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Biomedical subjects

P Pelissier

Publications and source records attributed to P Pelissier.

At least 19 recordsLinked to original sources
PubMed2007

Reliability of the pulp nail bone (PNB) classification for fingertip injuries.

Evans and Bernardis proposed the 'PNB classification', by which a fingertip injury is classified according to each structure: pulp P, nail N, bone B. The objective of this study was to assess the inter-observer reliability, repeatability and accuracy of PNB. One hundred patients presenting with a fingertip injury were included prospectively, photographed, then classified in randomly chosen orders by nine independent observers. A third were drawn randomly and classified a second time to measure repeatability. A reference classification was also provided by one of the authors of the PNB system. Classifications agreed with the reference in 59% of injuries for P, 55% for N and 54% for B. The Kappa values for inter-observer agreement were 0.520 for P, 0.512 for N, and 0.504 for B; for intra-observer agreement, they were 0.616 for P, 0.658 for N, and 0.577 for B. Although levels of agreement are comparable with results found for other classifications, they are insufficient for use of the PNB classification without improvement.

Adolescent↗
PubMed2006

Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases.

Free flaps are the first choice procedure to manage soft-tissue defect of the lower limb for many authors, but loco-regional pedicled flaps are an alternative since they were described in the 1980s. We analysed the changes in our practice to reconstruct soft-tissue defects of the distal third of the leg. A retrospective chart review identified 215 cases of distal leg soft-tissue defect treated in the department during 15 years. The mean age was 43, and the sex ratio was 2.4. The aetiology, the size, the septic status and location of each wound were noted. The surgical procedures used and the complications have been analysed. The size and location of the wounds were comparable over the 15 years considered. Microsurgical tissue transfers were predominant in the 1980s and decreased in the 1990s, whereas the pedicled flap had an opposite evolution. In our experience, pedicled flaps are related to a non-significant lower rate of complication (18%) than free flaps (27%). Moreover, complications of local and regional flaps are less severe. Our practice has changed to make pedicled flaps our first choice to cover soft-tissue defects of the lower limb. However, we still use free flaps as a first choice for wide or composite defects, when pedicled flaps are not feasible or for cosmetic considerations to avoid additional scarring of the leg.

Adolescent↗
PubMed2005

[First case in the world of autoreplantation of a limb associated with oral administration of an immunosupressant agent (FK 506-Tacrolimus)].

This is the case of the replantation of the upper limb of a sixty year old woman. The nature of the traumatism is an avulsion of the upper limb, at the junction of the middle third and the lower third of the humerus, which has a very bad prognosis. The originality of this report is the administration of Tacrolimus (immunosuppressive molecule) in an autotransplant. Tracolimus stimulates the nerve growing back, as already demonstrated in the animal and the fetus. In this preliminary report, the use of Tacrolimus over one year showed exceptional results. Indeed, the autors noticed clinical signs of intrinsic reinervation of the hand in the territory of the ulnar and median nerve. This has been confirmed with the use of electromyography. This is, as far as we know, the first observation of such results with adults and when the level of amputation is located so high. The authors think that the use of Tacrolimus should be tested in numerous cases of nerve lesions with bad prognosis such as high ulnar nerve lesions, serious plexus suffering or even in spinal cord trauma.

Administration, Oral↗
PubMed2005

[Contribution of French surgeons to reconstructive microsurgery].

The authors report the contribution of French surgeons and particularly the plastic surgeons to the reconstructive microsurgery since 1972. Different domains are reviewed: animal experimentation, anatomical studies, reimplantations, free tissular transfer, free bone transfer, strategic original concept of transfer, free toes transfer, microsurgical reconstruction of malformative hand, free lymphatic transfer, nervous microsurgery, flap prefabrication, allotransplantations and the future of microsurgery. Three societies have the place of honour: the French Society of Plastic Reconstructive and Aesthetic Surgery, the Group for Advancement of Microsurgery and the World Society for Reconstructive Microsurgery.

Adult↗
PubMed2005

[<< Reverse >> latissimus dorsi musculocutaneous flap: anatomic study of the secondary pedicles].

PURPOSE: The latissimus dorsi flap based on the secondary segmental vessels, wich is termed << reverse >> or << distally based >> latissimus dorsi flap, has been used to repair major thoraco-lumbar defects, to close myelomeningoceles and to reconstruct congenital diaphragmatic absences. The arc of flap rotation is markedly restricted because the blood supply is segmental. It is the most important factor that limits the flap mobility and so restricts its use. The authors report an anatomic study of these secondary pedicles in order to improve the flap dissection and to extend the arc of flap rotation. MATERIAL AND METHOD: The precise location of the secondary pedicles of the flap was determined by 24 anatomic dissections. RESULTS: The latissimus dorsi has 3, 4 or 5 secondary pedicles respectively in 50%, 25% and 25% of cases in the study. These pedicles take origin from the dorsal branches of the posterior intercostal arteries of the 7th, 8th, 9th, 10th and 11th intercostal spaces. CONCLUSION: The number of secondary pedicles is not constant. The entire flap can be safely based on 2 secondary pedicles when the latissimus dorsi muscle has 3 secondary pedicles. When this muscle has 4 or 5 secondary pedicles, the entire flap should be at least based on 3 secondary pedicles, particularly if the skin island is very far from the origin of these vessels.

