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A Mojallal

Publications and source records attributed to A Mojallal.

8 recordsLinked to original sources

[Scientific bases of fat transfer. Critical review of the literature].

Fat grafting is an old technique. Since its first description in 1893, fat was used in a lot of indications. After more then a century of evolution, there is still no commonly accepted standard method of fat transfer by all the authors. On the contrary, many different techniques have been described in the literature with the only aim of reducing resorption of the transferred fat. Today the main inconvenient of fat grafting remains the partial resorption the transferred tissue. After a review of the literature of the various technique of fat transfer presented according to their chronology in the operative procedure, we have observed that the techniques developed by certain authors are the opposite of the techniques developed by others. This shows the lack of rigorous work concerning the fat transfer. Whether they are experimental or clinical, in most of these studies, we can find at least one skew which could have influence the results and the conclusion of these studies. A critical revue of the literature offers the opportunity to reconsider the actual bases of fat transfer. The use of an objective way of quantifying the volumes in clinical practice could permit the comparison of different studies in the future.

Adipose Tissue↗

[Reduction mammaplasty using superior pedicle in macromastia].

SUBJECT: The authors present technical details, complications, morphologic and aesthetic results of 26 breast reduction mammaplasty for macromastia (breast reduction more than 1000 g) showing advantages and reliability of technique. MATERIALS AND METHODS: From January 2000 to December 2001, 223 patients underwent bilateral reduction mammaplasty with superior-based pedicled dermo-glandular flap. In 26 of them the weight of removed mammary tissue was over 1000 g in each breast. These 26 cases were evaluated, and the criteria adopted to analyse the results was morphologic and aesthetic evaluation of patient herself (very good, good, acceptable, unacceptable). RESULTS: Mean follow-up for all patients was 15 months. Twenty-six patients (mean age 33.2 years) underwent an average weight of 1131 g (930/2200 g) removed per breast. The following complications were observed: 1 Nipple Areolar Complex ischemia without necrosis; three infections (abscess); four delayed wound closure. The patient subjective evaluation of result was: "very good" in 19 cases (73%); "good" in 5 cases (19.2%) and "acceptable" in the others two cases (7.8%). No case was evaluated "unacceptable". CONCLUSION: Superior dermoglandular pedicle mammaplasty represent a very good and reliable solution for the treatment of macromastia, giving satisfactory cosmetics results with good nipple viability without necrosis. This technique is actually our first choice in the management of macromastia.

Adolescent↗

[Severe hand burns and flaps: indications].

Deep hand burns often leads to major deformities, involving cosmetic and functional disease as scar contracture, stiffness, or even amputation. Early surgical treatment and rehabilitation are always challenging but crucial in order to prevent burn sequelae. When tendinous, osseous, nervous or vascular component are involved, even hand vitality is engaged: cutaneous, fasciocutaneous, muscular or musculocutaneous flaps are then the only way of salvage for the hand. The purpose of this surgery is the early covering of essential components, allowing early rehabilitation and mobilisation. The problem remains the choice of surgical covering, according to the site, size, and depth of the burn, and local reliable opportunities. Care must be taken to preserve surgical ways for final sequela reconstruction.

Burns↗

[Donor site morbidity after free fibula flap. Report of 42 consecutive cases].

Donor site morbidity after free fibula flap was assessed in 42 patients, 37 of whom had undergone mandibular reconstruction and five proximal humerus. Lower limb reconstructions were excluded. The study comprised functional assessment with two international orthopaedic scales (Karlsson and Kitaoka); comparative lower limb clinical and X-ray assessment. Mean Karlsson score was 90.4/100 with 52% of excellent, 36% of good, and 12% of medium results. Mean Kitaoka score was 93.7/100 with 64% of excellent, and 36% of good results. Fifty-two percent of patients were pain free, 29% had pain on walking on uneven terrain, and 19% occasionally; 7% experienced instability. For 76%, physical activity was unrestricted. Clinical examination found no alteration in hindfoot axis, no joint laxity, mild and acceptable reduction in hallux plantar flexion power in 76% cases, and superficial fibular nerve hypoesthesia in 5% of cases. Methodology and results are detailed and compared to the literature. In conclusion, we found only slight morbidity and free fibula flap remains our first choice as bone flap.

