Service de chirurgie plastique

Saint-Pierre-du-Chemin, France

Service de chirurgie plastique

Saint-Pierre-du-Chemin, France
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Kerfant N.,Service de Chirurgie Plastique | Henry A.-S.,Clinique Spontini Brest | Hu W.,Clinique Spontini Brest | Marchac A.,Clinique Spontini Brest | Auclair E.,Clinique Spontini Brest
Plastic and Reconstructive Surgery | Year: 2017

Background: Composite breast augmentation with fat grafting and an implant has become very popular in the past 5 years. This achieves the core volume projection of an implant complemented by the natural appearance and feel of fat. However, no study has looked at the complications and reoperation rates of this technique. Methods: A retrospective chart review examined all patients who underwent the combined use of an implant and fat grafting for primary breast augmentation. Results: The study identified 156 patients between 2007 and 2013. The mean patient age was 31.7 years and the average body mass index was 18.85 kg/m2. The average implant size was 252 cc. Patients received a mean of 126 cc of fat (range, 30 to 250 cc) in subcutaneous soft tissue. Follow-up averaged 22.25 months (range, 1 to 86 months). The total complication rate was 7.7 percent and the reoperation rate was 9.94 percent. Baker grade II/III contracture was the most common complication [Baker grade II, n = 4 (2.56 percent); Baker grade III, n = 2 (2 percent)], followed by infections [n = 2 (1.28 percent)], hematoma [n = 2 (1.28 percent)], and malrotation [n = 1 (0.64 percent)]. Delayed reoperation was performed in nine patients (9.94 percent) after a mean interval of 31.7 months. Two patients who developed Baker grade III contractures needed surgery to correct the problem. Three cases (1.92 percent) required additional fat grafting for insufficient soft-tissue coverage. The mean volume of fat reinjection was 170 cc. Conclusions: Composite breast augmentation is a valuable, stable, reliable technique in breast aesthetic surgery with good, natural-appearing results. It provides long-term aesthetic benefits and avoids the submuscular plane. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Copyright © 2017 by the American Society of Plastic Surgeons.

Guinet V.,Service de chirurgie orthopedique et traumatologique | Cordier-Fuzeau C.,Center Hospitalier Of Dieppe | Auquit-Auckbur I.,Service de chirurgie plastique
Chirurgie de la Main | Year: 2013

The surgical management of the cubital tunnel syndrome has no strict rules to follow. Surgical treatments are various, but none of them has been shown to be superior to the others. This retrospective study presents the clinical results in 73 patients who underwent an anterior subcutaneous transposition of the ulnar nerve, between January 2000 and January 2010, with a minimum 3-year follow-up. Fifty-five patients were assessed with an average follow-up of 65.7 months. McGowan grading system as modified by Goldberg was used to analyse clinical results, preoperatively and at follow-up. The DASH score was used to assess physical function. The average preoperative evolution of symptoms was 16.7 months, and mean period to resolution was 4.7 months. The grade in McGowan grading system as modified by Goldberg significatively improved at follow-up (P= 0.0002). Only five patients kept paresthesia. The mean postoperative DASH score was 7.27/100. The satisfaction rate was 96%, and all the patients except one returned back to their occupation. There was neither infection nor complex regional pain syndrome. The anterior subcutaneous transposition leads to very good clinical results, satisfaction and physical function. It is an effective surgical method, without complication in our study, which gives long-term results. © 2013 Elsevier Masson SAS.

Dudrap E.,Service de chirurgie plastique | Bouhanna P.,rue Theodore de Banville
Annales de Chirurgie Plastique et Esthetique | Year: 2010

Subject: The eyebrow reconstruction should restore an eyebrow with a natural shape and with matching hair direction. Method: We describe the micrograft hair technique for eyebrow reconstruction, using either hair from the opposite eyebrow or hair from the scalp. We illustrate our technique with three clinical cases: a traumatic eyebrow injury, a burn scar and a progressive hair loss. Discussion: We insist on the advantages of this technique which is simple, " taylor-made" and which allows to choose the hair direction according to the eyebrow topography. The micrograft hair technique has many advantages in comparison with scalp strip grafting or hair-bearing island scalp flap techniques. Conclusion: The eyebrow reconstruction using micrograft hair technique is a simple effective technique offering a better cosmetic result than usual techniques by achieving a natural hair direction and density. © 2009 Elsevier Masson SAS.

