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Biomedical subjects

R Legré

Publications and source records attributed to R Legré.

At least 19 recordsLinked to original sources
PubMed2000

[Results of nerve sutures in the wrist in children].

INTRODUCTION: Wounds involving the peripheral nerves cause serious damage in the upper limb. The prognosis for recovery remains uncertain despite microsurgery. It is commonly accepted that the results are far better in children than in adults. We sought to confirm this idea on the basis of objective recovery criteria, discriminating between peripheral axonal regeneration and the child's own capacity to adapt. In other words, do nerves regenerate better in children? MATERIALS AND METHODS: The clinical results of 25 nerve sutures of the wrist, in children under 15, were analysed with a minimum follow-up of 12 months. The subjects were reviewed clinically and had an electromyogram. The resulting data was compared to that for adults found in the literature. RESULTS: Clinically, the overall function of the hand was always satisfactory. The sensory results were often excellent (S4 or S3+ in 23 cases/25). The mean value muscular testing was between M2 and M3. With respect to the EMG results, the values we recorded were rarely representative of the functional results. The motor recordings were mostly poor, demonstrating that the nerve supply was compensated by a phenomenon involving collateral innervation. DISCUSSION: The poor results of peripheral nerve surgery are only due to the quality of the restored innervation. Dellon and Mackinnon demonstrated that they were also due to the incapacity of the nerve centres to integrate a change in the profile of sensory information. It would therefore seem that not only the quantity of nerve tissue repair is insufficient, but also the quality. Children have a superior cerebral capacity to adapt than adults and probably benefit from better cortical acquisition processes and are thus capable of putting the changes in the nerve messages to better use. The analysis of the clinical and EMG results also reveals a trend demonstrated partial nerve repair in children. We think that the functional results suggest that children have a better central capacity to adapt.

Adolescent↗
PubMed2000

[Surgical repair of the axillary nerve. Results of a five-year follow-up].

INTRODUCTION: We report a series of 19 cases of axillary nerve lesions, which were operated between 1981 and 1995. MATERIAL AND METHODS: There were 14 isolated lesions of the axillary nerve and in 5 patients the lesion to the axillary nerve was associated either with a lesion of the radial nerve or with a lesion of the suprascapular nerve. Fourteen patients sustained shoulder stretch injury, three had fractures of the scapular girdle and two anterior shoulder dislocation. Patients were operated on 9 months after trauma through a combined anterior and posterior approach. The lesion was located in the quadrilateral space. In 17 cases the neuroma was excised and the nerve was reconstituted, using sural nerve grafts. In two cases the nerve was only freed from the surrounding scar tissue. RESULTS: Results were considered as satisfactory in 10 out of 14 isolated axillary nerve lesions. According the Constant score there were 2 very good, 8 good and 2 fair results. In this study, neurolysis and axillary nerve associated with suprascapular nerve lesions gave poor results. DISCUSSION: The successfully reinnervated deltoid muscle adds strength and endurance to the affected shoulder. Electromyographic study remains important in detecting spontaneous return of muscle function and determining the most favorable operative period before severe amyotrophy appears.

Adolescent↗
PubMed2000

[Qualitative retrospective study comparing 43 advanced-rotated flaps to 19 island type Venkataswami-Subramanian flaps].

OBJECTIVE: In case of a fingertip trauma, the surgeon'aim is to give the finger a good function, that means a fingertip with good sensibility and trophicity. The purpose of this study was to follow-up three different types of flaps used for fingertip reconstruction, and to analyse their sensibility and functional results. METHOD: 62 fingertip-flaps performed in 60 patients were included in this series. Patients were mainly males (45-60), adults (42-60), middle age (mean age = 40), right-handed (55-60) and home-injured (32-60). The dominant side was injured more often (43-60), by section (27-60) or crush (25-60). Patients were reviewed by the same investigator. Various types of flaps were used: 31 Atasoy flaps, 19 neurovascular island unipedicled flaps and 12 Hueston flaps. Sensory results were evaluated using static and moving two-point discrimination tests, and pain and hot-cold discrimination. Esthetic and functional results were also evaluated. RESULTS: The tactile sensibility was good or excellent in 63% of flaps and the nail looked good in 70% of flaps. Among all flaps, the Atasoy flap obtained the best results. DISCUSSION: This study showed the good quality of Atasoy and Hueston flaps in fingertip reconstruction. Neurovascular island flaps gave poor results without taking in account the severity of initial trauma.

