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P Pélissier

Publications and source records attributed to P Pélissier.

18 recordsLinked to original sources
PubMed2005

[Antebrachial flap based on distal perforators of the radial artery: anatomic study of 10 cases].

PURPOSE: The radial forearm flap based on distal perforators of the radial artery is a recent flap, derived from the so-called << chinese-flap >>. The interest of this flap resides in the preservation of the main arteries of the forearm. The aim of this study was to count the distal perforators of the radial artery and to study sub-cutaneous vascular system. MATERIALS AND METHOD: We performed 10 dissections on fresh cadavers, after selective injection of the radial artery with a solution of plasticized resin. The dissection was performed from the palmar flexor fold of the wrist up to 15 cm proximally, allowing to count all of the distal perforators. RESULTS: We determined three different intervals, among which the one located between 2 and 6 cm from the palmar flexor fold of the wrist was the most vascularized. This interval should be considered as the rotation point of the flap. CONCLUSION: This study allowed to make clear and more reliable the operative procedure to raise the flap. This procedure is easy to handle and intended to cover proximal defects of the dorsal aspect of the hand, while sparing the radial artery.

Arm↗
PubMed2005

[Adrenal hypoplasia congenita: four new cases in children].

Adrenal hypoplasia congenita (AHC) is an extremely uncommon disease of early onset. This condition can be lethal in the absence of adapted treatment. Some of these diseases are related to changes in the gene DAX1 that encodes a member of the superfamily of hormone nuclear receptors. It is a transcriptional repressor that is central in the morphogenesis of the adrenals and the gonadic differentiation. Here we report on four cases of X- linked AHC. In the first two familial cases, mutations were identified and mothers were heterozygotes. Abnormally low levels of estriol were evidenced during the pregnancy leading to an early diagnosis and adapted care of the affected male neonates. These children are doing well with a 21-and 20 months follow-up with hormone replacement at the present time. The two last cases corresponded to a contiguous gene syndrome associating AHC to glycerol-kinase deficiency that was revealed respectively at six days and seven years of age by acute adrenal insufficiency.

Adolescent↗
PubMed2004

The middle collateral artery: anatomic basis for the "extreme" lateral arm flap.

The vascularization of the posterolateral area of the arm is supplied by the terminal branches of the deep brachial artery [middle collateral artery (MCA) and posterior radial collateral artery]. Their anatomy has been a field of confusion for a long time. An extended lateral arm flap, named the "extreme" lateral arm flap, supplied by these branches and dissected as a retrograde island flap has been proposed as an alternative for large compound defects of the distal forearm. We carried out an extensive anatomic study of the "extreme" lateral arm flap on 69 upper limbs: 54 fresh injected with colored latex, 10 embalmed and 5 radiographed after Micropaque injection. Two origin levels of the MCA were found: a proximal one (37%) above the radial groove, and a distal one (63%) at the level of the groove. The deep brachial artery always bifurcated after the origin of the MCA into a posterior radial collateral artery (PRCA) and anterior radial collateral artery (ARCA). Indeed in our dissections, after the origin of the MCA from the deep brachial artery, there was always a common trunk named the radial collateral artery (RCA) which bifurcated into the ARCA and PRCA. In all dissected arms we always found the MCA anastomosed in a transverse pattern with the inferior ulnar collateral artery (IUCA), contributing to the anastomotic circle of the elbow. This circle represents the unique vascularization source of the reverse "extreme" lateral arm flap.

Aged↗
PubMed2003

The retrograde neurocutaneous island flap of the dorsal branch of the ulnar nerve: anatomical basis and clinical application.

It is well known that a cutaneous artery is constantly located near a cutaneous peripheral nerve, forming a vascular plexus around it. This vascular axis can be either a true artery or an interlacing network, ensuring the vascularization of the nerve and giving off several neurocutaneous perforators to the skin. The anatomy of the accompanying arteries of the dorsal branch of the ulnar nerve (DBUN) and their relationships with the dorsal branch of the ulnar artery (DBUA) were investigated in 22 fresh upper limbs injected with colored neoprene latex. A constant perineural vascularization of the terminal branch of the DBUN was observed in the fourth web space, connected distally with the corresponding dorsal metacarpal or palmar digital arteries. Our findings therefore provide anatomical bases for a new neurocutaneous island flap. Moreover, they allow us to describe a precise surgical technique in order to raise this flap over the larger branch of the DBUN, in the fourth intermetacarpal space. The flap is harvested on the medial aspect of the dorsum of the hand, and its point of rotation is located in the fourth web space, 1 cm proximal to the metacarpophalangeal joint. It is supplied by a reversed flow originating from distal anastomoses of the perineural vessel with the dorsal metacarpal and digital palmar arteries in the fourth web space. This flap does not involve in its pedicle the distal course of the DBUA. It represents a pure neurocutaneous flap.

