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Biomedical subjects

J M Servant

Publications and source records attributed to J M Servant.

At least 19 recordsLinked to original sources
PubMed1998

External-internal oblique reverse blood supply musculocutaneous flap for chest wall reconstruction.

A defect resulting from resection of advanced breast tumor can be quite large, posing a difficult reconstructive challenge. A significant number of such patients are found to have local recurrences after receiving beam radiation therapy and chemotherapy. The external oblique musculocutaneous flap is now considered a reliable option, with segmental blood supply from the posterior intercostal arteries. We report a 57-year-old man with local recurrence of breast tumor after external beam therapy. We faced a difficult challenge in performing reconstruction because of (1) several previous operations that used most of the usual options and (2) the absence of recipient vessels for microsurgery. We performed an external-internal oblique musculocutaneous flap with a reverse blood supply from the lateral branches of the inferior epigastric artery. Our use of a reverse-flow external-internal oblique flap supports the concept of rotating the muscles as a unit to encourage viability of the denervated and relatively devascularized component.

Arteries↗
PubMed1998

[Epithelioid sarcoma manifesting as chronic plantar arch ulceration].

BACKGROUND: Epitheloid sarcoma is an uncommon malignant soft tissue tumor observed in the distal extremities of young men. We report a case of long standing ulceration of the sole which was found to be an epithelioid sarcoma. CASE REPORT: A 78-year-old woman had an indolent ulceration of the left sole for several months. Physical examination disclosed a well demarcated 3-cm ulcerated lesion with a red center and flat edges. Skin sections confirmed the diagnosis of epithelioid sarcoma. Cells stained positively for anti-vimentin, anti-cytokeratin and anti-epithelial membrane antigen, but not for anti-S100 protein and anti-actin antibodies. Wide local excision was performed. DISCUSSION: Epithelioid sarcoma is an uncommon malignant tumor which apparently differentiates from mesenchymatous cells. It is usually observed in the distal extremities in young males, predominantly the hands and forearms. The tumor presents a firm, flesh-colored indolent nodule. Ulceration usually develops and involves the subcutis and deeper soft tissue, particularly fascial planes, aponeuroses and tendon sheaths. Treatment is wide surgical excision with or without radiotherapy. The case reported here on the sole of the foot in a 78-year-old women is unusual. Clinicians should be aware that the initial biopsy may not be contributive and that repeated biopsies may be necessary for positive diagnosis.

Aged↗
PubMed1998

[Method of esthetic evaluation of the reconstructed breast after cancer. Report of 76 cases].

The authors propose a simple method of aesthetic evaluation of breast reconstructions after cancer, based on a 20-point score. In the 76 patients included in this study and mainly reconstructed by implant, the following seven criteria were evaluated by a score: the reconstructed breast, the symmetrized breast, symmetry of the 2 breasts, the areola, the nipple, the areolo-nipple complex (ANC) and the overall reconstruction. The first score was established during the visit by the patient and independently by the same plastic surgeon. The score was then established during two sessions of projection of standardized photographs, by two groups, A and B, composed of 9 nurses and secretaries and 10 plastic surgeons, respectively. Statistical analysis of the results showed that the scores for these criteria were all correlated for all examiners. This study confirms the reliability of aesthetic evaluation of breast reconstruction after cancer, by a group composed of 2 men and 2 women, surgeons or non-surgeons, on photographs or on clinical examination, based on a 20-point score.

Breast Neoplasms↗
PubMed1998

[VCS microclip anastomosis on blood vessels of less than 2 millimeters in diameter. Preliminary experimental study in the rat].

The aim of this work was to study the possibilities and limits of the vascular microanastomoses with VCS microclips. VCS Microclips are a new mechanical anastomotic device, allowing a single operator to perform anastomoses without microsutures. The two arcuate limbs of the titanium microclips do not penetrate the vascular intima. The microclip anastomosis technique is based on symmetric eversion of the vessel walls, facilitated by everting forceps. We studied the medium and small Autosuture VCS microclips on different vessels ranging from 0.3 to 2 millimeters in diameter: aorta, carotid artery, femoral artery and femoral vein. Thirty nine end-to-end or end-to-side anastomoses were performed on Wistar rats. These anastomoses were performed by a single operator without the use of sutures. Patency was studied by the "empty and refill" test immediately and at two months. Histologic analysis of the anastomosis was performed at two months (hematein-eosin and orcein stains on longitudinal sections). Four out of thirty nine anastomoses were occluded during the 15 minutes following clamp release. Failure was always due to a technical error and occurred during the first trials. The thirty five other anastomoses were patent immediately and at two months post-operatively, except for the by-pass which was not viable. These anastomoses were still patent 30 minutes post-operatively. Light microscopy analysis confirmed that the microclip extremities did not penetrate the lumen, although the internal media was usually very thin at the level of the microclip jaws, especially for the smallest vessels. For vessels larger than 1 mm in diameter, the microclip extremities were usually outside the internal elastic lamina. No anastomotic aneurysm was found. Vascular healing was comparable with microsutures at 2 months. Microvascular anastomoses performed with microclips have numerous advantages, compared to usual microsutures: they are two to three times quicker, they can be performed step by step without turning the clamp and they can be performed with the right or left hand. There is theoretically no thrombogenic risk. The drawbacks are the need for complementary training and the cost of microclips which is five to six times that of sutures. End-to-side anastomoses of small vessels are more difficult than end-to-end anastomoses. The recipient vessels must be larger than 1.5 mm in diameter, otherwise the anastomosis may become stenosed. Microclips are especially useful to save time, i.e. for multiple anastomoses and for anastomoses of vessels larger than 1 millimeter in diameter. Some modifications of the material could allow vascular or hollow organ anastomoses with endoscopic assistance.

