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Biomedical subjects

J L Foyatier

Publications and source records attributed to J L Foyatier.

At least 19 recordsLinked to original sources
PubMed2005

[Severe hand burns and flaps: indications].

Deep hand burns often leads to major deformities, involving cosmetic and functional disease as scar contracture, stiffness, or even amputation. Early surgical treatment and rehabilitation are always challenging but crucial in order to prevent burn sequelae. When tendinous, osseous, nervous or vascular component are involved, even hand vitality is engaged: cutaneous, fasciocutaneous, muscular or musculocutaneous flaps are then the only way of salvage for the hand. The purpose of this surgery is the early covering of essential components, allowing early rehabilitation and mobilisation. The problem remains the choice of surgical covering, according to the site, size, and depth of the burn, and local reliable opportunities. Care must be taken to preserve surgical ways for final sequela reconstruction.

Burns↗
PubMed2003

[Surgical management of cutaneous necrosis in the purpura fulminans: report of 2 clinical cases].

The authors report their experience of the management of 2 patients with purpura fulminans. After a review of the epidemiology, diagnostic methods, natural course and prognosis of the disease, the various stages of the treatment are described. The urgency of the medical treatment is stressed and the specific technique of the surgical approach to the artificial dermis is detailed. The quality of initial management is of crucial importance and such extensive and deep cutaneous destruction is best dealt in burn centers.

Adolescent↗
PubMed2002

[Rhinoplasty in the immediate assumption of responsibility of nasal burns. Technical note and report of two cases].

We report the use of a traditional technique of rhinoplasty in the immediate assumption of responsibility of deep burn of the nasal edge which cannot be grafted. The limit of the realization of this gesture lies in the fact that it must exist nasal morphological characteristics at the patient. The two cases presented had an hypertrophic nose with osseous and/or cartilaginous bump. The reduction height of the osseo-cartilaginous frame allows closing the defect without cutaneous tension. One carries out a true excision-joining of the burn of the nasal dorsum. We note at one year of retreat, the discretion of the scar located on the centre line of the nose, the absence of after-effects as well as the cosmetic satisfaction of the patients with respect to the modifications morphological their noses.

Adult↗
PubMed2001

[Reconstruction of facial burn sequelae].

The deep burns of the face can lead to horrible scars functionally and aesthetically. Treatment of these scars need several surgical interventions frequently and during many years. In our region we deal with this type of wounds as team work, multidisciplinary approach carrying out many process starting by emergency treatment of acute burns till the social rehabilitation. The expansion technique was great help in improving the shape of scars, by using the expanding skin as full thickness grafts. Reconstruction of the anatomical units and application of aesthetic techniques (like rhinoplasty, lifting, tattooing and autologous fat injections) participate equally in improving the quality of results. Many examples of treatments of burns scars are shown.

Burns↗
PubMed2001

[Breast burn sequelae. Classification and therapeutic indications].

Reconstructive surgery of post-burns scars in female (either young children or adults) is a frequent need in our experience. The problems is to face the consequences by considering the growth of mammary gland either hormonal in case of children or breast reconstruction as if in case of malignancy in adult female. Classifications of post burn scars is helpful to adapt the method of initial treatment, is a real need. The authors have spent part of their experience to treat acute case of thoracic burns, proposing classification of three types and specific treatment for each.

Acute Disease↗
PubMed2001

[Giant lymphedema of the upper extremity. A case report].

The giant lymphoedema of upper limb still a difficult therapeutic problem. The authors report a case treated as a Charle's operation derived. They underline the operation's value. As they are experienced with the third-degree burned patients, they insist on the respect of the pre-muscular aponevrosis during the excision and how as possible it's better to take the split-thickness skin graft on the excised skin. Excision and graft are made during the same operation. They come back to the initial medical treatment and to the different surgical treatments.

Aged↗
PubMed1999

Mechanical forces induce scar remodeling. Study in non-pressure-treated versus pressure-treated hypertrophic scars.

Reparative process of second and third degree burns usually results in hypertrophic scar formation that can be treated by pressure. Although this method is efficient, its mechanisms of action are not known. In this work, we have studied the histological organization of hypertrophic scars submitted to pressure. Skin biopsies were performed 2 to 7 months after the onset of treatment in two adjacent regions of the scar, non-pressure- or pressure-treated and analyzed by immunohistochemistry and transmission electron microscopy for extracellular matrix organization and cellular morphology. In non-pressure-treated regions, fibrillin deposits did not present the classical candelabra-like pattern under epidermis and were reduced in dermis; in pressure-treated regions the amount was increased compared to non-pressure-treated regions but the organization was still disturbed. In non-pressure-treated regions, elastin was present in patch deposits; in pressure-treated regions elastin formed fibers, smaller than in normal dermis. Tenascin was present in the whole dermis in non-pressure-treated regions, whereas in pressure-treated regions it was observed only under epidermis and around vessels, as in normal skin. alpha-Smooth muscle actin-expressing myofibroblasts were absent in normal skin, present in large amounts in non-pressure-treated regions, and almost absent in pressure-treated regions. The disturbed ultrastructural organization of dermal-epidermal junction observed in non-pressure-treated regions disappeared after pressure therapy; typical features of apoptosis in fibroblastic cells and morphological aspects of collagen degradation were observed in pressure-treated regions. Our results show that, in hypertrophic scars, pressure therapy restores in part the extracellular matrix organization observed in normal scar and induces the disappearance of alpha-smooth muscle actin-expressing myofibroblasts, probably by apoptosis. We suggest that the pressure acts by accelerating the remission phase of the postburn reparative process.

