Annales de chirurgie plastique et esthétique
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Ann Chir Plast Esthet · Aug 2016
[Reconstruction of lower limb involving free serratus anterior with rib myo-osseous composite flap: 20 patients followed for 5 years].
In our team, free flap and especially serratus anterior muscle is the first option for the coverage of lower limb post-traumatic defects. For complex tissue loss, it may be advantageous to harvest the free serratus anterior with rib myo-osseous composite flap. We performed 20 osteomuscular serratus anterior composite flap between 2008 and 2010. ⋯ Use of vascularized rib in the treatment of lower limb traumatic defects is rare. The bone quality of rib is lower than fibula, but the coverage provided is better, due to serratus anterior muscle. The length and diameter of the vascular pedicle is very useful too. Our results are comparable to other series using this flap. Its coverage properties and the possibility of simultaneous bone reconstruction is useful. It allows one stage procedure for complex tissue losses with satisfactory results in the short and long term. The further realization of a free fibular transfer in cases of persistent non union remains possible.
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Ann Chir Plast Esthet · Jun 2016
A new strategy for prophylactic surgery in BRCA women: Combined mastectomy and laparoscopic salpingo-oophorectomy with immediate reconstruction by double DIEP flap.
Prophylactic surgery remains the most effective modality for reducing both breast and ovarian cancer rate in woman at high risk, such as BRCA1 or BRCA2. Autologous breast reconstruction with bilateral deep inferior epigastric perforator (DIEP) flap allows predictable and durable results. However, existing two-step approach separating salpingo-oophorectomy and reconstruction could even make DIEP flap impossible, or make insufflation more difficult during laparoscopy. Other authors described one-step procedure but with open laparotomy. The goal of this study was to verify the feasibility of a simultaneous procedure, including laparoscopic salpingo-oophorectomy. ⋯ One-step procedure for prophylactic surgery of ovarian and breast hereditary malignancies is feasible. First salpingo-oophorectomy with open laparoscopy then bilateral immediate or delayed breast reconstruction with DIEP flaps can be performed.
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Ann Chir Plast Esthet · Aug 2015
[Patient counseling in case of postoperative complication leading to emergency reintervention in plastic surgery. What is the current situation? How to improve? Retrospective study of counseling modalities and traceability in a series of 16 patients who needed emergency reintervention within a cohort of 402 patients].
Preoperative counseling is structured and well defined. Nevertheless, in the event of a complication leading to a new emergency surgical procedure, counseling is not well defined. We conducted a retrospective study of information delivered in this situation at our institution. ⋯ Information delivery traceability is mandatory. In case of complication leading to emergency reintervention, traceability should be done in the same way as prior to initial surgery.
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Ann Chir Plast Esthet · Apr 2015
[The role of skin substitutes in the surgical treatment of extensive burns covering more than 60 % of total body surface area. A review of patients over a 10-year period at the Tours University Hospital].
Progress in intensive care and surgery has made it possible to significantly improve the survival of victims with burns over 60% of total body surface area (TBSA). Coverage of the excised areas of these patients can be difficult when there is a shortage of skin donor sites; then the role of skin substitutes can be important. ⋯ By temporarily replacing the cutaneous barrier in the absence of sufficient donor sites, skin substitutes make it possible to increase the survival of patients with very extensive burns and to optimize their treatment.
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Ann Chir Plast Esthet · Jun 2014
[Predictive factors of mortality of the burnt persons: study on 221 adults hospitalized between 2004 and 2009].
The objective of the present study is the evaluation of the predictive factors of mortality to a troop of Moroccan grown-up serious burnt persons. Variables analyzed in the study are: the age, the sex, the localization of the burn, the degree of burn, indicates Total Body Surface Area (TBSA), indicate Unit of Standard Burn (UBS) and the indication of leases, sepsis and the medical histories (tobacco, diabetes). ⋯ Other factors such as the age, the degree of burn and the histories did not show a significant difference. An evaluation and a good knowledge of factors associated to a high risk of death allow an adequate coverage of this category of patients.