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Biomedical subjects

M A Germain

Publications and source records attributed to M A Germain.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Mandibular reconstruction using free vascularized fibula transplant].

Free revascularized fibular transplants have been used in surgery for the reconstruction of long bones since 1973. The reconstruction of the mandible using a free fibular transplant has been published in 1989 only by Hidalgo. The mandible and the fibula have little in common, except for their length and a similar structure in section. The anatomical study of the free osteofasciocutaneous fibular graft included 20 fresh subjects. The vascularization of the fasciocutaneous plate is either grouped or, more frequently, tiered (2/3 of cases). The technique to remove this graft is specified. Four clinical cases are reported, including three cases of neoplasm of the floor of the mouth invading the mandible, and one case of traumatic amputation of the lower part of the face. A free composed transplant taken from the fibula has been used in all four cases. The postoperative period was normal, and the grafts were completely successful. The main indications of free transplants made of fibular bone are: extensive (more than 8 cm) or compound losses of bony substance from the mandible. The richly vascularized transplant take from the fibula is very sophisticated and performant. The length of bone that can be removed is 25 cm; the bone may be osteotomized in 2 to 4 fragments retaining their vitality. Other tissular structures such as the skin, fascia, muscle, are removed with the bone. The independence in space is threefold and regards the bone, the teguments and the vascular pedicle. The microsurgical qualities of the vascular pedicle are considerable. These free transplants improve the quality of survival (endosseous implants in one case). The morphological, functional and esthetic result is good as a rule.

Adult↗
PubMed1990

[Auto-transplantation of small intestine, an emergency salvage procedure after failure of esophagoplasty].

The colon or stomach is generally used for extended oesophagoplasty. These pediculated plasties may be complicated by necrosis or stenosis and require total or partial resection at a later stage. We report such an outcome in this case report: failure of left coloplasty, partial failure of right coloplasty and stomach then rendered unusable. The cervico-thoracic oesophagus was reconstructed using a free revascularised small bowel transplant, re-establishing the continuity between the cervical oesophagus and the retrosternal right colon. This case presents several particularities: semi-emergency salvage procedure, use of a saphenous vein graft to revascularise the intestinal artery using the lingual artery as nutrient artery, venous drainage of the transplant via the intrathoracic left brachiocephalic vein, necessity for resection of the left half of the manubrium sterni and the head of the left clavicle.

Colon↗
PubMed1990

[Systematization and histomorphometry of human laryngeal nerves].

Laryngeal nerves were dissected from 100 fresh subjects in order to compare right and left superior and inferior laryngeal nerves. The origin and the distribution of the vascularization was studied. The structure of these nerves was precised through an histomorphometric approach (distribution number of myelinated fibers per mm2, diameter of myelinated fibers). A cartographic study of the laryngeal nerves confirmed the structure of this innervation. The main conclusion of this study is the importance of the plexis structure of the laryngeal innervation and the variations of the nerve fibers diameter as a function of the length of the fiber.

Computers↗
PubMed1990

[Pharyngoesophageal reconstruction using a vascularized free jejunal graft. Indications--technique and surveillance. Report of 90 cases].

Several procedures have been proposed for pharyngoesophageal reconstruction. The use of a revascularized free jejunal graft currently appears to be a method of choice for anatomical, physiological and technical reasons. The authors currently look back on a series of 90 patients having received a revascularized free jejunal graft between 1978 and 1989 inclusive. The indications predominantly include cancer of the pharynx invading the posterior wall and preserving the cervical esophagus, requiring total circular pharyngolaryngectomy (77 cases). Some benign lesions involve reoperated patients (13 cases). The technique for obtaining the jejunal graft is accurately codified: use of the 3rd jejunal loop in isoperistaltic conditions, refrigeration during the period of ischemia, revascularization by the cervical vessels. If a salvage operation is needed, it is necessary to prepare a saphenous venous graft at the beginning of the operation (3 cases). These grafts must be observed daily. Early negative signs include unexplained epistaxis, blood in the saliva, cervical skin suffering. Emergency fiberscopy must be performed with a bronchoscope or a rhinofiberscope. In case of suffering or necrosis of the graft, the patient must be reoperated immediately and a second free jejunal graft must be placed. The absence of postoperative mortality, low morbidity and good functional results obtained in the series are convincing reasons for using this procedure.

Emergencies↗
PubMed1990

[Vascular problems in gastric esophagoplasty after esophagectomy or circular pharyngolaryngectomy].

Gastric oesophagoplasty (GOP) after total oesophagectomy or circular pharyngolaryngectomy is complicated by an average anastomotic breakdown or fistula rate of 15%, and a stenosis rate of 8%. Ischemia related to the actual procedure itself undoubtedly plays a role in the production of such complications in spite of the rich vascular supply to the stomach. The authors report the results of an anatomical study involving 24 stomachs from non-embalmed adults studied by various forms of arteriography depending in the GOP technique employed. For healthy normotensive gastric arteries, they demonstrate the principal elements likely to influence the vascularisation of the graft and propose a provisional vascular score for ischemia. Based on this, they discuss the vascular risks associated with GOP techniques in general.