Anastomosis, Surgical↗
PubMed1998

[What is the cost of excision-suture of a skin lesion under local anesthesia? 2-month prospective evaluation in a public sector hospital].

The purpose of this study was to assess the cost of a minimal surgical operation: skin surgery under local anesthesia in the outpatients department. A two-month prospective study was carried out on 149 operations, with a mean duration of 33 minutes. The mean cost of the operation was 434 FF. Although this study is very specific and its results cannot be generalized, it gives a method and an order of magnitude. It shows that it is difficult to save money without decreasing the quality of the operation. The price list of the French national health care system, and the price of the surgeon himself are discussed.

Ambulatory Surgical Procedures↗
PubMed1998

[Approach to severe functional deficiencies: evaluating the efficacy of a special multidisciplinary consultation].

A global approach is required to evaluate severe functional deficits. We have developed a multidisciplinary consultation and assessed its usefulness after one year. A total of 62 patients were evaluated (mean age 35 years), usually for neurological functional deficit (50%). Among the 62 patients, surgery was proposed in 72.6% (operations performed in 66%). Others were managed with non-surgical procedures or abstention. The functional outcome as assessed by patients and physicians was poor (or no result) for 6%, fair for 15%, good or very good for 79%. These results suggest that such a multidisciplinary approach is worth being pursued. Some adjustments for psychological dysfunction may further improve outcomes.

Adolescent↗
PubMed1997

Surgical treatment of dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans is a rare dermal tumor that recurs after inadequate primary treatment. In a retrospective study, we analyzed the outcomes of 117 patients (mean age 39 years) treated surgically for a dermatofibrosarcoma protuberans. In most cases (107 patients), surgery was performed according to a protocol of taking wide peripheral resection margins of 5 cm and by resecting a disease-free anatomic zone deep to the lesion. The mean follow-up was 61 months. The results suggest a difference in prognosis between patients treated primarily with wide initial resection and those referred secondarily with recurrent disease following previous treatment by narrow resection margins. There was no recurrent disease in the 66 patients treated primarily by wide peripheral (5 cm) and deep resection of the tumor. Of the 41 patients referred secondarily at the time of recurrence, 2 developed further local disease within a year, despite equally aggressive local treatments. Both patients eventually died of metastatic fibrosarcoma. We emphasize the value of a highly aggressive local resection in the primary treatment of dermatofibrosarcoma protuberans to minimize local recurrence and potential malignant transformation. Modern reconstructive techniques provide satisfactory solutions for defects of almost any size and composition. Our findings suggest that radical primary resection of dermatofibrosarcoma protuberans in conjunction with immediate reconstruction of the primary defect provides the best outcome for the patient.

Adult↗
PubMed1997

[Evaluating the efficacy of a multidisciplinary approach of severe functional deficits].

Therapeutic indications aimed at improving function in handicapped persons are difficult to establish as the expected result of a given technique may vary. We have developed a multidisiplinary approach for handicapped persons. Our assessment of this activity which has concerned 62 patients from October 1995 to October 1996 is promising and encourages us to continue this type of attitude. Forty-six of the 58 persons evaluated stated they were well satisfied or very well satisfied with the management of their case and outcome was worse in none of the patients.

Adolescent↗
PubMed1997

[Iatrogenic extravasations of cytotoxic or hyperosmolar aqueous solutions. Value of surgical emergency by aspiration and lavage].

Iatrogenic extravasations are characterized by their unpredictable course, the possible repercussions of functional, cosmetic and psychological sequelae, and the absence of a therapeutic consensus. The authors present the protocol used in Hôpital Saint-Louis, based on a synthesis of current procedures, consisting of emergency conservative surgical aspiration and lavage, performed in a context of close collaboration with oncolosits, intensive care physicians and radiologists. From 1994 to March 1997, fifteen patients were operated following extravasation during seven chemotherapeutic protocols, three radiographic examinations with injection of contrast agents and five resuscitation procedures. This simple protocol, applied systematically, achieved cure without cutaneous or functional sequelae in all patients. Aspiration-lavage during the first twelve hours therefore constitutes the treatment of choice of iatrogenic extravasation with cytotoxic or hyperosmolar aqueous solutions.