Activities of Daily Living↗
PubMed1998

[Treatment of substance loss of the bones of the leg in traumatology by transfer of the free vascularized iliac crest. Apropos of 13 cases].

PURPOSE OF THE STUDY: Free iliac crest transfer as described by Taylor is an option for tibial bone reconstruction in traumatology. Our purpose was to evaluate results, bone reconstruction quality and delay for bone healing using microsurgical technique. MATERIAL: 13 men were operated on between December 1986 and January 1994, mean aged 31 years (extreme 18-58) Bone lesion was localized at the middle third in 5 cases and at the lower third in 8 cases. The bone defect was directly related to traumatism in 2 cases, and secondary to resection of infected or necrotic bone in 11 cases. Limb neurologic and vascular problems have always been evaluated before reconstruction and amputation always been discussed. Preoperative limb arteriography showed only one major vessel of the limb in 6 cases. Delay between injury and bone reconstruction averaged 11 months. METHODS: Bone debridement and bone stabilization by external fixator was performed on a first step. Resection of the fibula was performed to allow secondary compression at the reconstruction site. All necrotic and infected bone was "en bloc" resected using an oscillating saw. Bone reconstruction was performed in a second step when the wound was clean. Surgical team included a plastic surgeon for the micro surgical procedure and an orthopedic surgeon for bone fixation. Osteo-musculo-cutaneous flap and osteo-muscular flap were used according to the size of the skin defect. Bone osteosynthesis was achieved by direct fitting after distraction applied by the external fixator. Vessel anastomosis was performed under microscope. RESULTS: One patient had to be amputated due to a lesion of a single vessel by an llizarov wire. In the remaining 12 cases, bone healing has been achieved after 10 months on average. Bone reconstruction averaged 8 centimeters. A secondary procedure has had to be performed in 9 cases. Two stress fractures have been observed. DISCUSSION: "Carcinologic" resection of infected bone is one of the key of this procedure, as described by Weiland. Many techniques had been described to treat traumatic bone defects. Papineau's technique is a long procedure and leads to instable scars on the leg. Use of cancellous bone covered with a free or a pedicled muscular flap gives good results, but it may appear logical to treat a composite defect with a composite graft. Progressive bone lengthening using Ilizarov technique is not an easy procedure among adults. Use of vascularized bone graft is known to be a good procedure for treatment of osteomyelitis, but this type of technique is technically demanding. Fibula transfers are useful especially when defect are more than 10 cm. long, but this bone is fragile and stress fractures are frequent. Iliac crest is closer to the tibia and appears to be a good donor site when bone defect is 5 to 10 cm. long. CONCLUSION: Free iliac crest transfer appears to be a reliable procedure for traumatic tibial loss ranging from 5 to 10 cm long although amputation must always be discussed in such difficult traumatic cases, especially if there is a posterior tibial nerve lesion.

Adolescent↗
PubMed1997

Imaging of vascularized fibular grafts in large bone reconstruction in skeletally immature patients.

OBJECTIVE: To describe the imaging findings of vascularized fibular grafts (VFG) in large bone reconstruction in children and teenagers. DESIGN AND PATIENTS: Fifteen patients aged from 4 to 19 years underwent VFG for bone reconstruction for primary tumors involving bone in 13 cases and for chronic osteomyelitis in 2 cases. Lesions were located in the femur (6 cases), the tibia (6 cases), the humerus, the distal fibula and the ilium. Radiographic follow-up was performed in all patients, radionuclide studies in 12 patients and MRI in 8. RESULTS: Plain films showed a lamellated periosteal reaction on the VFG within 3 weeks following the procedure in all cases. Fusion of VFG and host bone occurred during the first 3 months. Radionuclide uptake of the VFG was seen in all cases but one. MRI showed cortical thickening and conservation of the high signal intensity of fatty marrow on T1-weighted sequences, and periosteal enhancement on dynamic post-contrast studies in all but one of the patients. CONCLUSION: Radionuclide studies and MRI show the periosteal enhancement and assess the viability of the VFG satisfactorily. However, we feel that plain films may be sufficient to ascertain this viability.

