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J L Cariou

Publications and source records attributed to J L Cariou.

At least 19 recordsLinked to original sources
PubMed2001

[Vascularized bone grafts in the treatment of hemifacial microsomia].

A systematic and theoretic review is performed on the vascularised bone donor sites that may be useful in the case of hemifacial microsomia. A review of the literature reveals that the iliac crest and the scapula are the most commonly used vascularised bone grafts. A case study is included in the paper, showing an hemifacial microsomia reconstruction using a composite fibular vascularised bone graft. They highlight the criterias they think fundamental for choosing the vascularised bone graft donor site regarding the aims of the reconstruction of a Pruzansky grade II or III.

Adult↗
PubMed2001

[Postoperative monitoring of free fibular grafts by dynamic magnetic resonance imaging. Preliminary results in three cases of mandibular reconstruction].

The vascularized free fibular graft has been used in mandibular reconstructive surgery since 1975. This technique has been progressively developed, and it is now the procedure of choice for mandibular reconstruction although in certain postoperative circumstances it can be difficult if not impossible to monitor bone vitality. However, bone vascularization can be detected by dynamic magnetic resonance imaging (MRI), as this technique has been experimentally and clinically validated in the early diagnosis of osteonecrosis. The aim of this study was to evaluate the efficacy of MRI for the postoperative monitoring of vascularized free fibular grafts in human mandibular reconstruction. Dynamic contrast-enhanced MRI was used to study the variation in contrast over time following injection of gadolinium contrast medium, and to evaluate the degree of bone marrow perfusion of the fibular graft. This variation in signal intensity was visualized in the form of a curve, i.e., a perfusion curve for the bone marrow region. An examination was performed in three patients at different postoperative times and under different conditions. In one case, MRI confirmed the presence of fibula blood supply in spite of the necrosis of the adjacent fascio-adipose layer. In this article, the methodological difficulties have been discussed, particularly as regards data processing, and the present results have been compared with the findings in the literature. Dynamic MRI is a simple, reliable, non-invasive technique and its use in the postoperative monitoring of bone marrow perfusion and vascularized free fibular grafts permits a determination of the status of the latter following surgery, i.e., whether there is an adequate blood supply or not.

Aged↗
PubMed2000

[Bone vascularization. Anatomic and physiological considerations, surgical deductions concerning osteosynthesis procedures and vascularized bone graft].

The authors report some general considerations concerning the bony anatomy and the bone blood flow. They describe the vascularization of the long bones involving arteries, veins, capillaries and lymphatic vessels. The double systemic and local control of the bone blood flow is evaluated. The local factors are numerous: autoregulation, nervous regulation as well as humoral, metabolic and cellular factors. Some surgical deductions are then discussed concerning osteosynthesis procedures and biomechanical properties of vascularized bone grafts.

Bone Transplantation↗
PubMed2000

[The peroneal or fibular free flaps. Surgical anatomy, operative procedures and indications].

The microsurgical story of the fibula began 25 years ago. The author reports on the vascular anatomy of the fibular free flaps, particularly the osseous, cutaneous and muscular branches of the fibular artery and their variations. This surgical anatomy explains the various osseous and composite flaps that can be harvested on the fibular vessels. The fibular flaps harvested on the anterior tibial vessels are used less often. The surgical procedure is explained about the typical osteocutaneous peroneal flap and the many other variations. The indications and results are discussed according to the international literature and the author's experience: 42 mandibular, 12 tibial, ten femoral, three radial, two humeral and one nasomaxillary reconstructions. The aetiological and topographical particularities, various abilities of the fibular donor site, preoperative strategy, bone implantation and contention, vascular anastomosis and delays of consolidation are analysed for each recipient site. The advantages and disadvantages of these fibular flaps are then discussed. Finally, the present and future associated procedures are evoked.

Bone Transplantation↗
PubMed2000

[Reconstruction of post-traumatic diaphyseal bone loss by segmental bone transfer].

