Alain Danino - Academia.edu (original) (raw)
Papers by Alain Danino
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2004
Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposit... more Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposits of hydroxyapatite crystals in periarticular soft tissue. The pathogenic mechanism remains to be clarified. This condition is generally observed in young subjects and a hereditary pattern is often discovered. We report the clinical, radiological, and biological findings in a case of right forefoot tumoral calcinosis observed in a sixteen-year-old girl and describe the surgical treatment and pathology results.
Annales de Chirurgie Plastique Esthétique
In the present study, the authors decided to focus on the effect of the venous outflow location i... more In the present study, the authors decided to focus on the effect of the venous outflow location in the survival of a flap with a choke vessels barrier by means of a rat bipedicled ventral island flap. In a first experiment, the extent of flap necrosis was examined in three experimental groups: group 1, alternate vein and artery ligation (n = 5); group 2, unilateral artery ligation (n = 5); group 3, unilateral pedicle ligation (n = 5). Less than 10% necrosis occurred in group 1; 28% in group 2 and 33% in group 3. In a second experiment we applied the first results to the delay phenomenon. 10 rats were divided into 2 groups: group 4, primary ligation of a complete pedicle on one side; group 5, primary alternate vein and artery ligation and the flaps were raised 21 days later. We observed 20% necrosis in group 4 and only 4% in group 5. The data of the first experiment indicate that a vein remaining near the artery can be a dramatic obstacle to the efficiency of choke vessels. The second experimental study shows the superiority of primary selective ligation in the delay phenomenon.
Annales de Chirurgie Plastique Esthétique
After 14 months of personal training with Professor Ichinose's team in Chiba (Japan), the... more After 14 months of personal training with Professor Ichinose's team in Chiba (Japan), the author reports a new chronology of the total external ear reconstruction for microtia. This approach, proposed by Dr Yoshimoto, subtracts in time spent on creating the cartilaginous framework from the total general anesthesia time. The principles of this technique and its chronology are described. The results of eight patients operated according to this method between February 1994 and October 1999 are analyzed and compared to the 35 previous reconstructions performed by this team. The advantage of this chronology has been established: this method allows a considerable reduction of the general anesthesia time, a rationalization of the cost of these reconstructions, an increased comfort for the patients and an easier learning process for young plastic surgeons.
Annales de Chirurgie Plastique Esthétique
ABSTRACT
Revue de Stomatologie et de Chirurgie Maxillo-faciale
economic cost is a timely topic which will have to be taken in consideration more and more for de... more economic cost is a timely topic which will have to be taken in consideration more and more for determining the appropriate indication for surgical procedures. "Health has no price, but it has a cost" is a common proverb urging us to think in terms real cost of a surgical procedure. The purpose of this study is to estimate the real cost of a usual and frequent intervention: removal of osteosynthesis material in mandibular fractures. Real cost was compared with the cost charged by the French health insurance fund. this retrospective study collected all the interventions concerning material removal after mandibular fractures performed in our department during 2002. The following parameters were retained: the number of consultations, the duration of occupation of the surgical unit and the recovery room, the list of materials and products used, the cost of the medical staffs and cleaning agents, the duration of hospitalization, other administrative loads and expenses. a series of 30 patients was found, each patient had had three consultations, the average duration of hospitalization was 36 hours, the time of occupation of the surgical unit was 100 minutes and occupation of the recovery room was 2 hours. The total real cost of this intervention was 510 Euros, the cost estimated by the health insurance fund was 110 Euros and the cost of hospitalisation charged was 997 Euros. these results show us the real cost of this intervention and the cost estimated by the French health insurance fund. It is highly noteworthy that the cost estimates were totally inadequate. This study leads to a discussion concerning a more global approach to the cost-benefit ratio of such an intervention as well as the indication for bioabsorbable material compared with titanium in facial traumatology.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposit... more Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposits of hydroxyapatite crystals in periarticular soft tissue. The pathogenic mechanism remains to be clarified. This condition is generally observed in young subjects and a hereditary pattern is often discovered. We report the clinical, radiological, and biological findings in a case of right forefoot tumoral calcinosis observed in a sixteen-year-old girl and describe the surgical treatment and pathology results. Based on this case and a review of the literature, we discuss the different pathogenic hypotheses as well as the appropriate diagnostic and therapeutic approach.
