Biomedical subjects

V Casoli

Publications and source records attributed to V Casoli.

10 recordsLinked to original sources

PubMed1999

Reverse dorsal digital and metacarpal flaps: a review of 27 cases.

Reverse dorsal digital and metacarpal flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks of the fingers. These flaps are transposed as reverse island flaps. Dissection of the flap is easy, fast, and preserves the collateral nerve and artery to the fingertip. A series of 27 flaps is reviewed, with more than 6 months of follow-up. Skin defects in all patients were located over or beyond the proximal interphalangeal joint as far as the fingertip and were combined with bone, joint, or tendon exposure. The flaps we used were reliable, and a joint or extensor tendon reconstruction could be performed at the same time. Patients were discharged the day after surgery and allowed to mobilize the finger early. No flap necrosis was observed, and donor site morbidity was minimal; primary closure or a skin graft was used in all patients. These flaps combine the advantages of an extended skin paddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects. When conventional local flaps are inadequate, this fast and simple procedure should be considered for its reliability and low associated morbidity.

Adolescent↗

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

[Role of emergency reconstruction of fingers by the "reposition-flap" technique. Report of eight cases].

Following replantation failure, fingertip reconstruction was performed as an emergency "reposition-flap" procedure in seven patients (eight fingers). This technique was intended for amputations distal to the DIP joint in long fingers, and IP joint in the thumb. Pulp was excised on the amputated segment, and the remaining bone and nail bed were reattached to the proximal stump with Kirschner wires. Pulp was reconstructed with a local advancement and sensitive flap. Trophicity and nail regrowth as well as mobility and strength were satisfactory in five cases. MRI examination showed revascularization of the distal bone fragment in four cases. This procedure is an alternative to amputation after replantation failure when patients do not accept finger shortening. The more distal the amputation, the better is the result.

Adult↗

PubMed1998

[Abdominoplasty with dissociated intraparietal liposuction. Technical note].

Liposuction has greatly contributed to the improvement of the aesthetic result of abdominoplasties. However, one should consider the high rate of seroma when liposuction is performed via an inferior approach during abdominoplasty. The authors present a new approach to achieve complete liposuction of the abdominal wall during conventional abdominoplasty. This approach is carried out via submammary incision after previous undermining of the abdominal wall. A permanent assessment of the thickness of the wall allows the liposuction to stay strictly in fat tissue. Finally, there is a total independence between liposuction and the undermining procedure which allows minimization of the postoperative seroma. This technic seems particularly useful in a context of extensive abdominal adipose with flaccidity of the abdominal wall, requiring extensive undermining. Thanks to this procedure, the authors have performed a one-stage operation in many cases in which two operations would necessary previously have been.

Abdominal Muscles↗

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↗

PubMed1997

[Submental island flaps. Surgical technique and possible variations in facial reconstruction].

The submental flap is an island myocutaneous flap supplied by the submental artery divided from the facial artery. Large skin paddles (up to 7 x 18 cm.) can be raised, perfectly matching with facial color. As an island flap it allows coverage of the homolateral oral cavity or the homolateral face (except the medial forehead region). Including the facial vessels in its pedicle allows a safe free transfer. A greater are of rotation is obtained transferring the flap on its distal pedicle. One can include in the flap a segment of internal basilar margin. The resulting scar is perfectly hidden under the mandible. The operative protocol is now well defined and makes the flap easy to use. 21 flaps have been transferred, resulting in a single partial necrosis of a flap extremity.

Face↗

PubMed1997

Reconstruction of the hand with forearm island flaps.