Aged↗
PubMed2001

[Microsurgery and esthetic considerations. Two cases of heel reconstruction].

With two case reports of heel reconstruction on female patients the authors report the advantages and drawbacks of the two main types of reconstruction: free or regional flaps. Regional flaps are technically easy and reliable but their aesthetic after-effects on the donor site may be disabling, specially on the leg of a female patient. Microsurgery is technically more difficult and presents more complications specially on the lower limb. However, in certain conditions, and with the appropriate choice of donor site, free flaps authorize good quality reconstructions with minimal aesthetic after-effects.

Accidents, Occupational↗
PubMed2001

[Terminal-lateral nerve anastomoses. Preliminary clinical report of two cases].

Nerve regeneration is based on three phenomenons of critical importance: neurotropism, nerve guidance and neurotrophis. These principles allow understanding the mechanisms of nerve suture and grafting, but also the newly described end-to-side nerve anastomoses. In this procedure, the distal stump of a severed nerve is anastomosed on the lateral side of an intact nerve, with or without removal of the perineurium. Authors report their beginning experience with this procedure (ten cases) and discuss the early results. End-to-side anastomosis seems to be a useful and reliable technique for clinical nerve repair. Even if nerve grafting remains the gold standard to bridge nerve defects, one has nothing to loose if a few minutes, anastomosing the severed nerve on the lateral side of an intact nerve, rather than doing nothing.

Adolescent↗
PubMed2001

[Vascularized bone pedicle grafts of the hand and wrist: literature review and new donor sites].

Some situations in hand surgery require vascularized bone grafts. Good mechanical strength and decreased time for bone healing may explain their use. Although many donor sites have been described, the authors were interested by donor sites with a blood supply provided by an accessory vessel not disturbing the perfusion of the hand. Literature review of the different donor sites demonstrate (a) Three sites at the dorsal aspect of the distal epiphysis and one at the dorsal distal ulna. Only the radialmost site has been regularly used for surgical application. (b) At the palmar aspect of the radial epiphysis, the pronator quadratus vascularised bone graft may be elevated in an antero or retrograde way. (c) Among the carpal bones, the pisiform and part of the capitate has been used as pedickled bone graft. (d) Metacarpals may also be a donor site. Description of sites at the proximal and distal part of the second metacarpal has been used for surgical applications. The authors describe a new site at the first metacarpal at the radiodorsal or uino-dorsal aspect which may be used as a composite bone-skin graft. A clinical application is presented. Clinical use of these pedicles graft is discussed and apply mainly for scaphoid nonunion and some case of Kienbock's disease. Distal stump reconstruction is possible with the new flap.

Bone Transplantation↗
PubMed2000

[The modiolus. Comparative anatomy, embryological and physiological review, surgical importance].

Monkeys, imitators of man's gesture never shared smile with him and their facial expressions only result in grimaces. Study of animal anatomy may explain why subtle expressions of the lips are a more man's special gift than laughter. These fine movements are related to a subcutaneous muscular structure termed modiolus, which is the meeting point of muscles involved in the motion of mouth and comparative anatomy shows this structure to be better defined in Man than in other primates. Embryologically, muscles that form the modiolus derive from a cellular concentration in the region of the second branchial arch. It is then logical to see these muscles converge to the corner of the mouth to form the modiolus, as they emerge from a common area. Functioning of the modiolus is complex, as its position may change many times in a minute to allow the orbicularis oris muscle to take any position and do any movement as if it was inserted on bone. With its complex physiology, the modiolus is of critical importance in the subtle expressions of the lips and must be preserved or reconstructed when performing repair of full-thickness tissue defects of lips.

Animals↗
PubMed2000

[Autologous bone grafts. Anatomo-physiology, technique and actual location for bone reconstructions].

The authors discuss the indications for conventional nonvascularized bone grafts, of which the scope of utilisation has been considerably reduced since the advent of vascularized bone grafts. The objective of this study is to highlight the essential knowledge regarding the biology and biomechanics of the incorporation of bone grafts. The principal donor sites are examined with respect to the operative techniques and the advantages and disadvantages. The authors then derive the principal indications for conventional bone grafting and illustrate them with examples selected for limb reconstruction.

Bone Transplantation↗
PubMed2000

[The scapula: a preferred donor site for a free flaps or pedicles transfer].

