Biomedical subjects
Publications and source records attributed to E Delay.
Few papers have been published in the international literature on reconstruction of the shape of the shoulder stump after scapulothoracic amputation. The authors report a case of reconstruction using a solid silicone implant after prior skin expansion. The essential objective of this reconstruction is to eliminate the need for an external prosthesis, which constitutes a major handicap for these patients.
The objective of this study was to evaluate the osteogenic capacities of a vascularized periosteal flap reinforced by a bone substitute, coral, to validate the possibility of creating prefabricated bone flaps with shapes adapted to a recipient zone, while limiting the donor site sequelae. 24 periosteal flaps, with preserved vascular pedicles, were raised from the medial femoral epiphyses of 12 ewes. In the same animal, these flaps were reinforced with a cylinder of coral and a cylinder of autologous graft. After implantation for 2 or 8 weeks depending on the animal, the flaps were submitted to histopathological and histomorphometric examination. The results of this examination demonstrated a similar course of the flaps regardless of the type of reinforcement, both in terms of implant resorption and the quantity of newly formed bone.
Very deep burns of the arm and elbow lead to soft tissue necrosis and infection with exposure of important structures. Aggressive debridement should be performed as early as possible to cut the vicious circle, and the defect, which may be extensive, should be covered by well-vascularized tissues. The reliability and versatility of the pedicled latissimus dorsi muscle or musculocutaneous flap make it our first choice in the management of this problem. A retrospective study of three patients for whom salvage of the upper limb has been achieved by the use of a pedicled latissimus dorsi flap is presented, illustrating the advantages of this technique.
Burns raise difficult repair problems. Previously expanded full-thickness skin grafts represent a good solution in many situations. Based on their experience of 22 cases, the authors present a review of the various indications for this technique.
Surgical oncology requires an indispensable cultural and interdisciplinary approach of cancer. It needs a solid surgical formation combined with knowledges in biology, pathology, radiology, chemotherapy, and radiotherapy so oncologist surgeons are better able to define the limits of intervention according to the natural history of each type of tumors and the last modern therapeutic means.
Post-coitus vagina-bladder fistulas are rarely encountered although they may be favoured by radiosurgical treatment for cervical cancer. Treatment is particularly difficult. When initial epiploplasty is a failure, most authors recommend an ileocytoplasty with ad integrum reconstruction of the vaginal and of bladder function.
According to the criteria established by Cahan et al., we report 14 radiation induced sarcomas occurring in the treated volume after radiation therapy for adenocarcinoma of the breast. All these sarcomas were treated by wide surgical resection. In spite of a macroscopic free margin, only patients who underwent major amputation could hope to be cured. All the centrally located sarcomas recurred.
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The reconstruction of major inferior abdominal wall defects is a rare but difficult problem. We present five consecutive cases of reconstruction following major excision for the treatment of tumors (3 cases) and radionecrosis (2 cases). The immediate reconstruction was performed by fasciomyocutaneous flaps of the thigh, pedicled on the tensor fascia lata (4 cases) or the rectus femoris (1 case). The functional results of the abdominal reconstruction are good. The sequelae of the donor site are mainly aesthetic; the function of the thigh is not affected by the harvest. These two flaps are very reliable. The rectus femoris flap has muscle throughout the extent of the flap and may be preferred in contaminated wounds or postradiation ulcers. It also allows the midline to be reached more easily.
Full thickness chest wall reconstruction must restore a leak-free and semirigid chest wall that allows good respiratory function. We present five consecutive cases of chest wall reconstruction with skeletal frame reconstruction by an osteomusculocutaneous latissimus dorsi flap. This flap allows transfer of the 11th and 12th ribs. The chest wall resection was performed for chest wall sarcomas (four cases) and radionecrosis (one case). The functional results are good. The bone scan showed the good vitality of the transferred ribs. This flap has the advantages of an autologous vascularized bone transfer. It is a useful flap for large full thickness chest wall reconstructions that need a skeletal frame reconstruction.
Repair of all forms of alopecia is one of the principal applications of scalp expansion. The authors have inserted 400 expansion prostheses, including 20 in the scalp. The surgical technique, choice of material and various types of flaps are described and illustrated by clinical cases of extensive alopecia.
Burn scars of the lower part of the face are a difficult problem in plastic surgery. Full thickness skin graft or local flaps usually give poor cosmetic result. Over the last 5 years, we used 24 skin expanders in the neck area to cover burn scars of the chin and jaw. Discussion of the method and 4 cases are reported.
Plastic surgery has acquired an important place in primary breast cancer treatment (conservative or radical) and in the treatment of sequelae. The authors have tried to define, based on their experience, the contraindications for breast reconstruction. They are rare from a technical point of view. The carcinologic contraindications are relative: highly aggressive cancers, locally advanced cancers, cancers with metastases or recurrences. Radionecrosis and radio-induced sarcomas, treatment sequelae are also contraindications for breast reconstruction. General contraindications are relative (major obesity, smoking, diabetes, general weakness). Psychological contraindications must be taken into consideration. The authors conclude that contraindications for breast reconstruction are mainly carcinologic and the decision for reconstruction is usually taken by the patient after complete medical information.
The authors report a series of 16 patients with extensive burns partially treated by epidermal culture between May 1985 and July 1988. This series consisted of 9 males and 7 females between the ages of 6 and 88 years (mean age: 34 years). The mean surface area of the burns was 66% (range: 30% to 92%). The technique of epidermis culture used was derived from that developed by Green and Rheinwald. A fragment of full-thickness skin taken from the patient was subjected to the action of trypsin. The keratinocytes were cultured on nutrient layers of 3T3 cells. After 10 days, the secondary cultures corresponded to stratified squamous epithelium with a differentiation similar to that of normal human epithelium. This cultured epithelium was used for autografts as well as allografts. Three deaths were related to septic or metabolic complications of the burn. The take rate of the initial graft was greater than 50% in 9 patients. In 3 patients the graft take rate was less than 50% and in 4 patients it was nil. The long-term evaluation of 12 patients revealed partial lysis of the grafts in 3 patients, a stable result in 6 patients and a healed surface greater than the grafted surface in three cases. The best results were obtained with autografts. The initial evaluation of taking of the graft is difficult, as the fine and shiny texture of the grafts is sometimes difficult to distinguish from non-covered zones. The good tolerance of cultured epidermis allografts is due to the fact that they are devoid of Langerhans cells. Although controversial, the reality of the taking of these allografts opens the way to establishing epidermis culture banks.(ABSTRACT TRUNCATED AT 250 WORDS)