Annales de chirurgie plastique et esthétique
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Ann Chir Plast Esthet · Feb 2014
Case ReportsReconstruction of cubital fossa skin necrosis with radial collateral artery perforator-based propeller flap (RCAP).
In recent years, perforator flaps have become an indispensable tool for the reconstruction process. Most recently, "propeller" perforator flaps allow each perforator vessels to become a flap donor site. Once the perforator of interest is identified by acoustic Doppler, the cutaneous or fascio-cutaneous island is designed and then customized according to the principle of "perforasome". ⋯ Ultimately, the result was very satisfying. Well experienced for lower-extremity reconstruction, perforator-based propeller flap are still few reported for upper limb. It is likely that in the future, propeller flap supersede in many indication not only free flaps and locoregional flaps but also, leaving no room for uncertainties of the vascular network, the classic random flaps.
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Ann Chir Plast Esthet · Dec 2013
[Botulinum toxin type A contribution in the treatment of Raynaud's phenomenon due to systemic sclerosis].
Raynaud's phenomenon is a vasospastic disorder of the extremities that can lead, in the hands, to pain, disability, ischemic ulcers and digital chronic ischemia. Medical and surgical current treatments are not fully effective while causing side effects. Recent studies have emphasized the value of botulinum toxin type A (BTX A) in the management of primary Raynaud's phenomenon. The originality of Raynaud's syndrome secondary to systemic sclerosis is to combine both arterial vasospasm and sclerosis of the arterial wall, what is supposed to reduce BTX A effects. The purpose of this work is to evaluate BTX A efficiency in patients with Raynaud's phenomenon secondary to systemic sclerosis. ⋯ BTX A appears to improve significantly Raynaud's phenomenon symptomatology in patients with systemic sclerosis despite the component of arterial sclerosis.
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Ann Chir Plast Esthet · Aug 2013
[Management of upper obstetrical brachial plexus palsy. Long-term results of non-operative treatment in 22 children].
Treatment of obstetrical brachial plexus palsy (OBPP) is always debated, especially for upper plexus palsy. Some authors perform early surgical treatment in case of absence of biceps contraction at the age of 3 months. Others prefer to wait until the age of 6 months before considering a surgical procedure when no suspicion of root avulsion is found. We think that a conservative approach with intensive rehabilitation program can obtain good functional outcome for patients who will recover biceps function spontaneously between 3 and 6 months, and that it is not necessary to perform surgery at 3 months. To argue our choice, we have compared the long-term outcome of two groups of children with upper OBPP conservatively treated regarding the age of biceps recovery (before or after 3 months). ⋯ This study shows that global shoulder function is comparable for two groups. The children who did not recover a biceps contraction at 3 months of age had a global shoulder function as good as the one who recovered biceps function earlier. We think our intensive rehabilitation program allowed us to avoid a useless early surgery. Surgical plexus treatment was indicated for children who did not have biceps contraction after 6 months of age.
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Ann Chir Plast Esthet · Jun 2013
[Financial rating optimization in pressure ulcers management: yes, but at what price?].
The surgical management of pressure ulcers remains very expensive even if preventive measures and improved care pathways allowed to reduce spending in this domain in recent years. Since 2004, the funding of French hospitals by "fee-for-service" and the needs of saving health spending necessarily compels us to interest ourselves in these purely economic considerations and sometimes modify our requirements for hospital stay to optimize a "patient' valorisation group". ⋯ Through a medico-economic analysis of our practices conducted in the plastic surgery department of the University hospital of Toulouse, we tried to identify how to optimize the surgical management of pressure ulcers in terms of valorisation of hospital stay. The aim is still to remain critical about the aberrations that this could introduce in the future for our clinical activity.