Back↗
PubMed2004

[Myanmar mission].

The authors report the accomplishment of humanitarian missions in plastic surgery performed by a small team in town practice in Yangon, about their 3 years experience in Myanmar with 300 consultations and 120 surgery cases. They underline the interest of this type of mission and provide us their reflexion about team training, the type of relation with the country where the mission is conducted and the type of right team.

Developing Countries↗
PubMed2002

[Foot reconstruction with the "bi-Masquelet" procedure].

A case of complex injury of the dorsal aspect of the foot is reported, the reconstruction of which combined two procedures described by A.C. Masquelet. The induced membrane and spongy autograft technique was used to reconstruct the metatarsal arch. The first stage was the insertion into the defect of a cement spacer which was responsible for the formation of a pseudosynovial membrane. The second stage was the reconstruction by a fresh autologous cancellous bone graft combined with hydroxyapatite. The membrane induced by the spacer prevents from the resorption of the graft and favors its vascularity and its corticalization. Soft tissue reconstruction was achieved by the mean of a supramalleolar island flap. Although bone healing occurred by the ninth month, the authors describe and discuss the possible mistakes when using this technique. Despite the many technical problems reported in this clinical case, bone reconstruction with the induced membrane and spongy autograft technique has proved to be easily handable and effective under adverse conditions.

Aged↗
PubMed2002

Modified "on-top-plasty" technique for restoring length to amputation stumps.

Five patients were successfully treated with a modified "on-top-plasty" technique, in which a finger stump is lengthened by transfer of an adjacent amputation stump with a reverse blood flow fingerstump. This technique can be performed in the acute phase or as a secondary procedure. A conventional on-top-plasty can be performed by transfer of a partially amputated index or ring finger to the "top" of the proximal phalanx of an amputated middle finger. Alternatively, the transferred part may be used in an intercalated fashion to reconstruct the middle phalanx, using a prosthesis to reconstruct the proximal interphalangeal joint. The results, complications and disadvantages of the technique are reported. We propose this procedure for the reconstruction of the middle ring finger when a free microneurovascular toe-to-hand transfer is contraindicated or refused by the patient.

Adult↗
PubMed2001

Limits and indications of the dorsal transposition flap: critical evaluation of 15 cases.

The dorsal transposition flap was used in 15 cases of distal fingertip amputation. The amputations were either oblique ulnar, oblique radial, oblique palmar, or transverse. Two flaps developed partial necrosis. Flat nail growth always occurred, but the nail was considered short in 4 cases due to a proximal amputation through the nail bed. The mean 2-point discrimination test result was 8 mm. Distal interphalangeal joint range of motion was normal in 5 cases. Four cases lacked 10 degrees from full extension, 9 cases lacked up to 20 degrees from full flexion, and 1 case lacked 35 degrees. Even if this procedure is simple, reliable, and fast, due to its limited size and arc of rotation, as well as its poor sensibility, this flap may only be indicated for oblique ulnar fingertip amputations.

Adolescent↗
PubMed2001

Treatment of facial haemangiomas: the present status of surgery.

Although conservative management is usually proposed for haemangiomas occurring in infancy, the presence of these tumours on the face may result in severe complications and provide an indication for treatment. In this paper, we report 35 patients who underwent surgical treatment for facial haemangiomas. The series consists of 23 females and 12 males, ranging in age from 2.5 months to 35 years. In six patients early surgery, before the age of 2 years, was performed because of severe complications, including visual occlusion, repeated bleeding and distortion of adjacent structures. In 16 children surgical resection of haemangiomas was carried out between 2 and 5 years of age, before complete involution. In 13 patients persisting haemangiomas were surgically treated at an older age. The operative technique depended on the location and size of the lesion, and focused on resection of the tumour and reconstruction of the adjacent structures when necessary. The postoperative outcomes were very satisfactory. Early surgery is mandatory in the management of large periocular haemangiomas, to prevent secondary amblyopia, and proliferative labial tumours, which are prone to bleeding and cause difficulty while eating. Early surgical treatment is also recommended for nasal-tip haemangiomas, which regress very slowly and may result in severe distortion of the cartilaginous framework. In conclusion, facial haemangiomas causing functional disturbance or serious psychological distress deserve surgical excision before the age of expected spontaneous regression; surgery can provide active treatment with excellent results and minimal morbidity.

Adolescent↗
PubMed2001

Vascular blood supply of the dorsal side of the thumb, first web and index finger: anatomical study.

Twenty-nine hands were dissected in order to define the dorsal blood supply of the thumb, the first web and the index finger. The main objective was to determine if it is possible to create a local osteocutaneous flap to cover partial and complex tissue defects in the distal part of the thumb. We found that the thumb metacarpal could be used as a donor site in these situations, with either a radiodorsal pedicle or an ulnadorsal pedicle.

