retained were their age, the context of occurrence, the treatment time, the depression applied, the technique of skin covering wound and the average healing time. We included 25 patients. The average age was 8.8 years. The context of the wound occurrence was mainly a road (44%) or a domestic (36%) accident. Substance losses were mainly located in the lower limb (84%). The depression applied was -90mmHg. The healing time was 18.4 days. Thin skin grafting was the main method chosen (88%). No complications related to Negative Pressure Wound Therapy equipment have been identified. Despite the weakness of the literature and the lack of consensus regarding its use, Negative Pressure Wound Therapy is an essential therapy in pediatric. It is a simple and effective technique in children. It can reduce the need for flaps coverage, even in the event of exposure of noble elements. The flaps should not, however, be excluded from the decision-making algorithm, on pain of complications or sequelae.
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Affiliation(s)
- L Pouzet
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France; Plastic and reconstructive surgery department, hôpital Maison-Blanche, CHU Reims, 45, rue Cognacq-Jay, 51092 Reims, France.
| | - U Lancien
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - A Hamel
- Pediatric orthopedics department, hôpital-Mère-Enfant, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Perrot
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - F Duteille
- Plastic and reconstructive surgery department, Burns centre, Hôtel-Dieu, CHU Nantes, 30, Boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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23
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Adam D, Hamel A, Perrot P, Duteille F. Long-term behavior of the vascularized fibular free flap for reconstruction of bony defects in children. ANN CHIR PLAST ESTH 2020; 65:219-227. [DOI: 10.1016/j.anplas.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
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Cinotti R, Besnard N, Desmedt L, Floch RL, Perrot P, Bekara F, Klouche K, Larcher R, Mahé PJ, Frasca D, Asehnoune K, Jung B, Roquilly A. Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study. Burns 2020; 46:1310-1317. [PMID: 32156477 DOI: 10.1016/j.burns.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/21/2019] [Revised: 01/28/2020] [Accepted: 02/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. METHODS We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU. RESULTS Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%-38%] and median ABSI was 7 [5-9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2-24] vs. 6 days [2-17] (P=0.3) and 17 days [4-32] vs. 8 days [3-23] (P=0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2-24] in the Intervention phase (P=0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P=0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P=0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P=0.6). CONCLUSION Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.
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Affiliation(s)
- Raphaël Cinotti
- Department of Anesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Boulevard Jacques Monod, Saint-Herblain 44800, France.
| | - Noémie Besnard
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Luc Desmedt
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Ronan Le Floch
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Pierre Perrot
- Department of Plastic and Burn Surgery, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Farid Bekara
- Department of Plastic and Burn Surgery, Montpellier University and Montpellier Teaching Hospital, Hôpital Lapeyronie 191, Avenue du Doyen Gaston Giraud, Montpellier Cedex 5, Montpellier 34295, France
| | - Kada Klouche
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France; INSERM U1046, CNRS UMR9214, Hôpital Lapeyronie 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Université deMontpellier, Montpellier 34295, France
| | - Romaric Larcher
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Pierre-Joachim Mahé
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Denis Frasca
- Department of Anesthesia and Critical Care, Centre Hospitalo-Universitaire, University Hospital of Poitiers, 2 rue de la Milétrie Poitiers 86021, France; INSERM SPHERE U1246 «MethodS for Patients-centered outcomes and HEalth REsearch», UFR des sciences pharmaceutiques, University of Nantes, University of Tours, 22 boulevard Benoni-Goullin, Nantes 44200, France
| | - Karim Asehnoune
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections». University hospital of Nantes, 22 boulevard Benoni-Goullin, Nantes 44200, France
| | - Boris Jung
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Antoine Roquilly
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections». University hospital of Nantes, 22 boulevard Benoni-Goullin, Nantes 44200, France
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Ramon A, Correia N, Smati M, Malinovsky JM, Bajolet O, Reynaud JP, Perrot P, Bodin F, Francois C. [Proposal of guidelines for antibiotic prophylaxis in plastic, reconstructive, and aesthetic surgery]. ANN CHIR PLAST ESTH 2019; 65:13-23. [PMID: 31831208 DOI: 10.1016/j.anplas.2019.10.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In plastic surgery, guidelines about antibiotic prophylaxis are inaccurate and incomplete, due to result the absence of high-level studies on this subject. The main aim is to establish national common recommendations for plastic surgery antibiotic prophylaxis. MATERIALS AND METHODS A working group will discuss and validate a multi-center analysis of practices in three University Hospital Centers compared to an interdisciplinary analysis of recommendations to the French Society of Anaesthesia and Intensive Care Medicine and scientific literature. This working group is composed of plastic surgeon members of the French Society of Aesthetic Reconstructive Plastic Surgery, infectious disease physicians, and anaesthesiologists to define clear and precise antibiotic prophylaxis recommendations. RESULTS Antibiotic prophylaxis with cefazoline (or clindamycine±gentamicine in case of allergy), has been recommended for general surgery with flap or implants, for breast surgery, lipofilling, and rhinoplasty. In other plastic surgery, no antibiotic prophylaxis has been recommended. CONCLUSION We established common recommendations for plastic surgery antibiotic prophylaxis that is the first step to update these recommendations. Now, they can be evaluated in clinical situation to validate them.
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Affiliation(s)
- A Ramon
- Chirurgie plastique, reconstructrice et esthétique, hôpital maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - N Correia
- Chirurgie plastique, reconstructrice et esthétique, hôpital maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - M Smati
- Anesthésie et réanimation, hôpital Maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - J M Malinovsky
- Anesthésie et réanimation, hôpital Maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - O Bajolet
- Équipe opérationnelle d'hygiène, hôpital Maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - J P Reynaud
- Chirurgie plastique reconstructrice et esthétique, Le jardin du centre - Bât A, 60, rue de l'Acropole, 34000 Montpellier, France
| | - P Perrot
- Chirurgie plastique reconstructrice et esthétique, Hôtel-Dieu, CHU Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Bodin
- Chirurgie plastique, reconstructrice et esthétique, hôpital de Hautepierre, CHU Strasbourg, avenue Molière, 67200 Strasbourg, France
| | - C Francois
- Chirurgie plastique, reconstructrice et esthétique, hôpital maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France.
