J.-L. Grolleau

University of Toulouse, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (109)50.75 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Complex heel injuries in children are rare and their management requires coverage combining resistance and thinness, to allow walking and footwear. The objective of this study was to create a decision-making algorithm for heel defect in children.
    Annales de chirurgie plastique et esthetique. 10/2014;
  • L. Chanel, A. André, J.-P. Chavoin, J.-L. Grolleau
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    ABSTRACT: Le gamme di medicazioni si arricchiscono ogni giorno con nuove associazioni di principi attivi. La medicazione ideale deve mantenere un ambiente umido, essere permeabile agli scambi gassosi, rimuovere l’essudato in eccesso e le componenti tossiche ed essere impermeabile ai liquidi e non aderente alla ferita. La sua scelta dipende dalle caratteristiche semeiologiche della ferita. Noi precisiamo le indicazioni e le regole di utilizzo di ogni categoria: idrogel, alginato, idrocolloide, idrofibra, idrocellulare, medicazione grassa e interfaccia, medicazione all’argento e al carbone, film di poliuretano e medicazioni adesive.
    09/2014; 12(3):1–9.
  • The Breast Journal 07/2014; · 1.83 Impact Factor
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    ABSTRACT: La correzione chirurgica dei seni piccoli è uno degli interventi più praticati in chirurgia estetica: questo inestetismo ha, infatti, una forte ripercussione psicologica sulla donna e sulla sua femminilità, di cui il seno è un simbolo. L’utilizzo di protesi mammarie ha dimostrato la sua efficacia da 60 anni. Il chirurgo deve conoscere bene la loro composizione e le loro modalità di fabbricazione, prima di impiantarle. È altrettanto importante che egli compia le scelte corrette di vie d’accesso e di volume e che, soprattutto, non esiti a correggere una ptosi, malgrado la legittima reticenza della paziente di fronte ai postumi cicatriziali. L’indicazione corretta, la protesi corretta e la tecnica corretta sono i tre pilastri del successo e della riconoscenza eterna delle pazienti.
    06/2014; 12(2):1–13.
  • Plastic and reconstructive surgery 03/2014; 133(3):432e-4e. · 2.74 Impact Factor
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    ABSTRACT: Introduction Surgical treatment of perineal pressure sores could be done with various fascio-cutaneous or musculo-cutaneous flaps, which provide cover and filling of most of pressure sores after spinal cord injuries. In rare cases, classical solutions are overtaken, then it is necessary to use more complex techniques. We report a case of a made-to-measure lower limb flap for coverage of confluent perineal pressure sores. Patient and method A 49-year-old paraplegic patient developed multiple pressure sores on left and right ischial tuberosity, inferior pubic bone and bilateral trochanters with hips dislocation. Surgical treatment involved a whole right thigh flap to cover and fill right side lesions, associated to a posterior right leg musculo-cutaneous island flap to cover and fill the left tronchanteric pressure sore. Result The surgical procedure lasted 6.5 hours and required massive blood transfusion. Antibiotics were adapted to bacteriological samples. There were no postoperative complications; complete wound healing occurred after three weeks. Discussion A lower limb sacrifice for coverage of a giant perineal pressure sores is an extreme surgical solution, reserved to patients understanding the issues of this last chance procedure. A good knowledge of vascular anatomy is an essential prerequisite, and allows to shape made-to-measure flaps. The success of such a procedure is closely linked to the collaboration with the rehabilitation team (appropriate therapeutic education concerning transfers and positioning).
