Biomedical subjects

P-Y Milliez

Publications and source records attributed to P-Y Milliez.

7 recordsLinked to original sources

PubMed2006

Anatomical comparative study of two vascularized bone grafts for the wrist.

Atrophic scaphoid non-union and lunate necrosis can be treated with vascularized bone grafting; through a posterior approach as described by Zaidemberg, based on a supraretinacular artery, or through an anterior approach, based on the volar carpal artery, according to Kuhlmann's procedure. The aim of our study was to determine the area covered by each of these two grafts and their respective future applications. Fifteen hands from eight adult human cadavers, free of any scar, were dissected after injection of colored fluid latex, through dorso-radial approach for Zaidemberg's graft and through volar approach for Kuhlmann's. We observed the morphological parameters of the pedicles and the arc of rotation of each flap. The volar vascularized graft had a constant origin and it could be transferred to the scaphoid, the lunate and the scapholunate joint. The posterior graft of Zaidemberg was technically more difficult to harvest because of the anatomical variations. It made it possible to reach the scaphoid, the trapezium and the scaphotrapeziotrapezoid joint line. Both these two vascularized bone grafts represent interesting procedures for treatment of scaphoid non-union or lunate necrosis, or intracarpal bones arthrodesis. They bring various possibilities of bone covering, related to specific area of mobilization and are not opposite procedures, but have different targeted indications. One must better define the respective places of the vascularized bone grafts, compared with the traditional free (non-vascularized) graft.

Adult↗

PubMed2006

[The total thigh flap in reconstructive surgery].

Plastic surgeons have sometimes to face large pelvic tissue defects, particularly in paraplegic patients with recurrent pressure sores. This is frequently a reconstructive challenge and different locoregional flaps may be useful to manage those wounds when medical solutions were unsuccessful. However, in cases when other reconstructive options have been exhausted the total thigh flap represents the last acceptable solution to cover the defects by providing a large volume of healthy tissue. We remind here the operative technique and its interest in reconstructive surgery by reporting our experience in two patients for which this flap was successfully used.

Adult↗

PubMed2006

[Recurrence of a basal cell carcinoma in a skin graft in spite of total excision. A case report].

The authors report an original case of a recurrence of basal cell carcinoma in a skin graft recipient site. The skin graft was used to resurface the defect following complete excision of basal cell carcinoma in the mandibular angle area. Three answers can be given to the question of the origin of that new carcinoma: recurrence of the primary carcinoma, metastasis to a lymph node or a transfer of a basal cell carcinoma located into the skin graft which grew further. This last hypothesis remains the most probable because the histology of the two carcinomas was different and that the patient presented many others locations of basal cell carcinomas. Skin grafted areas must be checked for recurrence of basal cell carcinoma in such patients because invisible basal cell carcinoma can be transferred within the graft where they can grow for their own.

Aged↗

PubMed2006

[Influence of the size and the localization of metastases in melanoma sentinel lymph nodes on the results of lymphadenectomy].

AIM: Thirty-five cases of lymphadenectomy carried out in the context of positive sentinel lymph node for malignant melanoma have been reviewed to assess the prognostic value of certain metastatic charachteristics. We have checked wether the type (macro or micrometastasis) and localisation (subcapsular or intraparenchymal) in the sentinel lymph node had predictive value for the lymphadenectomy outcome and evolution of the case. MATERIAL AND METHODS: The retrospective study relates to 35 cases (with an average 2 years history) taken from a total of 87 sentinel lymph node protocols; average age 46.5 years, Breslow 2.5 mm with an history of 25 months. RESULTS: Among the 35 positive sentinel lymph nodes we have 19 cases (54.2%) of micrometastasis. Among the 35 lymphadenectomy 5 cases (14.28%) turned out positive, 3 of which concerned micrometastatic sentinel lymph nodes. In our cohort the micrometastatic nature of sentinel lymph nodes did not have statistically significant impact upon the lymphadenectomy result but showed more favourable short-term evolution with 68.42% metastatic free evolution as against 43.75% in case of initial macrometastasis. The subcapsular localisation of micrometastasis equally represents a factor of improved prognosis (69.2% of metastatic free evolution against of 30.8% in the case of intraparenchymal localistion). CONCLUSION: Unfortunately, none of the studied criteria justifies a modification of our present clinical attitude whereby a systematic lymphadenectomy in cases of positive sentinel lymph nodes is performed, whatever the type or localisation of the relevant metastases.

Adult↗

PubMed2006

[Hereditary neuropathy with liability to pressure palsies (HNPP) in hand surgery: reminds and warn against a usually unrecognised disease].

Tomacula is a rare hereditary disease due to a deletion on chromosome 17. Clinical presentation varies but patients usually complain of recurrent paraesthesiaes and palsies related to compression or trauma of a peripheral nerve. Diagnosis is based on electrophysiological studies, nerve biopsies and genetic tests. Implications for the patient and family members are a genetic counselling and some simple preventive measures. Although there is no curative treatment for this neuropathy, surgery can be useful for decompression of nerves and neurolysis. However, the surgical act increases the risk of nerve damage. Knowing about the diagnosis can help the patient and the surgical team avoid causing lesions.

Chromosome Deletion↗

PubMed2006

[Total abdominal wall reconstruction. Management of full-thickness losses of the abdominal wall after a long ischemic compression].

The authors report an original case of a 70-year-old male with large musculocutaneous necrosis area of the abdominal wall following a long ischemic compression. Initial treatment was done using a wide excision of the abdominal wall necrosis and insertion of synthetic prosthesis to protect bowels. After 4 weeks of further surgical revisions, two splits thickness skin grafting were performed. The grafts were placed directly on granulations around and over the mesh and the healing was complete. Postoperative course was uneventful. In our experience, this technique allowed a good cicatrisation and a good esthetical result.

Abdominal Wall↗

PubMed2003

[Anterior radial nerve transposition in humerus midshaft fractures: anatomic and clinical study].

PURPOSE OF THE STUDY: Plate fixation of midshaft humerus fractures raises the risk of radial nerve injury. Anterior transposition of the radial nerve has been proposed as a possible solution but few reports have been published. The purpose of the present study was to validate the effect of transposition on the transposed radial nerve and its branches. MATERIAL AND METHODS: We conducted an anatomic study on 10 cadavers. The length of the radial nerve between 2 anatomic landmarks was determined before and after transposition and plate fixation. A clinical evaluation was performed four years after surgery in 6 patients with midshaft humerus fractures treated with plate fixation after radial nerve transposition. RESULTS: The anatomic study demonstrated a mean gain of 11 mm in the length of the radial nerve with no problem for the transposed nerve or its branches. Clinically, osteosynthesis was facilitated and tension on the nerve was reduced. DISCUSSION: These 2 complementary studies demonstrated the releasing effect of transposition on the radial nerve and the facilitated osteosynthesis reported by others. The benefit of transposition is particularly important when bone fixation is particularly difficult to achieve without risk of injuring the radial nerve. Transposition does however require an extensive dissection, and the patient must be informed. CONCLUSION: The ideal indication for anterior transposition of the radial nerve is an oblique fracture of the mid-third to lower-third of the humeral shaft with radial palsy at onset. A certain degree of comminution facilitates the technique. Indications for this technique could however be widened to include cases of difficult osteosynthesis where the option to transpose the radial nerve is always a peroperative decision.

Adult↗