Until the beginning of the 1980s, reconstruction of major post-traumatic diaphyseal bone loss as an alternative to amputation was possible only by massive autologous bone grafts. Such a technique was limited by the amount of available bone required for grafting. Ilizarov explained the distraction osteogenesis principle and designed a circular external fixation material that was suitable for compression-extension. He described the concept of segmental bone transfer, which allows bone regeneration to take place within the actual injured limb. Our present experience is based on the literature and the study of 12 cases. All patients presented with significant post-traumatic tibial bone loss ranging from 45 to 145 mm. In this article, we discuss the indications, benefits and risks of such a technique compared to classic methods. Mainly indicated in patients who have sustained significant bone loss, bone transfer is the method of choice for preserving bone stock and correcting limb discrepancy, although it does not reduce consolidation time. Moreover, circular external fixations are often poorly tolerated and may be replaced by unilateral devices that are easier to install.

Diaphyses↗
PubMed2000

[Facial artery. Embryological review, descriptive and functional anatomy based on a review of the literature].

After a summary of the embryology and anatomy of the arterial blood supply of the face, the authors present the descriptive anatomy of the facial artery and its eight most frequent branches. Variations of the origin, course and division of the artery are then described. The literature contains 3 to 5 different descriptions of the course of the artery. The authors considered 4 of these descriptions to be relevant: I (angular), II (nasal), III (superior labial), IV (hypoplastic). Seventeen different branches have been described, many of which are inconstant. The superficial and deep anastomotic network is described, with emphasis on the subdermal network and that of the transverse facial artery. The various vascular regions of the face, first described by Mitz and Whetzel, are described. Based on these observations, and on Lasjaunias'theory of the triple hemodynamic balance, the authors propose a functional analysis of the arterial blood supply of the face. According to this analysis, the anatomic variations observed are determined by regional hemodynamic balances. These observations influence the design and creation of certain local facial flaps, such as the submental, nasolabial and buccinator flap. They may also influence present concepts concerning the hemodynamics of arteriovenous malformations of the face.

Arteries↗
PubMed1998

[Vascular microanastomosis by eversion and stapling using VCS forceps. Presentation of the technique and experimental evaluation of its reliability].

With the objective of further improving the reliability of microvascular anastomoses, several different procedures are now available to microsurgeons, including eversion-stapling by VCS forceps. The authors start by presenting the technique, emphasizing the need for specific instruments and compliance with certain principles determining the success of these anastomoses. In the context of an experimental protocol in the pig, on vessels measuring an average of 2.5 mm in diameter, 80 anastomoses were performed by VCS stapling-eversion and studied clinically, histologically and ultrastructurally, comparing the results to those of conventional anastomoses by approximation-suture with needle and suture. In light of the results, eversion-stapling anastomoses appear to be more reliable due to the absence of intraluminal foreign body, permanent endothelial continuity and effective re-endothelialisation before day 7.

Anastomosis, Surgical↗
PubMed1997

[Value of fasciocutaneous tensor fasciae latae island flap in the treatment of large abdominal hernias. Apropos of a case].

One case of repeated incisional hernia is reported. This hernia was initially repaired but repeated infection occurred. This hernia was then successfully treated with a fasciocutaneous tensor fasciae latae island flap. The patient was reexamined two years after surgery and presented a functional abdominal wall. Other different reconstructive possibilities of regional myocutaneous flaps are described.

Abdominal Muscles↗
PubMed1997

[Microsurgical reconstructions of the lower face, after projectile injuries. Value of fibular flaps. Apropos of 20 cases].

Projectile trauma of the lower face causes major functional damage and disfigurement. Reconstruction with tissue flaps, after microsurgical revascularization to guarantee tissue vitality, can restore satisfactory mental function. We report 26 mental reconstructions, including 20 using free fibular flaps which, due to its vascular pedicle and length of the available bone, appears to be the best adapted for reconstruction of the lower face. When used with cutaneo-aponevrotic flaps, only one operation is needed.

Adult↗
PubMed1997

[Mechanical vascular clips with an automatic stapler in reconstructive microsurgery. Apropos of 16 clinical cases].

