PubMed Health⌕ Search

Biomedical subjects

G Demers

Publications and source records attributed to G Demers.

At least 19 recordsLinked to original sources
PubMed2006

Free flap reconstruction in the treatment of tumors involving the hard palate.

AIM: To report our experience in free flap reconstruction of the hard palate after malignant tumor resection, in terms of reconstruction method, immediate post-operative course and subjective functional results. PATIENTS AND METHODS: Files from 1988 to 1999 were reviewed for patients having undergone microvascular reconstruction of the hard palate. The immediate post-operative course (during the first month) was reviewed to determine the occurrence of complications. The surgeon's evaluation 1 year post-operatively was used to determine the intelligibility of speech, type of diet and the quality of nasal permeability. RESULTS: Thirty eight patients (28 men and 10 women) with malignant tumors involving the hard palate had undergone surgical reconstruction using microvascular free flap techniques: free radial forearm flap (13 cases), scapular flap (24 cases) or fibular flap (five cases). Two different flaps were employed in two cases (scapula plus fibula). A second flap was used with success in two cases of failure of the first flap, for a total of 42 free flaps for 38 patients. Complications occurred in seven cases, with two cases of flap necrosis. At 1 year, 33 patients achieved a normal diet and 35 normal or easily intelligible speech. CONCLUSIONS: Microsurgical reconstruction using free tissue transfer allows reconstruction of large defects of the hard palate, with low morbidity and an excellent functional outcome. We propose criteria for free flap reconstruction and choice of flap.

Adult↗
PubMed1999

[Midface reconstruction with free flaps].

STUDY AIM: Midface is situated between the occlusal plane and the transverse midorbital plane. The aim of midface reconstruction is to restore the bony and soft tissue contour of the face, to obtain a rigid support for the velum, to allow oronasal separation, and to allow support for the orbit and obliteration of the maxillary sinus in order to restore the main functions: respiration, speech, deglutition, mastication, olfaction, vision. PATIENTS AND METHODS: Between 1988 and 1997, 65 patients with defects to the midface in relation with cancer (n = 60), gunshot (n = 3), or congenital malformation (n = 2), underwent reconstruction with one or more transplants: forearm (n = 21), latissimus dorsi (n = 23), scapula (n = 12), composed subscapula (n = 10), and fibula (n = 4). Forty-seven of the patients were men and 18 were women. The mean age was 56 years (12-90 years). In patients with cancer, tumoral resection was immediately followed by midface reconstruction in the last 43 cases. Free flaps were selected for reconstruction of each part of the midface: cheek, nose, orbit floor, maxillary and palate. RESULTS: One post-operative death occurred (1.5%). The morbidity rate (18.7%) included necrosis of the free flaps in four cases. Average resumption of oral intake was ten days. The mean time to discharge was 17 days. Aesthetic and functional results were rated good or excellent in 53 patients. After one year, 52 patients were alive. Oral intake was normal in 48 patients, and mixed in four. Speech was excellent or good in 49 patients. From amongst the patients, 80% were able to find a job. CONCLUSION: Free flaps with micro surgery provides an optimal, functional, morphological and aesthetic outcome. Patients with advanced cancer of the midface are best managed through a multidisciplinary team approach. Microsurgical reconstruction represents the technical state of the art in case of extensive and complex midface defect.

Adolescent↗
PubMed1999

Musculocutaneous flap of the transverse nasalis muscle in repair of nasal-tip skin carcinoma.

OBJECTIVE: Reconstructing a nasal tip when there is neoplastic involvement is difficult, owing to the nature of the skin, which is thick, adhesive, and not very flexible, and to the proximity of the lower rim of the nasa ala, which must be respected. Dissection of twenty injected anatomic preparations has shown the reliability of using the vascular pedicle of the musculocutaneous flap of the transverse nasalis muscle. The technique was used in ten patients with skin carcinoma of the nasal tip. Esthetic results are excellent since the nasal ala is respected. A double-flap procedure may also be used for median defects.

Aged↗
PubMed1999

[The myocutaneous flap of the nasal transverse muscle].

The reconstruction of the nasal tip give difficulties. The nasal myocutaneous flap seems a good solution. We have studied twenty fresh corpses after injection of coloured latex and barium. This flap and its vascular pedicle were constant. We describe the technique. We used this flap on thirteen patients. The indications are the cutaneous lesions of the middle of the nasal tip or the nostrils. The results are excellent because this flap respects the anatomical unit of the nose. The morphological and esthetical results are excellent.

Angiography↗
PubMed1997

[Rectus abdominis myocutaneous flaps].

