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F Duteille

Publications and source records attributed to F Duteille.

At least 19 recordsLinked to original sources
PubMed2006

[Anatomic study and clinical application of the skin paddle of the serratus anterior free flap].

SUBJECT: Several authors used musculocutaneous free flaps of serratus anterior. However, the localization and dimensions of its skin paddle are not clearly defined in the literature. Thus, we realized an anatomical study trying to prove the reality of this skin paddle and its localisation, before considering clinical applications. PATIENT AND METHODS: Twenty-six dissections on 13 fresh anatomical subjects were realized. The protocol consisted in catheterization the thoracic branch of the thoracodorsal artery to inject a mixture of iodized product and methylene blue. The results were obtained by direct measurement of the blue cutaneous area and by radiographic evaluation of the radiopaque area, compared to reproducible anatomical reference marks. RESULTS: Twenty-five dissections were interpretable with superposable results. The skin paddle was always located compared to the 5th, 6th and 7th ribs between the anterior axillary line and the mamelonnary line. The area of the skin paddle was 11,75 cm of length (10-14), 10,75 cm of width (9-12) and 125 cm(2) from surface (110-140). Then, we realized between January and December 2003 several clinical applications of this anatomical study. We report 12 cases of free flaps of serratus anterior with skin paddle for the monitoring of the flap (4 musculocutaneous, 5 osteo-musculo-cutaneous, 3 of fascia with skin paddle). CONCLUSION: This study comes to the support from the anatomical observations from Salmon, the per-operational observations of several authors and our own clinical experiment. It certifies the autonomy of cutaneous vascularization by branches resulting from the surface fascia of the muscle. It specifies the localization and dimensions of the skin paddle of the serratus anterior flap in its muscular, osteo-muscular or fascial form, which still increases its versatility of use.

Adolescent↗
PubMed2005

Cement burns: retrospective study of 18 cases and review of the literature.

SUBJECT: Cement is increasingly used in the construction industry, but the occurrence of cement burns is rarely reported. This retrospective study concerns patients treated for cement burns in our unit between 1997 and 2002. MATERIALS AND METHODS: Eighteen patients 18-64 years of age, treated previously in our unit for cement burns, were interviewed by telephone for evaluation. RESULTS: The mean time since treatment was 39 months. Burns were predominantly seen on the lower limbs, and a third occurred during an accident on the job. All deep burns were excised, and 16 patients received grafts. Mean hospital stay was 10 days, and mean sick leave 2 months. Our study indicated that all patients were poorly informed about cement-related risks. DISCUSSION: Surgical treatment of full-thickness cement burns at diagnosis enables rapid healing with a minimum of sequelae and reduces the high socioeconomic costs resulting from these lesions. CONCLUSION: This study indicates once again the need to improve preventive measures; which are very often inadequate because of lack of awareness of risks.

Adolescent↗
PubMed2005

A new experimental rat model of osteosarcoma established by intrafemoral tumor cell inoculation, useful for biology and therapy investigations.

Satisfactory experimental models for preclinical cancer studies must follow several criteria: (1) reproducibility of the method used to induce the tumor and (2) clinical, pathological and kinetic similarity with the corresponding human tumors. We developed a model of osteosarcoma locally induced by the intrafemoral injection of osteosarcoma (OSR) cells in Sprague-Dawley rats. This method yields nearly 80% of bone tumors at the injection site. These tumors double their volume fairly slowly (in approximately 20 days) and lung metastases occur in 96% of the animals. The OSR cell-induced tumor is characterized by a direct production of mineralized matrix by the tumor cells themselves, as revealed by histochemical analysis. The microarchitectural parameters which were quantified by a microscanner show an increased trabecular bone volume (+238%) when OSR cells were injected in the femur, as compared to controls injected with vehicle. Osteoblastic markers such as alkaline phosphatase, osteopontin, osteocalcin and bone sialoprotein were expressed by the tumor in vivo, whereas the initially injected OSR cells did not express some of these markers, suggesting that OSR cells reacquired an osteoblastic phenotype in a favorable environment. The clinical, radiological and histological data show that this model shares high similarities with the osteocondensing forms of osteosarcoma in humans.

Animals↗
PubMed2005

[The serratus anterior free flap in limb reconstruction. About 30 cases].

