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Biomedical subjects

J L Grolleau

Publications and source records attributed to J L Grolleau.

At least 19 recordsLinked to original sources
PubMed2005

[Breast reconstruction after prolonged tissue expansion. About 247 cases].

SUBJECT: The purpose of this study was to analyse the complications and the aesthetic results in case of slow tissue expansion in prosthetic breast reconstruction. PATIENTS AND METHODS: We tracked 237 patients representing 247 mammary reconstructions operated between 1992 and 2004. These patients were distributed in two series, a series of 148 operated mammary reconstructions between 1992 and 2000 and a series of 99 reconstructions operated between 2001 and 2004. For every reconstruction, we analysed the progress of the expansion, the complications and the quality of the aesthetic results according to the radiotherapy and the type of implant used. RESULTS: The radiotherapy increases the risk of failure of the breast reconstruction and degrades the quality of the aesthetic results. Capsular contractures are rare and their frequency does not depend on the irradiation. Prosthesis infections and exposure are more frequent on irradiated ground. DISCUSSION: The tissue expansion in prosthetic breast reconstruction is a technique studied well in the literature, but few authors use a chronic expansion and compare the long-term results according to the radiotherapy. If our study confirms the noxious role of the radiotherapy as for the complications and for the aesthetic aspect of the results, it is not a question for us of an absolute contraindication. The weak rate of capsular contracture is attributable to the chronic character of the expansion, which allows the maturation of the capsule. The use of silicone gel implants decreases the deflations but does not improve the results. CONCLUSIONS: The radiotherapy increases the risks of failure of the tissulaire expansion and decreases the quality of the aesthetic results. The chronic character of the expansion allows to obtain a rate of capsular contracture weak, even on irradiated ground. The silicone gel implants make it possible to obtain a perennial result.

Adult↗
PubMed2005

["Morphobreast": patient's data bank management for objective selection of implant's volume in hypotrophic breasts].

Good selection of mammary implant volume is essential to satisfy patient's real desire of breast augmentation. The authors have developed a data processing called "Morphosein": it is an active press-i-book, allowing recording and exploitation of basic morphologic datas before and after operating procedure. They use Filemaker Pro as basic software and database, which is fed with personnal patients. This tool allows a comparative research on patients having a similar morphologic and on results obtained with different types of implants. These datas, store since 4 years, give to the authors' objective informations to help the patient's choice.

Adult↗
PubMed2005

[Silicone or saline - filled implants for breast augmentation?].

The use is to oppose silicone and saline implants. Both are used in regular practice. What are the arguments to choose in between the two types? We separated three different criteria groups: prosthesis characteristics, surgical procedures and complications. For each criterion we made a review of literature looking for arguments in favour or against silicone or saline implants. The number of criteria to choose the correct type of prosthesis is very important. We conclude that surgeon experience; desires of the patient and evolution of prosthesis are the most important criteria.

Breast↗
PubMed2005

[Poland'syndrome and hand's malformations: about a clinic series of 37 patients].

INTRODUCTION: Poland's syndrome is a rare malformation which associates thoracic anomalies and anomalies of homolateral upper end. We wish to know the frequency of hand's malformations in this syndrome in our clinical experience. MATERIAL AND METHODS: We have revised 37 patients who were seen initially for a thoracomammary anomaly. This clinical series from plastic surgery service of Toulouse has been revised to know the importance of hand's malformations. RESULTS: Hand's malformations in Poland's syndrome are rare in your study, they touch only 12% patients. We find only 4 malformations in 33 patients, four were lost. They were only females, we find three brachymesophalangies and a major form. DISCUSSION: Hand's malformations in Poland's syndrome are less frequent than classically. There is no parallelism between gravity of thoracic malformation and that one of upper end. In this series, we find only one case with syndactyly; originally, Poland's syndrome was named << Poland's syndactyly >>. Finally, we think that we can talk about Poland's syndrome without anomaly of homolateral upper end, the major element is musculary agenesia of sternocostal pectoralis major. The search of homolateral upper end has to be systematic in front of suspicious of Poland's syndrome.

