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Biomedical subjects

J L Cariou

Publications and source records attributed to J L Cariou.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Posterolateral sural fasciocutaneous island flap with proximal aponeurotic pedicle. Anatomical study and use for cutaneous cover of the knee. Apropos of 9 clinical cases].

The authors propose an elaborate variant of the classical saphenous or lateral leg fascio-cutaneous flap with a proximal pedicle for the cover of post-traumatic skin defects of the knee. The original feature of this flap resides in the purely aponeurotic or adipo-fascial pedicle which increases the arc of rotation, while minimizing cutaneous sequelae of the donor site. Twenty four injected cadaveric dissections were used to define the neurovascular content of the lateral sural fascia: the lateral and medial superficial sural arteries and their territory of perfusion, accompanying veins and the short saphenous vein, as well as the lateral and medial sural cutaneous nerves. The technique of harvesting of the island flap is described. Nine patients were operated between 1991 and 1994, with an uncomplicated postoperative course in terms of flap vitality and donor site. The skin cover of the knee was considered to be of excellent quality, stable and sensitive, with a follow-up ranging from 6 months to 3 years four months.

Adult↗
PubMed1995

[1984-1994: ten years of skin flaps. Improvements and conceptual developments. Development of vascular concepts, classification and clinical concepts].

After a brief review of definitions and semantics, the author recalls the state of the art before 1984 concerning arterial and venous cutaneous blood supply. Studies and concepts published since 1984 include those of Nakajima, who distinguished six types of cutaneous arteries, Gumener, who emphasized the vascular entity represented by the subcutaneous connective tissue, and Taylor. This author, after many studies on the whole body, defined forty arterial and venous cutaneous territories, border-arteries and veins oscillating at the borders of these territories, as well as a number of neurovascular entities (neurocutaneous arteries and veins). In terms of haemodynamics, the concepts of anatomical, haemodynamic and potential arterial cutaneous territories, the concepts of arteriosome and venotome and the concept of low venous pressure zones are analysed. These anatomical and concepts haemodynamic are the basis for the feasibility and reliability of the various cutaneous, musculocutaneous and fasciocutaneous flaps. A number of classifications for these various flaps have been proposed since 1984: a theoretical classification (Kunert's), classifications according to vascular systematization, including Nakajima's classification, and many others. The author proposes a practical classification which should allow a better understanding and better national and international exchange. In parallel, the design and indications of various types of flaps have also advanced since 1984. Skin flaps without a systematized blood supply do not correspond to random flaps. Musculocutaneous flaps have advanced in three directions: partial muscular harvesting when the objective of the flap is essentially cover, an increase of the skin flap surface area; substitution, in certain anatomical regions, of the concept of fasciocutaneous flap for that of musculocutaneous flap, particularly in thoracolumbar and anterior thoracic regions. The author notes the progress in fasciocutaneous flaps: distal pedicle leg flaps, development of decreased cutaneous morbidity resulting in fasciosubcutaneous flaps and proximal or distal fascial (or fascio-adipose) pedicle fasciocutaneous island flaps, progress of normal flow or reverse flow island septocutaneous flaps on the main vessels of the limbs towards to similar types of island flaps on secondary vessels, especially in peri-articular sites. The other clinical concepts analysed include grafted fascial flaps, grafted adipose and fascioadipose flaps, neurocutaneous flaps, "tailormade" flaps and chimeric flaps. This progress in vascular and clinical concepts of skin cover flaps over the last ten years is illustrated by many examples of skin cover, particularly involving the posterior aspect of the heel.

Female↗
PubMed1994

[Arterial phenomenon of autonomization of vascularized island flaps reviewed by expansion of the vascular pedicle. An experimental study in the rat].

This experimental study performed in rats examined the possible vascular extensions of a periprosthetic membrane neoflap with an axial vascular pedicle towards an adjacent cutaneous angiotome. 22 Wistar rats were operated. After tattooing the superficial iliac circumflex angiotome, the adjacent epigastric pedicle was expanded. After expansion and a two-month rest period, clinical and microangiographic studies were performed. In 50% of cases, the iliac island skin flap raised on the periprosthetic membrane created by the epigastric pedicle was considered to be viable. The microangiographic results were identical. The pathophysiological mechanism is analysed in the light of the literature.

Angiography↗
PubMed1994

[Choice of free composite flap in the reconstruction of loss of substance in the mandible. Apropos of 28 cases].

The retrospective analysis of 56 mandibular defects, 28 of which were reconstructed by free revascularised bone flaps, and the difficulties of their reconstruction led the authors to propose a new anatomosurgical bony classification of mandibular defects. This classification, a theoretical transcription of traumatic and oncological realities, distinguishes more or less extensive anterior defects (Aa and Ab), lateral defects (La), lateroterminal defects (Lb) and defects exceeding the hemimandible (T). These bony imperatives, either alone or associated with skin lesions, depending on the traumatic or neoplastic aetiology, influence the indication for microsurgical reconstruction and the choice of particular bone and integument combined or composite flaps. The authors have deliberately adopted the option of one-stage multiple tissue reconstruction by the same composite flap and propose a justification for this microsurgical choice based on the proposed classification as well as the the theoretical and practical advantages and disadvantages of the various composite free revascularised bone flaps. Two donor sites appear to be particularly suitable: iliac and fibular.