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Avril P, Vidal L, Barille-Nion S, Le Nail LR, Redini F, Layrolle P, Pinault M, Chevalier S, Perrot P, Trichet V. Epinephrine Infiltration of Adipose Tissue Impacts MCF7 Breast Cancer Cells and Total Lipid Content. Int J Mol Sci 2019; 20:ijms20225626. [PMID: 31717935 PMCID: PMC6888424 DOI: 10.3390/ijms20225626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/06/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Considering the positive or negative potential effects of adipocytes, depending on their lipid composition, on breast tumor progression, it is important to evaluate whether adipose tissue (AT) harvesting procedures, including epinephrine infiltration, may influence breast cancer progression. METHODS Culture medium conditioned with epinephrine-infiltrated adipose tissue was tested on human Michigan Cancer Foundation-7 (MCF7) breast cancer cells, cultured in monolayer or in oncospheres. Lipid composition was evaluated depending on epinephrine-infiltration for five patients. Epinephrine-infiltrated adipose tissue (EI-AT) or corresponding conditioned medium (EI-CM) were injected into orthotopic breast carcinoma induced in athymic mouse. RESULTS EI-CM significantly increased the proliferation rate of MCF7 cells Moreover EI-CM induced an output of the quiescent state of MCF7 cells, but it could be either an activator or inhibitor of the epithelial mesenchymal transition as indicated by gene expression changes. EI-CM presented a significantly higher lipid total weight compared with the conditioned medium obtained from non-infiltrated-AT of paired-patients. In vivo, neither the EI-CM or EI-AT injection significantly promoted MCF7-induced tumor growth. CONCLUSIONS Even though conditioned media are widely used to mimic the secretome of cells or tissues, they may produce different effects on tumor progression, which may explain some of the discrepancy observed between in vitro, preclinical and clinical data using AT samples.
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Affiliation(s)
- Pierre Avril
- INSERM, Université de Nantes, UMR1238, Phy-Os, Sarcomes osseux et remodelage des tissus calcifiés, F-44035 Nantes, France; (P.A.); (L.V.); (L.-R.L.N.); (F.R.); (P.L.); (V.T.)
| | - Luciano Vidal
- INSERM, Université de Nantes, UMR1238, Phy-Os, Sarcomes osseux et remodelage des tissus calcifiés, F-44035 Nantes, France; (P.A.); (L.V.); (L.-R.L.N.); (F.R.); (P.L.); (V.T.)
| | - Sophie Barille-Nion
- CRCINA, INSERM, Université d’Angers, Université de Nantes, F-44035 Nantes, France;
| | - Louis-Romée Le Nail
- INSERM, Université de Nantes, UMR1238, Phy-Os, Sarcomes osseux et remodelage des tissus calcifiés, F-44035 Nantes, France; (P.A.); (L.V.); (L.-R.L.N.); (F.R.); (P.L.); (V.T.)
| | - Françoise Redini
- INSERM, Université de Nantes, UMR1238, Phy-Os, Sarcomes osseux et remodelage des tissus calcifiés, F-44035 Nantes, France; (P.A.); (L.V.); (L.-R.L.N.); (F.R.); (P.L.); (V.T.)
| | - Pierre Layrolle
- INSERM, Université de Nantes, UMR1238, Phy-Os, Sarcomes osseux et remodelage des tissus calcifiés, F-44035 Nantes, France; (P.A.); (L.V.); (L.-R.L.N.); (F.R.); (P.L.); (V.T.)
| | - Michelle Pinault
- INSERM Université de Tours, UMR1069, Nutrition, Croissance et Cancer, F-37032 Tours, France; (M.P.); (S.C.)
| | - Stéphane Chevalier
- INSERM Université de Tours, UMR1069, Nutrition, Croissance et Cancer, F-37032 Tours, France; (M.P.); (S.C.)
| | - Pierre Perrot
- INSERM, Université de Nantes, UMR1238, Phy-Os, Sarcomes osseux et remodelage des tissus calcifiés, F-44035 Nantes, France; (P.A.); (L.V.); (L.-R.L.N.); (F.R.); (P.L.); (V.T.)
- CHU de Nantes, Service de Chirurgie Plastique et des Brûlés, F-44035 Nantes, France
- Correspondence: ; Tel.: +33-2-40-08-73-02
| | - Valérie Trichet
- INSERM, Université de Nantes, UMR1238, Phy-Os, Sarcomes osseux et remodelage des tissus calcifiés, F-44035 Nantes, France; (P.A.); (L.V.); (L.-R.L.N.); (F.R.); (P.L.); (V.T.)
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Poinas A, Perrot P, Lorant J, Nerrière O, Nguyen JM, Saiagh S, Frenard C, Leduc A, Malard O, Espitalier F, Duteille F, Chiffoleau A, Vrignaud F, Khammari A, Dréno B. CICAFAST: comparison of a biological dressing composed of fetal fibroblasts and keratinocytes on a split-thickness skin graft donor site versus a traditional dressing: a randomized controlled trial. Trials 2019; 20:612. [PMID: 31661012 PMCID: PMC6819456 DOI: 10.1186/s13063-019-3718-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 09/13/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Wound repair is one of the most complex biological processes of human life. Allogeneic cell-based engineered skin substitutes provide off-the-shelf temporary wound coverage and act as biologically active dressings, releasing growth factors, cytokines and extracellular matrix components essential for proper wound healing. However, they are susceptible to immune rejection and this is their major weakness. Thanks to their low immunogenicity and high effectiveness in regeneration, fetal skin cells represent an attractive alternative to the commonly used autologous and allogeneic skin grafts. METHODS/DESIGN We developed a new dressing comprising a collagen matrix seeded with a specific ratio of active fetal fibroblasts and keratinocytes. These produce a variety of healing growth factors and cytokines which will increase the speed of wound healing and induce an immunotolerant state, with a slight inflammatory reaction and a reduction in pain. The objective of this study is to demonstrate that the use of this biological dressing for wound healing at the split-thickness skin graft (STSG) donor site, reduces the time to healing, decreases other co-morbidities, such as pain, and improves the appearance of the scar. This investigation will be conducted as part of a randomized study comparing our new biological dressing with a conventional treatment in a single patient, thus avoiding the factors that may influence the healing of a graft donor site. DISCUSSION This clinical trial should enable the development of a new strategy for STSG donor-wound healing based on a regenerative dressing. The pain experienced in the first few days of STSG healing is well known due to the exposure of sensory nerve endings. Reducing this pain will also reduce analgesic drug intake and the duration of sick leave. Our biological dressing will meet the essential need of surgeons to "re-crop" from existing donor sites, e.g., for thermal-burn patients. By accelerating healing, improving the appearance of the scar and reducing pain, we hope to improve the conditions of treatment for skin grafts. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03334656 . Registered on 7 November 2017.