Adolescent↗
PubMed2004

[Complications of laser facial resurfacing].

Laser resurfacing is a burn of the superficial skin layers: it's a controlled burn in its depth, that can destroy epidermis and the dermis superficial part, but not deeper for avoiding healing complications. All complications and the normal postoperative follow-up can be explained by the fact that laser resurfacing is a burn of the dermis and epidermis, with the destruction, partial or total, of their components. It's essential to understand the normal postoperative process and complications to avoid them and to treat them in the beginning. Infection, persistent erythema, pigmentation troubles like hyperpigmentation or depigmentation and demarcation surrounding the resurfacing area, healing troubles like hypertrophic scarring, keloids, excess of skin retraction are the main complications. Careful preoperative explanation of laser-resurfacing follow-up will help the patient adjust more easily to postoperative care.

Cicatrix↗
PubMed2003

[Funnel chest: filling technique with deep custom made implant].

Through 97 patients over 9 years, the authors present a surgical treatment for "funnel chest" using custom-made silicone elastomer prothesis which are deeply placed, behind muscle and aponevroses. They justify the choice of this simple and non invasive technique, by the fact that this deformation is only morphological in most cases or even only inaesthetic with exceptional cardiac or pulmonary consequences. Patient's motivation being mainly due to psychological disconfort, the non invasive aspect of the technique leads them to choose surgery, particularly as results are good and complications seldom.

Adolescent↗
PubMed2002

[Deflation of breast implants, pre-filled with saline or hydrogel. Results and analysis of 650 treated patients].

SUBJECT: The main mechanical side effect of saline or hydrogel filled implants is deflation. The aim of this study was to analyse the prosthetic deflation rate in the last 7 years in the plastic surgery unit of Toulouse. PATIENTS AND METHODS: We tracked 650 patients operated on between july 1993 and july 2000 (representing 1117 primary implants) which we separated in two groups: the first group contained patients in need of breast reconstruction; the second group contained all the patients with implants placed for aesthetic or breast asymMetry reasons. For each of the two groups we determined the number and the type of implants, as well as the rate and the mean delay after which deflation occurred. RESULTS: During this period, we've determined that: rate of deflation of group 1 (reconstruction) is highest than group 2 (aesthetic), despite sort of implant; rates of deflation of pre-filled hydrogel implants are highest than rates of deflation of pre-filled saline implants. DISCUSSION: Only a few series concerning implants deflation have been described in the literature. We can find a large difference in results which vary from 2 to 76%. We were surprised by the result of our series with a rate of deflation up to 15% with a medium follow-up 5 years in both groups and a mean delay before the fourth year. Deflation's factors are numerous: type of sterilisation, rippling, texture, valve's incompetence, prosthetic patch, guarantee control and iatrogenic causes. Because the silicone gel implants (the one uncomplicated by deflation) were taken off the french market, the saline implants tried to supplant them but without satisfactory results. CONCLUSIONS: With the unacceptable rate deflation of implants in our study, the return in the french market of silicone gel implants seems us an acceptable alternative.

Adolescent↗
PubMed2002

[The tuberous breast: a review].

The tuberous breast is one of the most challenging problem in breast surgery. Pediatricians, gynaecologists and plastic surgeons are particularly concerned with the treatment of these young patients. A good assessment of the pathology and a precise knowledge of the surgical procedures are keypoints for a successful treatment. A case report will precede a literature overview of this very complex problem.

Adolescent↗
PubMed2001

[Large abdominal parietectomy for late abdominal wall recurrence of colonic cancer: reconstruction with latissimus dorsi free flap with delayed insertion].

Parietal recurrence following conventional treatment of colorectal cancer is an infrequent event and is usually associated with an intra-abdominal recurrence. The study aim was to report a large solitary abdominal wall recurrence observed 80 months after the resection of a sigmoid adenocarcinoma and treated by a left hemiparietectomy associated with a segmental colectomy. The abdominal wall reconstruction combined a prosthesis and a latissimus dorsi myocutaneous free flap with delayed insertion after initial transfer.