Adolescent↗
PubMed1997

[Coverage flaps for loss of substance of the scalp. Our experiences apropos of 42 cases].

We report our experience with 42 coverage flaps for tissue loss involving the scalp. Malignant tumors of the scalp were the major cause of tissue loss. Repair modalites and outcome are reported. This series included 23 local flaps, one pediculated regional flap, and 18 free flaps associated with three cranioplasties and four dura mater plasties due to invasion of the subjacent tissues. We discuss therapeutic indications and insist on selection criteria which depend on etiology (localization, form depth), local factors (integrity of the pericranium and subjacent structures) and general factors (age, sex, physical and psychological status, socioprofessional context, patient expectations). In all cases, we opted for tissue repair which offers greater safety with minimum function and esthetic morbidity.

Adolescent↗
PubMed1995

[Accidents of chemotherapy involving the upper limb].

Subcutaneous extravation of antimitotic agents in the upper limb is a rare complication of chemotherapy. The functional integrity of the limb can be compromised due to severe skin damage. Extensive soft tissue necrosis is difficult to manage and cannot always be repaired without sequellae. Based on an analysis of a series of patients and a review of the literature, we report the main pathophysiological features and clinical signs of such accidents as well as the still debated therapeutic management. Two points are essential: the emergency situation created by these accidents requiring adequate and rapid treatment despite the apparently benign appearance of the extravation and imperative prevention which is the main therapeutic tool.

Antineoplastic Agents↗
PubMed1994

[Cutaneous flaps].

The use of skin flaps has long been known. Since the beginning of the 20th century, with better knowledge of skin vascularisation and technological development, the plastic surgeon has had at his disposition a wide choice: skin flaps, fasciocutaneous flaps, myocutaneous flaps, blood-carrying flaps and free flaps. The use of a flap for healing should be considered with regard to grafting techniques or directed healing. The criteria for choosing the type of flap are important, in order to obtain a good quality of skin cover with minimum scarring and loss of function.

Dermatologic Surgical Procedures↗
PubMed1994

[Coverage of arterial repair of the upper limb. Choice of a technique apropos of 24 cases].

Twenty-four cases of complex trauma of the upper limb, with soft tissue damage including at least loss of part of an artery and the overlying skin, were recorded and treated in the Hand Emergency Unit at the Timone Hospital in Marseilles. These cases were dealt with globally in a single staged operation with careful wound care, bone stabilisation when this was deemed necessary, arterial shunt and repair of the soft tissues. To cover the exposed arterial shunt, the choice of coverage technique depends on the site of the lesion, on the extent of soft tissue damage, and also on the reliability of the flap and its residual scar. The authors analyse their series and present their indications.

Arm Injuries↗
PubMed1994

[Mandibular reconstruction using an iliac crest free flap vascularized by the deep circumflex iliac vessels. A clinical study apropos of 30 cases].

Thirty cases of mandibular defects were reconstructed with a free iliac flap vascularised by the deep circumflex iliac vessels. Twenty five of these cases involved soft tissue damage with a defect of the mandible. The surgical procedure described by I. Taylor was used. Three anatomical variations of the pedicle were found. The features of the iliac bone are particularly suitable for mandibular reconstruction. The natural shape of the iliac bone does not require complex osteotomies and its healing capacity allows simple osteosynthesis. The thickness of the muscular pedicle, and thus the flap, is determined by the position of the lower edge of the skin components with respect to the iliac crest. This type of flap currently remains very useful in reconstruction of major mandibular and adjacent soft tissue destruction because of the very low incidence of failure (2 cases) and complications.

Adolescent↗
PubMed1994

[Vaginal reconstruction by musculocutaneous flap of the rectus abdominis after pelvic cancer surgery. Apropos of 11 cases].

Surgical treatment of gynecological neoplasms leads to two problems: pelvic defect, and vaginal reconstruction. The authors have been using rectus abdominis musculo-cutaneous flap as described by Tobin. Eleven patients have been treated. A horizontal flap was used in one patient and a vertical one for the 10 other patients. The authors had one failure. In the ten other patients the average healing time was 21 days and 5 patients were able to return to sexual activities. The use of rectus abdominis flap would appear to be an easy and reliable technique for pelvic reconstruction.