Annales de Chirurgie Plastique Esthétique
France has a population of about 60 million peoples and each ten years data about the standard of... more France has a population of about 60 million peoples and each ten years data about the standard of living are collected by the central bureau of statistics, we considered the collection of data on 5000 households in 1999 in our geographical area would afford a unique opportunity to compare the equivalent status of French adults with repaired cleft of the lip and palate (CLP). Aspects of social adjustment were investigated in a sample of 82 French adults 18-35 years old with repaired complete unilateral cleft of the lip and palate (CLP). All subjects received a standardized regimen of care from the Burgundy cleft palate team of Dijon. The investigation, based on response to a questionnaire, partly replicated a national survey of social and economic life in the population (Standard of living survey Burgundy, INSEE France 1999), so that adults with complete clefts could be compared with a large control sample of the same age. The control group was constituted by subjects between 18 and 35 years in the standard of living survey Burgundy 1999, INSEE France, they were taken from a regional probability sample of households. This report covers education, employment, and marriage. The significant difference between groups was assessed by: Student's t-test or analysis of variance for continuous variables and chi2 test for categorical variables. The results demonstrated that there are significant differences in educational attainment and employment between adults with cleft of the lip and palate and other people. Fewer with cleft of the lip and palate marry, and when they marry they do so later in life, scholarship history showed significant delay in the cleft of the lip and palate group, independence regarding housing was lower in the cleft of the lip and palate group. If cleft of the lip and palate adults functioned within normal limits with regard to employment. However, levels of income were substantively lower than control groups. It would appear that cleft subjects experience some limitation in their ability to secure vocational and economic rewards from society. As a conclusion we can say regarding our results that the cleft of the lip and palate group, even with the smallest degree of malformation (unilateral without associated malformation), showed a significant delay in the independence process.
Revue de Stomatologie et de Chirurgie Maxillo-faciale
The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. T... more The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. There are several qualifiers used to describe prematurely erupted teeth. Massler and Savara defined "natal teeth" as teeth present at birth and "neonatal teeth" as teeth erupted within the first month of life. The aim of this study, based on 5 cases, is to present clinical and structural characteristics, etiology, management techniques, complications and a review of the literature for natal teeth. Our study is a retrospective study of 17,000 infants who were examined in the Neonatal Department of Children Hospital between 1984 and 2001. The material consisted of 5 infants with natal teeth, identified by the pediatrician. We analyzed the family history, the pregnancy history, the gender, the etiology, the complete examination of the infant, the clinical, the structural characteristics, the complications and the management of the teeth. We found 4 boys and 1 girl, 2 of the newborns were premature, all of them observed to have natal teeth. The incidence was 1: 3,400 births. There were 14 natal teeth, 10 incisors (70%) and 4 canines (30%), no molar was found. Nine of the teeth (6 incisors and 3 canines) were maxillary (65%) and 5 (4 incisors and 1 canine) were mandibular (35%). No morphological syndrome was discovered. Most of the teeth were mobile in all directions and were extracted because of the possibility of aspiration, the difficulty in feeding and the ulceration of the ventral surface of the tongue. According to the literature, this phenomenon is rare and the incisors are the teeth most commonly involved. Natal teeth are more common than neonatal teeth and nearly 90% of these teeth are the normal primary teeth. The presence of natal teeth is due to several factors related to an unknown cause of disturbed biological chronology. There is no conclusive evidence of a correlation between early eruption and systemic disorders, but some investigators suggest that natal teeth may be associated with certain syndromes. We must keep in mind that radiographic examination is essential for the differential diagnosis between supernumerary and normal primary teeth. The supernumerary teeth should always be extracted but the decision to extract a normal mature natal tooth should be done according to scientific knowledge, mobility of the tooth, local or general complications and parental opinion.