    Annales de Chirurgie Plastique Esthétique 02/2014; · 0.32 Impact Factor
  • L. Chanel, J.-L. Grolleau, F. Lauwers, A. André
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    ABSTRACT: Introduction The avulsion of the flexor digitorum profundus from its distal insertion, or jersey finger, is an injury commonly missed in the accident and emergency department. Typically, after 3 weeks, the retracted tendon stump prevents direct reinsertion of the tendon. Sawaya et al. have proposed a treatment involving a zone 5 Z-plasty lengthening on the 4th finger. We conducted an anatomical study to evaluate the tendon advancement that could be obtained in the long digits using this method. Method Tendon avulsion was recreated in 17 fresh cadaver hands by severing the flexor digitorum profundus from its distal insertion. A 3, 4 or 5 cm Z-plasty was performed at the wrist and, after section of the vinculum breve, the advancement was measured with wrist extension at 0°. Results 68 tendon reconstructions were performed. The mean advancement obtained was 1.5 cm [max: 2.5 cm – min: 0.5 cm], 2.3 cm [max: 3.2 cm; min: 1.3 cm] and 2.5 cm [max: 3.5 cm; min: 1.7 cm] for 3, 4 and 5 cm Z-plasties respectively. Tendon advancement in the ring finger and middle finger was limited by the lumbrical (2 cases) or by synovial adhesions in the carpal tunnel (16 cases). There was no such limitation for the index finger. Discussion Advancement of the flexor digitorum profundus by a 4 cm Z-plasty at the wrist seems to be a useful technique for reinsertion of a retracted tendon. The best results were obtained in the index finger. This technique could be considered as an alternative to palliative surgery or a tendon graft. In the other fingers, the fact that advancement was limited due to Verdan's quadriga effect and synovial adhesions highlights the significance of the relationship between the tendons themselves and with their environment on the physiology of finger flexion.
    Journal of Plastic Reconstructive & Aesthetic Surgery 01/2014; · 1.44 Impact Factor
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    ABSTRACT: Les tumeurs glomiques sont des lésions bénignes et rares qui se développent aux dépens des glomus neuro-myo-artériels. L’exérèse chirurgicale complète de la tumeur reste la référence. Difficiles à diagnostiquer, leur prise en charge est souvent tardive, laissant se dégrader progressivement la qualité de vie. Cet article a pour but d’évaluer l’amélioration de la qualité de vie après chirurgie. Une étude rétrospective menée de 1992 à 2011 a permis d’analyser 23 tumeurs glomiques du membre thoracique chez 22 patients. La douleur était le symptôme prédominant chez tous les patients. La qualité de vie des patients ainsi que le handicap ont été évalués en préopératoire et en postopératoire à l’aide de deux questionnaires chez 11 patients : le Medical Outcome Study Short Form (MOS-SF 36, version française) et l’Échelle d’incapacité fonctionnelle de la main de Cochin (EFMC). Une évaluation de la douleur par échelle visuelle analogique (EVA) a complété l’étude. L’âge moyen des patients était de 48 ans avec un sex ratio de 0,28. La localisation était digitale dans 20 cas (87 %). Le délai entre l’apparition des symptômes et la chirurgie était de 8,5 ans. Les patients avaient consulté en moyenne 2,8 praticiens. La douleur moyenne préopératoire sur l’EVA était de 8,7/10, alors qu’en postopératoire elle était notée à 0,8/10. Les échelles d’évaluation ont été soumises à 11 patients avec un recul moyen de 11 ans après la chirurgie. Les douleurs avaient disparu chez 10 patients (91 % des cas). Une limitation des efforts physiques avant la chirurgie était mentionnée par cinq patients (45 %), contre un (9 %) à distance (p = 0,006). L’amélioration était également significative pour les mouvements fins (p = 0,03). La chirurgie avait eu un impact positif sur la vie sentimentale pour trois patients (27 %). Avant la chirurgie, une gêne dans la vie sociale existait chez quatre patients (36 %), contre un (9 %) après chirurgie. Les tumeurs glomiques ne sont que rarement diagnostiquées lors des consultations de première intention, laissant de nombreux patients en errance diagnostique à l’origine d’une dégradation de la qualité de vie, entre douleur chronique et limitation des activités. L’amélioration significative de la qualité de vie après la chirurgie doit inciter à un diagnostic plus précoce de cette pathologie.
