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Introduction
Skills and Expertise
Publications
Publications (220)
Objective
The optimal method for maintaining intraoperative blood pressure during microsurgical procedures remains controversial. While intravenous fluid administration is essential, overfilling can lead to complications. Vasopressor agents are used cautiously due to their vasoconstrictive effects, which could potentially lead to flap failure. Nume...
The optimal treatment for full-thickness burn injuries involves surgical intervention, which may include skin grafting or reconstruction by flap. The complexity of treatment arises from the need for both effective temporary wound coverage and permanent skin restoration while also considering the potential risk of finger amputation in the case of ha...
Total penile reconstruction represents a surgical challenge. Autologous reconstructions offer limited aesthetic results and variable urinary function recovery. To date, five genitourinary vascularized composite allotransplantations have been performed worldwide. However, in all cases, vascular complications have been reported. The objective of this...
Vascularized composite allotransplantation makes it possible to reconstruct loss ofsubstance of complex anatomical structures for which reconstructive surgery has no satisfac-tory solution. Of these, hand and face transplants are the most common. With approximately200 hand transplants and 49 face transplants in the world in 20 years, they remain ex...
Objectif
Aujourd’hui controversée en raison du risque de rejet immunitaire et de la morbidité secondaire à la prise d’un traitement immunosuppresseur au long cours, l’allotransplantation de membre supérieur reste pourtant actuellement la seule option thérapeutique pour une reconstruction ad integrum du membre supérieur [1], [2]. Alors que les techn...
Objectif
Typiquement, l’arche axillaire est définie comme un feuillet charnu allant du grand dorsal à la face antérieure de l’humérus. La phylogénie semble donner l’explication la plus pertinente et la plus plausible de cette variante anatomique en tant que vestige du panniculus carnosus. Cependant, les auteurs ne sont pas unanimes sur son origine....
Background:
For 50 years, static cold storage (SCS) has been the gold standard for solid organ preservation in transplantation. Although logistically convenient, this preservation method presents important constraints in terms of duration and cold ischemia-induced lesions. We aimed to develop a machine perfusion (MP) protocol for recovery of vascu...
BACKGROUND: Venous anatomy of the digits and the hand is poorly reported in the literature compared to the arterial anatomy. While knowledge of the venous anatomy is crucial to ensure safe skin incisions, skin flap design or blood return restoration for digital replantations, data in anatomical and clinical textbooks is rather limited. The purpose...
Background
Machine perfusion is gaining interest as an efficient method of tissue preservation of Vascularized Composite Allografts (VCA). The aim of this study was to develop a protocol for ex vivo subnormothermic oxygenated machine perfusion (SNMP) on rodent hindlimbs and to validate our protocol in a heterotopic hindlimb transplant model.
Metho...
Purpose: The decellularization of Vascularized Composite Allotransplantation (VCA) represents a first step in circumventing the need for immunosuppression by depleting donor cells from VCAs. Here we present a model of decellularization of VCAs in rats.
Methods: Rat hind limbs based upon the common femoral artery were harvested and perfused through...
Purpose: The current gold standard in organ storage is static cold storage (SCS) at 4°C in a preservation solution (UW, HTK). While kidneys can be stored for 24 hours in SCS, Vascularized Composite Allografts (VCA) have been transplanted up to 12 hours in this condition. We aimed to determine the limits of VCA viability with SCS. We used a partial...
Background: A general belief is to consider elderly patients as poor candidates for
free flap reconstruction, which does not reflect our 20-year
experience for breast
reconstruction (BR). The aim of this study was to determine the safety and benefits of
BR using deep inferior epigastric perforator (DIEP) free flap in the elderly population.
Methods...
Introduction: Vascularized Composite Allotransplantation refers to the transplantation of multiple tissues as a functional unit from a deceased donor to a recipient with a severe injury. These grafts serve as potential replacements for traumatic tissue losses. The main problems are the consequences of the long immunosuppressive drugs medications an...
Vascularized composite allotransplantations (VCA) represent the most advanced reconstruction option for patients without autologous surgical possibilities after a complex tissue defect. Face and hand transplantations have changed disfigured patients' lives, giving them a new aesthetic and functional social organ. Despite promising outcomes, VCA is...