The authors present all the possibilities that the scapula can offer as a donor site for bone. After having reviewed the potential for acromial transfer on a pedicled trapezial flap, they summarise the anatomical basis for the transfer of the lateral border. There are two systems of vascular supply, one based on the circumflex scapular vessels described by Téot and the other based on the vessels of the angle of the scapula described by Deraemacker. This dual blood supply forms a very rich anastomosis with a predominant periosteal supply that allows for multiple osteotomies to be made. The technique of harvesting and the indications are highlighted as well as an iconography, which presents the principle forms of reconstruction that have been described until today. The authors support the use of the pedicled transfer of the lateral border, which is poorly known and above all poorly used. Their experience in five consecutive clinical cases demonstrates all the potential of this technique for humeral reconstruction. As a microsurgical transfer, however, the principal advantage of using the inferior scapular axis is offset by a few drawbacks, the principal one being the difficulty of dissection. Its main indication as a free flap is in the maxillofacial surgery where it allows very precise reconstructions of the mandible, the palate or the maxillozygomatic region.

Bone Transplantation↗
PubMed1999

[Humanitarian plastic surgery missions. Actions and reflections].

After recalling the various possible objectives of humanitarian missions in underprivileged countries, the authors describe the context of their plastic surgery missions, each lasting two to three weeks, with the support of Interplast. These missions have been conducted in India, Pakistan, Thailand, Vietnam and Afghanistan. The organization is now classical: on site supply of anaesthetic and all disposable material, 50 to 100 operations over a fortnight in a local hospital. The diseases most frequently observed were cleft lip and palate and post-burn skin retractions. The authors emphasize the fact that the mission director must be an experienced surgeon in order to select the most reliable and the simplest procedure. They analyse the meaning of their commitment and the way in which this humanitarian action is perceived by the recipient country.

Adult↗
PubMed1998

[Facial epitheliomas: general considerations, surgical techniques and indications].

Carcinoma of the face is the skin disease most frequently encountered by plastic surgeons in everyday practice. Although basal cell carcinomas and squamous cell carcinomas are generally easy to recognize, their treatment remains subject to various schools of thought, or even individual practices, which are often difficult to define. This article defines a general plan of management of these tumours; their histological duality corresponds to a therapeutic duality. Resection of a basal cell carcinoma requires safety margins of 3 to 4 mm, versus at least 5 mm for a squamous cell carcinoma. In a high-risk subject, with a sclerodermiform carcinoma or undifferentiated squamous cell carcinoma, this safety margin may be as much as 10 mm or more. Frozen section examination is preferable in these situations. Six anatomical regions are studied selectively to define the main rules of reconstruction: nasal region, orbitopalpebral region, labial region, malar region, frontal region and auricular region. Each region will be subdivided into several subterritories, each requiring different strategies. The objectives, methods and indications of each reconstruction are selectively defined. The final strategy proposed is based not only on the author's personal experience, but also on the results of the national survey on carcinomas. As a complement to these therapeutic guidelines, the authors raise the problem of incomplete resection, which requires the definition of a peripheral infiltration index predictive of the recurrence rate. Surgery obviously cannot constitute exclusive treatment carcinomas, hence the value of presenting other methods currently available in the therapeutic armamentarium. Surveillance is essential in every case, determined by the patient's risk of recurrence or even metastatic dissemination.

Basal Cell Carcinoma↗
PubMed1998

[National survey on therapeutic strategy in facial epitheliomas].

The national survey concerning the therapeutic strategy for carcinomas of the face published here reviews the therapeutic strategies to this everyday disease. The 30 centres included in our statistics have a combined experience of several thousand cases. 61% of these centres operate on more than 50 carcinomas per year. The following conclusions can be drawn from these data. The general national option is for treatment of the defect by flaps than by skin graft, all reconstruction situations combined. In the case of skin grafts, the retroauricular and supraclavicular sites are the most frequently used. 71% of authors also perform skin grafts immediately after the initial resection. Directed healing is only indicated in the treatment of small defects with a preferential site: the medial canthus. Frozen section examination is requested at the time of the initial resection in an average of 24.3% of basal cell carcinomas versus 43.9% of squamous cell carcinomas, with a range of 0 to 100% in the two series. 16 resection sites were then proposed, to define the most frequent cases. Consensus was exceptional. At the very most, a fairly unified strategy was defined for defects of the eyelids and lips, where there is a preference for classical Abbé or Mustardé flaps for the lower eyelid. Similarly, kite flaps are usually preferred in the nasolabial region. In all other cases, the responses vary considerably and are submitted to statistical analysis, completed by a general discussion.

Carcinoma↗
PubMed1998

[Advanced epitheliomas of the face: when to stop?].