Annales de Chirurgie Plastique Esthétique
Informed consent is a legal and ethical requirement before every surgical procedure especially wh... more Informed consent is a legal and ethical requirement before every surgical procedure especially when it comes to esthetic surgery. Obtaining a satisfactory understanding of the risks and benefits of the operation by patients remains a critical problem. This trial aimed to assess the value of visual information. Patients scheduled to undergo abdominoplasty were approached during the first preoperative consultation. All patients were given an information leaflet about the procedure and completed a Spielberger state trait anxiety inventory (state-trait inventory, STAI form Y-1): questionnaire to assess baseline anxiety. The patients were then randomly assigned to watch or not watch the information CD-Rom during the second preoperative consultation. The day before surgery the patient completed a second anxiety questionnaire and a knowledge questionnaire. 67 patients were screened, 2 declined to participate and 5 were unable to complete the form. Of the remaining 60 patients 30 were assigned to look at the CD-Rom and the remaining 30 not. The groups were similar in regards to age, sex, education and initial anxiety score. Patients who watched the CD-Rom were significantly less anxious before a esthetic surgery than those who did not (Mean STAI 45 for the "image group" [38.2-46.3] vs 55 for the "no image group" [49.9-63.8]). Furthermore they also scored higher in the knowledge questionnaire than the "no image" group as far as the purpose and the procedural details of the surgery were concerned. However statistical difference of knowledge regarding the potential complications of the procedure was not found.
Annales de Chirurgie Plastique Esthétique
Background. For the burn surgeon, the treatment of necrotizing soft tissue infections is one of t... more Background. For the burn surgeon, the treatment of necrotizing soft tissue infections is one of the most demanding surgical emergencies, requiring "radical excisions" of the infected tissue and reconstruction. During the infection period, the excised sites are treated with application of gauzes soaked in saline solution. When the septic period is over, the excision sites are usually covered by sterile paraffin gauze dressing. Our aim was to evaluate a new calcium polyuronate dressing enriched with zinc and manganese ions (test group) versus the reference therapeutic combination (control group) from the septic period to the grafting of skin. Materials and methods. A multicentre, prospective, controlled, randomized clinical trial was conducted from November 2003 to July 2005. The primary endpoint was the waiting period for carrying out the skin graft and the percentage of grafted patients at 28 days after the last excision. The secondary endpoints were blood loss, exudates amounts, and pain during dressing changes. Results. Twenty-five patients were included, 14 with the new dressing and 11 with the reference therapeutic combination. The average waiting period for skin graft was 18 days in the test group versus 27.1 days in the control group (p = 0.128). All the patients in the test group received their grafts within 28 days after the last excision, compared with 60% (p = 0.043) in the control group. Bleeding during dressing change was statistically lower in the test group: 45.5% of the patients did not bleed compared with 0% in the control group (p = 0.045). Treatments were well tolerated. Conclusion. The properties of this new calcium polyuronate enriched with zinc and manganese ions seem to accelerate granulation tissue development, allowing skin grafting earlier in favourable conditions with less bleeding and less pain during dressing renewal.
Eplasty
Objective: Severe ballistic injuries to the face create complex, composite defects of 2 facial su... more Objective: Severe ballistic injuries to the face create complex, composite defects of 2 facial subunits. These injuries have an extremely high economic impact for the Medicare system. The surgical goal with these patients is to restore basic functions of the face with a rapid morphological improvement. Our hypothesis is as follows: Early restoration of facial segments with a single free multiple island latissimus dorsi flap without primary bone reconstruction can significantly reduce hospitalization time and allow earlier psychiatric therapy with good morphological results. Surgical method: (1) Large debridement, bony stabilization with external fixation, and tracheotomy. (2) Definitive early reconstruction of soft tissue with composite free latissimus dorsi-scapular musculocutaneous flap. (3) Several refinements will optimize the results. Study design: Retrospective case series of lower-and middle-face composite facial close-range high-energy gunshot wound patients were evaluated. Age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, functional outcomes, time of tracheotomy closure, hospitalization duration, and beginning of psychiatric treatment were analyzed.
Annales de Chirurgie Plastique Esthétique
Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in t... more Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom. The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques. We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization. Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient. The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.
