A. de Taddéo | Dijon (original) (raw)
Papers by A. de Taddéo
JPRAS Open, 2015
Introduction-High-energy trauma of the hand often causes tissue loss involving bone, tendon and s... more Introduction-High-energy trauma of the hand often causes tissue loss involving bone, tendon and skin and is sometimes accompanied by devascularization of digits. Bone stabilization is the first step in the management of such injuries. Materials and methods-A young patient presented composite tissue loss of the dorsum of his right (dominant) hand following an accident with a surface planer. Tissue loss involved the diaphyses of the first 4 metacarpals, tendons and skin with almost complete amputation of the 3rd finger. Bone stabilization comprised osteosynthesis using pins associated with cement to fill the bone defect. Hunter tendon rods were used for tendon repair and a pedicle groin flap (McGregor) was used to achieve skin coverage. The cement was replaced with autologous cortico-cancellous bone graft combined with bone paste (Nanostim) 3 months after the cement stabilization. Results-Eleven months after the accident, the patient was able to return to work as a carpenter. Pinch and Grasp strength in the injured hand were half that in the contralateral hand, but there was no loss of sensitivity. Mobility was very satisfactory with a Kapandji score of 9 and a mean TAM of 280°. The patient can write, open a bottle and does not feel limited for everyday activities. Radiographically, the bone of the 3 reconstructed metacarpals appears consolidated. Conclusion-The induced membrane technique allowed the reconstruction of small bone deficits in the long bones of the hand in a two-step procedure, the first step taking place in an emergency context of composite tissue trauma.
ZUNAECHST WIRD DISKUTIERT, WELCHE SPANNWEITE FUER DIE GESTALTUNG VON MISCHFLAECHEN BESTEHT. DURCH... more ZUNAECHST WIRD DISKUTIERT, WELCHE SPANNWEITE FUER DIE GESTALTUNG VON MISCHFLAECHEN BESTEHT. DURCH BEGLEITENDE UNTERSUCHUNGEN (EICHENAUER, V. WINNING, STREICHERT) IN UNTERHACHING, DAS MIT SEINEM DOERFLICHEN CHARAKTER ALLERDINGS NICHT ALS TYPISCHES PROBLEMGEBIET BEZEICHNET WERDEN KANN, WURDE IM VORHER-NACHHER-VERGLEICH ERMITTELT, WIE SICH DURCH DEN UMBAU ZU EINER MISCHFLAECHE STAERKE UND GESCHWINDIGKEIT VON KRAFTFAHRZEUG-, RAD- UND FUSSGAENGERSTROEMEN, GESPRAECHSINTENSITAETEN IM STRASSENRAUM, KINDERSPIEL UND LAERMINTENSITAETEN VERAENDERTEN. OFFENBAR SIND FUER MISCHFLAECHEN NACH WIE VOR DIE EINSATZGRENZEN, DIE VERTRETBAREN GESCHWINDIGKEITEN, DIE ZWECKMAESSIGE AUSDEHNUNG, DIE IM EINZELFALL ANZUWENDENDEN GESTALTUNGSREGELN UND DIE ZULAESSIGKEIT DES OEPNV UMSTRITTEN. VERF. BERICHTET SCHLIESSLICH UEBER DIE VERKEHRSBERUHIGENDEN MASSNAHMEN MIT BEIBEHALTUNG DES TRENNUNGSPRINZIPES IN DER NAEHE DES KLAUSENER PLATZES IN BERLIN-CHARLOTTENBURG, EINEM DICHT BEBAUTEN INNENSTADTNAHEN WOHNGEBIET (GFZ =...
Revue de stomatologie, de chirurgie maxillo-faciale et de chirurgie orale, 2013
Maxillofacial defects often affect various type of tissues and require reconstruction using compo... more Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. The mean age of the 10 patients was 60.2years. The average length of bone defect was 8cm. The average cutaneous defect area was 36.8cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no re...