Background: Previous vascularized composite allograft (VCA) studies from our laboratory have shown that topical FK506 delivery in non-human primates (NHPs) was limited by inadequate dermal penetration and rejection persisted. Herein, we report the first utilization of FK506 via subcutaneously implanted discs to mitigate VCA rejection in NHPs.
Metho...
Over the past 20 years, vascularized composite allografts (VCAs) have emerged as a realistic option in reconstructive surgery. Long-term follow-up reports indicate that face transplant patients have gained in quality of life and social integration. However, they require close monitoring of their immunosuppressive therapy because they are at high-ri...
![Axillary arch of Langer from Testut [48]](publication/346492913/figure/fig5/AS:963575623471117@1606745739758/Axillary-arch-of-Langer-from-Testut-48_Q320.jpg)
Introduction
Typically, the axillary arch is defined as a fleshy slip running from latissimus dorsi to the anterior aspect of the humerus. Phylogeny seems to give the most relevant and plausible explanation of this anatomical variant as a remnant of the panniculus carnosus. However, authors are not unanimous about its origin. We report herein the i...
Plastic surgery is a dynamic field but remains poorly understood by general practitioners, medical students, health professionals, and the public. The main health care professionals in the community who are involved in the follow-up of plastic surgery patients are nurses; they help to facilitate wound healing and rehabilitation in the postoperative...
The 2007 Banff working classification of skin‐containing Tissue Allograft Pathology addressed only acute T cell‐mediated rejection in skin. We report the longitudinal long‐term histological follow‐up of six face transplant recipients, focusing on chronic and mucosal rejection.
We identified three patterns suggestive of chronic rejection (lichen pla...
In this chapter, Vincent Hunsinger, MD, former chief of clinic in the department of Professor Lantieri at Georges Pompidou European Hospital in Paris and in post-bariatric silhouette surgery after massive weight loss under the direction of Professor Ibrahim Dagher (Hospital Antoine Beclère, Clamart, France) presents a technique of improvement of po...
Background
Since the first successful facial transplantation in 2005, the benefits of this procedure in terms of aesthetics, functionality, and quality of life have been firmly established. However, despite immunosuppressive treatment, long-term survival of the allograft might be compromised by chronic antibody-mediated rejection (CAMR), leading to...
Background
Infection with SARS-CoV-2 is responsible for the COVID-19 crisis affecting the whole world. This virus can provoke acute respiratory distress syndrome (ARDS) leading to overcrowed the intensive care unit (ICU). Over the last months, worldwide experience demonstrated that the ARDS in COVID-19 patients are in many ways “atypical”. The mort...
The descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles of domestic animals is not fully known. Improvement of our knowledge in this field could lead to better development of animal models for both pedagogical purposes and surgical experimentation. The objective of this comparative study was to descri...
Background:
Transplantation of vascularized composite allografts is limited mainly by the need for life-long immunosuppression. The consequent side effects and looming specter of chronic rejection portend eventual allograft loss. Development of tolerogenic protocols is thus of utmost importance to the field of vascularized composite allograft tran...
Background:
Plastic surgery is a transversal discipline that many people misunderstand, including general practitioners, medical students, paramedics and the public. Plastic surgeons often collaborate with physiotherapists for post-acute care and rehabilitation. They ensure optimal post-operative recovery of the patient. Herein, the authors assess...
Background:
The national ranking examination (NRE) marks the end of the second cycle (6th university year) of French medical studies and ranks students allowing them to choose their specialty and city of residency. We studied the potential predictive factors of success at the 2015 NRE by students attending a French School of Medicine.
Methods:
F...
Alors que l’importance du rétablissement du retour veineux sur le pronostic des replantations digitales est fondamentale, l’anatomie veineuse de la main et des doigts est peu connue par rapport à l’anatomie artérielle. Les données disponibles dans la littérature sur le sujet sont rares. L’objectif de cette étude anatomique descriptive était d’étudi...