European Journal of Surgical Oncology
Annales de Chirurgie Plastique Esthétique
The aim of this study was to analyze outcome in patients enrolled in sentinel node biopsy procedu... more The aim of this study was to analyze outcome in patients enrolled in sentinel node biopsy procedure in early-staged cutaneous melanoma. Therefore a prospective study was conducted enrolling patients presenting with early-staged cutaneous melanoma. Our study focused on age and sex, duration from diagnosis to treatment, duration of hospitalization, dressing care and work inability in current follows. Duration from scintigraphy to surgery was analyzed and compared to sensibility of the procedure. What is more we observed rate and kind of complications and economical consequences, increasing duration of dressing care and work inability. The authors aimed at evaluating costs of SLN procedure including hospitalization, lymphoscintigraphy, general anaesthesia, costs of dressings, inability and overcosts of complications. Forty-five patients were enrolled in our study (sex-ratio 1/2) mean aged 60 years old. Duration from diagnosis to treatment was mean 36 days. Sensibility of the procedure was excellent in trunk and limbs cases, lower in head and neck. In current cases patients were mean hospitalized three days, underwent 20 days of dressings and work inability depended on further interferon treatment. Complications occurred in 25% as seroma or local infections requiring antibiotherapy. Duration to healing was then 45 days increasing inability. Global costs of SLN procedure were significantly higher than previous wait and watch policy. SLN biopsy is an expensive and invasive procedure with a high rate of complications. It defers melanoma treatment, only way to gain survival.
Plastic and reconstructive surgery, 2015
Plastic surgery (Oakville (Ont.)), 2015
In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of... more In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of recipient vessels appropriate for microvascular reconstruction. The creation of temporary arteriovenous fistulas using venous interposition for subsequent microvascular reconstruction has rarely been reported in the head and neck. The authors report the largest series of temporary arteriovenous loops for head and neck reconstruction in vessel-depleted necks. The authors performed a case series of major head and neck reconstructions using temporary arteriovenous fistulas with a saphenous vein graft. A subclavian surgical approach was used. All reconstructions were performed at least two weeks after the creation of the initial fistula. The authors have performed nine reconstructive cases for malignancy using five different free flaps. The subclavian and transerve cervical arteries were used, and the subclavian, internal jugular and cephalic veins were used for microanastomosis. Two cases ...
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2004
ABSTRACT
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2004
Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposit... more Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposits of hydroxyapatite crystals in periarticular soft tissue. The pathogenic mechanism remains to be clarified. This condition is generally observed in young subjects and a hereditary pattern is often discovered. We report the clinical, radiological, and biological findings in a case of right forefoot tumoral calcinosis observed in a sixteen-year-old girl and describe the surgical treatment and pathology results.
Annales de Chirurgie Plastique Esthétique
In the present study, the authors decided to focus on the effect of the venous outflow location i... more In the present study, the authors decided to focus on the effect of the venous outflow location in the survival of a flap with a choke vessels barrier by means of a rat bipedicled ventral island flap. In a first experiment, the extent of flap necrosis was examined in three experimental groups: group 1, alternate vein and artery ligation (n = 5); group 2, unilateral artery ligation (n = 5); group 3, unilateral pedicle ligation (n = 5). Less than 10% necrosis occurred in group 1; 28% in group 2 and 33% in group 3. In a second experiment we applied the first results to the delay phenomenon. 10 rats were divided into 2 groups: group 4, primary ligation of a complete pedicle on one side; group 5, primary alternate vein and artery ligation and the flaps were raised 21 days later. We observed 20% necrosis in group 4 and only 4% in group 5. The data of the first experiment indicate that a vein remaining near the artery can be a dramatic obstacle to the efficiency of choke vessels. The second experimental study shows the superiority of primary selective ligation in the delay phenomenon.
Annales de Chirurgie Plastique Esthétique
After 14 months of personal training with Professor Ichinose's team in Chiba (Japan), the... more After 14 months of personal training with Professor Ichinose's team in Chiba (Japan), the author reports a new chronology of the total external ear reconstruction for microtia. This approach, proposed by Dr Yoshimoto, subtracts in time spent on creating the cartilaginous framework from the total general anesthesia time. The principles of this technique and its chronology are described. The results of eight patients operated according to this method between February 1994 and October 1999 are analyzed and compared to the 35 previous reconstructions performed by this team. The advantage of this chronology has been established: this method allows a considerable reduction of the general anesthesia time, a rationalization of the cost of these reconstructions, an increased comfort for the patients and an easier learning process for young plastic surgeons.