Annales de Chirurgie Plastique Esthétique, 2014
Annales de Chirurgie Plastique Esthétique, 2014
The composite radial forearm flap is a surgical option in the reconstruction of large traumatic o... more The composite radial forearm flap is a surgical option in the reconstruction of large traumatic or oncologic orofacial defects. Nevertheless, it has been criticized for its poor bone transport faculties that would make this flap insufficient in large osseous mandibular reconstructions, or for oral prosthetic rehabilitation with dental implants. What is more, the morbidity of the donor site has often been pointed. The aim of this radioanatomic study was to revisit the vascularization of the composite radial forearm flap, focusing on the bone stick. A radioanatomic study was performed on seven upper limbs taken from fresh cadavers. First, the vessels were washed with a 40°C solution of potassium acetate. Then an intra-arterial injection of a mixture of lead oxide and agar-agar was performed. 3D-CT-scan examinations of the anatomical pieces were performed. In a second step, the flaps were harvested and analyzed with a Microscan examination (NanoSPECT-CT Bioscan(®), voxel 220 microns). Collateral branches of the radial artery to the bone and the skin were counted and classified. One radial diaphyseal artery was present in all the cases. The nutrient foramen took place at the anteromedial aspect of the diaphysis, between 45 and 65 % of the length of the bone. A dense anastomotic periosteal network was highlightened, supplied by one to four musculoperiosteal branches, and one to six fascio-periosteal arteries arising from the radial artery. A total of mean five osseous branches, and 12 cutaneous branches have been observed. The results of the present preclinical study suggested that a 16-cm bone stick could be harvested with an optimal vascular safety, without consideration for the morbidity at the donor site. The original approach in this study, relating anatomy to the preclinical imaging, allowed a precise visualization of the microvascularization of the soft and hard tissues. It opened a field of innovative research in plastic and reconstructive surgery.
Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale, 2013
Maxillofacial defects often affect various type of tissues and require reconstruction using compo... more Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. The mean age of the 10 patients was 60.2years. The average length of bone defect was 8cm. The average cutaneous defect area was 36.8cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no reconstruction failure. Three patients had mild speech disorders, five had moderate speech disorders, and two major speech disorders. Four patients had a normal food intake, three patients needed mixed food, and three patients liquid food. The indications of radial forearm osteofasciocutaneous free flap for complex maxillofacial reconstructions should be extended. Its vascularization is less compromised by arteritis. Its pedicle may be long and adequate for a contralateral anastomosis. It is reliable and easy to harvest. But the bone quality is not as good as fibula.
Revue de stomatologie, de chirurgie maxillo-faciale et de chirurgie orale, 2013
Maxillofacial defects often affect various type of tissues and require reconstruction using compo... more Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. The mean age of the 10 patients was 60.2years. The average length of bone defect was 8cm. The average cutaneous defect area was 36.8cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no re...
JPRAS Open, 2015
Introduction-High-energy trauma of the hand often causes tissue loss involving bone, tendon and s... more Introduction-High-energy trauma of the hand often causes tissue loss involving bone, tendon and skin and is sometimes accompanied by devascularization of digits. Bone stabilization is the first step in the management of such injuries. Materials and methods-A young patient presented composite tissue loss of the dorsum of his right (dominant) hand following an accident with a surface planer. Tissue loss involved the diaphyses of the first 4 metacarpals, tendons and skin with almost complete amputation of the 3rd finger. Bone stabilization comprised osteosynthesis using pins associated with cement to fill the bone defect. Hunter tendon rods were used for tendon repair and a pedicle groin flap (McGregor) was used to achieve skin coverage. The cement was replaced with autologous cortico-cancellous bone graft combined with bone paste (Nanostim) 3 months after the cement stabilization. Results-Eleven months after the accident, the patient was able to return to work as a carpenter. Pinch and Grasp strength in the injured hand were half that in the contralateral hand, but there was no loss of sensitivity. Mobility was very satisfactory with a Kapandji score of 9 and a mean TAM of 280°. The patient can write, open a bottle and does not feel limited for everyday activities. Radiographically, the bone of the 3 reconstructed metacarpals appears consolidated. Conclusion-The induced membrane technique allowed the reconstruction of small bone deficits in the long bones of the hand in a two-step procedure, the first step taking place in an emergency context of composite tissue trauma.