Objectif
Alors que l’importance du rétablissement du retour veineux sur le pronostic des replantations digitales est fondamentale, l’anatomie veineuse de la main et des doigts est peu connue par rapport à l’anatomie artérielle. Les données disponibles dans la littérature sur le sujet sont rares. L’objectif de cette étude anatomique descriptive étai...
We report a case of pedicled omental flap use together with osteosynthesis treatment of a chronic L4-L5 spondylodiscitis due to a large sacral eschar. The 43-years-old patient was paraplegic and had depleted regional flaps solutions due to multiple previous surgeries. The procedure was carried out in supine position then in prone position whereby t...
Purpose
While anatomical variations of the subscapular vessels are frequently encountered during axillary dissection, little is found in the literature. The aim of this cadaveric study was to define arterial and venous anatomical variations and frequencies of the subscapular vascular pedicle and its terminal/afferent vessels in women.
Methods
We p...
Introduction
Vascularized composite allotransplantation (VCA) remains the most advanced treatment option to restore motor function and aesthetics in patients living with devastating disfigurements. However, the current method of organ preservation (static cold storage), successfully used in solid organ transplantation, can jeopardize the quality of...
Since 2005, at least 38 face transplantations have been performed worldwide. Available recommendations on psychological management are based on isolated cases or small case series, either not focused on mental health or with a short follow-up. We propose herein a clinical commentary on psychological and psychiatric outcomes from the follow-up of a...
Perforator free flaps allow breast reconstructions « like with like » with skin and fat, excluding mammary gland, with a low morbidity. Those autologous reconstructions prevent material associated infections, capsular contracture and implant replacements, associated to breast reconstructions including implants. DIEP flap was described in 1994 to re...
Résumé
L’utilisation de lambeaux libres perforants en reconstruction mammaire permet des reconstructions pérennes avec une morbidité réduite, offrant une meilleure qualité de vie à long terme. Ces lambeaux perforants peuvent être prélevés aux dépens des vaisseaux épigastriques inférieurs profonds (DIEP) et des artères glutéales supérieures (SGAP) o...
Introduction/Objectifs
L’examen classant national (ECN) de fin de deuxième cycle des études médicales françaises classe les étudiants pour leur choix de spécialité et de ville de formation [1], [2], [3]. Nous avons étudié les facteurs prédictifs potentiels de réussite à l’ECN.
Patients et méthodes
De mars 2016 à mars 2017, nous avons étudié rétros...
Classical bladder exstrophy (CBE), affecting 1 birth out of 30,000, is characterized by an evaginated bladder plate through a defect in the lower abdominal wall, multiple abdominal wall anomalies including a pubic bone arch dehiscence. Numerous approaches from childhood to adulthood are thus required, depending on the severity of the deformity, inc...
Background:
The clinical photography in plastic and reconstructive surgery has known a numerical breakthrough. The storage of online data, massive means of analysis such as facial recognitions algorithms poses a serious issue when it comes to the protection of personal data. We will assess a platform's benefits in connection with the computerized...
Background The volume of the profunda femoris artery perforator (PAP) flap limits its indications to small- and medium-sized breast reconstructions after modified radical mastectomy for cancer. We report a modified PAP flap design, including not only a vertical extension that increases its volume but also the skin surface, which suits larger breast...
PURPOSE: Over 2 million people in the U.S. are living with limb loss, and roughly 185,000 new amputations occur each year. To date, vascularized composite allograft (VCA) remains the only viable treatment option to restore motor and aesthetic function in these patients. A pressing challenge in the field of VCA is the methods of tissue preservation...
Introduction
Various methods have been suggested for releasing postburn neck contractures. When a contracture is limited to a small area, Z-plasties and/or local skin flaps successfully resolve these problems. However, when the contractures involve a wide area, it is difficult to reconstruct the anterior neck using conventional methods, such as ski...
L’étude historique de la découverte et de la description des pédicules épigastriques inférieurs, subscapulaires, thoraciques internes et du lymphocentre inguino-fémoral nous a permis de comprendre les fondements sur lesquels reposent nos connaissances actuelles. La mise au point des techniques microchirurgicales dans les années 1960 a rendu possibl...
