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ABSTRACT: INTRODUCTION: Many surgical techniques have already been described to repair full thickness defects of the inferior part of the nose. The Schmid-Meyer fronto-temporal flap procedure, a little known technique, is based on the old principle of autonomization of a cutaneous flap and uses a tailor-made composite cartilaginous graft placed in the temporal region. This graft is progressively detached and allows mucosal/cartilaginous/and cutaneous nasal repair. Can this technique still be used for nasal full-thickness reconstruction? PATIENTS AND METHOD: Nine cases of nasal reconstruction using this procedure were performed. The 4-steps of the operative technique were described and the results were analyzed retrospectively. RESULTS: This procedure allows, for some specific indications, excellent reconstruction of the ala, the columella or the nasal tip. In eight cases out of nine, the result was judged good or very good by both patients and physicians. In 78%, the reconstruction was performed under local anesthesia. DISCUSSION: The Schmid-Meyer flap procedure may still be used for full-thickness reconstruction of the lower third of the nose because it allows a high quality of nasal reconstruction and few scar sequels.
Revue de stomatologie et de chirurgie maxillo-faciale 11/2012; · 0.35 Impact Factor
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ABSTRACT: Post-ablative medial canthus and medial orbital wall reconstruction may involve various materials. Few articles present such reconstructions using cartilage homografts, and very few opt for conchal cartilage. In some cases of medial orbital wall excision, at least half of the eyelid must also be removed. We present two cases where we decided to use conchal cartilage to reconstruct the medial orbital wall and tarsomarginal Hübner grafts to reconstruct the eyelid. This combination offers several advantages: a very limited resorption, only one operative field and a reduced infection risk.
Annales de chirurgie plastique et esthetique 10/2012; · 0.33 Impact Factor
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ABSTRACT: Several surgical techniques are available for full thickness chest wall reconstruction. The choice has to be adapted to the size of the loss of tissue, its location, and must finally be accepted by the patient's. We propose a new and unpublished solution.
We have in our care a 54 years-old patient suffering from a previous loss of chest wall tissue measuring 7 cm(2) due to surgical treatment of mediastinal Hodgkin's disease with sternal and costal invasion. Because of the sequelae, the goal focused on aesthetic reconstruction. Heartbeat was visible under the skin due to a loss of secondary left breast tissue from an initial treatment with absorbable Vicryl(©) mesh followed by a local skin, and glandular flap. Our choice of reconstruction consisted of inserting a moldable titanium mesh followed by 200 g implants in each breast during the same operation. We did not experience any complications and the patient is satisfied with the results.
No example of reconstruction using only a moldable titanium mesh was found in the literature on chest wall reconstruction. Our elegant choice is innovative in our discipline. However, this reconstruction materiel is already part of therapy procedures in other specialized surgeries.
This case report illustrates the various facets of our speciality: bring a solution at once repair, aesthetic and unique according to the request of the patient. The use of a moldable titanium mesh allows the reconstruction of stable chest wall. The small size does not present any functional difficulties, but rather unsightly sequel.
Annales de chirurgie plastique et esthetique 05/2012; 57(4):392-9. · 0.33 Impact Factor
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ABSTRACT: The middle or upper third of the auricle can be reconstructed with a composite chondro-cutaneous peninsular flap of the conchal part of the auricle. This peninsular flap is based on the anastomotic network between the posterior auricular and the superficial temporal artery. The authors report their experience about 24 clinical cases. Most of the cases were partial auricular amputations for squamous cell carcinoma. The surgical procedure allows a hidden cartilaginous donor site, the concha, allowing in a single operation a color- and texture-matched reconstruction. This flap represents an alternative to more complex surgical procedures, and can easily be realised under local anaesthesia.