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Affiliation(s)
- Alexandra Poinas
- Clinical Investigation Centre CIC1413, Nantes INSERM and CHU Nantes, 5, allée de l’île Gloriette, 44093 Nantes Cedex 1, France
| | - Pierre Perrot
- Plastic and Reconstructive Surgery Department, Burns Centre, Jean Monnet, CHU Nantes, 30 Boulevard Jean-Monnet, 44093 Nantes Cedex 1, France
| | - Judith Lorant
- CRCINA, INSERM, Université de Nantes, Nantes, France
| | - Olivier Nerrière
- Cell and Gene Therapy Unit, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes, France
| | - Jean-Michel Nguyen
- Department of Epidemiology and Biostatistics, CHU Nantes, CRCINA, INSERM 1232, Université de Nantes, Nantes, France
| | - Soraya Saiagh
- Cell and Gene Therapy Unit, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes, France
| | - Cécile Frenard
- Dermato-oncology Department, CHU Nantes, CRCINA, INSERM 1232, Université de Nantes, Place Alexis Ricordeau, 44093 Nantes, France
| | - Audrey Leduc
- Plastic and Reconstructive Surgery Department, Burns Centre, Jean Monnet, CHU Nantes, 30 Boulevard Jean-Monnet, 44093 Nantes Cedex 1, France
| | - Olivier Malard
- Department of ENT and Cervico-facial Surgery, CHU Nantes, 44093 Nantes, France
| | - Florent Espitalier
- Department of ENT and Cervico-facial Surgery, CHU Nantes, 44093 Nantes, France
| | - Franck Duteille
- Plastic and Reconstructive Surgery Department, Burns Centre, Jean Monnet, CHU Nantes, 30 Boulevard Jean-Monnet, 44093 Nantes Cedex 1, France
| | - Anne Chiffoleau
- Sponsor Department, CHU Nantes, 5 Allée de L’île Gloriette, 44093 Nantes Cedex 1, France
| | - Florence Vrignaud
- Clinical Investigation Centre CIC1413, Nantes INSERM and CHU Nantes, 5, allée de l’île Gloriette, 44093 Nantes Cedex 1, France
| | - Amir Khammari
- Clinical Investigation Centre CIC1413, Nantes INSERM and CHU Nantes, 5, allée de l’île Gloriette, 44093 Nantes Cedex 1, France
- Dermato-oncology Department, CHU Nantes, CRCINA, INSERM 1232, Université de Nantes, Place Alexis Ricordeau, 44093 Nantes, France
| | - Brigitte Dréno
- Clinical Investigation Centre CIC1413, Nantes INSERM and CHU Nantes, 5, allée de l’île Gloriette, 44093 Nantes Cedex 1, France
- Cell and Gene Therapy Unit, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes, France
- Dermato-oncology Department, CHU Nantes, CRCINA, INSERM 1232, Université de Nantes, Place Alexis Ricordeau, 44093 Nantes, France
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Le Floch R, Mahé P, Perrot P. [Not Available]. Ann Burns Fire Disasters 2019; 32:237-244. [PMID: 32313540 PMCID: PMC7155414] [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] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 06/11/2023]
Abstract
Traumatology is an old specialty, and most knowledge about it was developed during wars. On the other hand, burn care is much more recent and knowledge has been acquired in particular from civilian disaster casualties. This paper aims to describe some of the disasters that led to progress in burn care.
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Affiliation(s)
- R. Le Floch
- Réanimation Chirurgicale et des Brûlés, CHU Nantes, Nantes, France
| | - P.J. Mahé
- Réanimation Chirurgicale et des Brûlés, CHU Nantes, Nantes, France
| | - P. Perrot
- Service des Brûlés, CHU Nantes, Nantes, France
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Oillic J, Leduc A, Duteille F, Ruffin L, Le Floch R, Bertrand-Vasseur A, Perrot P. [Not Available]. Ann Burns Fire Disasters 2019; 32:234-236. [PMID: 32313539 PMCID: PMC7155411] [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] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/22/2019] [Indexed: 06/11/2023]
Abstract
High-voltage electrical burns are rare, but the functional prognosis is often disastrous. Electrical currents are responsible for a wide range of injuries and their clinical assessment is difficult. For a case of severe electrical burn, and based on the literature, the authors performed an early MRI to elaborate their surgical strategy and avoid multiple surgeries by determining the level of amputation. Analysis of the different MRI signals and the per-operative study of the tissues led the team to take an early surgical approach and we were able to determine the level of limb amputation. Early analysis of lesions by MRI imaging allows us to consider a more aggressive surgical approach and thus reduce the number of interventions and the duration of stay in the intensive care unit.
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Affiliation(s)
- J. Oillic
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, CHU de Nantes, France
| | - A. Leduc
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, CHU de Nantes, France
| | - F. Duteille
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, CHU de Nantes, France
| | - L. Ruffin
- Service de Réanimation Chirurgicale, CHU de Nantes Hôtel Dieu, France
| | - R. Le Floch
- Service de Réanimation Chirurgicale, CHU de Nantes Hôtel Dieu, France
| | | | - P. Perrot
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, CHU de Nantes, France
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30
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Duteille F, Kanlagna A, Bellier Waast F, Leduc A, Perrot P, Saboye J, Casanova D. [Brachioplasty and its complications]. ANN CHIR PLAST ESTH 2019; 64:686-693. [PMID: 31481252 DOI: 10.1016/j.anplas.2019.07.010] [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: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Due to an increasing number of major weight loss after bariatic surgery, the demand for body-coutouring surgery increase in paralell. Among all the technics which can be realized, brachioplastyis one of them. The goal is to reach a functionnal but an aesthetic improvement too. The literature show that the rate of major complication is very low (or not reported in the majority of the series). Minor complication is more common : hypertrophic scar, large scar, paresthesia, and wound dehiscence. Re-operation can be asked by the patient in order to improve the result. With the help of clinical cases and literature review the authors try to analyse the balance between benefice and risk to realize a second operation.