Annales de Chirurgie Plastique Esthétique
ABSTRACT
Revue de Stomatologie et de Chirurgie Maxillo-faciale
economic cost is a timely topic which will have to be taken in consideration more and more for de... more economic cost is a timely topic which will have to be taken in consideration more and more for determining the appropriate indication for surgical procedures. "Health has no price, but it has a cost" is a common proverb urging us to think in terms real cost of a surgical procedure. The purpose of this study is to estimate the real cost of a usual and frequent intervention: removal of osteosynthesis material in mandibular fractures. Real cost was compared with the cost charged by the French health insurance fund. this retrospective study collected all the interventions concerning material removal after mandibular fractures performed in our department during 2002. The following parameters were retained: the number of consultations, the duration of occupation of the surgical unit and the recovery room, the list of materials and products used, the cost of the medical staffs and cleaning agents, the duration of hospitalization, other administrative loads and expenses. a series of 30 patients was found, each patient had had three consultations, the average duration of hospitalization was 36 hours, the time of occupation of the surgical unit was 100 minutes and occupation of the recovery room was 2 hours. The total real cost of this intervention was 510 Euros, the cost estimated by the health insurance fund was 110 Euros and the cost of hospitalisation charged was 997 Euros. these results show us the real cost of this intervention and the cost estimated by the French health insurance fund. It is highly noteworthy that the cost estimates were totally inadequate. This study leads to a discussion concerning a more global approach to the cost-benefit ratio of such an intervention as well as the indication for bioabsorbable material compared with titanium in facial traumatology.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposit... more Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposits of hydroxyapatite crystals in periarticular soft tissue. The pathogenic mechanism remains to be clarified. This condition is generally observed in young subjects and a hereditary pattern is often discovered. We report the clinical, radiological, and biological findings in a case of right forefoot tumoral calcinosis observed in a sixteen-year-old girl and describe the surgical treatment and pathology results. Based on this case and a review of the literature, we discuss the different pathogenic hypotheses as well as the appropriate diagnostic and therapeutic approach.
Annales de Chirurgie Plastique Esthétique
France has a population of about 60 million peoples and each ten years data about the standard of... more France has a population of about 60 million peoples and each ten years data about the standard of living are collected by the central bureau of statistics, we considered the collection of data on 5000 households in 1999 in our geographical area would afford a unique opportunity to compare the equivalent status of French adults with repaired cleft of the lip and palate (CLP). Aspects of social adjustment were investigated in a sample of 82 French adults 18-35 years old with repaired complete unilateral cleft of the lip and palate (CLP). All subjects received a standardized regimen of care from the Burgundy cleft palate team of Dijon. The investigation, based on response to a questionnaire, partly replicated a national survey of social and economic life in the population (Standard of living survey Burgundy, INSEE France 1999), so that adults with complete clefts could be compared with a large control sample of the same age. The control group was constituted by subjects between 18 and 35 years in the standard of living survey Burgundy 1999, INSEE France, they were taken from a regional probability sample of households. This report covers education, employment, and marriage. The significant difference between groups was assessed by: Student's t-test or analysis of variance for continuous variables and chi2 test for categorical variables. The results demonstrated that there are significant differences in educational attainment and employment between adults with cleft of the lip and palate and other people. Fewer with cleft of the lip and palate marry, and when they marry they do so later in life, scholarship history showed significant delay in the cleft of the lip and palate group, independence regarding housing was lower in the cleft of the lip and palate group. If cleft of the lip and palate adults functioned within normal limits with regard to employment. However, levels of income were substantively lower than control groups. It would appear that cleft subjects experience some limitation in their ability to secure vocational and economic rewards from society. As a conclusion we can say regarding our results that the cleft of the lip and palate group, even with the smallest degree of malformation (unilateral without associated malformation), showed a significant delay in the independence process.