Adult↗
PubMed1994

[Fascia superficialis temporalis in facial reconstructive surgery. Apropos of 35 cases].

The fascia superficialis temporalis (FST), one of the planes of cranial cover, can be raised to form an axial pedicle flap or a vascular island flap on superficial temporal vessels. Its fibrovascular structure, the area able to be raised and the possible addition of other superficial tissues (scalp, forehead skin) and deep tissues (calvarial bone) mean that this flap can be used in surgery of the external and intracavitary facial contours and shapes. The authors report their experience of 35 facial reconstructions: 7 ear reconstructions, 5 suspensions of a paralysed labial commissure, 10 conjuctivo-palpebral revisions, repair of 5 subcutaneous defects, 3 haired resurfacings, 1 inferior labial, 1 cheela, 1 orbitomalar reconstruction, 1 malo-commissuro-labial repair, 1 prefabricated free flap. The donor site sequelae were considered to be negligible: 1 case of temporal anaesthesia with dysaesthesiae, 4 cases of band alopecia. The analysis of these 35 reconstructions reveals the quality of all cases of defect repair, especially palpebral; the ease and persistence of suspensions of the labial commissure; the value of FST as a conjunctival and buccal mucosal substitute; the density of the hair contribution. However, total or partial ear reconstruction using this technique constitutes a more limited indication.

Adolescent↗
PubMed1993

[Cheek-commissuro-labial reconstruction using a fascia superficialis temporalis composite island flap. Apropos of a clinical case].

Management of full thickness defects of cheek and lips area is a challenge with both aesthetic and functional aims. Many surgical procedures can be proposed. A composite island temporal flap gathering fascia superficialis temporalis, an heary portion and a beardless skin paddle is a very interesting alternative. Surgical procedure and results are explained, concerning a gun shot injury clinical case.

Adult↗
PubMed1993

[Experimental study of the reliability of end to end arterial microanastomosis].

Since 1978 (Lauritzen), several experimental and clinical procedures of end-in-end vascular microanastomosis have been described, including that proposed by Wang (1986) in which the tubulisation is accompanied by a counter-incision of the recipient vessel. Our experimental study was designed to assess the reliability of this procedure, to quantify it in relation to the diameter of the artery and direction of flow and to verify the existence of absence of any particular intraluminal histological phenomena. 42 Wistar rats were operated under general anaesthesia. 42 microanastomoses were performed: 15 carotid and 15 femoral in the direction of arterial blood flow, and 15 carotid anastomoses in the opposite direction to flow. The 15 carotid anastomoses performed in the direction of flow were all patent at each of the postoperative examinations (D0, D + 15, D + 90). Patency decreased in the anastomoses performed in the opposite direction to blood flow (10 out of 15 carotid anastomoses were patent) and as a function of the arterial diamenter (5 out of 12 femoral anastomoses were patent). Horizontal and transverse histological sections performed on the 15th and 90th days demonstrated continuity of the intimal endothelial lining and thickening of the adventitia of the two internalised and recipient walls in every case. In practice, although this experimental study demonstrates the clinical reliability of this internalised microanastomosis procedure in rat carotid arteries, the other results and the anatomo-clinical discrepancy do not justify its clinical use in all circumstances, particularly in the opposite direction to blood flow and in arteries with a diameter less than or equal to 1 mm.

Anastomosis, Surgical↗
PubMed1993

[Dedifferentiated chondrosarcoma with maxillary involvement. An anatomo-clinical study, surgical treatment and prosthetic rehabilitation. Apropos of a case].

A 19 year old girl presented with a dedifferentiated chondrosarcoma of maxilla. The recurring tumor, diagnosed initially from the provoked pain, appeared on the scan image as a heterogeneous mass containing numerous calcifications. Histology showed, within a well differentiated chondrosarcoma, an anaplastic sarcomatous zone of the malignant fibrous histiocytoma (MFH) type. This histologic appearance is consistent with a poorer clinical prognosis. Radical surgery of the 4th tumor recurrence was combined with maxillofacial prosthetic rehabilitation. This appears to be first reported case of a dedifferentiated chondrosarcoma of the MFH type located in the maxilla.

Adult↗
PubMed1992

[Free composite flaps with the fibula and their adaptation to mandibular reconstructive surgery. Apropos of 9 cases].