Abdominal Muscles↗
PubMed1999

Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience.

OBJECTIVE: To compare various techniques for the treatment of pilonidal sinus. DESIGN: Retrospective study SETTING: University Hospital of Toulouse, France. SUBJECTS: 246 consecutive patients who presented between 1979 and 1996. The male:female ratio was 2:1, and the mean age 26 years (range 18-69). INTERVENTIONS: 218 one or two stage excision and rotation skin flaps, and 28 simple incisions. RESULTS: 16 sinuses recurred, and no flaps necrosed. CONCLUSION: Excision and rotation skin flaps offers an effective and elegant alternative to the more classic operations for pilonidal sinus as it causes less postoperative pain and shortens convalescence.

Adolescent↗
PubMed1999

Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry.

A variety of breast deformities of differing appearances can be grouped together within an extensive syndrome that is characterized by anomalies of the breast base and preferentially involves the lower quadrants. Tuberous breasts are the most typical, but not the only, form of the deformity. The authors studied a series of 37 patients who had breast surgery, and they used a classification of three types: I, II, and III (in increasing order of severity). In type I breasts (minor form), only the lower medial quadrant is deficient; in type II breasts, both lower quadrants are deficient; and in type III breasts, all four quadrants are deficient. The study showed a predominance of minor forms (54 percent of breasts operated on) and of combinations including at least one minor form (81 percent of patients). Seventy percent of women had a breast asymmetry of more than 100 g. Only 27 percent of breasts operated on were hypotrophic, 45 percent were of normal volume, and 28 percent were hypertrophic. The authors propose a procedure to treat the minor forms of the deformity, using a mammaplasty with a superior pedicle and a lower lateral dermoglandular flap to fill the deficient lower medial quadrant. They define the indications of the classic techniques according to the type of deformity and stress the frequent need for secondary revision.

Adolescent↗
PubMed1999

[Incisional hernia. Patient management. Approach to the future operated patients].

Incisional hernia, an abnormal orifice of the midline abdominal wall secondary to an operation, presents in a wide range of forms to the plastic surgeon: small orifice (< 6 cm) in a young, muscular subject, or vast defect (> 10 cm) in an obese subject who has undergone multiple operations, or who presents one or more diseases. Regardless of this presentation, the approach to the patient must always be just as rigorous, based on a precise assessment of the clinical signs. This clinical examination is irreplaceable, but is often insufficient, incomplete, and misleading. Only CT imaging of the abdominal wall provides a good analysis of the damage. Beyond the simple orifice, a large incisional hernia is responsible for a whole range of disease. This "incisional hernia disease", with its visceral and respiratory components, requires a multidisciplinary assessment. The anaesthetist and respiratory physician must assess the repercussions of this lesion and detect any risk factors. Based on this assessment, major incisional hernias (2/3 of the 350 operated patients of our series) require specific preparation involving the following elements: eradication of any site of wound infection, weight loss, muscle building, abdominal and chest physiotherapy, and pneumoperitoneum. Pneumoperitoneum according to the Goni Moreno protocol is an essential element of the preparation of the most difficult forms (irreducible, double, or complicated incisional hernias). Only this gaseous expansion of the abdomen can facilitate reintegration of the viscera and reconstruction of the abdominal wall. In our practice, the operation itself consists of 2 types of procedures: simple local abdominoplasty (e.g. Judd's technique) for small incisional hernias (about 20% of cases), or a combination of reconstitution of the deep fascia by extensive cleavage of the posterior sheath of the rectus abdominis and prosthesis. This prosthesis, which lines the fascial plane, is placed extraperitoneally. This technique, with several variants described here, is based on a similar concept to that promoted by Rives et al. and Stoppa et al. It is the preferred procedure in all large incisional hernias (80% in our experience). Patient selection, intensive preparation, meticulous technique, and intensive postoperative nursing give stable, solid results (90% of patients) and ensure optimal security, bearing in mind that repair of a large incisional hernia is always difficult and sometimes dangerous (1% mortality, 6 to 10% morbidity in all large series).