Arteries↗
PubMed2001

Dorso-ulnar osteocutaneous reverse flow flap of the thumb.

Three cases of distal thumb reconstruction with a reverse pedicled osteocutaneous flap taken from the dorso-ulnar aspect of the first metacarpal are presented. Even though the indications are rare, this flap is useful for the reconstruction of distal osteocutaneous defects of the thumb where more complex procedures are not feasible or considered as excessive.

Adult↗
PubMed2001

Ten years of experience with the submental flap.

This article describes the authors' experience with the submental flap over the past 10 years. A brief review of the key points and some refinements in the operative technique are discussed. The results concern 31 patients with a mean age of 57 years. All flaps were pedicled except two. One case of composite flap with bone was used. The mean size of the flap was 11.8 x 5.5 cm, and the mean postoperative stay was 11.1 days. Complications encountered were one case of temporary palsy of the marginal mandibular branch of the facial nerve, one hematoma at the recipient site, and two cases of partial flap loss. Color and texture match were good. The authors believe this flap to have great clinical potential and to be a worthwhile addition to the existing surgical armamentarium.

Adult↗
PubMed2001

Internal use of n-butyl 2-cyanoacrylate (Indermil) for wound closure: an experimental study.

n-Butyl 2-cyanoacrylate glue (Indermil) was used for the closure of dorsal wounds on rabbits. A 4-cm-long and 1-cm-wide laceration was created bilaterally on the back of 15 rabbits. One side was closed with absorbable 2-0 subcutaneous sutures and fast absorbable 3-0 skin sutures, whereas the other side was closed with cyanoacrylate glue applied on both deep and superficial tissues. A partial wound dehiscence occurred on the glue side in one animal at 2 weeks. The animal was killed at this time and considered a bad result in the glue group. In all other animals, no seroma, partial dehiscence, or wound infection occurred. Histopathologic analysis revealed that Indermil induced edema and a mild acute inflammatory reaction and resorbed almost completely within 2 months when applied to well-vascularized tissues. The application of glue on the cutaneous wound edges is a fast and easy procedure that does not seem to delay or inhibit the healing process or its quality.

Animals↗
PubMed2001

The submental flap: its uses as a pedicled or free flap for facial reconstruction.

The submental flap is an alternative to microsurgical flaps for facial and intraoral defects. The submental flap is simple and can be raised rapidly. It produces good color, texture, and contour match without a conspicuous site. Its versatility and its rotational arc explains its large application in facial surgery. The pedicle is reliable when the flap is not used with a reverse flow. The surgeon must know the possible presence of valves in the venous system of the face and plan to perform a venous microsurgical anastomosis if venous congestion jeopardizes the flap's survival. The location of the flap in a lymph node area restricts its uses for traumatic cases, and for benign and malignant tumors, to reduce the potential of cancer spreading to the lymph nodes (e.g., basal cell carcinoma).

Aged↗
PubMed2001

[An original case of laryngomucocele after Tucker surgery].

Although discovered since nearly 2 centuries, the cystic tumours of the laryngeal ventricle remain very badly known by otorhinolaryngologists. Air-containing or cystic, these lesions can be congenital or acquired. We present an original case of laryngomucocele, acquired after a partial laryngectomy of Tucker type for a laryngeal neoplasty. Through a review of the literature, we expose in the second time, the etiopathogenic mechanisms of these lesions. If this pathology contributes to mislay the diagnosis during the post-operative survey, small surgical details at the time of the initial intervention, can prevent the appearance of this lesion. The treatment is a surgical procedure, with an endoscopic way or a cervicotomy.

Acute Disease↗
PubMed2000

Soleus-fibula free transfer in lower limb reconstruction.

Free-fibula transfer has been widely used since 1975. Many modifications have been described; one of them, association of the lateral part of the soleus muscle to the fibula, is reported here through a 14-case series. This composite flap is intended for extensive defects of the lower limbs involving bone and soft tissues. The flap is considered by the authors to be reliable, with a constant vascularization. A 20-cm length offibula may be harvested associated either with the lateral part of the soleus muscle or with the whole muscle. Moreover, the soleus muscle represents a vascular security inasmuch as it preserves both medullar and periosteal bone supply. Fourteen cases have been performed by the authors since 1978 and could be reviewed with a minimum 2-year follow-up. Average length of bone defect was 12 cm, and average length offibula harvested was 18.6 cm. Soft-tissue defect was always associated and ranged from 8 x 4 cm to 20 x 30 cm. The fibula was harvested with the lateral part of the soleus muscle in 10 cases and with the whole soleus muscle in 4 cases. One total treatment failure was reported and was related to intimal degenerative lesions on veins used for arteriovenous bypass. In other patients, mean time for bone healing was 11 months. Patients could walk again, on average, 17 months after reconstruction. Sequelae at the donor site were minimal.

Adolescent↗