Adult↗
PubMed1993

[The diagnostic value of arthrography of the wrist in the evaluation of carpal ligament injuries: radio-surgical correlations. Apropos of 20 cases].

Intra-carpal ligament tears lead to radiocarpal arthritis early diagnosis allows early treatment. Standard and dynamic X rays are not always able to make the diagnosis. In these cases, arthrography of the wrist may give the diagnosis. To establish the specificity of this examination we tried to correlate surgical findings with arthrographic suspicions. Exact diagnosis was established in 12 out of 13 cases of suspected scapholunate ligament tears in 5 out of 6 cases of suspected luno-triquetral ligament tear suspicion and none of the 3 cases of suspected T.F.C.C. rupture suspicion. Wrist arthrography appears to have a good specificity for first row intra-carpal ligament tears. The indication arthrography must be discussed with wrist arthroscopy for the diagnosis of long term wrist pain after clinical examination and standard and dynamic X rays.

Adolescent↗
PubMed1992

[Multicentric study of 143 cases of resection of the proximal carpal bones].

Proximal row carpectomy is an old procedure but the good results published in the literature, it still has bad reputation. The authors conducted a retrospective multicentric study in 143 patients, 128 of whom were post-traumatic cases. And results were good in terms of pain relief. Increase in grip strength was observed in 80% of cases. Wrist range of motion was not improved by resection. The results were not predicted by preoperative status. No prognostic factor could be defined on the basis of study.

Adolescent↗
PubMed1992

[Choice of technique in covering an excision of neoplastic tissue in the inguinal area].

Cancer surgery of the groin may lead to large skin resection with exposure of the femoral vessels. A reliable coverage technique must be chosen to enable this kind of surgery. Six patients were operated on, and ten flaps were used (3 omentum - 3 rectus abdominis - 1 fascia lata - 1 gracilis - 2 latissimus dorsi free flaps). In the light of our results, omentum must be used when laparotomy is associated with inguinal resection and omentum is available. In the other cases, resection size could prohibit the use of local flaps and a contralateral rectus abdominis flap is chosen which allows coverage of the inguinal area down to the middle third of the thigh.

Abdominal Muscles↗
PubMed1991

[Surgical excision of giant venous angioma of the face under extracorporeal circulation: apropos of a case by a multidisciplinary team].

Because of the risk of haemorrhage related to their resection, deep angiomas of the face are often considered to be inaccessible to treatment. The use of cardiopulmonary bypass with profound hypothermia allows the surgeon to operate in a bloodless field, enabling almost oncological resection of the tumour. The authors report a case of venous angioma of the submaxillary region treated in this way after failure of limited surgery and embolisation. Complete resection of the lesion was achieved and the defect was repaired with a pectoralis major flap and a latissimus dorsi flap. The authors stress the value of a multidisciplinary approach: a cardiac surgeon for CPB, an ENT surgeon for resection and a plastic surgeon for reconstruction.

Extracorporeal Circulation↗
PubMed1990

[Analysis of sequelae of the latissimus dorsi flap removal. Report of 44 cases reviewed and tested].

Since Tanzini, the latissimus dorsi muscle flap has been widely used in plastic surgery. Based on the experience of two plastic surgery units, we decided to try to define the sequelae of this operation. In order to simplify our analysis we only considered free flaps. Out study is based on 42 patients (26 pure muscular flaps and 16 musculo-cutaneous flaps). The sequelae were analysed in terms of aesthetic and functional criteria. The aesthetic sequelae appeared to be minima in the case of pure muscular flaps, but more severe in the case of musculo-cutaneous flaps. Functional sequelae in the shoulder were observed on muscle testing in 30% of cases, although there were no repercussions on sport or work activities. Analysis of spinal posture demonstrated a modification in the frontal plane in 40% of cases although this could not be clearly attributed to the donor site. On the basis of this study, we can conclude that the latissimus dorsi flap retains an important place in the therapeutic arsenal of plastic surgery due to its reliability and its minor cicatricial and functional sequelae at the donor site.

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