    Chirurgie de la Main. 01/2014;
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    ABSTRACT: Introduction Complex heel injuries in children are rare and their management requires coverage combining resistance and thinness, to allow walking and footwear. The objective of this study was to create a decision-making algorithm for heel defect in children. Materials Children received for heel defect, reconstructed with flap in our plastic surgery unit of Bordeaux with a follow-up greater than 10 years were investigated. Three children operated between 1999 and 2003 were included. A free contralateral reinnervated medial plantar flap, a free latissimus dorsi flap and a lateral supramalleolar flap were performed. Patients were reviewed in consultation to assess quality of reconstruction and functional outcomes. Three scores were used, the Foot Function Index (FFI), the AOFAS Ankle and Hindfoot Scale and the Maryland Foot Score. Results No growth disorder has been found. Scores greater than 80 for the Maryland Foot Score and AOFAS Ankle and Hindfoot Scale and less than 10 for the FFI were very satisfactory in cases 1 and 3. We found pain and greater functional impairment in the second case. Conclusions “Like-with-like” reconstruction remains the gold standard, whether in loco-regional or free flap. The fasciocutaneous flaps allow custom reliable coverage with little donor site morbidity. Loco-regional flaps remain easily accessible but donor site sequelae are not negligible.
    Annales de Chirurgie Plastique Esthétique. 01/2014;
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    ABSTRACT: Introduction Hyaluronic acid has come to represent the most widely used injectable cosmetic product in the world. Brought into being by the Swedish company Q-Med, in 2007 Macrolane™ was authorized for use in France, and the year after, it received official European approval as a means of breast augmentation. Since then, however, numerous controversies pertaining to its side effects have led to its withdrawal from the worldwide breast augmentation market. The objective of this article is to carry out a review of the literature providing updated information on Macrolane™ and its recent indications. Materials and methods We carried out a review of the literature on the PubMed and PubMed Central data bases through use of the keywords “Macrolane™”, “NASHA”, “hyaluronic acid” and “soft filler”, and subsequently analyzed the levels of evidence and possible biases of the different publications. The official sites of the French, English, Spanish and American scholarly organizations of plastic surgery were likewise consulted. Perusal of the notifications and recommendations for use brought out by the Q-Med company completed our study. Results A large majority of the available clinical series on Macrolane™ with regard to not only breast augmentation, but also its other indications, offer an insufficient level of evidence and present a number of conflicts of interest. Since April 2012 Macrolane™ has been temporarily withdrawn by its distributors from the worldwide breast augmentation market. In point of fact, Macrolane™ injections have been found to interfere with breast imaging and screening for breast cancer. As regards the latest indications for this controversial product, it is not yet possible to step back and take stock. Conclusions Present-day scientific data fail to justify the market reappearance of Macrolane™ breast augmentation products. Q-Med has shown full awareness of the problem by imposing worldwide restrictions on products aimed at penis as well as breast enlargement. Larger cohorts of female patients are more necessary than ever, as is an approach based on stepping back and taking stock.
    Annales de Chirurgie Plastique Esthétique 01/2014; · 0.32 Impact Factor
  • Journal of Plastic Reconstructive & Aesthetic Surgery 01/2014; · 1.44 Impact Factor
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    ABSTRACT: La corrección quirúrgica de las mamas pequeñas es una de las intervenciones más practicadas en cirugía estética: esta falta de armonía tiene de hecho una importante repercusión psicológica sobre la mujer y su feminidad, de la cual la mama es un símbolo. El uso de las prótesis de mama ha demostrado su eficacia desde hace más de 60 años. Antes de implantarlas, es necesario que el cirujano esté familiarizado con su composición y su modo de fabricación. Es igualmente importante que tome las decisiones correctas en relación con las vías de acceso y de volumen y que, sobre todo, no dude a la hora de corregir una ptosis a pesar de las reticencias legítimas de la paciente ante el precio cicatricial que supone. Una buena indicación, una buena prótesis y una buena técnica son los tres pilares del éxito y de la gratitud eterna de las pacientes.
    EMC - Cirugía Plástica Reparadora y Estética. 01/2014; 22(1):1–13.