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Affiliation(s)
- F Duteille
- Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, CHU de Nantes, 44093 Nantes cedex 01, France.
| | - A Kanlagna
- Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, CHU de Nantes, 44093 Nantes cedex 01, France
| | - F Bellier Waast
- Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, CHU de Nantes, 44093 Nantes cedex 01, France
| | - A Leduc
- Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, CHU de Nantes, 44093 Nantes cedex 01, France
| | - P Perrot
- Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, CHU de Nantes, 44093 Nantes cedex 01, France
| | - J Saboye
- 54, allée des Demoiselles, 31000 Toulouse, France
| | - D Casanova
- Service de chirurgie plastique reconstructrice et esthétique, CHU de Marseille, 13000 Marseille, France
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Abstract
AIM OF THE STUDY Ten percent of childhood burns could arise from maltreatment. While describing 6 severe cases of inflicted scalds by immersion in children, we expose our systematic diagnostic approach of abuse and confirm the serious nature of burn when they are inflicted. PATIENTS AND METHOD The retrospective study concerned children hospitalized for scalds by immersion between 2013 and 2016 and for whom child abuse has been confirmed. Sex, age, burns description, needs of surgery, length of stay at hospital and protection plan set up were collected. RESULTS Six cases of burns by immersion due to maltreatment were identified (5 boys, 1 girl) with a median age of 12 months. The average total burn surface area was 19%. Burns were of deep second and third degree and always symmetric. Every child underwent surgery at least once. Concern information was transferred for all of them. CONCLUSION Teams taking care of children with burns must be trained to the difficult diagnostic of abuse or neglect so that early social interventions can be set up in case of maltreatment.
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Affiliation(s)
- P Ridel
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHU de Nantes, hôpital Hôtel Dieu, 44093 Nantes cedex 01, France.
| | - M Lemesle
- Unité d'accueil des enfants en danger (UAED), pédiatrie, CHU de Nantes, hôpital femme-enfant-adolescent, 44093 Nantes cedex 01, France
| | - N Vabres
- Unité d'accueil des enfants en danger (UAED), pédiatrie, CHU de Nantes, hôpital femme-enfant-adolescent, 44093 Nantes cedex 01, France
| | - U Lancien
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHU de Nantes, hôpital Hôtel Dieu, 44093 Nantes cedex 01, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, centre des brûlés, CHU de Nantes, hôpital Hôtel Dieu, 44093 Nantes cedex 01, France.
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Duteille F, Perrot P, Bacheley MH, Bell E, Stewart S. Ten-Year Safety Data for Eurosilicone's Round and Anatomical Silicone Gel Breast Implants. Aesthet Surg J Open Forum 2019; 1:ojz012. [PMID: 33791608 PMCID: PMC7671289 DOI: 10.1093/asjof/ojz012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 11/29/2022] Open
Abstract
Background Although silicone breast implants have been available for over 60 years, their safety and efficacy continue to be assessed via long-term clinical and vigilance studies. Complications often associated with breast implant surgery include but are not limited to capsular contracture and rupture. Objective The authors investigate and evaluate the safety and performance of Eurosilicone’s (Eurosilicone S.A.S, Apt Cedex, France) Cristalline Paragel breast implants at least 10 years postimplantation. Methods Nine hundred and ninety-five of Eurosilicone’s textured mammary implants were implanted in 526 women undergoing primary (423 patients) and revision surgery (103 patients) at 17 centers throughout France. Complications were recorded at 3 months and annually thereafter for 10 years. Descriptive statistics were used and the Kaplan-Meier method was utilized to analyze key complications. Results Seventy-four women (98 implants) experienced capsular contracture across all cohorts. The Kaplan-Meier 10-year cumulative risk of capsular contracture (Baker Grade III/IV) per implant was 11.5% in the primary augmentation cohort and 25.2% in the primary reconstruction cohort. Sixteen implant ruptures were observed by surgeon examination giving a Kaplan-Meier risk of 3.8% per patient and 3.5% per implant. Surgical re-intervention (explantation/exchange) was reported 80 times resulting in a Kaplan-Meier cumulative risk of 13.3% and 31.6% for primary augmentation and primary reconstruction, respectively, per patient. Local complication rates including infection and seroma were low with risk rates of 0.6% and 0.2% by subject. Conclusions This multicenter clinical study demonstrates the long-term safety and efficacy profile through 10 years for Eurosilicone round and anatomical silicone gel breast implants. Level of Evidence: 3
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Affiliation(s)
- Franck Duteille
- Centre des Brûlés, Immeuble Jean Monnet, Centre Hospitalier Universitaire, Nantes, France
| | - Pierre Perrot
- Centre des Brûlés, Immeuble Jean Monnet, Centre Hospitalier Universitaire, Nantes, France
| | | | - Erin Bell
- GC Aesthetics (the parent company of Eurosilicone), Glasgow, UK
| | - Sharon Stewart
- GC Aesthetics (the parent company of Eurosilicone), Glasgow, UK
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Duteille F, Tilliet Le Dentu H, Atlan M, Perrot P. Use of Integra Flowable Wound Matrix for nasal dorsum reconstruction or augmentation: A series of 6 cases. J Plast Reconstr Aesthet Surg 2018; 72:848-862. [PMID: 30579904 DOI: 10.1016/j.bjps.2018.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/15/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Franck Duteille
- Department of Plastic, Aesthetic and Reconstructive Surgery, Burn Center, Hôtel Dieu, CHU de Nantes, 44093 Nantes Cedex 01, France.
| | - Hadrien Tilliet Le Dentu
- Department of Plastic, Aesthetic and Reconstructive Surgery, Burn Center, Hôtel Dieu, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - Michael Atlan
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - Pierre Perrot
- Department of Plastic, Aesthetic and Reconstructive Surgery, Burn Center, Hôtel Dieu, CHU de Nantes, 44093 Nantes Cedex 01, France.