Although revascularized fibula bone transfers have been used in reconstructive surgery of long bones for about fifteen years, the first reported cases of mandibular reconstruction were only published in 1989 by Hidalgo. The mandible and the fibula actually have very few points in common apart from their respective length and a certain similarity of cross-section. However, free composite flaps including the fibula are adapted to reconstruction of the mandible for several reasons: the length of the bone which can be raised (25 cm) and osteotomized into several fragments; the addition of other components (skin, aponeurosis, muscle, etc.) for skin and/or mucosal repair; the spatial independence of these various elements; the microsurgical qualities of the peroneal artery. This possibility of multidirectional and multiple tissue bony mandibular reconstruction is analysed on the basis of 9 clinical cases: 5 cases of traumatic sequelae of the lower third of the face following gunshot injuries, 2 cases of radiation osteonecrosis, 2 benign bone diseases. The triple bone, integument and vascular adaptation between the fibular donor site and the recipient site must be assessed preoperatively. Due to the quality of the morphological and functional results compared with the limitations of other free composite bone transplants, the authors propose free composite fibular flaps as adapted and adaptable solutions for one-stage reconstruction of extensive mandibular defects (> 10 cm) associated with small or large mucocutaneous lesions.

Adult↗
PubMed1992

[Periprosthetic membrane island flap with axial pedicle. Experimental study on the effect of time and expanded volume].

This experimental study, conducted in the rat, assessed the influence the volume of expansion and time after expansion on the vascularised area of a periprosthetic membrane axial pedicle (epigastric) expanded island flap. 15 Wistar rats were operated on and divided into 3 series according to the expanded volume (20 cc, 40 cc) and the time (1, 2 months). The membrane vascularisation derived from the pedicle was study by microradiography based on geometric parameters. At equal times, the volume essentially increased the length of the pedicle and had little effect on the vascularised area. For equal expanded volumes, increasing latency time increased the length and especially the width of opacification derived from the pedicle. The periprosthetic membrane axial pedicle island flap is an experimental entity whose vascularised area, obtained after a certain amount of expansion, is influenced more by time than by the volume of expansion.

Animals↗
PubMed1991

[Experimental concept of periprosthetic membrane neo-flap with axial vascular pedicle].

This study was designed to demonstrate that progressive inflation of an expansion prosthesis placed under the epigastric pedicle of the rat induced the formation of vascular connections between this vessel and the periprosthetic membrane. 17 Wistar rats were operated under general anaesthesia. The 7 cc prosthesis was implanted into the inguinal fold and the valve was placed in a dorsal position via limited incisions. 11 rats were studied, divided into 3 series: 3 control rats (non-inflated prosthesis), a series in which the prosthesis was inflated up to 20 cc (at a rate of 5 cc per week) and a series in which the fate of the capsular flap isolated as a vascular island flap in a prefabricated silicone block was studied. The assessment was threefold: clinical, microradiographic after injection of lipiodol into the epigastric artery and histological. The clinical and microradiographic studies demonstrated the reality of the blood supply of part of the periprosthetic membrane and its connections with the epigastric axial pedicle. This membrane surface, constituting a real biological flap prefabricated by expansion, corresponds to the peripedicular zone (2 x 1 cm). The viability of the island flaps was confirmed after 8, 14 and 21 days. Histological studies confirmed the hypervascularisation and richness of the collagen fibres as a result of expansion.

Animals↗
PubMed1991

[Arterial anatomy of peroneal flaps assessed by Doppler study and arteriography].

Clinical applications of fasciocutaneous peroneal island flaps are important. 25 patients with cutaneous or composite defects of the lower extremity have been investigated by preoperative Doppler flowmeter and angiography. This before and after reviewed study allow the authors to establish a clinically useful peroneal arterial map which particularly concern the number and distribution of the postero-lateral septocutaneous arteries. The false positive and negative results of these two examinations are presented and explain differences with anatomic findings. Two anatomic variations are revealed by arteriography and are important for the surgical procedure. The first is the inconstant "circumflex peroneal artery" (12 cases on 22) which is the uppermost posterolateral cutaneous vessel which arises from the posterior tibial artery. The second is the angiographic view of a proximal bifurcation of the peroneal artery (9 cases). Regarding these findings, the authors classify the indications of preoperative angiography: absolute, useful, useless according to each case.

Adolescent↗
PubMed1990

[Changes in the peroneal flap and its use in reconstructive surgery of the lower limb. Apropos of an experience of 10 cases].

A peroneal fasciocutaneous flap supplied by the peroneal septocutaneous vessels and raised from the lateral side of the lower leg was reported by Yoshimura in 1983. This flap which can be used as a proximally or distally pedicled or free flap is very useful for leg skin coverage. This flap has a great potential for skin cover and composite reconstruction of the lower limb due to its multiple structural facets (cutaneo-aponevrotic or composite flap), its possible extensions to other vascular territories and the variable geometry of its mode of transfer. 8 reconstructions have been performed. Their indications are described: 4 proximally pedicled flaps (3 with the fibula), 4 reverse-flow island flaps (1 with Soleus and Peroneus longus muscles). The authors stress the importance of preoperative assessment of the feasibility of a given flap which may be limited by post-traumatic, surgical or anatomic modifications. In particular, the uppermost septocutaneous artery which corresponds inconstantly to the "circumflex peroneal artery" can only be visualized by preoperative arteriography. This artery supplies a proximal peroneal flap which can be used as an island or a free flap. We have used this new variety as a free flap in 2 cases and were satisfied with the results. These various clinical applications without any significant complication or flap failure confirm the biological performance and the safe procedure of peroneal flaps.

Adolescent↗