From all of the flaps reviewed, it is important to know how to select the most suitable choice in each case. Aside from the technical expertise of the surgeon, the indication depends on the size and the location of the substance loss. For large defects in any location, the radial forearm flap remains the most reliable and safest choice. For children and women, the authors prefer distant pedicled transfers or free flaps to minimize cosmetic donor site morbidity. For small or medium defects that cannot be managed by a local transposition flap, the indication is based on the location of the wound. Palmar defects, if proximal and ulnar, may be covered using the dorsal ulnar flap, with little morbidity in the donor area. The anterior interosseous flap seems a better choice whenever vascularized tendon, nerve, or bone are needed also. For the first web space and neighboring radial defects, the posterior interosseous flap provides a reasonable alternative. Dorsal defects of the hand can be reconstructed with a posterior interosseous flap, provided there is no suspicion of injury to the anastomotic dorsal system of the wrist. The anterior interosseous flap is a good choice for composite osteocutaneous transfers. For complex composite defects, the ulnar artery forearm flap distally based may be indicated for reconstructive problems requiring vascularized flexor tendons. The anterior interosseous flap is able to provide excellent quality vascularized bone. Indications depend above all on the surgeon's experience and on the different schools. As always, the better flap is that which is performed by the surgeon who has mastered the particular surgical technique. In conclusion, this article is devoted to an update on forearm flaps and illustrates the innovative strength of this specialty. It also points out that, through in depth knowledge of the anatomy, flaps may be raised from many anatomic regions of a limb without disturbing the main vascular axis of that extremity. Minimizing the donor site morbidity while maximizing the quality of the reconstruction is the primary concern when indications are established for reconstructive hand surgery, which is where one of the authors' main research efforts resides.

Forearm↗

PubMed1997

[Update mid-term review of the pedicular extension in reverse YV flow. Review of a 7-year experience].

Since 1990, the authors use a surgical procedure called reverse flow YV pedicle extension to transfer a flap distally to its donor site. Their clinical experience, based on of 8 different applications and more than 80 clinical cases, demonstrates the reliability of the procedure. Nevertheless, the latissimus dorsi transfer, based on scapular vessels, must be an exceptional indication due to the need to achieve a venous microanastomosis. Moreover, the "extreme lateral arm flap" is considered to require a precise preoperative anatomical assessment because of the variants of the pedicle bifurcation. The authors are convinced that further applications will extend their experience of this procedure.

Humans↗

PubMed1996

[Boomerang flap. A true single-stage pedicled cross finger flap].

The indications for cover of long fingers have been considerably modified over recent years as a result of the concept of retrograde flow flaps. However, in some cases in which the dorsal digital networks cannot be used, cross-finger flaps are still indicated for cover of long fingers beyond the PIP joint. The authors present a new flap eliminating the need for this rather complicated procedure. The donor site takes advantage of the rich dorsal collateral arterial network of P1 of an adjacent healthy finger. The flap can be raised due to the constant existence of a bifurcation between the collateral dorsal digital arterial networks and the anastomoses situated at various levels between the dorsal and palmar collateral networks of the long fingers, which are constant as far as the PIP joint. A dorsolateral flap can therefore be raised from a healthy finger and transferred to the injured finger by raising the fatty connective tissue, including the dorsal collateral pedicles, in the shape of a boomerang. This flap covers distal defects from the PIP joint to the fingertip. The authors describe the anatomical basis for raising of the flap, the operative technique and report six clinical cases with a mean follow-up of 11 months.

Arteries↗

PubMed1995

[1984-1994: Ten years of skin flaps. Prefabricated flaps].

The term prefabrication of flaps corresponds to completely different technical modalities, often complementary and associated, which share the common feature of extending the indications and potential of pedicle or free flaps. Current methods of prefabrication of flaps can be considered to be based on one or several basic principles of reconstructive surgery. The authors discuss and analyse various modalities: a free flap can be made autonomous or can be expanded prior to transfer. A transfer can be initially prefabricated at its donor site by performing several operative steps in situ. A free transfer can be performed on the main vascular axis of a flap which is subsequently transferred, for example: free scalp transfer to reconstruct an eyebrow on a donor site reconstructing half of the face, but the first in situ operative phase usually consists of performing cutaneous, bone, cartilaginous or even alloplastic material transplants. The transfer is only performed after a sufficiently satisfactory complex anatomical, functional or esthetic unit has been achieved, in order to avoid difficult or dangerous remodeling operations after transfer. The most revolutionary appearance in the area of prefabrications is certainly induction of a pedicle or free neoflap in a so-called random territory. The addition of an arteriovenous pedicle associated with fascia underneath a muscle, underneath a skin cover, in contact with an osteoperiosteal segment allows a perfectly transferable neovascularized unit to be obtained after several weeks. All of the procedures described: autonomization before transfer, expansion before transfer, in situ prefabrication of a complex unit by addition of several tissue units (autologous or alloplastic) in one or several stages and finally vascular induction of a muscular, cutaneous or bone unit, etc. by transfer of a vascular axis in contact with this anatomical structure and combinations of these various modalities obviously open up a new approach which will considerably extend the already remarkable possibilities offered by free tissue transfers.

Adult↗