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Laporte J, Herlin C, Delicque J, Saunière D, Perrot P, Duteille F. [Free flaps use in chronic wounds: Retrospective study about 91 cases]. ANN CHIR PLAST ESTH 2018; 64:251-258. [PMID: 30327209 DOI: 10.1016/j.anplas.2018.07.014] [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: 03/22/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Chronic wounds represent a major health challenge with no current standardized surgical treatment. The use of free flaps is little discussed in the literature, with a supposed propensity to failure given unfavorable local conditions and land often debility. We present here the analysis of our monocentric experience of the use of free flaps in the curative treatment of chronic wounds. PATIENTS ET METHODS We performed a retrospective monocentric study over 18 years of all free flaps used for the treatment of a chronic wound between January 2001 and September 2016. Several criteria were evaluated on patients, wounds, free flaps used and immediate to late outcomes. RESULTS Ninety-one patients were included (sex ratio M/F: 3.55) with an average age of 41.6±16 years. Wounds were localized to the leg in 92.3% of cases and 58% of patients had initial osteomyelitis. The flaps used were predominantly muscle flaps (61.6%). The flaps survival rate was 92.3%. With a mean follow-up of 50 months, the reconstructive failure rate was 20.9%. The presence of a chronic osteomyelitis is the only statistically significant factor of reconstruction failure (P=0.0169) with a risk of failure multiplied by 5. CONCLUSION Our study demonstrates that the reliability of free flaps in the treatment of chronic wounds is comparable, regardless of the time since the initial cutaneous lesion, to that existing in the treatment of acute wounds or in the reconstruction after oncological excision. The presence of a chronic osteomyelitis, however, represents a major risk of reconstruction failure by increasing 5 times the risk of failure. Recent changes in the integumentary reconstruction paradigm of the lower limb will undoubtedly allow in the next few years to establish more rationally the place of muscle free flaps in the therapeutic armamentarium of chronic wounds.
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Affiliation(s)
- J Laporte
- Plastic and reconstructive surgery department, university hospital Caremeau of Nîmes, place du Pr-Robert-Debré, 30029 Nîmes, France.
| | - C Herlin
- Plastic and reconstructive surgery department, university hospital Lapeyronie of Montpellier, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - J Delicque
- Medical imaging department, university hospital Saint-Éloi of Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - D Saunière
- Plastic and reconstructive surgery department, university hospital Caremeau of Nîmes, place du Pr-Robert-Debré, 30029 Nîmes, France
| | - P Perrot
- Plastic and reconstructive surgery department, university hospital Hôtel-Dieu of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Duteille
- Plastic and reconstructive surgery department, university hospital Hôtel-Dieu of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Tiry E, Leduc A, Dumont R, Ridel P, Perrot P, Duteille F. [Not Available]. Ann Burns Fire Disasters 2018; 31:209-212. [PMID: 30863255 PMCID: PMC6367856] [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] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Most hospitals use protocols for surgical antibioprophylaxis (ABP). Despite SFB's 2009 recommendations promoting ABP in burn patients and stating the molecules to be used, wide variations exist within hospitals and among French hospitals, in cases of skin grafting and use of dermal substitutes. We contacted surgeons in 12 French Burn Centres (BCs) via email and questioned them about ABP in cases of skin grafting (thin and total) as well as in the use of dermal substitutes, in acute and sequelae settings. Eight BCs answered. In the acute phase, 3 BCs (37.5%) always use ABP in skin grafts, 2 (25%) use ABP on suspicion of wound infection and 3 (37.5%) never use ABP. When installing skin substitute, 5 BCs (62.5%) use ABP, one (12.5%) does so if the wound is suspected of being infected and 2 (25%) never use ABP. For sequelae, 5 BCs (62.5%) use ABP whatever the surgery, while 3 (37.5%) never use it. Infection onset after skin graft or use of dermal substitute is frequent. Our study shows wide variations in the use of ABP in these surgeries. A multi-centre evaluation of the implementation of SFB's 2009 recommendations and their role in preventing postoperative infections after skin grafting and skin substitute use, both in acute and sequelae phases, could help harmonize practices in BCs.
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Affiliation(s)
- E. Tiry
- Service des Brûlés, CHU Nantes, France
| | - A. Leduc
- Service des Brûlés, CHU Nantes, France
| | - R. Dumont
- Service de Réanimation Chirurgicale et des Brûlés, CHU Nantes, France
| | - P. Ridel
- Service des Brûlés, CHU Nantes, France
| | - P. Perrot
- Service des Brûlés, CHU Nantes, France
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Lancien U, Duteille F, Perrot P. Extradigital glomic tumor of the forearm. About a case and review of literature. ANN CHIR PLAST ESTH 2018; 63:187-189. [DOI: 10.1016/j.anplas.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/22/2017] [Indexed: 11/25/2022]
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Duteille F, Leduc A, Verdier J, Atlan M, Perrot P. Management of finger deep burns: The interest of local flaps. Burns 2018; 44:468-474. [DOI: 10.1016/j.burns.2017.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/07/2017] [Accepted: 08/18/2017] [Indexed: 11/30/2022]
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Abstract
BACKGROUND The safety and efficacy of all medical devices, including breast implants, is important and consistent performance is best shown by undertaking long-term clinical and vigilance studies. Local complications such as capsular contracture and rupture are risks often associated with breast implant surgery. OBJECTIVES The authors investigate and evaluate the safety and performance of Eurosilicone's (Eurosilicone S.A.S, Apt Cedex, France) Cristalline Paragel breast implants at 8 years postimplantation. METHODS In this prospective clinical study, 995 Eurosilicone textured cohesive Cristalline Paragel mammary implants were implanted in 526 women undergoing augmentation and reconstructive surgery at 17 centers across France. Complications were recorded at 3 months and annually thereafter for 8 years. Descriptive statistics were used and key complications were analysed using the Kaplan-Meier method. RESULTS Capsular contracture was reported in 8.5% of implants across all cohorts through 8 years. The Kaplan-Meier risk of capsular contracture (Baker Grade III/IV) per implant was 8.4% in the primary augmentation cohort and 18.0% in the primary reconstruction cohort. Eight implant ruptures were identified by surgeon examination during this follow-up period. The Kaplan-Meier risk of rupture occurring within 8 years postimplantation, across all cohorts, was 1.4% per patient and 0.9% per implant. Actual implant removal rate (explantation/exchange) was 6.0% and 13.8% for primary augmentation and primary reconstruction, respectively. Actual rates of local complications including infection and seroma were low with risk rates of 0.6% and 0.2% by subject. CONCLUSIONS This multicenter clinical study involving Eurosilicone's silicone gel breast implants in both round and shaped profiles demonstrates an excellent safety and efficacy profile through 8 years.