Auxenfans C.,Banque de Tissus et Cellules | Lequeux C.,Banque de Tissus et Cellules | Perrusel E.,Banque de Tissus et Cellules | Mojallal A.,Service de Chirurgie Plastique | And 2 more authors.
Journal of Tissue Engineering and Regenerative Medicine | Year: 2012

Tissue-engineered autologous skin is a potential alternative to autograft for burn coverage, but produces poor clinical responses such as unsatisfactory graft intake due to insufficient vascularization. Endothelialized skin equivalents comprising human umbilical vein endothelial cells (HUVECs) survive significantly longer due to inosculation with the capillaries of the host, but these cells are allogeneic by definition. The aim of this study was to reconstruct an autologous endothelialized skin equivalent by incorporating progenitor or pre-differentiated endothelial cells derived from adipose tissue, easily accessible source for autologous transplantation. Human adipose tissue-derived stem cells were isolated from lipoaspirates and amplified to obtain endothelial progenitor cells, which were subsequently differentiated into endothelial cells. These cells were then seeded along with human fibroblasts into a porous collagen-glycosaminoglycan-chitosan scaffold to obtain an endothelialized dermal equivalent. Then, human keratinocytes give rise to a endothelialized skin equivalent. Immunohistochemistry and transmission electron microscopy results demonstrate the presence of capillary-like tubular structures in skin equivalents comprising pre-differentiated endothelial cells, but not endothelial progenitor cells. The former expressed both EN4 and von Willebrand factor, and Weibel-Palade bodies were detected in their cytoplasm. This study demonstrates that adipose tissue is an excellent source of autologous endothelial cells to reconstruct endothelialized tissue equivalents, and that pre-differentiation of stem cells is necessary to obtain vasculature in such models. © 2011 John Wiley & Sons, Ltd.

Meningaud J.-P.,Service de Chirurgie Plastique | Donsimoni J.-M.,Service de Chirurgie Plastique
Revue de Stomatologie et de Chirurgie Maxillo-Faciale | Year: 2012

The main objective of facial allografts is functional. On this account, oral rehabilitation is pivotal. Two types of cases are possible. Firstly, the indication of facial allograft concerns only the soft tissues. If so, dental care is similar to the one of patients with an organ transplant. Dental implants are a priori contraindicated. A possible indication has to be discussed with the multidisciplinary team. Secondly, the indication is the one of a mandibular and/or maxillary reconstruction. The objective will be a total reconstruction. It could be performed immediately with the allotransplantation of a toothed mandible or maxillar, if the local status permits it. To date, among patients who have benefited from a toothed allotransplant, no tooth has been lost. The first cases have been operated in 2009. If donor teeth cannot be conserved with the allotransplant, the oral rehabilitation will have to be done ideally with adjunctive prostheses. It is rarely possible, for example because of the lack of crests. In case of impossibility, an implant-based rehabilitation can be discussed. One case has been performed with basal implants (cortically anchored disk-design implants) with a five-year follow-up without loosing any loss of implant or infection. © 2012 Published by Elsevier Masson SAS.

Introduction: At the opposite of other surgery, there is no classification of postoperative complications in plastic surgery. We propose a new classification combining complications in six stages to facilitate the objective assessment and comparison of complications of plastic surgery techniques in the context of publications and practice assessment. Patients and methods: We have chosen to present a retrospective study of 16 cases of bodylifts made by the same surgeon and with the same procedure. The follow-up was scheduled with a reassessment at 1 month and 6 months. All postoperative complications have been identified (medical or surgical). Complications were presented in " classical" form, describing the number and nature of each complication. These results were then reorganized by stages according to the resulting consequences on patient management: stage 0: no complication; stage 1: prolonged hospitalization; stage 2: medical or surgical care beyond the period considered normal; stage 3: requiring surgical intervention; stage 4: major morbidity and stage 5: death of a patient. Results: First, the results are presented in a classical way describing the number and nature of each complication. Over 90% of patients had stage less or equal to 2 at 6 months. Fifty percent of patients (n= 8) had a long-term treatment or care (stage 2) after 6 months of evaluation. Discussion: The purpose of this classification is to enable an objective evaluation of surgical techniques. It shows the complications in terms of the consequences they generate on the management of the patient and not on the nature of each complication. Therefore, it shows that there is no real complication after bodylift but the immediate postoperative care must be longer. © 2009 Elsevier Masson SAS.

Guillou-Jamard M.-R.,Caen University Hospital Center | Labbe D.,Caen University Hospital Center | Bardot J.,Service de Chirurgie Plastique | Benateau H.,Caen University Hospital Center
Annals of Plastic Surgery | Year: 2011

AIMS:: Lagophthalmos is the major functional complication of facial paralysis because, in the absence of treatment, it can lead to corneal scarring and blindness. This disorder can be treated in a number of ways, including levator lengthening by aponeurosis interposition, a technique developed by Paul Tessier. We assessed the benefits of this technique, and compared the results to those with other techniques, in particular, the use of gold implants. MATERIALS AND Methods: A total of 29 patients were operated by the same surgeon using levator lengthening by aponeurosis interposition as described by Paul Tessier. Aesthetic and functional results were assessed according to predefined criteria during patient consultation at 1 year and by the patients themselves (questionnaire). We reviewed other surgical techniques used to treat lagophthalmos and compared findings with previous international studies. Discussion: The use of a gold plate implant remains the most widely used technique for the treatment of lagophthalmos. Although the functional results are good, the implant is always visible, leading to the disappearance of the superior palpebral fold and a risk of exposure and therefore of infection. Levator lengthening, a technique developed by Paul Tessier, allows identical functional results to be obtained, but conserves a natural appearance of the upper eyelid. It is a simple surgical procedure associated with a low morbidity rate. Conclusion: The lengthening of the levator by aponeurosis interposition is a simple, reliable, and easily reproducible technique allowing treatment of paralytic lagophthalmos with good results, in terms of both function and aesthetics. © 2011 by Lippincott Williams & Wilkins.