Annales de chirurgie plastique et esthetique 06/2011; 57(4):356-65. · 0.33 Impact Factor
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ABSTRACT: The complete dorsal nasal aesthetic unit can be raised in a vascular island flap based on the superior alar artery, at the level of the nasalis muscle. This flap uses the vertical glabellar cutaneous laxity. It hides scars between the nasal aesthetics units and its distal rotation point allows a pure translation of the nasal skin without distortions encountered when using medial canthal rotation flaps. This local flap is reliable and had been successfully used for four patients without complications or secondary procedures. It allows large reconstructions for up to 25 mm defects leaving minimal scars. It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose, and has also been used for alar reconstructions.
Annales de chirurgie plastique et esthetique 10/2010; 57(3):267-72. · 0.33 Impact Factor
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ABSTRACT: We report a primitive neuroendocrine breast tumor (NET) in a male. This situation is uncommon by its mode of discovery. We have treated a 74-year-old man with a lesion in the left areola initially considered as an organized hematoma due to a severe trauma. The ablation was performed by direct access under local anesthesia. The analysis of the piece has showed a NET of the breast due to the positivity of the neuroendocrine, cytokeratin and hormone markers. No other NET lesion was found, excluding the secondary origin of the breast tumor. Complementary therapies associated mastectomy, lymphadenectomy, hormonotherapy. Male breast cancer is rare. NET are exceptional, only a dozen of male NET is reported. These tumors affect a specific population and have a better prognosis than infiltrating ductal carcinoma. In our case, no causal link can be demonstrated between trauma and tumor microenvironment necessary for the growth of quiescent cancer cells.
Annales de chirurgie plastique et esthetique 10/2010; · 0.33 Impact Factor
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ABSTRACT: Our patient showed major abdominal cutaneous necrosis. Detersion removed the entire thickness of half of the right-hand wall of the abdomen. We are going to explain how, by combining well known procedures, we conducted this closure. This deals with a patient aged 53, with a long case history of dermatomyositis and highly debilitating sub-cutaneous calcinosis. This patient has been treated with Imurel and high doses of corticoids since 1997. In the face of the much debilitated terrain of the patient, it was not certain that a local flap or even a pediculated flap could be made to cover this loss of substance with a minimum of risk. A cutaneous extension was then envisaged using a system of Wisebands fillets. To protect the parietal plate, accelerate its growth and reduce the skin tension, we used in combination a system of foam dressing with negative pressure therapy (NPT). The optimized NPT was used for 2 weeks. The Wisebands were installed for 1 month. The treatment lasted for 50 days and required five short sessions of general anaesthesia. The histopathological interpretation revealed an EBV lymphoma. The assessment of the extension and the therapeutic treatment of the lymphoma contributed to the duration of hospitalisation and the number of general anaesthesia sessions. The synergy effect of these two associated procedures have allowed a faster skin closure; 18 months later, no complications have occurred. The wound has closed totally and the abdominal wall is solid in spite of not having resorted to a flap or separation.
Annales de chirurgie plastique et esthetique 03/2009; 54(2):165-70. · 0.33 Impact Factor
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ABSTRACT: The ideal solution first recommended is the use of Abbé-Mustardé's flap with lower lid transposition to rebuild the total loss of the upper eyelid. Every step of the surgical technique has been detailed to improve the result and keep the drawbacks under control. After having read articles on this subject, we describe three clinical cases, which enable us to compare with others surgical techniques that cannot rebuild all the levels of the eyelids and the edge of the eyelashes.
Annales de Chirurgie Plastique Esthétique 03/2007; 52(1):62-7. · 0.41 Impact Factor
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ABSTRACT: In his paper entitled "The reversed dermis flap" published in 1978, Pakiam explained the advantages of de-epithelialising local flaps and applying them dermis-side down. We present a ten-year series of 107-reversed dermis flaps used to raise depressed scars. There have been no significant complications in this series except two cases of infection and six cases of postoperative haematoma. All patients were satisfied with the cosmetic outcome. We do not use this flap as much as we used to since Coleman demonstrated how efficient lipostructure could be especially when applied to thin depressed scars. The reversed dermis flap remains invaluable in cases of widespread scars or when lipostructure is dangerous or impossible.