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Affiliation(s)
- Franck Duteille
- Principal Investigator, Centre des Brûlés, Immeuble Jean Monnet, Centre Hospitalier Universitaire, Nantes, France
| | - Pierre Perrot
- Clinical Investigator, Centre des Brûlés, Immeuble Jean Monnet, Centre Hospitalier Universitaire, Nantes, France
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Tilliet Le Dentu H, Lancien U, Sellal O, Duteille F, Perrot P. [Contribution of computer-aided design for the conception of custom-made implants in Pectus Excavatum surgical treatment. Experience of the Nantes plastic surgery unit]. ANN CHIR PLAST ESTH 2017; 63:1-10. [PMID: 29246660 DOI: 10.1016/j.anplas.2017.11.006] [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: 09/11/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pectus excavatum is the most common congenital chest malformation and is a common reason for consultation in plastic surgery. Our attitude is most often a filling of the depression with a custom-made silicone prosthesis. The objective of this work was to evaluate the interest of computer-aided design (CAD) of implants compared to the conventional plaster molds method. PATIENTS AND METHODS We have collected all the cases of custom-made silicone implants to treat funnel chests in our plastic surgery department. The quality of the results was evaluated by the patient, and in a blind manner by the surgical team using photographs and standardized surveys. The pre-operative delays, the operating time and length of hospital stays, the number of surgical recoveries, and the post-operative surgical outcomes were recorded. RESULTS Between 1990 and 2016, we designed 29 silicone thoracic implants in our department. Before 2012, implants were made from plaster chest molds (n=13). After this date, implants were designed by CAD (n=16). Patients rated their results as "good" or "excellent" in 77% and 86% of cases respectively in the plaster and CAD groups. The surgical team's ratings for CAD implant reconstructions were better than in the plaster group: 8.17 versus 6.96 (P=0.001). CAD implants were significantly less detectable than the plaster group implants. The operating time was reduced in the CAO group: 60.2 compared to 74.7minutes in the plaster group (P=0.04), as was the length of hospitalization: 3.5 versus 5.3 days (P=0.01). There were no significant differences between the two groups in terms of post-operative complications. CONCLUSION The management of pectus excavatum by a custom-made silicone implant is a minimally invasive method that provides good cosmetic results. The design of these implants is facilitated and qualitatively improved by CAD.
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Affiliation(s)
- H Tilliet Le Dentu
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - U Lancien
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - O Sellal
- Pharmacie centrale, hôpital Saint-Jacques, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France.
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Le Floch R, Laguerre J, Perrot P. [Not Available]. Ann Burns Fire Disasters 2016; 29:300-306. [PMID: 28289367 PMCID: PMC5347311] [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] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
The 2016 SFB congress focused on 'non-thermal burns', and this session lasted the whole day of Thursday 2nd June. While the reports on radiation-induced burns are currently being prepared by the presenters themselves, this paper on chemical and electrical burns was put together by the above-mentioned authors using notes taken during the session and video of the presentations. Any reader desiring further information on a topic can contact the author of the relevant presentation directly.
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Duteille F, Beneteau C, Camut MV, Perrot P. [Congenital deformities of the hand and upper limb]. ANN CHIR PLAST ESTH 2016; 61:429-438. [PMID: 27545656 DOI: 10.1016/j.anplas.2016.07.006] [Citation(s) in RCA: 3] [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: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Abstract
Congenital deformities of the hand and upper limb include a significant number of clinical situations. Their expression is, as in all congenital diseases, variable. Therefore, we can almost consider that each clinical situation is a bit unique. The difficulty, as any congenital disease, is the fact that the clinical cases are extremely diverse and difficult to classify. So what to do and surgical strategies are often matter of "School". This is even more true that the evaluation of results is very difficult due to low series (poor statistical value) and functional assessment to be partly due to the growth of the child. It is impossible in a few pages to describe all malformations of the hand and upper limb, summarize the indications and evaluate the results. Also, this chapter is not exhaustive and we will focus primarily on the most frequent pathologies.
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Affiliation(s)
- F Duteille
- Service de chirurgie plastique et reconstructrice, centre des brûlés, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 01, France; Inserm U957, laboratoire de physiopathologie de la résorption osseuse, université de Nantes, 44035 Nantes, France.
| | - C Beneteau
- Service de pédiatrie, hôpital Mère-et-Enfant, CHU de Nantes, 44093 Nantes cedex 01, France
| | - M-V Camut
- Service de chirurgie plastique et reconstructrice, centre des brûlés, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 01, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, centre des brûlés, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 01, France; Inserm U957, laboratoire de physiopathologie de la résorption osseuse, université de Nantes, 44035 Nantes, France
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Duteille F, Yeo S, Perrot P. [Microsurgery in children]. ANN CHIR PLAST ESTH 2016; 61:770-778. [PMID: 27475030 DOI: 10.1016/j.anplas.2016.07.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 11/28/2022]
Abstract
While we celebrated the fortieth anniversary of the first free flap in children, new techniques emerged in reconstructive surgery (NPT, artificial dermis…) and reduced microsurgery procedures. However, microsurgery in children as in adults still have clinical applications in reconstructive surgery. Free flaps remain essential in clinical situations where they are the only ones to provide capacity for growth and stability scarring, two elements essential to the future quality of life of the children.
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Affiliation(s)
- F Duteille
- Service de chirurgie plastique et reconstructrice, centre des brûlés, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France; Inserm U957, laboratoire de physiopathologie de la résorption osseuse, université de Nantes, 44035 Nantes, France.
| | - S Yeo
- Service de chirurgie plastique et reconstructrice, centre des brûlés, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, centre des brûlés, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France; Inserm U957, laboratoire de physiopathologie de la résorption osseuse, université de Nantes, 44035 Nantes, France
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Perrot P, Lancien U, Ridel P, Gouin F, Bodin F, Duteille F. Utilisation d’un membre banque pour le comblement d’une perte de substance axillaire. ANN CHIR PLAST ESTH 2016. [DOI: 10.1016/j.anplas.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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44
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Perrot P. [Not Available]. Ann Burns Fire Disasters 2016; 29:155-158. [PMID: 28149241 PMCID: PMC5241195] [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] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
The round table on perioral burns was divided into two sessions: "Acute care" and "Sequelae", the latter with open-exchange case reports. Here is the review, written after viewing the video of the meeting, which the author attended.
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Affiliation(s)
- P. Perrot
- Corresponding author: Pierre Perrot,
Service des brûlés, CHU Nantes, 44093 Nantes CEDEX1,France.