The free transverse rectus abdominis myocutaneous (TRAM) flap is vascularized by the inferior epigastric pedicle. There are many techniques according to the indication. We describe the technique for breast reconstruction after mastectomy for cancer. The rectus muscle is taken between the umbilicus and the arcuate line. The skin paddle, was taken transversely like an abdominoplasty. The incision extends from 1 cm above the umbilicus to include the perforators around it. The mean length of the vascular epigastric pedicle is 6 cm. This study was performed from one hundred dissections.

Breast Neoplasms↗
PubMed1996

[Diffuse gastric angiomatosis. A clinical case. Review of the literature].

Stomach angiomatosis is a rare disease. We report an exceptional case of diffuse gastric angiomatosis complicated with severe bleeding; the patient underwent two operations for dramatic haemorrhage with shock. Selective arteriography provided the diagnosis. Total gastrectomy was performed in a third operation providing remission with a 3 year follow-up. The diagnosis of gastric angiomatosis is difficult and is essentially based on the fundamental selective angiography. Histology examination confirms the diagnosis and demonstrates vascular malformations. Cases reported in the literature are usually isolated cases: 47 angiomatoses of the stomach have been reported. Treatment is always surgical with gastrectomy providing complete remission. This case report demonstrates the need for a revision of the classifications of vascular tumours of the stomach.

Angiomatosis↗
PubMed1995

[Transformation techniques for the fibula of the mandible].

Free flaps from the fibula to rebuild the mandible have allowed for improved results in the reconstruction of this bone. We propose a new and more precise technique to further enhance the functional and esthetic reconstructive result. We base the planning for the free flap on specific measurements obtained on the cephalometric analysis. Preoperative angular determinations allow for more precise fibula osteotomies prior to transection of the donor vessels.

Cephalometry↗
PubMed1995

[Reconstruction by free jejunal transplant after circular pharyngolaryngectomy (functional results and survival)].

One hundred and ninety seven patients with cancer of the hypopharynx underwent after circular resection, reconstruction with a free jejunal graft. The quality of free jejunal grafts is controlled by many investigations: clinical examination, radiography, electromyography, fibroscopy with biopsy. These investigations show that technically jejunal grafts must be short and linear to give the best functional results. Average resumption of oral intake was 14 days. Oral feeding was possible in 92% of cases. The free jejunal grafts with microsurgery are one of the more reliable procedures for reconstruction of pharynx and cervical esophagus after resection for cancer. (2 post-operative deaths and 8 grafts necrosis on 197 cases). The cumulative survival rate of 5 years was 35% for free jejunal graft. Survival depends on selection of the patients for local and nodes invasion. The quality of survival has improved. This operation must be reserved for the hypopharyngeal cancers which need a circular resection and do not invade the esophagus. The surgery is performed for a curative aim. The distant follow up of the patients is imperative: consultation every four months and then every six months: clinical examination, endoscopic, E.N.T., bronchial, and esophageal investigation. Chemotherapy and radiotherapy have specific indications.

Adult↗
PubMed1994

[The subscapular combined free flap. Original technique].

Combinations of subscapular pediculated flaps have been used in recent years. These single pedicle flaps include the latissimus dorsi, the serratus, the scapular crest and the ortho and para-scapular skin flaps. Together these flaps comprise a combined subscapular transplant. This combined flap is particularly important since the different components provide great spatial flexibility. Complex and massive pluri-tissular substance losses can thus be reconstructed. We report our work in anatomy and techniques. We found variations in the origin of the subscapular pedicle in 25% of the cases in our anatomy study (50 cases). We recommend dissection of the vascular pedicle via the axillary route first. Thus necessary adaptations can be made as a function of the variations observed. This combined flap can be removed with the patient in supine position. The fact that the position of the patient does not have to change is essential for cervicofacial surgery performed by two teams. The pedicle of the cutaneous scapular flaps is dissected starting ventrally. Since 1990, we have performed 15 combined subscapular transplantations for cervicocephalic reconstructions.

Humans↗
PubMed1994

[Total esophagoplasty using a double pedicled free graft from the jejunum: the last resort].

After repeated failures of classic oesophagoplasties (gastroplasty and coloplasty) a last chance reconstruction could rely on a free jejunal transplant. We report an exceptional and original case where digestive tract was re-established between the orostoma and the epigastric antrum. The patient has four neoplasms in the throat, thoracic oesophagus. After circular pharyngolarynectomy and total oesophagectomy, all the usable vascularized plasties had necrosed. The ultimate reconstruction was performed with a free jejunal transplant carrying two vascular bundles revascularized with the cervical vessels and the internal thoracic vessels. Several recommendations are proposed: Save as much of the digestive tube as possible; preserve the physiological gastroduodenal circuit; redissect the residual plasty in order to raise the new one as high as possible; perform a sub-cutaneous insertion of the residual plasties and the jejunal transplant; and if the loss of digestive substance is greater than 30 cm, a long free jejunal transplant with two vascular bundles should be used.