Annales de Chirurgie Plastique Esthétique 07/2006; 51(3):231-4. · 0.41 Impact Factor
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ABSTRACT: When the medial third of the upper or lower eyelid has to be reconstructed after full-thickness tumour excision, we usually use Hübner tarsomarginal grafts, but when medial canthal lesions spread to the medial orbital wall without invading the orbital margin, conchal graft becomes our first surgical option. Previously reported solutions to this difficult problem are few and concern more directly medial orbital wall fractures. We found no article dealing specifically with the use of conchal graft in post-ablative reconstruction of the medial orbital wall. Nevertheless the concha presents great advantages over bone grafting or rib cartilage, because it is more flexible and malleable. And it is less prone to extrusion or infection as may be allografts implants. It is a very effective way to repair medial orbital defects, but graft reorientation must be perfect to match exactly the medial orbital wall concavity.
British Journal of Plastic Surgery 01/2006; 58(8):1152-7. · 1.29 Impact Factor
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ABSTRACT: Blasius designed the first orbitonasolabial flap in 1842, which has since, been reshaped by many other surgeons. Three years ago, we were confronted with a difficult reconstructive case where ipsilateral local flaps were insufficient to cover a huge defect of the periorbital region. We performed 11 cadaver dissections to determine the type of vascularisation of the orbitonasolabial flap and to define its arc of rotation prior to contralateral use. This contralateral orbitonasolabial flap was subsequently applied to seven cases with satisfactory results.
British Journal of Plastic Surgery 11/2005; 58(7):940-3. · 1.29 Impact Factor
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ABSTRACT: How to use the orbitonasolabial flap in vascular island thanks to his pedicle based an angular vessel. An anatomic study based on 11 cadavers allows to check the existence of a constant pedicle. This flap was used on 6 patients aged 62 to 90 years old on an average period of 16 months to fill up jugular, orbital, nasolabial and inner canthal defects. Two complications have occurred, a superficial necrosis of the lower part of the flap having spontaneously healed and an ectropion on a senile part. It has been necessary to degrease a second time in 50% of the cases. Nevertheless, the flap can be considered reliable and able to cover tissue defect in the central facial region with minor aesthetic and functional sequel on the donor site.
Annales de Chirurgie Plastique Esthétique 09/2005; 50(4):288-95. · 0.41 Impact Factor
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ABSTRACT: Dermatofibrosarcomata protuberans are rare locally aggressive tumours that have a very high recurrence rate in the absence of wide resection. Normally, when the area to be covered is exceptionally large or when skin grafting is not possible because of the location, pedicle or free flaps are used. We report one case of wide excision where the opportunity arose to apply aesthetic surgery techniques combining bilateral superiorly based mammaplasty and reverse abdominoplasty.
British Journal of Plastic Surgery 07/2005; 58(4):556-60. · 1.29 Impact Factor
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ABSTRACT: Hidradenitis suppurativa is a chronic, suppurative and scarring disease characterized by painful, inflamed lesions in the axillae, perineum, groin, scrotum and other parts of the body with apocrine-bearing skin including genital skin. Appropriate medical treatment alone appears to be insufficient for managing most patients with severe lesions. In the vast majority of cases, surgery consists in complete excision of the lesions with primary closure or healing by secondary intention. In severe cases, radical excision of all diseased apocrine-bearing skin is mandatory and the resulting defects are generally repaired by mesh skin grafts. In the most severe cases it may be necessary to realize loco-regional flaps. Generally we reconstruct the perineal region with bilateral fasciocutaneous thigh flaps. We report a case of hidradenitis suppurativa where the lesions were so extensive from penis to anus we had to imagine a tailor-made flap based on the abdominoplasty techniques.