  • Plastic and reconstructive surgery 11/2013; 132(5):868e-70e. · 2.74 Impact Factor
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    ABSTRACT: Las malformaciones congénitas de la pared torácica que se presentan con mayor frecuencia son el tórax en embudo y, en menor medida, el tórax en quilla. La ausencia de alteraciones funcionales cardíacas o respiratorias y la agravación progresiva de la malformación durante el crecimiento son las razones que llevan cada vez más al cirujano, ya sea plástico, pediátrico o torácico, a escoger la solución de corrección mediante endoprótesis a medida. Esta técnica parece preferible y menos agresiva que las técnicas radicales de osteocondroplastia modelante o de resección del plastrón esternocondral con reemplazo por placa protésica. En este capítulo se describen e ilustran las diferentes formas clínicas de las malformaciones torácicas, así como su implicación psicológica, que a veces es muy importante, e incluso la única verdadera indicación de esta corrección puramente morfológica. Se detallan las modalidades técnicas de realización de la endoprótesis a medida, así como las técnicas de colocación en posición retromuscular según la forma clínica y el sexo. Los resultados cosméticos mejoran con la colocación en posición retropectoral y con la calidad de la endoprótesis. En un futuro próximo, la realización de maquetas por prototipificación rápida a partir de imagen de escáner 3D aportará una precisión imposible de obtener con el molde externo. La simplicidad de esta operación gracias a un trabajo multidisciplinario proporciona resultados casi siempre satisfactorios con ausencia de morbilidad. Los únicos inconvenientes postoperatorios pueden ser los derrames de Morel-Lavallée, bastante frecuentes, y una molestia mecánica durante los grandes esfuerzos causada por la anchura o el peso de la endoprótesis.
    EMC - Cirugía Plástica Reparadora y Estética. 07/2013; 8(1):1–12.
  • J.L. Grolleau, J.P. Chavoin, M. Costagliola
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    ABSTRACT: Las malformaciones congénitas de mama tienen consecuencias psicológicas graves en las adolescentes lo que justifica que se les proponga una intervención quirúrgica. Para caracterizar las anomalías, se hará referencia a la anatomía morfológica de una mama ideal que está definida por parámetros objetivos y mensurables. Se distinguen dos grandes tipos de malformaciones: las anomalías de volumen y las anomalías de forma y asimetrías. Entre las anomalías de volumen, la hipertrofia bilateral es la patología más frecuente y la única capaz de acarrear un perjuicio funcional mientras que las hipoplasias malformativas mayores bilaterales son poco frecuentes. Las asimetrías mamarias, combinando hipertrofia, hipotrofia, uni- o bilaterales, determinan numerosas formas clínicas, por lo que es necesaria una estrategia quirúrgica que asocie diferentes técnicas. La utilización de un dibujo de resección cutánea preestablecido es de gran utilidad para tratar tales casos. Las anomalías malformativas caracterizadas comprenden esencialmente el síndrome de Poland y las mamas tuberosas. El síndrome de Poland corresponde a una entidad clínica que asocia una hipoplasia mamaria con una malformación torácica de importancia variable,siendo la mínima expresión una agenesia del fascículo esternal del músculo pectoral mayor. En las formas moderadas, la implantación de una prótesis mamaria debe ir asociada a una prótesis infraclavicular o a una transposición del músculo dorsal ancho. El tratamiento de las formas mayores del síndrome de Poland es difícil y requiere técnicas procedentes de la reconstrucción mamaria después de un cáncer. Las mamas tuberosas se caracterizan por una deficiencia de la base mamaria que predomina en el polo inferior de la glándula y por un desarrollo anterior exagerado de la mama. La anomalía es a menudo asimétrica y puede ser clasificada según tres estadios que requieren métodos quirúrgicos diferentes. Sin embargo, cualquiera que sea el volumen de las mamas, el principio base del tratamiento continúa siendo la corrección de la base mamaria y la redistribución armoniosa del volumen glandular asociado según los casos a una disminución o a un aumento de volumen.