Adult↗
PubMed1993

Anatomic basis of mandibular reconstruction by free vascularised fibular graft.

The free osteofasciocutaneous fibular transplant is a direct development of the free fibular bone graft used from 1983 in reconstructive surgery of the long bones. In 1989, Hidalgo was the first to publish a method of reconstruction of the mandible by composite free fibular transplants. The aim of this study was to specify the anatomy of the osteofascio-cutaneous fibular graft and particularly of the vessels to the skin. The sensory innervation of this transplant is described.

Fascia↗
PubMed1992

[Free myocutaneous flap of the latissimus dorsi in cervicofacial surgery].

Free myocutaneous latissimus dorsi transplants are exceptionally used in cervicofacial surgery. The authors have performed an anatomical study of 23 non-embalmed subjects, using injections of neoprene latex and barium sulfate into the axillary artery and dye injections. Dissections, arteriographs and corrosion show that the lower scapular pedicle is constant, with an average length of 9.5 cm and a caliber that is sufficient for vasuclar microsurgery. Eight patients with large T4 cervicocephalic neoplasms were operated, including two with tongue tumors, one with a tumor of the oropharynx, two oromandibular lesions, two lesions of the maxillary sinus and a neuroblastoma involving the middle level of the facial structures. A free myocutaneous latissimus dorsi transplant was used. The transplant was revascularised by neck vessels using microsurgical techniques. Complete success was obtained in all eight patients. Good functional, cosmetic and morphological results were obtained as a rule. In cervicofacial surgery, the authors have thus chosen and used a free myocutaneous latissimus dorsi transplant in three topographic indications: for the oropharynx, to fill large cavities, especially the maxillary sinus, and to fill the middle level of the facial structures and of the base of the skull.

Adult↗
PubMedDate not supplied

[Salvage esophagoplasty using free jejunal transplant after repeated failure of other esophagoplasties. 25 cases].

Salvage oesophagoplasty using a free jejunal transplant is the ultimate reconstruction possible after repeated failures using the classic procedures of oesophagoplasty. The free jejunal transplant appears to be the best choice. Twenty-five free jejunal transplants were performed by the same surgeon for such reconstructions including 13 cases involving benign lesions and 12 cases of cancer. There were no post-operative death and none of the transplantations was a complete failure although three cases of stenosis and fistulization occurred. Several recommendations can be made: save the existing digestive tract, redissect the residual digestive plasty and pull it up. The residual digestive flap can be examined by opacification or endoscopically in order to evaluate its length. An arteriography of the pediculated plasty gives information on its vascularization. A free jejunal graft can safely cover 25 to 30 cm. When possible, residual plasties should be positioned subcutaneously. The reconstruction of the cervico-thoracic oesophagus usually requires a vascular bypass with a saphene graft. In difficult cases, it may be necessary to remove a part of the sternal manubrium and the head of the clavicular bone in order to avoid compressing the jejunal graft. When the length of the reconstruction is greater than 30 cm, a long jejunal transplant with two pedicules (1 pedicule revascularized from the cervical vessels and the other pedicule from the internal thoracic vessels) is needed. An alternative technique would be a free antebrachial flap (six cases operated with two post-operative deaths at 6 weeks and two fistulas).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Tumors of the mandible. Justification of a second reconstruction after recurrence on the first revascularized bone graft].

The use of free vascularized bone grafts for mandibular reconstruction has led to a consideration of the new entity of recurrent tumour on bone grafts. Exeresis of the mandible was performed in 4 patients with bone tumours: osteosarcoma 1, osteochondroma 1, carcinoma 1 and ameloblastoma 1. A free vascularized bone graft was used for the reconstruction. Tumours recurred with a delay of 10 to 18 months after the initial reconstruction. The frequency of tumoural recurrence can be measured in our series of 46 patients (24 with fibular grafts, 15 with scapular grafts, 4 with radius grafts and 3 with iliac bone grafts). Recurrence rate at our institution was 4.3%. The 2 other cases involved patients from other institutions. The main factor involved in tumoural recurrence is the aggressive nature of the primary tumours, even after extensive initial resection as performed in our patients. Free bone grafts were invaded as were neighbouring tissues. Secondary reconstruction of the mandible was performed in 3 cases with a fibula graft. In the fourth patient, no operation was possible due to the diffuse nature of the invasion and the poor status of the patient's vessels and general health. Local extension, and not the tumour histology, is the main factor in deciding upon reoperation. The explosive nature of recurrences is linked more to the aggressive character of the tumour than to the status of the revascularized free bone graft. Secondary reconstruction is justified after recurrence on bone grafts depending on the complexity of the major resection involving extensive tissue exeresis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