Between 2001 and 2003, 30 serratus anterior free flaps have been realized in our unit for reconstruction of lower limb. The flaps were indicated for repair of traumatic soft tissue defect in 19 cases, for chronic wound in six cases, for purpura fulminans in two cases, for pressure sore in one case and after tumor resection in 1 case. There were 29 patients: 25 males and four females. They ranged in age from 5 to 64 years. The size of the soft tissue defects ranged between 15 and 180 cm(2). Four different types of serratus anterior flaps were used: 20 muscle flaps ; four myocutaneous flaps ; five costo-osteomuscular flap ; one costo-osteomyocutaneous flap . In all cases we used osteo flap (8 th rib) in order to restore bone defect, which ranged from 9 to 15 cm. Necrosis occurred in two flaps because of venous thrombosis. The functional outcome was good for all patients and the aesthetic sequelae at the donor site were considered as minor. The serratus anterior flap can be used in many different ways: different kinds of flaps (osteo-cutaneous-muscle); very variable size of flap (15 to 180 cm(2) in our series) , different length of pedicle possible. Because of his versatility and his absence of major functional or aesthetic sequelae the serratus anterior free flap has become day by day our favourite option in limb reconstruction.

Adolescent↗
PubMed2005

[The orbitonasolabial flap. Anatomical and clinical study].

How to use the orbitonasolabial flap in vascular island thanks to his pedicle based an angular vessel. An anatomic study based on 11 cadavers allows to check the existence of a constant pedicle. This flap was used on 6 patients aged 62 to 90 years old on an average period of 16 months to fill up jugular, orbital, nasolabial and inner canthal defects. Two complications have occurred, a superficial necrosis of the lower part of the flap having spontaneously healed and an ectropion on a senile part. It has been necessary to degrease a second time in 50% of the cases. Nevertheless, the flap can be considered reliable and able to cover tissue defect in the central facial region with minor aesthetic and functional sequel on the donor site.

Aged↗
PubMed2004

[The "vessel case flap". About one case in the lower limb].

The authors report an atypical case of lower limb repair in a 69-year-old patient, who presented a closed fracture of the tibia initially fastened with a plate. Skin necrosis developed after osteosynthesis, exposing the plate and the fracture bone. Because of the vascular state of the patient (smoking, arteritis, diabetes), any microsurgical procedure seemed likely to fail. The incisions previously performed contraindicated any form of pedicle flap in the leg area. An original solution was then proposed, involving the long extensor muscle of the great toe pedicled proximally on the anterior tibial artery. After six months of follow-up, healing and bone consolidation have been achieved. The interest of this exceptional technique is considered with respect to therapeutic choices for lower limb repair.

Aged↗
PubMed2004

[Anatomical study of the nerve supply of the trapeziometacarpal joint. Fifteen dissections].

PURPOSE OF THE STUDY: When the radiological signs are minimal in patients with a painful carpal syndrome involving the trapeziometacarpal joint (TMCJ), selective articular denervation can be proposed as an alternative after failure of conservative treatment. Results have been variable, sometimes disappointing, suggesting the anatomic basis of denervation should be revisited. The purpose of this work was to study the nerve supply to the TMCJ in order to acquire the indispensable elements necessary for performing effective selective articular denervation. MATERIAL AND METHODS: This anatomical study was performed by dissection under magnification (4.5-x350) of 15 upper limb cadaver specimens. The median nerve, its thenar and volar cutaneous branches and the terminal sensorial branches of the radial nerve were dissected. Articular branches to the TMCJ were carefully identified. Histological samples were taken to verify the neurological nature of the elements dissected. RESULTS: All TMCJs dissected exhibited radial and median nerve supply. Branches of the median nerve predominated in number and caliber. The volar cutaneous branch gave rise to articular branches in eleven dissections and the thenar branch gave rise to articular branches via a retrograde arciform trajectory between the short abductor and the opponens digiti pollicis in thirteen. For five dissections, the TMCJ branches arose directly from the median nerve within the carpal tunnel. At histological analysis the dissected elements were identified as nerves. DISCUSSION: There have been few anatomic studies concerning the nerve supply of the TMCJ. Unlike the findings reported by Cozzi in 1960, we did not find the dorsal sensorial branch of the radial nerve to play an exclusive or preponderant role in the innervation of the TMCJ. The median nerve supply to the TMCJ appeared to be more significant, particularly for the volar cutaneous and especially thenar branches. CONCLUSION: Total and definitive selective denervation of the TMCJ appears to be a most difficult procedure which would require a very wide access and extensive dissection, including the thenar branch which would raise the risk of significant complications.

Cadaver↗
PubMed2003

[Free flap for soft tissue loss of the limbs in trauma victims].