Adolescent↗
PubMed1999

Composite cervicofacial flap for reconstruction of complex cheek defects.

The authors present the reconstructive technique for complex cheek defects using the composite cervicofacial flap and study the possibilities, advantages, disadvantages, and results that can be expected. The design follows the classic outline of Mustardé's flap. The skin is undermined for 2 cm anterior to the ear, then after incision of the superficial musculoaponeurotic system (SMAS), undermining is continued below the plane of the SMAS, level with the facial nerve branches. It is continued forward to the facial vessels, which give rise to branches that ensure the blood supply of this composite flap and contribute to its high reliability. In the cervical region, undermining is done beneath the platysma, which is transected transversely in the lower cervical region to allow good upward mobility and satisfactory transposition of the flap. The flap is adapted to the defect and the medial suture line is placed as near as possible to the medial limit of the cheek aesthetic unit. The authors carried out a retrospective study of 7 patients with complex facial reconstruction after excision of malignant lesions. The defects measured from 4x4 cm to 9x7 cm. In 4 patients excision included the periosteum, and in 1 patient excision involved the entire thickness and removed the entire anterior half of the cheek. In 4 patients reconstruction involved the cheek and eyelid. In spite of the advanced age of the patients (88, 69, 91, 67, 70, 82, and 59 years), there was no distal edge necrosis. The only complication was a single case of facial paresis, which resolved spontaneously. The results were considered very good in all 7 patients. The authors conclude that the composite flap increases the possibilities of the cervicofacial flap. It is more mobile, more reliable, thicker, and more adaptable. It can be used in complex cheek defects that involve the periosteum, or even in full-thickness defects. The quality of the results obtained using this flap represents a considerable advance in facial reconstruction.

Aged↗
PubMed1997

[Treatment of pain in children burns].

Burn injury is considered by children as one of the most painful traumas (just after bone factures). Burn pain in children can and must be controlled as well as for adult patients, with almost identical techniques. Continuous pain from injury and intermittent pain caused by therapeutic procedures must be evaluated and treated separately. Due to very high levels of nociception, satisfactory management of procedural pain requires the use of opioid therapy. Non pharmacological methods are meaningless if pharmacological treatment is not optimal.

Burns↗
PubMed1997

[Reconstruction of the silhouette after gastroplasty].

The authors report their experience in reconstruction of the silhouette in patients experiencing rapid and marked weight loss after calibrated vertical gastroplasty, usually greater than 50 kg. They present a one-stage strategy for reconstruction of the silhouette, combining repair of the abdomen, waist and thighs. The serious nature of surgical procedure requires a very precise preoperative assessment and, most importantly, very detailed information of the patient concerning this operation and the expected results. Very intensive preoperative, intraoperative and postoperative psychological support is essential.

Cicatrix↗
PubMed1996

[Skin flaps and expanded full-thickness skin grafts. Indications in the repair of burn sequelae].

The great majority of sequelae of deep burns concern the skin. Their correction essentially raises problems of replacement of scarred skin by good quality skin. Sequelae of burns logically constitute one of the best indications for progressive mechanical skin expansion by prosthesis, which allows for considerable improvement of the aesthetic results. This improvement is related to the use of skin replacement tissues with the same quality as the original tissue. Local expanded flaps and expanded full-thickness skin grafts are the two essential techniques used. The authors review the general rules concerning the use of expansion prostheses, then describe the various indications for expanded flaps and expanded full-thickness skin grafts in the sequelae of burns of the face, neck, thorax and limbs. The main indications are illustrated by clinical cases.

Burns↗
PubMed1996

[Transposition flaps adn full-thickness skin grafts used as interposition tissue: progressive physiological expansion].

The capacity of health skin to expand, which has been known for a long time, has been used in plastic surgery since the work by Radovan. The sequelae of deep burns are sometimes responsible for retraction, particularly in flexion folds of the limbs, which are treated in our department by interposition of healthy skin in the form of local flaps or full-thickness skin grafts. The follow-up of several hundred patients over several years demonstrated that, in addition to the immediate skin gain, expansion or extension of the interposed healthy skin occurs. Nevertheless, only histological examination could confirm the reality of this progressive physiological expansion observed during the follow-up of our patients.

Humans↗
PubMed1995

Salvage of extensively burned upper limbs by a pedicled latissimus dorsi flap.

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.

Adult↗
PubMed1995

[Treatment of burns in infants].

Because of the potential severity of their residual deformities, burn injuries in infants justify an early management in specialized centres when they cover more than 5% of body surface and in every case when hands, face, or external genitalia are concerned. Cooling with cold water is the first aid treatment to be performed as early as possible after the injury. The treatment in specialized centres must be both general and surgical. General treatment includes fluid and electrolyte therapy, temperature control, appropriate nutrition and pain suppression. Pain suppression is a major part of the treatment and morphine must be largely used. Surgical treatment starts as soon as the patient arrives in the centre and is eventually performed under general anesthesia: all the burned areas are covered with occlusive dressings. Infections are prevented by systematic cultures and adjusted antibiotic therapy. A vigorous rehabilitation program must be instituted as soon as possible: massages, compressive clothes, splints, physical therapy, plastic surgery. Primary prevention by sustained parental education is important in order to reduce the frequency of burn injuries in infants.

Age Factors↗