    EMC - Cirugía Plástica Reparadora y Estética. 07/2013; 8(1):1–15.
  • Journal of Plastic Reconstructive & Aesthetic Surgery 07/2013; · 1.44 Impact Factor
  • C. Crouzet, B. Chaput, J.-L. Grolleau
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    ABSTRACT: 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”. In the future, this may lead the surgeon to bias the real needs of the patient for the benefit of hospital establishment. 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.
    Annales de Chirurgie Plastique Esthétique. 06/2013; 58(3):183–187.
  • A. André, J.-P. Chavoin, J.-L. Grolleau
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    ABSTRACT: A menudo, en el tratamiento de las grandes eventraciones se necesitan métodos quirúrgicos complementarios. Se detallarán sucesivamente las suturas y las técnicas de cirugía plástica aponeurótica, para luego precisar el lugar de la prótesis en la reconstrucción parietal. Se analizarán la reparación parietal con plastia aponeurótica y la colocación de la prótesis en posición retromuscular y preperitoneal, que es el método de preferencia. Los colgajos, sobre todo el colgajo de músculo tensor de la fascia lata, conservan sus indicaciones para las eventraciones infraumbilicales en un contexto séptico. Simplificando, se considera que las eventraciones de un volumen razonable pueden tratarse mediante sutura o plastia aponeurótica aislada. En cambio, en caso de eventración extensa o de recidiva, sólo la colocación de una prótesis permitiría una reparación duradera. Al final, se analizará la cuestión de la pérdida de sustancia total de la pared abdominal y, someramente, la reconstrucción umbilical.
    EMC - Cirugía Plástica Reparadora y Estética. 06/2013; 21(2):1–14.
  • A. André, J.-P. Chavoin, J.-L. Grolleau
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    ABSTRACT: Il trattamento delle grandi eventrazioni richiede spesso la congiunzione di metodiche chirurgiche complementari. Noi analizzeremo successivamente le suture, nonché le plastiche aponeurotiche, quindi preciseremo il ruolo della protesi nella ricostruzione parietale. Esamineremo la riparazione parietale con plastica aponeurotica e posizionamento della protesi in sede retromuscolare e prefascioperitoneale, metodo che ha la nostra preferenza. I lembi, in particolare il lembo di muscolo tensore della fascia lata, conservano delle indicazioni nelle eventrazioni sotto-ombelicali in terreno settico. Semplificando, si può ritenere che le eventrazioni di dimensione ragionevole possano essere trattate con sutura o plastica aponeurotica isolata. Al contrario, quando l’eventrazione è estesa o quando si tratta di recidiva, solo l’utilizzo di una protesi sembra in grado di ottenere una riparazione duratura. Noi affronteremo, infine, la problematica delle perdite di sostanza trapassanti della parete addominale e, in poche parole, la ricostruzione ombelicale.
    06/2013; 11(2):1–15.
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    ABSTRACT: The nose is a complex entity, combining aesthetic and functional roles. Descriptive anatomy is a fundamental science that it can be difficult to relate directly to our daily surgical activity. Reasoning in terms of aesthetic subunits to decide on his actions appeared to us so obvious. The aim of this paper is to resume the anatomical bases relevant to our daily practice in order to fully apprehend the restorative or cosmetic procedures. We discuss the limits of the systematization of these principles in nasal oncology.
    Annales de Chirurgie Plastique Esthétique. 04/2013; 58(2):132–145.

Publication Stats

165 Citations
50.75 Total Impact Points

Institutions

  • 1996–2014
    • University of Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
    • Centre Léon Bérard
      Lyons, Rhône-Alpes, France
  • 1994–2012
    • Centre Hospitalier Universitaire de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2005
    • Institut Claudius Regaud
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 1999
    • University of Geneva
      • Division of Plastic and Reconstructive Surgery
      Genève, GE, Switzerland
  • 1998
    • Hôpitaux Universitaires de Genève
      Genève, Geneva, Switzerland