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Biomedical subjects

V Pinsolle

Publications and source records attributed to V Pinsolle.

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

[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

[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

[Noma. Proposal for a surgical treatment].

The authors present their experience of surgical treatment of noma in situation of surgical camp. The strategy is focused on two objectives: treatment of tissue loss itself and treatment of the trismus. After having presented the means at disposal, going from local flaps, quickly exceeded, to distant flaps, they decided upon the indications by taking in account the NOILTULP classification. Thus, the authors present their experience of fascia temporalis skin grafted for oral lining in combination with the submental or Backamjian flap for external coverage. The treatment of the trismus is less codified requiring osteotomies in stages 3 and 4. They finally insist first on the prevention of this disease, very accessible to antibiotics at the initial stage of stomatitis and second on simple means very efficient to prevent the trismus which impairs heavily the functional outcome of the reconstructions.

Clinical Protocols↗
PubMed2003

[Primary intraosseous carcinoma of the jaws: results of treatment of 9 cases and proposed classification].

INTRODUCTION: Primary intraosseous carcinoma of the jaws is a rare squamous cell carcinoma arising in the jaw, having no initial connection with the oral mucosa and presumably developing from residues of the odontogenic epithelium. OBJECTIVES: To present 9 cases and to propose a staging system of primary intraosseous carcinoma of the jaws. CASES AND METHODS: Careful assessment of the clinical, radiological and histological examination of the specimens identified 9 patients with primary intraosseous carcinoma of the jaws. RESULTS: The male/female ratio was 8/1 and the mean age of patients at the time of diagnosis was 61.7 years. All lesions were located in the mandible. Usually, clinical symptoms had benign aspect and delay the diagnosis. Radiographic features were unilocular osteolytic lesion and ill-defined margins were usually noted with a mean tumor size of 3.4 centimeters. The mean delay of the diagnosis was 4.9 months. Surgery at the tumor site consisted of hemi-mandibulectomy in all cases. All patients but one had neck dissection. The postoperative radiotherapy mean dose was 62.6 Gy. Histologically, most squamous cell carcinomas were well differentiated with keratinization. All lymph nodes metastasis had capsular involved. Complications occurred in 2 cases. Four patients had recurrences in the mean delay of 13.8 months. The estimated overall 2-and 5-years survival was 65% and 46.5% respectively. DISCUSSION: Primary intra-osseous carcinoma of the jaws is a rare tumor none classified by UICC with poor prognosis. We recommend an aggressive treatment with postoperative radiotherapy. We propose a computer tomographic classification: T1 (tumor strictly intra-osseous), T2 (tumor with cortical destruction without involvement of adjacent soft-tissues) and T3 (tumor involvement of adjacent soft-tissues).

Adult↗
PubMed2002

[Thumb arthritis yesterday and today. Epidemiologic comparison in an ancient population].

The aim of the study was to assess the rate of thumb osteoarthritis in an ancient population (before the industrial revolution) according to the age, the sex and the side affected, and to compare the results to the current epidemiologic data. This study was performed in bones from the convent graveyard of the Soeurs Grises de Beauvais (15th to 18th century). The rate of thumb osteoarthritis was assessed in 73 adult individuals (34 men and 39 women) divided into 2 age groups: 35-49 and over 50. The rates of thumb osteoarthritis in each group were compared according to different factors (age, sex, side affected). The statistical study showed a higher rate of thumb osteoarthritis in elder people in general, and in male but not in female individuals. The rate of bilateral thumb osteoarthritis was higher in women. However, no difference was found between both sides of human body whatever the age or sex. As for the female population, the results were identical those of the current data. However, there was a higher rate of thumb osteoarthritis in men of any age group. A functional fatigue could provide a higher rate of secondary thumb osteoarthritis since the women in this series (nuns), who were less affected by overwork, had a rate of primary thumb osteoarthritis identical to the rate found in the current literature.

Adult↗
PubMed2001

Primary intraosseous carcinoma of the jaws.

OBJECTIVES: To present 8 new cases of primary intraosseous carcinoma of the jaws and to review the literature for an analysis of treatment modalities and patient outcomes. DATA SOURCES: A MEDLINE search from 1970 to 1999. The articles chosen and the study of the references of every one that produced additional articles provided database information for 28 patients. Eight new patients from our institutions were added. STUDY SELECTION: Our criteria of inclusion included the absence of ulceration of the oral mucosa, a negative result in the search for a distant primary tumor, and convincing histological documentation. DATA EXTRACTION: The variables of the analysis included age, sex, site of the tumor, condition of the oral mucosa, tumor size, neck status, treatment modalities, recurrences, and survival. DATA SYNTHESIS: Twenty-eight patients were identified in the literature, for a total of 36 patients. There were 28 males (78%) and 8 females (22%) ranging in age from 4 to 76 years (mean, 54 years). The tumor site was the mandible in 33 patients (92%) and the maxilla in 3 (8%). Of the 34 patients treated, 19 (56%) had recurrences. Overall 2- and 4-year survival was 60.5% and 39.9%, respectively. Patients who underwent radical surgery and postoperative radiotherapy (n = 11) had a 2- and 3-year survival probability of 61.3% and 40.9%, respectively, whereas in the remaining patients (n = 25), the rates were 59.7% and 31.3%, respectively (P =.60). CONCLUSIONS: Strict diagnostic criteria must be applied. The prognosis associated with primary intraosseous carcinoma of the jaws is poor and suggests the need for aggressive treatment.