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45
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Picarda G, Chéneau C, Humbert JM, Bériou G, Pilet P, Martin J, Duteille F, Perrot P, Bellier-Waast F, Heslan M, Haspot F, Guillon F, Josien R, Halary FA. Functional Langerinhigh-Expressing Langerhans-like Cells Can Arise from CD14highCD16−Human Blood Monocytes in Serum-Free Condition. J I 2016; 196:3716-28. [DOI: 10.4049/jimmunol.1501304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 02/23/2016] [Indexed: 12/31/2022]
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Rodriguez Calleja L, Jacques C, Lamoureux F, Baud'huin M, Tellez Gabriel M, Quillard T, Sahay D, Perrot P, Amiaud J, Charrier C, Brion R, Lecanda F, Verrecchia F, Heymann D, Ellisen LW, Ory B. ΔNp63α Silences a miRNA Program to Aberrantly Initiate a Wound-Healing Program That Promotes TGFβ-Induced Metastasis. Cancer Res 2016; 76:3236-51. [PMID: 26988989 DOI: 10.1158/0008-5472.can-15-2317] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/04/2016] [Indexed: 12/18/2022]
Abstract
Primary cancer cell dissemination is a key event during the metastatic cascade, but context-specific determinants of this process remain largely undefined. Multiple reports have suggested that the p53 (TP53) family member p63 (TP63) plays an antimetastatic role through its minor epithelial isoform containing the N-terminal transactivation domain (TAp63). However, the role and contribution of the major p63 isoform lacking this domain, ΔNp63α, remain largely undefined. Here, we report a distinct and TAp63-independent mechanism by which ΔNp63α-expressing cells within a TGFβ-rich microenvironment become positively selected for metastatic dissemination. Orthotopic transplantation of ΔNp63α-expressing human osteosarcoma cells into athymic mice resulted in larger and more frequent lung metastases than transplantation of control cells. Mechanistic investigations revealed that ΔNp63α repressed miR-527 and miR-665, leading to the upregulation of two TGFβ effectors, SMAD4 and TβRII (TGFBR2). Furthermore, we provide evidence that this mechanism reflects a fundamental role for ΔNp63α in the normal wound-healing response. We show that ΔNp63α-mediated repression of miR-527/665 controls a TGFβ-dependent signaling node that switches off antimigratory miR-198 by suppressing the expression of the regulatory factor, KSRP (KHSRP). Collectively, these findings reveal that a novel miRNA network involved in the regulation of physiologic wound-healing responses is hijacked and suppressed by tumor cells to promote metastatic dissemination. Cancer Res; 76(11); 3236-51. ©2016 AACR.
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Affiliation(s)
- Lidia Rodriguez Calleja
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Camille Jacques
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - François Lamoureux
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Marc Baud'huin
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France. Nantes University Hospital, Nantes, France
| | - Marta Tellez Gabriel
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Thibaut Quillard
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Debashish Sahay
- Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale, Université Claude Bernard Lyon 1, Paris, France
| | - Pierre Perrot
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France. Nantes University Hospital, Nantes, France
| | - Jerome Amiaud
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Celine Charrier
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Regis Brion
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Fernando Lecanda
- Division of Oncology, Adhesion and Metastasis Laboratory, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Navarra, Spain
| | - Franck Verrecchia
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France
| | - Dominique Heymann
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France. Nantes University Hospital, Nantes, France
| | - Leif W Ellisen
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts.
| | - Benjamin Ory
- INSERM, UMR-S 957, Nantes, Equipe labellisée LIGUE 2012, France. Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, Rue Gaston Veil, Nantes, France.
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Duteille F, Truffandier MV, Perrot P. 'Matriderm' dermal substitute with split-thickness skin graft compared with full-thickness skin graft for the coverage of skin defects after surgical treatment of congenital syndactyly: results in 40 commissures. J Hand Surg Eur Vol 2016; 41:350-1. [PMID: 26141023 DOI: 10.1177/1753193415594101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F Duteille
- Service de chirurgie plastique et reconstructrice - Centre des brûlés, Hôpital Jean Monnet, Nantes, France Inserm U957, Laboratoire de Physiopathologie de la Résorption Osseuse, Université de Nantes, Nantes, France
| | - M V Truffandier
- Service de chirurgie plastique et reconstructrice - Centre des brûlés, Hôpital Jean Monnet, Nantes, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice - Centre des brûlés, Hôpital Jean Monnet, Nantes, France Inserm U957, Laboratoire de Physiopathologie de la Résorption Osseuse, Université de Nantes, Nantes, France
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48
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Avril P, Le Nail LR, Brennan MÁ, Rosset P, De Pinieux G, Layrolle P, Heymann D, Perrot P, Trichet V. Mesenchymal stem cells increase proliferation but do not change quiescent state of osteosarcoma cells: Potential implications according to the tumor resection status. J Bone Oncol 2015; 5:5-14. [PMID: 26998421 PMCID: PMC4782020 DOI: 10.1016/j.jbo.2015.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 10/07/2015] [Revised: 11/13/2015] [Accepted: 11/30/2015] [Indexed: 12/11/2022] Open
Abstract
Conventional therapy of primary bone tumors includes surgical excision with wide resection, which leads to physical and aesthetic defects. For reconstruction of bone and joints, allografts can be supplemented with mesenchymal stem cells (MSCs). Similarly, adipose tissue transfer (ATT) is supplemented with adipose-derived stem cells (ADSCs) to improve the efficient grafting in the correction of soft tissue defects. MSC-like cells may also be used in tumor-targeted cell therapy. However, MSC may have adverse effects on sarcoma development. In the present study, human ADSCs, MSCs and pre-osteoclasts were co-injected with human MNNG-HOS osteosarcoma cells in immunodeficient mice. ADSCs and MSCs, but not the osteoclast precursors, accelerated the local proliferation of MNNG-HOS osteosarcoma cells. However, the osteolysis and the metastasis process were not exacerbated by ADSCs, MSCs, or pre-osteoclasts. In vitro proliferation of MNNG-HOS and Saos-2 osteosarcoma cells was increased up to 2-fold in the presence of ADSC-conditioned medium. In contrast, ADSC-conditioned medium did not change the dormant, quiescent state of osteosarcoma cells cultured in oncospheres. Due to the enhancing effect of ADSCs/MSCs on in vivo/in vitro proliferation of osteosarcoma cells, MSCs may not be good candidates for osteosarcoma-targeted cell therapy. Although conditioned medium of ADSCs accelerated the cell cycle of proliferating osteosarcoma cells, it did not change the quiescent state of dormant osteosarcoma cells, indicating that ADSC-secreted factors may not be involved in the risk of local recurrence.
