Breast Institute

Belfort, France

Breast Institute

Belfort, France
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Ayestaray B.,University Paris - Sud | Ayestaray B.,Breast Institute | Bekara F.,University Paris - Sud | Andreoletti J.-B.,Breast Institute
Aesthetic Plastic Surgery | Year: 2013

Background: Lip reconstruction may lead to disappointing results due to secondary deformity and visible scars. The Z-plasty in the Tennison technique is an effective method for repairing the upper lip subunits. The main issue is the visible and ungracious scar. Methods: A 38-year-old woman was treated for an upper lip deformity secondary to a dog bite injury. At 1 month after a direct suture, a scar contracture with a defect of Cupid's bow and a vermilion height deficiency occurred. A Tennison procedure was chosen to repair the deformity. A small-wave incision procedure also was considered to minimize visibility of the scar. These two techniques were coupled in a small-wave plasty. The small-wave plasty design was performed with a superior flap base (L1) of 7 mm and a circle arc of 10 mm. The superior height (H1) was 3 mm. The middle flap base (L2) was 4 mm, and the circle arc was 6 mm. The middle height (H2) was 2 mm. Results: The surgery time was 55 min with the patient under general anesthesia. The skin healing was completed in 10 days without scar contracture. The upper lip subunits were reconstructed with a regular Cupid's bow and a symmetric vermilion height. The scars were slightly visible at 1 month postoperatively. The results were stable after a follow-up period of 12 months. No revision was needed. Conclusion: The small-wave plasty, which couples a Tennison technique with a small-wave incision procedure, is efficient in reconstructing the subunits of the upper lip after a scar contracture deformity. This method should be used for upper lip reconstruction for minimal scar visibility. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2013 Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.


Ayestaray B.,University of Nimes | Bekara F.,University of Nimes | Andreoletti J.-B.,Breast Institute
Aesthetic Plastic Surgery | Year: 2013

The authors describe a vacuum-assisted skin grafting method to optimize graft take in the retroauricular region. This method is demonstrated after skin tumor resection of the retroauricular and mastoid areas. © 2012 Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.


Ayestaray B.,University of Nimes | Ayestaray B.,Breast Institute | Bekara F.,University of Nimes | Andreoletti J.-B.,Breast Institute
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Background: Head and neck lymphoedema secondary to jugular lymphadenectomy is a severe issue, without efficient solution. Successful treatment of lymphoedema of the upper and lower limbs has become possible with supermicrosurgical lymphaticovenular anastomosis. The technique based on two end-to-side anastomosis is named π-shaped lymphaticovenular anastomosis. We have evaluated this method for chronic head and neck lymphoedema. Methods: From November 2010 to April 2011, four patients with a chronic head and neck lymphoedema were treated by π-shaped lymphaticovenular anastomosis. Three patients had a unilateral lymphoedema, and one patient had a bilateral lymphoedema. The mean age of the patients was 63.2 years (range, 46-77 years). The mean duration of the lymphoedema was 2.6 years (range, 1-5). Every patient was operated under local anaesthesia through a face-lift skin incision. One π-shaped lymphaticovenular anastomosis was performed at each operative site. Results: The average operative time to perform one π-shaped lymphaticovenular anastomosis was 1.9 h (range, 1.8-2.5). The calibre of lymphatic vessels used for lymphaticovenular anastomosis ranged from 0.3 to 0.7 mm (average, 0.5). A venous back-flow was found in seven lymphaticovenular anastomosis (70%). Three patients (75%) had a qualitative improvement of skin tissue and a significant circumferential reduction after surgery. The average circumferential differential reduction rate was 3.7% (range, 0.6-7.8) (p = 0.006). The average cross-sectional area differential reduction rate was 7.2% (range, 1.2-15.1) (p = 0.007). The average volume differential reduction rate was 6.9% (range, 2-14.8) (p = 0.05). Conclusions: The authors present a new option to treat head and neck lymphoedema. π-Shaped lymphaticovenular anastomosis is an effective method to reduce the severity of skin tissue fibrosis and lymphoedema volume. Further studies with larger groups of patients are required to confirm the outcome of this preliminary study. EBM Level = level 4. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


Ayestaray B.,University of Nimes | Ayestaray B.,Breast Institute | Bekara F.,University of Nimes | Andreoletti J.-B.,Breast Institute
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Background: Lymphoedema supermicrosurgery is known to be difficult to perform. Lymphatic vessels are not easy to individualise, because of their small calibre (inferior to 1 mm) and their translucent appearance. Patent blue is an organic colourant, which is able to enhance the lymphatic network. We have evaluated the morbidity and the efficacy of patent blue lymphatic enhancement, with a view to perform lymphaticovenular anastomosis. Methods: From November 2010 to January 2012, 20 patients with chronic lymphoedema of the upper limb were treated by lymphaticovenular anastomosis. The mean age of the patients was 60.1 years (range, 47-78 years). The mean duration of lymphoedema was 3.2 years (range, 1-9 years). The mean volume of patent blue injected subdermally before surgery was 1.3 ml (range, 1-2 ml). The number and the calibre of enhanced lymphatic vessels at each operative site were noted. The quality of patent blue enhancement was analysed. The efficacy of surgery was assessed by quantitative measures. Results: The mean number of coloured lymphatic vessels per operative site was 2.1 (range, 1-4). The calibre of lymphatic vessels ranged from 0.3 to 0.8 mm (average, 0.57 mm). The quality of enhancement was moderate in two patients (8%), good in nine patients (36%) and excellent in 14 patients (56%). The mean number of lymphaticovenular anastomosis performed per operative site was 2.8 (range, 2-4). The mean operative time was 2.3 h (range, 2-3 h). No allergic (0%) and infectious (0%) reactions secondary to patent blue injection occurred. No secondary lymphangitis (0%) was noted. The delay of skin resorption of the blue stain ranges from 20 to 45 days (average, 30.3 days). Four patients (20%) had a remaining blue staining at the injection site. The average circumferential differential reduction rate was 13.2% (range, 4.2-27.2%) (p < 0.001). The average cross-sectional area differential reduction rate was 24.1% (range, 9.5-46.7%) (p < 0.001). The average volume differential reduction rate was 22.8% (range, 7.2-48.8%) (p < 0.001). Conclusions: Patent blue-enhanced lymphaticovenular anastomosis is a safe and effective technique to treat patients with secondary lymphoedema. Its ease of use, low cost and efficiency should make it used on a priority basis to perform lymphaticovenular anastomosis. © 2012 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

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