Aged↗
PubMed1997

[Lipoma of the superficial lobe of the parotid gland. A case report].

We report the case of a patient with a lipoma of the superficial lobe of the right parotid gland. Lipomas of the parotid gland are very rare. They are said to constitute one to two percent of all parotid tumours. Only six cases were found in the recent literature. Preoperative diagnosis is difficult when the physical examination reveals a renitent, well-localized and painless mass. However, magnetic resonance imaging is now the imaging modality of choice to facilitate the diagnosis, but the diagnosis can only be confirmed by histological examination of the tumour. We discuss the value of superficial parotidectomy, while some authors suggest an enucleation of lipomas of the superficial lobe of parotid.

Humans↗
PubMed1997

[Rectus abdominis free flap breast reconstruction. A series of 23 cases].

Free TRAM flap breast reconstruction was performed in 23 patients from july 1993 through november 1995 at the Saint-Louis Hospital in Paris. The surgical team was composed of eight different surgeons. In all cases a delayed breast reconstruction procedure was performed. All patients in this series had previously received radiation therapy and 82.6% patients presented with excess body weight. Decision to perform a free flap procedure was confirmed peroperatively under two conditions. Adequate caliber of the donor and recipient vessels was required, allowing the anastomoses to be performed without magnification in most cases. Preservation of the thoraco-dorsal vessels was the rule so as to allow later use of a latissimus dorsi flap if necessary. Thus in 8 of the 31 cases in which a free flap was initially indicated a pedicled flap was actually performed so as to satisfy the above conditions. All procedures were performed by two surgical teams working simultaneously. Flap harvest met local tissue requirements in all cases. A lateral strip of rectus abdominis muscle and fascia was preserved when this appeared feasible. The abdominal wall was reinforced by prosthetic means in 82.6% of cases. The average operative time was 9 hours. Results were considered satisfactory or very satisfactory in most cases. The complication rate was 39.1%. Among the complications noted were 1 case of partial flap necrosis, 1 case of fat necrosis, 1 abdominal hernia, 1 abdominal bulge (both abdominal complications occurred in patients in whom no prosthetic material was used for abdominal repair). This complication rate also includes revision of the microsurgical anastomoses in 2 cases; in both cases the flap survived completely. This study tends to suggest that the free TRAM flap for breast reconstruction is a reliable technique. It is the authors' belief that it should replace the bipedicled TRAM flap since it combines ample flap vascularization with minimal rectus harvest.

Adult↗
PubMed1996

["Beret" flap and other flaps in the reconstruction of cancer related loss of substance of the ear].

Major tissue loss involving the ears and periauricular area due to carcinologic exeresis is an important problem in reconstructive surgery. We present the "béret" flap, a frontal flap with an occipital pedicle, emphasizing the simplicity of the procedure and its reliability. We present our personal experience and data in the literature and recall the main clinical and histological features of these tumors as well as the clinical course and treatment.

Aged↗
PubMed1994

[Repair and suture of cutaneous wounds].

Suturing is the preferred method for closing a simple wound. The procedure should be preceded by surgical debridement of the wound and carefully done level by level. A number of topographical characteristics should be known and kept in mind. The best technique, in the best possible environment, is a necessary condition, not always sufficient, to reduce the importance of sequelae.

Dermatologic Surgical Procedures↗
PubMed1994

[Microsurgical expanded musculocutaneous flaps of the latissimus dorsi].

Four successful cases of expanded free latissimus dorsi myocutaneous flaps are reported. Expansion of free latissimus dorsi flaps has 2 distinct advantages: moulding of the flap prior to its transfer to a convex surface (cranium); primary closure of the donor site. The latissimus dorsi myocutaneous flap seems to be the flap of choice for pre-transfer expansion.

Adult↗
PubMed1993

Dermatofibrosarcoma protuberans of the chest and the shoulder: wide and deep excisions with immediate reconstruction.

Dermatofibrosarcoma protuberans is a rare malignant tumor of the skin. The only satisfactory treatment is surgical and consists of a wide excision. In our department, we have established the limits of the excision required to be a margin of 5 cm on the surface, whereas in the depth, we excise the first healthy anatomical structure encountered. Latissimus dorsi flap reconstruction was used for the major tissue deficit for 15 patients with dermatofibrosarcoma protuberans of the chest and the shoulder. When compared to skin grafting, this technique results in an improved aesthetic appearance and a stable cover for the periosteumless clavicle. Fourteen patients were followed for an average of 37.6 months and all remained free of disease.

Adolescent↗
PubMed1993

[Use of parascapular semi-free flap in the covering of substance loss of the lower third of the leg and foot. Apropos of 3 cases].

The authors present the use of semi-free parascapular flap for coverage of defects on the distal part of the leg and the foot. 3 cases illustrate this technic. This is a microsurgical cross-leg flap. The flap is temporarily anastomosed on vessels on the opposite leg when local and free flaps are not suitable on the ipsilateral limb. This procedure needs one or two separating operations. The cross-leg fasciocutaneous flap must be discussed.

Adolescent↗