PURPOSE OF STUDY: We report a series of 67 free flaps performed between 1995 and 2001 for soft tissue loss of the limbs in trauma victims. We searched for elements predictive of failure in order to better identify indications. MATERIAL AND METHODS: The series was predominantly masculine (52 men, 15 women). Mean age was 38.7 years (range 18-63). Thirty-four free flaps were performed on the upper limb and 33 on the lower limb. Trauma was caused by: direct crush with or without bone injury (n=23), burns (n=10), stripping (n=5), complications of open fractures (n=29). The free flaps were performed on day 0 (day of trauma) (n=7), on day 1 or 2 (n=5), from day 3 to 7 (n=12), and from day 8 to 31 (n=43). RESULTS: There were 19 complications: hematoma (n=2), infection (n=1), vascular problem (n=16), and 7 flaps were lost (10.4%). Logistic regression analysis demonstrated that the type of trauma and vascular complications were determinant factors predictive of failure. Conversely, the limb (upper versus lower), side, gender, age, or time from trauma to flap were not found to influence chances of success. DISCUSSION: Our series demonstrated that free flap repair performed in a trauma context for loss of soft tissues of the limbs is a relatively reliable surgical technique since the rate of success is similar to that reported for pediculated flaps. The usefulness of free flaps in the trauma setting is thus demonstrated, but the most appropriate modality remains to be determined. Many authors point out the importance of early cover to limit the risk of complications (osteitis, delayed bone healing). Others have not found this factor to be determinant. In everyday practice, emergency cover is not always possible and the question is whether a flap can be successful if performed late after the initial trauma. Our study demonstrates that the chances of success of a free flap are equivalent when performed early or late after trauma. CONCLUSION: Free flaps play an important role in achieving cover of tissue loss of the limbs. The type of trauma appeared to be the only factor predictive of failure.

Adolescent↗
PubMed2002

[Injuries of the first web. Surgical indications].

Treatment of the first web injuries are based on the concept of one stage repair of the complex injuries of the hand with early motion. Radical debridement is specially important in case of muscular attrition. Fasciotomie of the first web is systematic in case of crush injuries for avoiding compartimental syndrome. For prevention of first web retraction, one or two Kirchner wires are placed in emergency between first and second metacarpal, and later a spilt in maximal anti-position of the first ray. In case of communited fractures, skeletal stabilisation use inlay internal devices, such the blocked intramedullary nail. First web reconstruction must take into consideration the cutaneous functionnal units of the hand, described by Michon. Thin and split-thickness grafts are rarely used for covering skin defects of the first web space, because their ability of retraction. Exposition of bone or tendons leads to the realisation of a flap. Soft tissue coverage must be achieved in emergency or after a second look within the first 48 hours. The kite flap is the most useful local flap for the first web space. The interosseous flap is the best choice among the regional pedicled flap. The use of the Chinese flap must be very careful, because the possibility of contusion of the radial pedicle in these types of injuries. It is only in case of contra-indication of the interosseous flap that free flaps can be realised, as the lateral arm flap or the parascapular flap. The groin flap keeps few indications for aesthetic reasons, or when regional flaps and microsurgery are contra-indicated.

Bone Nails↗
PubMed2002

[Four bone versus capito-lunate limited carpal fusion. Report of 40 cases].

Fourty patients with limited carpal fusion have been retrospectively reviewed. The aim of this study was to compare the results of four bone fusions (30 wrists) versus capitolunate fusion (11 wrists). Follow-up averaged 30 months with a range of 15-96 months. Twelve patients presented SLAC-wrist (scapho-lunate advanced collapse) and fourteen with SNAC-wrist (sapho-non union advanced collapse). There were seven cases of primitive wrist arthritis, one mid-carpal instability, one sequella of Fenton's syndrome, one Preiser's disease and two Kienbock's disease. All 40 patients were evaluated by the same observer. In terms of range of motion, the capito-lunate fusion led to better results than the four bone fusions with a gain of 10 degrees in volar flexion and 12 degrees in radial deviation. Results in term of post operative pain are similar in the two groups of patients with 90% painless wrist in four bone fusion and 81% with capito-lunate fusion. Results for strength were equivalent. Radiological bone fusion was obtained within nine weeks. Absence of fusion was observed in two patients with capito-lunate fusion. Our result in terms of joint motion and strength are similar to those found in the literature. Correction or not of the DISI deformity during the procedure did not affect the results (on 19 patients). The Four bone fusion procedure is still a good treatment in SLAC or SNAC wrist. Capito-lunate fusion remains a good choice, despite the risk of non-fusion.

Adult↗
PubMed2001

Use of osteocutaneous "double-barrel fibular flaps" in limb reconstruction: four clinical cases.

The use of a vascularized fibular transfer is a technique used for the reconstruction of large defects in long bones. A technical variation that consists of osteotomizing the transplant, giving two distinct segments, is adapted in the reconstruction of long bones with a large diameter, in particular, the femur or the proximal tibia. The results obtained using this technique in four clinical cases are presented here. The length of the bone defects was between 7.5 and 11 cm. There were two cases involving the tibia, one case the distal humerus, and one case the pelvis.

Adolescent↗
PubMed2001

A comparative clinical and electromyographic study of median and ulnar nerve injuries at the wrist in children and adults.

The outcome of 38 median and ulnar nerve injuries at the wrist in 15 adults and 15 children were studied with a follow-up of at least 1 year. Each patient was assessed clinically and with nerve conduction studies. The results confirm a markedly superior sensory recovery in children. However the children had persistent motor deficiencies. This difference in the clinical results of adults and children was not reflected in the nerve conduction results which were similar in both groups.