Revue de Stomatologie et de Chirurgie Maxillo-faciale
The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. T... more The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. There are several qualifiers used to describe prematurely erupted teeth. Massler and Savara defined "natal teeth" as teeth present at birth and "neonatal teeth" as teeth erupted within the first month of life. The aim of this study, based on 5 cases, is to present clinical and structural characteristics, etiology, management techniques, complications and a review of the literature for natal teeth. Our study is a retrospective study of 17,000 infants who were examined in the Neonatal Department of Children Hospital between 1984 and 2001. The material consisted of 5 infants with natal teeth, identified by the pediatrician. We analyzed the family history, the pregnancy history, the gender, the etiology, the complete examination of the infant, the clinical, the structural characteristics, the complications and the management of the teeth. We found 4 boys and 1 girl, 2 of the newborns were premature, all of them observed to have natal teeth. The incidence was 1: 3,400 births. There were 14 natal teeth, 10 incisors (70%) and 4 canines (30%), no molar was found. Nine of the teeth (6 incisors and 3 canines) were maxillary (65%) and 5 (4 incisors and 1 canine) were mandibular (35%). No morphological syndrome was discovered. Most of the teeth were mobile in all directions and were extracted because of the possibility of aspiration, the difficulty in feeding and the ulceration of the ventral surface of the tongue. According to the literature, this phenomenon is rare and the incisors are the teeth most commonly involved. Natal teeth are more common than neonatal teeth and nearly 90% of these teeth are the normal primary teeth. The presence of natal teeth is due to several factors related to an unknown cause of disturbed biological chronology. There is no conclusive evidence of a correlation between early eruption and systemic disorders, but some investigators suggest that natal teeth may be associated with certain syndromes. We must keep in mind that radiographic examination is essential for the differential diagnosis between supernumerary and normal primary teeth. The supernumerary teeth should always be extracted but the decision to extract a normal mature natal tooth should be done according to scientific knowledge, mobility of the tooth, local or general complications and parental opinion.
Annales de Chirurgie Plastique Esthétique
Informed consent is a legal and ethical requirement before every surgical procedure especially wh... more Informed consent is a legal and ethical requirement before every surgical procedure especially when it comes to esthetic surgery. Obtaining a satisfactory understanding of the risks and benefits of the operation by patients remains a critical problem. This trial aimed to assess the value of visual information. Patients scheduled to undergo abdominoplasty were approached during the first preoperative consultation. All patients were given an information leaflet about the procedure and completed a Spielberger state trait anxiety inventory (state-trait inventory, STAI form Y-1): questionnaire to assess baseline anxiety. The patients were then randomly assigned to watch or not watch the information CD-Rom during the second preoperative consultation. The day before surgery the patient completed a second anxiety questionnaire and a knowledge questionnaire. 67 patients were screened, 2 declined to participate and 5 were unable to complete the form. Of the remaining 60 patients 30 were assigned to look at the CD-Rom and the remaining 30 not. The groups were similar in regards to age, sex, education and initial anxiety score. Patients who watched the CD-Rom were significantly less anxious before a esthetic surgery than those who did not (Mean STAI 45 for the "image group" [38.2-46.3] vs 55 for the "no image group" [49.9-63.8]). Furthermore they also scored higher in the knowledge questionnaire than the "no image" group as far as the purpose and the procedural details of the surgery were concerned. However statistical difference of knowledge regarding the potential complications of the procedure was not found.
Annales de Chirurgie Plastique Esthétique
Background. For the burn surgeon, the treatment of necrotizing soft tissue infections is one of t... more Background. For the burn surgeon, the treatment of necrotizing soft tissue infections is one of the most demanding surgical emergencies, requiring "radical excisions" of the infected tissue and reconstruction. During the infection period, the excised sites are treated with application of gauzes soaked in saline solution. When the septic period is over, the excision sites are usually covered by sterile paraffin gauze dressing. Our aim was to evaluate a new calcium polyuronate dressing enriched with zinc and manganese ions (test group) versus the reference therapeutic combination (control group) from the septic period to the grafting of skin. Materials and methods. A multicentre, prospective, controlled, randomized clinical trial was conducted from November 2003 to July 2005. The primary endpoint was the waiting period for carrying out the skin graft and the percentage of grafted patients at 28 days after the last excision. The secondary endpoints were blood loss, exudates amounts, and pain during dressing changes. Results. Twenty-five patients were included, 14 with the new dressing and 11 with the reference therapeutic combination. The average waiting period for skin graft was 18 days in the test group versus 27.1 days in the control group (p = 0.128). All the patients in the test group received their grafts within 28 days after the last excision, compared with 60% (p = 0.043) in the control group. Bleeding during dressing change was statistically lower in the test group: 45.5% of the patients did not bleed compared with 0% in the control group (p = 0.045). Treatments were well tolerated. Conclusion. The properties of this new calcium polyuronate enriched with zinc and manganese ions seem to accelerate granulation tissue development, allowing skin grafting earlier in favourable conditions with less bleeding and less pain during dressing renewal.