Abdominal Muscles↗
PubMed1999

[Incisional hernia repair techniques for the abdominal wall].

Incisional hernia repair has been the subject many publications over the last century. Suture techniques in one plane (Judd, 1912) or in several planes (Quenu, 1896) were described first. They remain suitable for the closure of small incisional hernias. Rectus abdominis sheath dissection techniques, also known as fascioplasties, then reinforced hernia repair by prolonging the anterior (Welti-Eudel, 1941) or posterior leaflet (Gibson, 1920) of the sheath. These plasties are still widely used, either alone, to repair medium-sized hernial orifices, or in combination with a prosthesis to repair large hernial orifices. Autologous tissues, such as fascia graft (Mac Arthur, 1901) or skin graft (Gossec, 1949) are now used because of the marked capacity of prostheses for secondary distension and their sensitivity to infection. Flaps, especially the tensor fasciae latae flap (Nahai, 1974), are indicated in infraumbilical incisional hernias in a septic context. Currently, only reinforcement prostheses can achieve lasting repair of large incisional hernias. Some teams still use intraperitoneal mesh implantation, but most teams prefer extraperitoneal implantation, generally associated with fascioplasty. Extraperitoneal mesh may be placed in a pre-musculo-aponeurotic or retromuscular position. Based on their experience, the authors opted for a pre-fascio-aponeurotic retromuscular prosthesis. They describe in detail the technique used and the results obtained based on the analysis of a series of 252 patients.

Abdominal Muscles↗
PubMed1999

[Angiomyoma of the hand: a post-traumatic tumor?].

A 69-year-old woman presented with a tumor of the lateral aspect of the proximal phalanx of the little finger of the right hand. The finger was injured by a ring during a handshake. Excision and histopathological examination revealed the diagnosis of angio-myoma, a benign vascular tumor originating from the smooth muscle cells of arterial or venous walls. Angiomyomas belong to the family of leiomyomas and rare, small tumors (less than one centimeter), preferentially occurring in women between the ages of 40 and 60 years. They may be painful. Only one case of sarcomatous degeneration has been described in the literature. Trauma has never been previously reported as a cause of angio-myoma, but in this case the traumatic origin of the tumor was not in doubt.

Aged↗
PubMed1998

[Breast reconstruction after mastectomy for cancer].

In spite of advances in breast cancerology, partial or total mastectomy still has wide indications and remains a mutilative procedure. Since its introduction over thirty years ago, breast reconstruction has become an accepted, codified and efficient procedure. The techniques which can be used can be broadly divided into two categories: reconstructions with implants, which have been greatly improved by skin expansion techniques, and reconstructions using myocutaneous flaps. Whatever method is used, the breast is modeled during the reconstruction procedure and surgery is frequently necessary to obtain a symmetric opposite breast; a good knowledge of plastic surgery is thus a requisite.

Breast Neoplasms↗
PubMed1998

A predetermined design for easier aesthetic abdominoplasty.

The authors have presented a predetermined design of cutaneous resection for abdominoplasty without relocation of the umbilicus. The design is characterized by two lateral tips, pointing upward, and a central dome. The upper and lower edges of the cutaneous incision are of the same length, which prevents puckers and allows optimal evolution of the scar. The median cutaneous resection removes the horizontal base of the triangular area of pubic hair, producing a lower final scar and giving the mons pubis a more youthful appearance. The lateral cutaneous resections allow transverse redraping of the abdominal skin, and the oblique scars, placed in the natural folds, are easily concealed even under brief attire. Unlike individual resection techniques that require practice and experience, this technique is perfectly codified and can be carried out by less experienced surgeons.

Abdomen↗