From October 1995 through March 1997, we performed 30 microsurgical reconstructions and achieved microvascular anastomoses in 16 with an automatic stapler (VCS) which allows insertion of titanium clips in the everted vessel walls. The mean age of the patients (15 men, 1 woman) was 42 years. Mean vessel diameter of the donor and recipient sites was 2 mm for the arteries and 3 mm for the veins. Recipient vessels had suffered radiation damage in 3 cases. Micro-anastomoses were performed in 26 cases, with end-to-end sutures in 24 and end-to side sutures in 2. There were 11 arterial procedures including 3 bypasses and 15 venous procedures with 1 bypass. Peroperative thrombosis occurred in 2 cases and were treated by undoing the anastomoses and resuturing manually. There were no early or late postoperative vascular complications. This clinical experience confirms the advantages of this mechanical approach to microanastomotic procedures for small vessels as previously demonstrated in experimental work: a system avoiding transfixation, rapid procedure, reliability.

Adult↗
PubMed1996

[Fasciocutaneous flap of the posterior surface of the thigh with distal pedicle. Anatomical study and surgical value. A propos of 3 cases].

In the light of previous studies, the authors conducted an anatomical study on 21 cadaveric dissections with injection in order to define the characteristics of the distally based fasciocutaneous flap of the posterior surface of the thigh, described for the first time in 1988 by Maruyama. This leaf-shaped flap extends from the popliteal region to the gluteal sulcus. It possesses an axial arterial network derived from the popliteal artery, reinforced by the perforating arteries derived from the vessel or the profunda femoris artery. The venous return is ensured by venae comitantes and the communicating saphenous vein. The flap raising technique is described. From 1991 to 1994, 3 patients were operated in order to cover a defect of the knee (1 case) and amputation stumps (2 cases). The postoperative course was uneventful and the results were considered to be stable and of excellent quality with a follow-up of 2 to 4 years.

Adult↗
PubMed1996

[The folded fibula flap: anatomical study and clinical application to septic post-traumatic femoral reconstruction. A propos of 6 cases].

The reconstruction of extensive femoral defects, particularly septic, by revascularized free fibula flap has become part of routine practice for many years. Following the demonstration of secondary stress fractures, splitting of the fibula into two vascularized barrels was proposed in 1987 to avoid this complication. The authors conducted an anatomical study on 100 dry bones in order to define the situation of the fibular foramen which is usually found at about 1.45 cm from the midpoint of the fibula. This foramen must be spared during the intermediate splitting osteotomy in order to obtain two bone barrels: one with a double centromedullary and periosteal blood supply which will be used like a contromedullary pin, and the other with only a periosteal blood supply, which will be used as a medial or lateral splint. The deductions concerning the preoperative strategy and splitting technique are explained as a function of the length of the defect. From 1989 to 1993, 6 male patients underwent extensive femoral reconstruction (average length of 9.8 cm). Four free revascularized transfers were performed, including one osteocutaneous flap. In two cases, the osteocutaneous transfer was a proximally based island pedicle flap. Apart from one patient who was subsequently amputated, five patients underwent a secondary autologous bone graft after an average of three months. Consolidation was achieved after a mean of 12.6 months. A secondary stress fracture was observed in one case. With a minimum follow-up of two years, all patients are able to walk with a mean shortening of 2 cm of the reconstructed limb and without any donor site sequelae.

Adult↗
PubMed1996

[The coral orbital floor. Its value in traumatology. The results of a multicenter study of 83 cases].

A madreporic coral graft was used for orbital floor reconstruction following facial trauma. This report presents a multicentric study of 83 patients with a follow-up period of 15 to 24 months. The results of this study indicate no significant rejection or infection opposed to so many synthetic implants outcome. The radiological follow-up demonstrates a partially resorption of the implant within about 2 years and its replacements by new bone. Coral implant was used to correct enophthalmos or diplopia due to enlarged orbital dimensions. It was technically easy to insert and its anatomic shape does not require to be fashioned before use. Its inflexibility allows to bridge large bone defects and this implant should be considered as an attractive alternative to autogenous grafts, avoiding a second surgical site, in reconstructing orbital floor fractures.

Adolescent↗