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Affiliation(s)
- Pierre Avril
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France
| | - Louis-Romée Le Nail
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France; University Hospital, Service de Chirurgie Orthopédique et Traumatologique, Tours F-37044, France; Faculté de Médecine, Université François Rabelais, Tours F-37044, France
| | - Meadhbh Á Brennan
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France
| | - Philippe Rosset
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France; University Hospital, Service de Chirurgie Orthopédique et Traumatologique, Tours F-37044, France; Faculté de Médecine, Université François Rabelais, Tours F-37044, France
| | - Gonzague De Pinieux
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France; Faculté de Médecine, Université François Rabelais, Tours F-37044, France; University Hospital, Service d'Anatomie Pathologique, Tours F-37044, France
| | - Pierre Layrolle
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France
| | - Dominique Heymann
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France
| | - Pierre Perrot
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France; University Hospital, Service de Chirurgie Plastique et des Brûlés, Nantes F-44093, France
| | - Valérie Trichet
- INSERM, UMR 957, Equipe Labellisée LIGUE 2012, Nantes F-44035, France; Université de Nantes, Nantes Atlantique Universités, Laboratoire de Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, Nantes F-44035, France
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Koutsomanis A, Bruant-Rodier C, Roedlich MN, Bretz-Grenier MF, Perrot P, Bodin F. [Radiological trap and oncological precautions in a patient who has undergone a permanent withdrawal of PIP breast implants]. ANN CHIR PLAST ESTH 2015; 60:533-6. [PMID: 26232069 DOI: 10.1016/j.anplas.2015.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 04/08/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
Abstract
We report the case of a 57-year-old patient who presented radiological images similar to ruptured breast implants one year after the supposed withdrawal of the latter. This woman had benefited for the first time from cosmetic PIP breast implants in 2000. Early in 2014, she requested the removal of the implants without renewal because she was feeling pain and functional discomfort. A few months after the operation, she consulted for breast swelling in the upper pole of the breast. Radiological assessment showed liquid formations compatible with the presence of implants. At our request, the rereading of the MRI by the radiologist definitively concluded on a bilateral seroma within the persistent fibrous capsule. In the absence of symptoms, clinical monitoring had been decided. But at the recrudescence of anaplastic large cell lymphoma cases associated with breast implants, a cytological sampling was intended. In case of cytological abnormality or recurrence of the seroma, a surgical procedure should be performed. In conclusion, the removal of a breast implant without capsulectomy may result in the formation of a seroma whose images resemble those of an implant. It is always worthwhile to provide precise clinical data to the radiologist in order to help him to make informed interpretations. Every serous effusion in a breast lodge having contained a silicone implant must evoke the diagnosis of anaplastic large cell lymphoma.
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Affiliation(s)
- A Koutsomanis
- Service de chirurgie plastique et reconstructrice, hôpital civil, CHU de Strasbourg, 1, place de l'Hôpital, B.P. n(o) 426, 67091 Strasbourg cedex, France
| | - C Bruant-Rodier
- Service de chirurgie plastique et reconstructrice, hôpital civil, CHU de Strasbourg, 1, place de l'Hôpital, B.P. n(o) 426, 67091 Strasbourg cedex, France
| | - M-N Roedlich
- Service de radiologie, unité d'imagerie de la femme, CHU de Strasbourg, 67098 Strasbourg cedex, France
| | - M-F Bretz-Grenier
- Service de radiologie, unité d'imagerie de la femme, CHU de Strasbourg, 67098 Strasbourg cedex, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, CHU de Nantes, 44093 Nantes cedex 1, France
| | - F Bodin
- Service de chirurgie plastique et reconstructrice, hôpital civil, CHU de Strasbourg, 1, place de l'Hôpital, B.P. n(o) 426, 67091 Strasbourg cedex, France.
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Vildy S, Macher J, Abasq-Thomas C, Le Rouzic-Dartoy C, Brunelle F, Hamel-Teillac D, Duteille F, Perret C, Perrot P, Cassagnau E, Chauty-Frondas A, Aubert H, Barbarot S. Life-threatening hemorrhaging in neonatal ulcerated congenital hemangioma: two case reports. JAMA Dermatol 2015; 151:422-5. [PMID: 25565634 DOI: 10.1001/jamadermatol.2014.3666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Congenital hemangiomas (CHs) are rare benign vascular tumors that differ from common infantile hemangiomas in that they grow in utero and are fully developed at birth. While ulceration is a common, predominantly benign complication in infantile hemangioma, little is known about the prognosis of ulcerated CH. However, it has been observed that ulcerated CH may be complicated by life-threatening bleeding episodes. OBSERVATIONS We report 2 cases of ulcerated rapidly involuting congenital hemangiomas (RICH) that were complicated by life-threatening bleeding episodes in the neonatal period. In both cases, the CHs were fed by high-flow vessels and the ensuing massive bleeding was due to superficial vessel wall erosion induced by the ulceration. Both patients were successfully treated with intravascular embolization; one patient underwent additional hemostatic surgery. CONCLUSIONS AND RELEVANCE These 2 cases highlight the importance of closely monitoring children with ulcerated CH because of the risk of severe bleeding. Embolization is the treatment of choice in the case of severe bleeding, as the natural history of RICH is to spontaneously regress.
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Affiliation(s)
- Sophie Vildy
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | - Julie Macher
- Department of Intensive Care of Neonatology, Nantes University Hospital, Nantes, France
| | | | | | - Francis Brunelle
- Department of Interventional Radiology and Dermatology, Necker Enfants Malades University Hospital, Paris, France
| | - Dominique Hamel-Teillac
- Department of Interventional Radiology and Dermatology, Necker Enfants Malades University Hospital, Paris, France
| | - Franck Duteille
- Department of Vascular and Plastic Surgery, Nantes University Hospital, Nantes, France
| | - Christophe Perret
- Department of Vascular and Plastic Surgery, Nantes University Hospital, Nantes, France
| | - Pierre Perrot
- Department of Vascular and Plastic Surgery, Nantes University Hospital, Nantes, France
| | | | - Anne Chauty-Frondas
- Department of Intensive Care of Neonatology, Nantes University Hospital, Nantes, France
| | - Helene Aubert
- Department of Dermatology, Nantes University Hospital, Nantes, France
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