Adolescent↗
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 iliac crest. Perspective on a donor site of exceptional free flaps, 20 years after its initial description].

The iliac crest represents the principle 'reservoir' for the cortico-spongy bone. After having been used for a long time in the form of a conventional graft, it has been the object, in the last 20 years, of increasingly sophisticated transfers, making it possible to extract it in vascularized form. The authors present the anatomical bases of these transfers, which can be conceived on four different vascular axes: the superficial circumflex iliac axis, which was the first used, the deep circumflex iliac axis, the superior gluteal axis, and the lateral femoral circumflex axis. After having presented the various techniques of extraction of the anterior and posterior crests, the authors attempted to delineate the indications of each variant in the reconstruction of the members and the cervico-facial sphere. A comparison with the fibula flap will be finally carried out in order to parallel the advantage and respective disadvantages of these two transfers.

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↗
PubMed2000

[The technique and location of secondary donor sites of vascularized bone grafts in the therapeutic arsenal of the plastic surgeon].

Most of the donor sites for conventional bone grafts can also provide vascularised bone grafts. Increased progress in vascular research has enabled the harvesting of grafts that are increasingly reliable and versatile. This work does not give emphasis to classic vascularised bone transfers like the iliac crest, the fibula or the lateral border of the scapula but highlights 'secondary' sites which are often underutilized. Several donor areas are studied; the upper limb including the clavicle, the lower limb, the thorax and the cranium. The hands and toes, which constitute a specific entity, are excluded. In each chapter the authors have emphasised the fundamental points relating to the anatomy, the technique of harvesting and the indications.

Bone Transplantation↗
PubMed2000

[Does surgery promote the development of metastasis in melanoma?].

Surgery, which is currently the only curative treatment for malignant melanoma, is suspected, in particular presentations, to induce adverse effects such as an increase of metastasis spread. A literature review was performed in order to examine the alleged causes of such phenomena. A medline search covering the 1985-1999 period was performed first. The chosen articles and the study of the references of each of them produced additional articles. The hypothesis is based on the alleged existence of tumor dormancy as micrometastates at an early stage of the disease. Surgery could induce metastasis spread directly by increasing the rate of circulating tumor cells and indirectly above all by disturbing complex mechanisms of tumor regulation such as the balance between activating and inhibiting factors of tumor angiogenesis. Surgery itself as well as the surgical stress could also make easier metastasis spread owing to antitumor immune mechanisms disturbance. Currently, there is no adequate evidence to induce a modified approach in the management of cutaneous melanoma. Surgery remains the mainstay of treatment. However, basic research on angiogenesis and immunity must be carried on.

Humans↗
PubMed1998

[Treatment of fibrous dysplasia of the cranio-facial bones. Report of 25 cases].

Fibrous dysplasia accounts for approximately 2% of bone tumors. The ribs, proximal femurs and cranio-facial bones represent the majority of bone lesions. Surgery is the mainstay of treatment but the technique is controversial: conservative surgery or removal of dysplastic lesions followed by implantation of autogenous bone graft. The aim of this study was to assess the indications of each method. The medical records of 25 patients with fibrous dysplasia of the cranio-facial bones treated between January 1, 1980 and December 31, 1994 at the Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Bordeaux, France, were reviewed. Fourteen (56%) patients were women and 11 (44%) men. The median age at the time of diagnosis was 23 years (ranging from 8 to 56 years). The mean follow-up was 8 years. Two patients were unavailable for follow-up after treatment. The primary sites of the tumors were the mandible (n = 19 [76%]), maxilla (n = 1 [4%]) and skull (n = 5 [20%]). For mandibular lesions, the primary treatment always included a correction of deformations and asymmetry, which was the only treatment in 14 cases. Two patients required subsequent surgery to reduce further bone enlargement (1 and 2 years later in the first case and 11 years later in the second) without further problems. In 3 cases a segmental mandibulectomy followed by implantation of autogenous bone graft was required, and no further recurrence was observed. Therefore, the success rate of conservative surgery was 74% initially, and up to 86% after subsequent surgery. Skull lesions, although often very extensive, were remarkably stable and asymptomatic. They were successfully treated 4 times by conservative surgery, mainly for cosmetic reasons. One patient, with an ethmoidal tumor producing a mass effect along the course of the optic nerve, underwent a combined cranio-facial resection. As for the only maxillary tumor, three curettages were performed throughout an 11-year period and there was no evidence of further recurrence 4 years after the last intervention. In all cases, conservative surgery may be recommended as primary treatment of fibrous of the craniofacial bones, providing essential structures like the optic nerve are not at risk. Cosmetic results and local control proved excellent, and a further removal of the tumor remained feasible in the event of a recurrence. Success or failure did not correlate with tumor size, which justifies the use of this technique.

Adolescent↗