Adolescent↗
PubMed2001

A comparison between clinical results and electromyographic analysis after median or ulnar nerve injuries in children's wrists.

The purpose of this study was to analyze the results of median or ulnar nerve transections to the wrist in 14 children between 1994 and 1999. On sustaining their injury, all patients underwent treatment at the University Hospital of Nancy. They were all seen afterward for clinical and electromyographic evaluations. The clinical examination was mainly to judge the quality of sensory recovery, using the Weber and Dellon tests, as well as motor recovery. Electromyographic examination of the motor and sensory tissues was carried out systematically on each patient. The analysis of these results highlights discordance between the quality of the clinical results and nerve regrowth identified via electromyography. Good nerve regrowth does not necessarily mean a good sensory recovery.

Adolescent↗
PubMed2001

[Antecubital flap: advantages in elbow coverage. An anatomical study and experience of five clinical cases].

The antecubital flap is a fasciocutaneous strip that has its blood supply provided by the first proximal collateral of the radial artery. This flap was described for the first time in 1983 by Lamberty and Cormack, but it has not been widely used and there have been only a few reports in the literature concerning this procedure. The aim of the present investigation was to demonstrate via an anatomical study and a report on five cases the viability of the various anatomical features of this cutaneous flap, and also its positive contribution to elbow reconstruction. The anatomical study involved eight fresh cadavers (eight upper limbs). An injection of colored prevulcanized latex was made in the humeral artery in the lower third of the arm. The aim was to determine which artery provided blood supply to the flap, its anatomical location, and also to look for possible distal anastomoses which would permit a distal pedicled flap to be removed. Contrary to the findings of other authors, in the present study it was found that the vessel providing blood to the antecubital flap always branched off from the radial artery. However, no anastomoses with distal vascularization were detected, which would have permitted a distal pedicled flap to be obtained. The use of the antecubital flap for elbow coverage was then illustrated by five clinical cases of soft tissue defects of the elbow. This method was found to be reliable, practical, and the flap could be rapidly dissected. Moreover, this particular technique is sensitive, and has an interesting rotational arc. The distal cutaneous island flap has the advantage of limiting scar tissue. A comparison between the antecubital flap and other pedicled flaps has then been made. In conclusion, it appears that this little-known procedure has definite advantages, and that it should be included in the range of surgical techniques that are available for soft tissue reconstruction in the case of elbow defects.

Adult↗
PubMed2001

[Comminutive fracture of the trapezium treated by ligamentotaxis. A case report].

We report a case of trapezium fracture treated by continuous traction. The fracture involved the trapezium alone and was associated with scapho-trapezium subluxation. Three percutaneously inserted pins were used for traction, one scapho-capitate pin and two pins in the first and second metacarpal bones. This allowed distraction of the entire first row. Good anatomic reconstruction of the trapezium was evidenced radiographically. The functional outcome was quite satisfactory with mobility strictly the same as the healthy side and complete pain relief.

Accidents, Occupational↗
PubMed2000

[Malignant melanoma in the child: an uncommon illness].

BACKGROUND: Malignant melanoma are uncommon in children and are sometimes difficult to distinguish from Spitz nevi. Histological diagnosis is particularly difficult. CASE REPORT: Three prepuberty children (aged 14, 10 and 14 years) underwent excision of suspicious nevi found at pathology examination to be malignant melanomas. After complementary treatment the recurrence-free survival has been 18, 14 and 4 years respectively. DISCUSSION: Clinical signs of malignant melanomas are unspecific. As in adults, any modification in a melanic lesion should led to excision and pathology examination. In the literature, there is often a confusion between malignant melanoma developing in children and young adults making it difficult to determine the prognosis of the childhood disease. Prognosis of cutaneous malignant melanomas is generally good (excluding giant nevi and congenital malignant melanoma).

Adolescent↗
PubMed2000

Transplantation of the proximal fibula based on the anterior tibial artery. Anatomical study and clinical application.

The purpose of this study was to investigate the feasibility of microvascular transplantation, based on the anterior tibial artery, of the epiphysis and the proximal half of the diaphysis of the fibula. India ink injections into the anterior tibial artery were performed in 13 unembalmed adult cadavers, following which transverse frozen sections were taken. Dye was observed in the fibula, both within the intramedullary cavity and at the level of the periosteum, in all specimens. The average distal limit reached by the dye, measured from the tip of the epiphysis, was 10.4 cm in the intramedullary cavity and 11.8 cm in the periosteum. Based on these anatomical findings one case of humeral reconstruction has been performed with a fibular transplant, including both the epiphysis and a segment of diaphysis, vascularized solely by the anterior tibial artery.

Adult↗