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Biomedical subjects

P Banzet

Publications and source records attributed to P Banzet.

At least 19 recordsLinked to original sources
PubMed2006

[Surgical treatment of male-to-female transsexuals: a ten-year experience assessment].

From May 1995 to March 2005 sixty-three consecutive male-to-female gender transformation surgeries were performed at our university center by one author. Our retrospective study collected data from medical records, questionnaire and physical examination. Fifty-nine percent of patients had autologous blood transfusion. Histological examination of testicles found beginning cancer in 1 case. After a-8-year initial period where secondary bilateral Z-plasties were systematically performed, this procedure was abandoned because it left unnatural visible scars. Excluding haematomas (9 cases), we found 8 major complications (12,6%): 1 rectal lesion, 1 leg compression, 5 skin necrosis of the vaginoplasty (total necrosis in 2 cases, partial necrosis in 2 cases, necrosis of full-thickness skin graft in 1 case), and 1 secondary post-traumatic rectovaginal fistula. The questionnaire was completed by 22 patients with a-45-month mean follow-up. Results were graded on a 0 to 10 scale. Mean grades were global satisfaction: 7.6, life quality: 8.4, genitalia appearance: 8.0, clitoris sensitivity: 8.4, urinary function: 8.3, vaginal function: 7.2, sexual function: 7.0. Rate of general satisfaction was high. In a few cases however, patients expressed some disappointment both in being considered as women in their daily living and in having sexual intercourse. These poor results seem clearly related to unfavourable anatomical and morphological initial conditions. Our series demonstrates that surgical treatment of psychiatric disorders meets physical limitations.

Adult↗
PubMed1999

[Surgical repair of abdominal wall].

Surgical repair of abdominal wall defects following tumour resection only raises real problems when the nature of the tumour required wide, or even transfixing excision, as in the case of sarcomas or very advanced carcinomas. Superficial repair is performed according to the algorithm of the simplest technique: secondary healing, partial suture, total suture, transplant, or flap (pedicled or free). In the case of transfixing resection, the combination of a biomaterial for reconstruction of the deep plane and a superficial flap is necessary. For very large transfixing defects of the abdomen, a free flap may be required and, in this case, delayed insertion after initial transfer may further reduce the operative risk ("apple turnover" technique). The complications observed in a detailed series of 9 cases operated at Saint-Louis Hospital consisted of one intraoperative cardio-circulatory arrest during second-stage surgery and one late infection at three years. The authors believe that the indications for delayed insertion of a free flap are still very topical in cases in which a very large grafted free flap is necessary in conjunction with a prosthesis. Large abdominal defects after cancer resection can be reconstructed by modern reconstructive surgery.

Abdominal Muscles↗
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↗
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↗
PubMed1996

[Chemotherapy and immunotherapy of metastatic malignant melanomas].

Prognosis in metastatic malignant melanoma is poor because of chemo and radiotherapy resistance. However, some drugs, such as dacarbazine, cisplatinum or fotemustine, a new nitrosourea, have produced a response rate of more than 20%. Combining these drugs increases response rate to 30-40%. Immunotherapy by interferon-alpha 2 shows about 15-20% response rate but interleukin-2 would be more effective especially in combination with cisplatinum and interferon-alpha 2 with 50% response and long survival after cessation of treatment.

Antineoplastic Combined Chemotherapy Protocols↗
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

[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

[Treatment of Darier-Ferrand tumors of the head and neck. Retrospective analysis of 20 cases].

Dermatofibrosarcoma protuberans is an unusual cutaneous neoplasm. Because of its high propensity for local recurrence, a wide and deep excision is recommended as the only satisfactory treatment. This tumour can raise difficult problems of reconstruction to plastic surgeons particularly when located in the face. The authors present a retrospective study of twenty cases of dermatofibrosarcoma protuberans of the head and neck treated at the Saint-Louis hospital over a period of twelve years.

Adolescent↗
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↗
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

[Plastic surgery and the treatment of breast cancer].

For many patients conservative treatments are available at the present time in case of breast cancer. Nevertheless, radical mastectomy is to be performed in a few cases. Breast reconstruction is then able, when required by the patient, to improve her quality of life. This present study aims to discuss both the technical modalities and the indications of this type of reconstructive surgery.

Breast↗
PubMed1992

[Free radial antebrachial flap. A retrospective study of 48 cases. Practical applications].

The authors have studied 48 chinese forearm free flaps operated since 1982 at St-Louis, Hospital Paris. Analysis of early complications and failures shows that the few problems that occurred seem to involve hemodynamics more than technical problems. The results support the hemodynamic theory about radial forearm free flaps: low-flow flap which contrasts with the wide diameter of the radial artery. This kind of free flap may not support interpositional vein graft for arterial bridging (stasis, distension of the graft then thrombosis), which must be taken into account in the operating procedure. When the radial artery needs to be lengthened, we therefore systematically reduce the risk of thrombosis by re-establishing radial artery outflow for safety: either by distal radial artery anastomosis, or with an arteriovenous shunt.

Adolescent↗
PubMed1992

[Free-tissue transfer in plastic surgery (emergencies excluded). Apropos of a 10-year experience].

Over a period of ten years the authors have performed 176 elective free tissue transfers. Flaps used were 99 latissimus dorsi, 46 chinese forearm flaps, 12 fibula, 6 toes, 5 omentum, 4 parascapular, and 4 others flaps. Recipient sites were lower limbs in 106 cases, head and neck in 50 cases, forearm and hand in 13 cases, thorax, abdomen, and buttocks in 7 cases. The overall failure rate was 5.7 per cent. Analysis of these failures taught us some original principles. Among these principles, the risk of vascular thrombosis is very important when a venous graft is performed on one end of the artery of a low blood flow flap such as chinese forearm or fibular flaps when the other end of this artery is ligated. When such a graft is done we think that the best way to avoid thrombosis is to suture the other end of the flap artery to a recipient vessel which can be even the distal end of the flap vein itself. Pretransfer expansion of a latissimus dorsi flap was successfully performed in 4 cases. Migrating semi-free flap method, in which the vascular pedicle of a flap is temporarily sutured to recipient vessels located far from the defect, was performed in 12 cases, in most cases on lower limbs where this method constitutes a modern variant of the cross-leg. Folded free-flap method, in which a flap is folded on itself during some days before excision of the recipient site, was performed in 14 cases. Analysis of this series also allowed us to review in detail our usual strategic principles for vascular anastomoses in the head and lower limbs.

Adolescent↗