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Saint-Pierre-du-Chemin, France

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.

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.

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.

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.

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