Annales de Chirurgie Plastique Esthétique 07/2005; 50(3):242-6. · 0.41 Impact Factor
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ABSTRACT: In 1976, Hübner described a new technique to repair full-thickness defects of the eyelids. In 1993, we decided to adopt this simple and easily reproducible technique that guarantees restoration of the normal aspect of the margin. Subsequently, 17 eyelid reconstructions were performed on 13 patients, requiring the harvesting of 22 tarsomarginal grafts. No cosmetic or functional sequelae in the donor eyelids were observed. One or several functional complications were present in seven out of 17 reconstructed eyelids, including two cases of epiphora, one case of lagophtalmos and two cases of lid notch. Loss of the eyelids was observed in three cases out of six upper eyelid reconstructions and in nine cases out of 11 lower eyelid reconstructions. In all cases, the margin integrity was otherwise preserved. Very few simple techniques achieve that level of quality in the eyelid reconstruction process.
British Journal of Plastic Surgery 05/2005; 58(3):361-5. · 1.29 Impact Factor
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ABSTRACT: The fronto-temporal flap described by Schmid and modified by Meyer is a tubular flap with an internal supraciliary pedicle which allows the transposition of the temporal skin with the addition of ear cartilage on the tip of the nose or the ala nasi. This meticulous reconstruction requires four stages which are workable under local anesthesia. Four clinical cases allow to specify the advantages and the drawbacks of this technique. They place this technique in the therapeutic possibilities between the composite grafts and various local and distant flaps.
Annales de Chirurgie Plastique Esthétique 03/2000; 45(1):24-30. · 0.41 Impact Factor
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ABSTRACT: Enucleation frequently and progressively causes an enophtalmus and atrophia of the inferior eyelid, thereby leading to a height deficiency. Buccal mucous grafts give rise to phenomena such as secondary retraction. This may have complex and painful post-operative outcomes. However, when a septal chondromucous graft is performed, the height in the inferior palpebral part becomes more aesthetic, more retentive and quickly allows the wearing of a more voluminous prosthesis. Thus, the notinable enophtalmus can be corrected and the aesthetic quality of the looking is substantially restored. The authors report this surgical procedure and the results obtained with 21 patients which appear to be particularly promising.
Annales de Chirurgie Plastique Esthétique 01/1998; 42(6):594-602. · 0.41 Impact Factor
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ABSTRACT: Many methods have been proposed for the reconstruction of full thickness defects of the eyelid are numerous, but all are imperfect. The texture, colour, and functional role of the eyelid require the use of a ciliated composite transplant. Among the various techniques described, Hübner's transplants, free transfers of a segment composed of connective tissue of the tarsus and the ciliary margin of the contralateral eyelid, covered by a palpebral flap, can be used to reconstruct a hemi-eyelid, or even two-thirds of the eyelid with good aesthetic and functional results.
Annales de Chirurgie Plastique Esthétique 05/1995; 40(2):169-75. · 0.41 Impact Factor
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ABSTRACT: The in and out flap of Pers, described in 1967, is used for the reconstruction of alar defect. After an anatomical reminder of the blood supplied of the nasolabial region, we mentioned four cases of this flap, with some little modifications of drawing and closing of donor site. The others ways of repear of alar defect are discussed.
Annales de Chirurgie Plastique Esthétique 02/1991; 36(3):228-34. · 0.41 Impact Factor
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ABSTRACT: Launois-Bensaude adenolipomatosis or Madelung's disease was described in 1898. Typically, the lipomatosis affects chronic alcoholic patients with a symmetrical distribution around the neck and occiput. The mass gradually diffuses into the scapular, deltoid, chest wall or abdominal areas. Cosmetic deformity and the difficulty of obtaining clothes, lead patients to seek surgical treatment. This surgical management (only effective treatment) has a severe tendency to haemorrhage and dissection is complicated by infiltrations of neighbouring tissue. Suction curettage lipectomy associated with classical surgical resection were performed in three patients, in different sites. Respective indications for the various techniques are studied in this paper.
Annales de Chirurgie Plastique Esthétique 02/1990; 35(2):128-33. · 0.41 Impact Factor