Eplasty
Objective: Severe ballistic injuries to the face create complex, composite defects of 2 facial su... more Objective: Severe ballistic injuries to the face create complex, composite defects of 2 facial subunits. These injuries have an extremely high economic impact for the Medicare system. The surgical goal with these patients is to restore basic functions of the face with a rapid morphological improvement. Our hypothesis is as follows: Early restoration of facial segments with a single free multiple island latissimus dorsi flap without primary bone reconstruction can significantly reduce hospitalization time and allow earlier psychiatric therapy with good morphological results. Surgical method: (1) Large debridement, bony stabilization with external fixation, and tracheotomy. (2) Definitive early reconstruction of soft tissue with composite free latissimus dorsi-scapular musculocutaneous flap. (3) Several refinements will optimize the results. Study design: Retrospective case series of lower-and middle-face composite facial close-range high-energy gunshot wound patients were evaluated. Age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, functional outcomes, time of tracheotomy closure, hospitalization duration, and beginning of psychiatric treatment were analyzed.
Annales de Chirurgie Plastique Esthétique
Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in t... more Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom. The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques. We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization. Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient. The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.
European Journal of Surgical Oncology
Annales de Chirurgie Plastique Esthétique
The aim of this study was to analyze outcome in patients enrolled in sentinel node biopsy procedu... more The aim of this study was to analyze outcome in patients enrolled in sentinel node biopsy procedure in early-staged cutaneous melanoma. Therefore a prospective study was conducted enrolling patients presenting with early-staged cutaneous melanoma. Our study focused on age and sex, duration from diagnosis to treatment, duration of hospitalization, dressing care and work inability in current follows. Duration from scintigraphy to surgery was analyzed and compared to sensibility of the procedure. What is more we observed rate and kind of complications and economical consequences, increasing duration of dressing care and work inability. The authors aimed at evaluating costs of SLN procedure including hospitalization, lymphoscintigraphy, general anaesthesia, costs of dressings, inability and overcosts of complications. Forty-five patients were enrolled in our study (sex-ratio 1/2) mean aged 60 years old. Duration from diagnosis to treatment was mean 36 days. Sensibility of the procedure was excellent in trunk and limbs cases, lower in head and neck. In current cases patients were mean hospitalized three days, underwent 20 days of dressings and work inability depended on further interferon treatment. Complications occurred in 25% as seroma or local infections requiring antibiotherapy. Duration to healing was then 45 days increasing inability. Global costs of SLN procedure were significantly higher than previous wait and watch policy. SLN biopsy is an expensive and invasive procedure with a high rate of complications. It defers melanoma treatment, only way to gain survival.
Plastic and reconstructive surgery, 2015
Plastic surgery (Oakville (Ont.)), 2015
In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of... more In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of recipient vessels appropriate for microvascular reconstruction. The creation of temporary arteriovenous fistulas using venous interposition for subsequent microvascular reconstruction has rarely been reported in the head and neck. The authors report the largest series of temporary arteriovenous loops for head and neck reconstruction in vessel-depleted necks. The authors performed a case series of major head and neck reconstructions using temporary arteriovenous fistulas with a saphenous vein graft. A subclavian surgical approach was used. All reconstructions were performed at least two weeks after the creation of the initial fistula. The authors have performed nine reconstructive cases for malignancy using five different free flaps. The subclavian and transerve cervical arteries were used, and the subclavian, internal jugular and cephalic veins were used for microanastomosis. Two cases ...
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2004
ABSTRACT