ZUNAECHST WIRD DISKUTIERT, WELCHE SPANNWEITE FUER DIE GESTALTUNG VON MISCHFLAECHEN BESTEHT. DURCH... more ZUNAECHST WIRD DISKUTIERT, WELCHE SPANNWEITE FUER DIE GESTALTUNG VON MISCHFLAECHEN BESTEHT. DURCH BEGLEITENDE UNTERSUCHUNGEN (EICHENAUER, V. WINNING, STREICHERT) IN UNTERHACHING, DAS MIT SEINEM DOERFLICHEN CHARAKTER ALLERDINGS NICHT ALS TYPISCHES PROBLEMGEBIET BEZEICHNET WERDEN KANN, WURDE IM VORHER-NACHHER-VERGLEICH ERMITTELT, WIE SICH DURCH DEN UMBAU ZU EINER MISCHFLAECHE STAERKE UND GESCHWINDIGKEIT VON KRAFTFAHRZEUG-, RAD- UND FUSSGAENGERSTROEMEN, GESPRAECHSINTENSITAETEN IM STRASSENRAUM, KINDERSPIEL UND LAERMINTENSITAETEN VERAENDERTEN. OFFENBAR SIND FUER MISCHFLAECHEN NACH WIE VOR DIE EINSATZGRENZEN, DIE VERTRETBAREN GESCHWINDIGKEITEN, DIE ZWECKMAESSIGE AUSDEHNUNG, DIE IM EINZELFALL ANZUWENDENDEN GESTALTUNGSREGELN UND DIE ZULAESSIGKEIT DES OEPNV UMSTRITTEN. VERF. BERICHTET SCHLIESSLICH UEBER DIE VERKEHRSBERUHIGENDEN MASSNAHMEN MIT BEIBEHALTUNG DES TRENNUNGSPRINZIPES IN DER NAEHE DES KLAUSENER PLATZES IN BERLIN-CHARLOTTENBURG, EINEM DICHT BEBAUTEN INNENSTADTNAHEN WOHNGEBIET (GFZ =...
Revue de stomatologie, de chirurgie maxillo-faciale et de chirurgie orale, 2013
Maxillofacial defects often affect various type of tissues and require reconstruction using compo... more Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. The mean age of the 10 patients was 60.2years. The average length of bone defect was 8cm. The average cutaneous defect area was 36.8cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no re...
Annales de Chirurgie Plastique Esthétique, 2014
Annales de Chirurgie Plastique Esthétique, 2014
The composite radial forearm flap is a surgical option in the reconstruction of large traumatic o... more The composite radial forearm flap is a surgical option in the reconstruction of large traumatic or oncologic orofacial defects. Nevertheless, it has been criticized for its poor bone transport faculties that would make this flap insufficient in large osseous mandibular reconstructions, or for oral prosthetic rehabilitation with dental implants. What is more, the morbidity of the donor site has often been pointed. The aim of this radioanatomic study was to revisit the vascularization of the composite radial forearm flap, focusing on the bone stick. A radioanatomic study was performed on seven upper limbs taken from fresh cadavers. First, the vessels were washed with a 40°C solution of potassium acetate. Then an intra-arterial injection of a mixture of lead oxide and agar-agar was performed. 3D-CT-scan examinations of the anatomical pieces were performed. In a second step, the flaps were harvested and analyzed with a Microscan examination (NanoSPECT-CT Bioscan(®), voxel 220 microns). Collateral branches of the radial artery to the bone and the skin were counted and classified. One radial diaphyseal artery was present in all the cases. The nutrient foramen took place at the anteromedial aspect of the diaphysis, between 45 and 65 % of the length of the bone. A dense anastomotic periosteal network was highlightened, supplied by one to four musculoperiosteal branches, and one to six fascio-periosteal arteries arising from the radial artery. A total of mean five osseous branches, and 12 cutaneous branches have been observed. The results of the present preclinical study suggested that a 16-cm bone stick could be harvested with an optimal vascular safety, without consideration for the morbidity at the donor site. The original approach in this study, relating anatomy to the preclinical imaging, allowed a precise visualization of the microvascularization of the soft and hard tissues. It opened a field of innovative research in plastic and reconstructive surgery.
Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale, 2013
Maxillofacial defects often affect various type of tissues and require reconstruction using compo... more Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. The mean age of the 10 patients was 60.2years. The average length of bone defect was 8cm. The average cutaneous defect area was 36.8cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no reconstruction failure. Three patients had mild speech disorders, five had moderate speech disorders, and two major speech disorders. Four patients had a normal food intake, three patients needed mixed food, and three patients liquid food. The indications of radial forearm osteofasciocutaneous free flap for complex maxillofacial reconstructions should be extended. Its vascularization is less compromised by arteritis. Its pedicle may be long and adequate for a contralateral anastomosis. It is reliable and easy to harvest. But the bone quality is not as good as fibula.
Revue de stomatologie, de chirurgie maxillo-faciale et de chirurgie orale, 2013
Maxillofacial defects often affect various type of tissues and require reconstruction using compo... more Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. The mean age of the 10 patients was 60.2years. The average length of bone defect was 8cm. The average cutaneous defect area was 36.8cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no re...