Adult↗
PubMed1990

[Comparative study of vascularization of the stomach after hyperselective vagotomy and anterior seromyotomy].

Based on a Micropaque arteriography study of 21 stomachs from non-embalmed adults, the authors compare the ischemic consequences of highly selective vagotomy (HSV) with those of anterior seromyotomy (ASM) combined with posterior trunk vagotomy. HSV inevitably produced an avascular band 2-4 cm wide in the lesser curve region. ASM, to be total and effective, needs to produce hemostasis of the submucosal plexus thereby also producing ischemia of the denuded mucososubmucosal band. It is however possible to avoid the submocosal plexus by remaining more superficial; however, it is then necessary to combine an additional neurotomy otherwise the procedure is likely to fail. In any event, the partial ischemia associated with ASM is much less serious than that noted after HSV.

Adult↗
PubMed1989

[Prefabricated free transplants. Experimentation].

The principle of prefabricated transplants consists in the manufacturing of compound transplants complete with a vascular pedicle containing an artery, a vein, a muscle and its nerve, some cell tissue, bone tissue, cartilage, periosteum and innerved skin. This transplant is constructed and modeled in accordance with its intended use, around the preselected vascular pedicle, whence the term prefabricated. Neovascularization revascularizes these different structures. The free transplants together with their vasculonervous pedicles are excised five weeks after manufacture and then transplanted to the recipient site. Experimentally, we grafted 15 free prefabricated transplants in Wistar rats. One failure was observed due to thrombosis of the anastomoses. Experimental data from macroscopic, arteriographic, microangiographic, and histological examinations, with injection of a staining material, show that neovascularization develops at the level of the transplant. The emphasis is on creating free transplants selectively using various tissues and selected vascular pedicles. These transplants constitute a useful prospective alternative for very elaborate reconstructive surgery.

Animals↗
PubMed1986

[Laryngeal nerves. A histomorphometric and cartographic study].

Major difficulties in laryngeal reconstruction are due to laryngeal nerves. A study was conducted of 100 larynges from fresh subjects after vascular injection. Vascularization of superior laryngeal nerves is derived essentially from superior laryngeal and ascending pharyngeal arteries. Inferior laryngeal nerves obtain their vascular supply from inferior thyroid and main carotid arteries. Histomorphometric study of laryngeal nerves used semi-automatic techniques: microscope, numerical table, computer, printer. The number of fibers per nerve varied between 511 and 2.244, the number of nerve fasculi between 3 and 14, and the diameter of myelinated fibers between 2 and 12 micron. Fibers of left inferior laryngeal nerve had a mean diameter (8.9 to 10.2) greater than those of right inferior laryngeal nerve (5.1 to 5.2 micron). Nerve tissue represented 60% to 66% of total. The left recurrent was longer than right nerve but had larger fibers providing more rapid conduction. Cartography of laryngeal nerves from 2 mm serial sections confirmed their plexis structure, this study providing new and objective precisions on laryngeal nerve structure.

Histological Techniques↗
PubMed1986

[Vascularization of the larynx. Update of classical anatomic data from an anatomical study of 100 subjects].

The study was conducted after arterial and venous neoprene latex injection to 100 fresh subjects. Three laryngeal arteries are constant: superior, inferior and posterior. The superior laryngeal artery is of variable origin: in 84% of cases it arises from superior thyroid artery. Anastomoses between the three laryngeal pedicles and the muscle territories supplied by the arteries are described. Vascularization of cartilages is according to a precise plan and cricothyroid and cricoarytenoid joints are the site of constant arterial anatomoses. Origin of superior laryngeal artery fluctuates due to sliding phenomena. The notion of a neurovascular pedicle is fundamental: it is formed by the neural crest derivation and the corresponding artery, that is to say the artery and nerve of a branchial arch. This is to be compared with the notion of pure musculocutaneous and glandular pedicles. The larynx is a junctional zone between 4th and 6th branchial arches and is integrated with the cervicocephalic system of aortic arches.

Arteries↗
PubMed1986

[Choice of the 3d portion of the jejunum for reconstruction of the pharynx in circular pharyngolaryngectomies. Indications and advantages].

Many procedures are used for reconstruction of a pharyngeal gutter after circular pharyngolaryngectomy, interrupter of digestive continuity. The operation chosen was used of third part of jejunum for reconstruction, and its indications and limitations are described. The choice was based on anatomic data from dissection of 100 cadavers and values for different measurements performed (length of transplant, height of mesentery, caliber and length of vessels), and more particularly on constancy and reliability of vascularization of this digestive segment. To these advantages are added bacteriologic, technical, histologic and physiologic reasons. Results are analyzed of 11 operations carried out in the same department, from among a larger group comprising now 45 cases. Postoperative course was usually uncomplicated with rapid restoration of deglutition (a mean of 11.77 days in 9 of the 11 cases). Preoperative radiotherapy is not a contraindication and postoperative radiotherapy should be given routinely as a complement to surgery. It is usually well tolerated and transplant necrosis is not provoked. Nevertheless, the seriousness of this type of lesion is underlined by the high incidence of carcinologic failures, with an elevated risk of local and regional recurrence and of distant metastases.

Aged↗