Progress in plastic surgery has allowed an ever increasing extension of the indications for facial reconstruction. Although carcinomas are now detected earlier and earlier, the practitioner is nevertheless faced, several times during his working life, with "historical" cases. Although it is fairly rare to observe long-term progression of squamous cell carcinomas, basal cell carcinomas can take on considerable proportions due to their very low metastatic risk. In these situations, the dilemma between conservative management and performing an inevitably major procedure is never easy to resolve. Moreover, it is often the discomfort experienced by the patient's family which encourages him to accept the operation. The objective of the procedure is more often aesthetic rather than curative, although this latter objective must always be attempted. Consequently, the practitioner should never hesitate to defer reconstruction for several months in order to ensure reliable local surveillance. The value of epitheses is clearly established in this situation. When a reconstruction can be performed, "major" measures are generally necessary, making use of all of the regional or even distant plastic surgery techniques used for facial surgery. However, microsurgery is a last resort indication, which should only be used when the various pedicle flaps have been exhausted. The microsurgical delay technique (Jean-Marie Servant's "apple turnover" technique) is particularly useful in these situations. In the light of seven clinical cases, the authors try to define the essential concepts of this type of management. In fact, the respective limits of active intervention and conservative management are defined by each surgeon's common sense and experience. The constant improvement of the quality of epitheses make them the current treatment of choice for the restoration of extensive defects. Lastly, one of the main factors to be considered before taking any treatment decision is the psychology of these patients, as it is always difficult to explain the discovery of lesions at this advanced stage.

Aged↗
PubMed1997

[Lateral brachial flaps].

The "extreme" lateral arm flap is a new method for covering the distal upper limb. This flap is a modification of the classical lateral arm flap allowing his transfer as a pedicled flap to cover the forearm and the wrist. This technique is based on a new concept: "the reverse flow VY pedicle advancement". This requires an arterial bifurcation of the deep humeral artery: the medial collateral artery described in this study.

Aged↗
PubMed1995

NCA2, a second nuclear gene required for the control of mitochondrial synthesis of subunits 6 and 8 of ATP synthase in Saccharomyces cerevisiae.

Respiratory-competent nuclear mutants have been isolated which presented a cryosensitive phenotype on a non-fermentable carbon source, due to a dysfunction of the mitochondrial F1-Fo ATP synthase. This defect results from an alteration of the mtDNA-encoded protein synthesis level of subunits 6 and 8 of the Fo sector, due to the simultaneous presence of a mutation in two unlinked nuclear genes. These mutations promote a modification of the expression of the cotranscript ATP8-ATP6 (formerly denoted AAP1-OL12): this mRNA undergoes a maturation at a unique site reaching to two cotranscripts of 5.2 and 4.6 kb in length: in the mutant, the relative amount of 5.2 kb cotranscript was greatly lowered. NCA2 was isolated from a wild-type yeast genomic library by genetic complementation. The relative level of the 5.2 kb transcript, as the synthesis of subunits 6 and 8, was partly restored in the transformed strain. A 1848 nucleotide open reading frame was depicted that encoded an amphiphilic protein of 70,816 Da. Disruption of chromosomal DNA within the reading frame promoted a dramatic decrease of the 5.2 kb mRNA but did not abolish the respiratory competence of a wild-type strain. Hybridization analyses indicated that NCA2 is located on chromosome XVI and produces a single 2750 base transcript.

Amino Acid Sequence↗
PubMed1995

NCA3, a nuclear gene involved in the mitochondrial expression of subunits 6 and 8 of the Fo-F1 ATP synthase of S. cerevisiae.

Respiratory-competent nuclear mutants have been isolated which presented a cryosensitive phenotype on a non-fermentative carbon source, due to a dysfunctioning of the mitochondrial F1-Fo ATP synthase which results from a relative defect in subunits 6 and 8 of the Fo sector. Both proteins are mtDNA-encoded, but the defect is due to the simultaneous presence of a mutation in two unlinked nuclear genes (NCA2 and NCA3, for Nuclear Control of ATPase) promoting a modification of the expression of the ATP8-ATP6 co-transcript (formerly denoted AAP1-OLI2). This co-transcript matures at a unique site to give two cotranscripts of 5.2 and 4.6 kb in length: in the mutant, the 5.2-kb co-transcript was greatly lowered. NCA3 was isolated from a wild-type yeast genomic library by genetic complementation. The level of the 5.2-kb transcript, like the synthesis of subunits 6 and 8, was partly restored in the transformed strain. A 1011-nucleotide ORF was identified that encodes an hydrophilic protein of 35417 Da. Disruption of chromosomal DNA within the reading frame promoted a dramatic decrease of the 5.2-kb mRNA but did not abolish the respiratory competence of a wild-type strain. NCA3 is located on chromosome IV and produces a single 1780-b transcript.

Amino Acid Sequence↗