Adolescent↗

[Historical review of the use of adipose tissue transfer in plastic and reconstructive surgery].

Use of adipose tissue transfer in plastic and reconstructive surgery is not new, and has been the subject of numerous studies. Transfer of autologous adipose tissue was reported for the first time at the end of the 19th century. Ideas and techniques have greatly changed during the last century. Adipocyte transfer has attracted renewed interest in recent years, due in particular to the development of Lipostructure by Coleman, who introduced a procedure based on strict methodology and the use of specific material. The history of adipose tissue transfer is retraced through the works of various authors and briefly recounted by highlighting the major landmarks of its advance. The evolution of ideas and techniques can be divided into three periods. The period before the introduction of lipoaspiration was termed "open surgery", when adipose tissue was harvested by surgical excision. The next period is that following the discovery of lipoaspiration, called the "unrefined" period, during which adipose tissue was obtained by aspiration and reinjected without preparation. During the third period, following the works of Coleman, the adipose tissue now undergoes non-traumatic refinement before grafting; this period is called "non-traumatic refined". Various studies have shown that this technique causes little damage to the cells and have demonstrated survival of the tissue transferred. Discovery of the developmental capacities of the various lineages from a mesodermal stem cell, and in vitro culture of these cells, opens up new research perspectives and clinical applications. From this precursor cell, adipocytes, osteoblasts, chondrocytes, myocytes and neurone-like cells can be developed. The future of autologous reconstruction appears promising.

Adipocytes↗

[The effect of different factors on the survival of transplanted adipocytes].

Most authors supported the theory of adipocyte survival. The viability of these cells has been demonstrated by various experimental clinical, radiological and biochemical studies. After a review of the literature, the authors report the various factors, which influence the survival of the transplanted adipocytes. These factors are presented according to their chronology in the operative procedure. The techniques used are very diverse. The reference technique chosen is that described by Coleman (Lipostructure). The following factors are studied: type of anaesthesia, infiltration, donor site of adipose tissue, method of harvesting, method of refining adipose tissue, anabolic complements, receiving site, reinjection technique, number of grafting sessions, freezing of adipose tissue and complementary postoperative treatments. It seems imperative that each phase of the operative procedure should be carried out without damage to the adipocytes, in particular their harvesting, refining and reinjection. All the other factors studied require comparative analysis in order to demonstrate their true importance. This opens up various directions of research aiming to improve the survival of the transplanted adipocytes.

Adipocytes↗

[Clinical evaluation of structural fat tissue graft (Lipostructure) in volumetric facial restoration with face-lift. About 100 cases].

INTRODUCTION: Adipose tissue has been used for volume restoration for over a century. Coleman's Lipostructure is a recent procedure for adipocyte transfer, based on strict methodology and the use of specific material. Our aim in this work is to provide an answer to several questions: what is the place of this technique in the restoration of facial volumes? Do aesthetic subunits have an impact on the result? MATERIAL AND METHODS: This retrospective study concerned 100 patients who had undergone volumetric facial restoration with face-lift and Lipostructure. A five-member jury carried out subjective evaluation through a questionnaire sent to the patients, and objective evaluation by assessment of pre- and postoperative photographs. RESULTS: Mean time since surgery was 15 months. Overall patient satisfaction was 82% with a mean score of 15/20 on subjective evaluation and of 13.3/20 on objective evaluation. The results differed significantly according to the facial aesthetic subunit involved, the best results being obtained in the malar region and the cheek, and the least satisfactory in the upper and lower lips. This technique has few drawbacks. Prolonged oedema is the only complication (8%). CONCLUSION: We consider that at the present time Lipostructure is the best means of restoring facial volume. It is a simple, effective and reproducible technique. Its application in all fields of plastic surgery is an essential adjunct to our specialty.

Adipose Tissue↗

[Surgical management of cutaneous necrosis in the purpura fulminans: report of 2 clinical cases].

The authors report their experience of the management of 2 patients with purpura fulminans. After a review of the epidemiology, diagnostic methods, natural course and prognosis of the disease, the various stages of the treatment are described. The urgency of the medical treatment is stressed and the specific technique of the surgical approach to the artificial dermis is detailed. The quality of initial management is of crucial importance and such extensive and deep cutaneous destruction is best dealt in burn centers.

Adolescent↗