Gaudy-Marqueste C.,Service de Dermatologie | Perchenet A.-S.,Service de Chirurgie Plastique | Tasei A.-M.,Aix - Marseille University | Madjlessi N.,Service de Dermatologie | And 3 more authors.
Journal of the American Academy of Dermatology | Year: 2011

Background: Lentigo maligna (LM) and acral lentiginous melanoma (ALM) are often large and clinically ill defined. The surgical challenge is to spare tissue while still achieving clear margins. Objective: We sought to provide a retrospective assessment of a two-phase surgical technique for lentiginous melanomas (MM) not suitable for en bloc resection. Methods: In the first phase, a narrow band of skin, "the spaghetti", is resected just beyond the clinical outline of the MM, immediately sutured, and sent for pathological examination without removing the MM. The same procedure is repeated beyond the segments which are shown to be not tumor free and so forth until the minimal tumor-free perimeter is outlined. No operative wound is left between operative sessions. In the second phase, the MM resection and reconstruction are performed at the same time. Results: In 21 patients with LM (n = 16) or ALM (n = 5), the mean operative defect size was 27.5 cm 2 (range, 1.97-108.4 cm 2). The mean number of steps in the procedure was 1.55 (1-4). Grafts were used for reconstruction in all cases. The relevance of the "spaghetti"-defined outline was confirmed in 19 of 21 patients. After a median follow-up period of 25.36 months (range, 0-72 months), the local control rate was 95.24% with one case (4.76%) of in-transit invasive recurrence after 48 months. Limitations: This study was performed at a single center and included a limited number of patients. The follow-up time was relatively brief. Conclusion: The "spaghetti technique" is simple and reliable for LM and ALM. Unlike Mohs surgery, it does not require specific training of surgeons or pathologists. Unlike staged surgery, it does not leave patients with an open wound on the face or soles before final reconstruction. © 2009 by the American Academy of Dermatology, Inc.

Mathieu V.,CNRS Multiscale Modelling and Simulation Laboratory | Vayron R.,CNRS Multiscale Modelling and Simulation Laboratory | Richard G.,Septodont | Lambert G.,Septodont | And 3 more authors.
Journal of Biomechanics | Year: 2014

Dental implants are now widely used for the replacement of missing teeth in fully or partially edentulous patients and for cranial reconstructions. However, risks of failure, which may have dramatic consequences, are still experienced and remain difficult to anticipate. The stability of biomaterials inserted in bone tissue depends on multiscale phenomena of biomechanical (bone-implant interlocking) and of biological (mechanotransduction) natures. The objective of this review is to provide an overview of the biomechanical behavior of the bone-dental implant interface as a function of its environment by considering in silico, ex vivo and in vivo studies including animal models as well as clinical studies. The biomechanical determinants of osseointegration phenomena are related to bone remodeling in the vicinity of the implants (adaptation of the bone structure to accommodate the presence of a biomaterial). Aspects related to the description of the interface and to its space-time multiscale nature will first be reviewed. Then, the various approaches used in the literature to measure implant stability and the bone-implant interface properties in vitro and in vivo will be described. Quantitative ultrasound methods are promising because they are cheap, non invasive and because of their lower spatial resolution around the implant compared to other biomechanical approaches. © 2013 Elsevier Ltd.

Aktouf A.,Service de chirurgie plastique | Auquit-Auckbur I.,Service de chirurgie plastique | Coquerel-Beghin D.,Service de chirurgie plastique | Delpierre V.,Service de chirurgie plastique | Milliez P.-Y.,Service de chirurgie plastique
Annales de Chirurgie Plastique et Esthetique | Year: 2012

Background: Breast augmentation is one of the most frequent intervention in plastic surgery. In March 2010, the Afssaps has withdrawn from the market all the Poly Implant Prothèses (PIP) silicone implants, the authors report a retrospective study of 99 patients who had breast augmentation by PIP implants. The aims of this work are to evaluate the ruptures observed with these implants and to propose a management. Methods: We included in the study 99 patients and 192 silicone gel implants. The interventions were performed between 2005 and 2010. On 192 implants, 184 had a textured surface and eight a smooth one. According to the latest recommendations from the Afssaps, all patients had a clinical examination and an ultrasonography looking for rupture signs. MRI was performed in case of doubt. Results: We found 23 ruptured implants: 18 intracapsular and five extracapsular ruptures, involving 17 patients. We also found 28 patients with axillary lymphadenopathy and eight patients with locoregional silicone spread. Finally, we found that 35 patients had chronic breast pains. Conclusion: Given our results, it seems reasonable to withdraw all the PIP silicone breast implants. © 2012 Elsevier Masson SAS.

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