Objectif
L’anatomie descriptive des pédicules vasculaires épigastriques inférieurs, subscapulaires et thoraciques internes chez les mammifères domestiques est imparfaitement connue [1]. L’amélioration de nos connaissances dans ce domaine pourrait permettre de développer des modèles animaux destinés à la pédagogie et à l’expérimentation chirurgicale...
Objectif
L’état actuel des connaissances des variations anatomiques du pédicule subscapulaire et de ses branches terminales est insuffisant. Les études traitant des variations artérielles de ce pédicule sont rares, voire inexistantes en ce qui concerne les veines [1,2]. L’objectif de cette étude anatomique descriptive était d’étudier la fréquence d...
Free flaps have become a reliable practice for breast reconstruction. However, the venous congestion is still the most frequent reason of flap failure. It is due to bad quality of the internal mammary veins, a preferential superficial venous outflow of the flap or due to venous thrombosis. The transposition of the cephalic vein could useful in some...
The deep inferior epigastric perforator (DIEP) flap is a workhorse of breast reconstruction. Risks of herniation derive from violation of the rectus abdominis muscle anterior rectus sheath (ARS) and might be reduced by Minimally Invasive Laparoscopic Dissection (MILD) of the deep inferior epigastric vessels. We performed a feasibility study on five...
Introduction:
The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonet...
The calvarium is an extremely unusual site of metastasis of renal cell carcinoma. We report a 62-year-old man who was enrolled for palliative medical management for an exophytic calvarial metastasis. His quality of life was greatly compromised with everyday local care and bandages due to recurrent events of infection and bleeding, limiting his soci...
Based on a case of reconstruction after oncologic resection of the hard palate, the authors document the key technical points for harvesting a posterior-based buccinator myomucosal flap (Bozola's flap), and its limitations and indications after oncologic resection of tumors originating from the oral cavity and/oropharynx.
Background:
More than 30 face transplantations have been done worldwide since 2005 but no documented long-term follow-up has been reported in the literature. We aimed to answer remaining question about the long-term risks and benefits of face transplant.
Methods:
In this single-centre, prospective, open study, we assessed 20 patients presenting...
While the use of medicinal leech therapy (MLT) in reconstructive and orthopaedic surgery is widely described, post-operative complications related to leeches remain a major concern. Aeromonas spp. strains are involved in the majority of reported cases. As surgical success rate is directly impacted, an adapted antibiotic prophylaxis should be instit...
Background:
Neurofibromas in neurofibromatosis type 1 induce aesthetic and functional morbidity. Perioperative bleeding has been reported as an obstacle to neurofibroma resections. The authors studied the requirement for blood transfusion during surgical treatment of neurofibromatosis type 1.
Methods:
Six hundred twenty-two procedures performed...
Background:
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 s...
Introduction:
Many flaps have been described in autologous breast reconstruction, the most common being the deep inferior epigastric perforator (DIEP) flap. This flap cannot be harvested in a certain range of patients. The profunda artery perforator (PAP) flap, based on perforators from profunda femoral artery, is therefore a good option.
Objecti...
Approximately 30-50% of individuals with Neurofibromatosis type 1 develop benign peripheral nerve sheath tumors, called plexiform neurofibromas (PNFs). PNFs can undergo malignant transformation to highly metastatic malignant peripheral nerve sheath tumors (MPNSTs) in 5-10% of NF1 patients, with poor prognosis. No effective systemic therapy is curre...
Background:
Sequelae due to breast cancer are very high and negatively impact patient quality of life (QoL). Although deep inferior epigastric perforator (DIEP) flap has become a standard for autologous breast reconstruction (BR), there are limited data regarding long-term QoL. This study aimed to measure patient QoL more than 5 years after DIEP f...
Autologous breast reconstruction by deep inferior epigastric perforator (DIEP) flap provides higher postoperative pain at the abdominal donor site than at the thoracic one. The authors evaluated the analgesic efficacy of ultrasound-guided transverse abdominis plane block for postoperative analgesia after immediate breast reconstruction by DIEP flap...
Introduction:
On 29 March 2010, the Poly Implant Prothèse (PIP(®)) breast prosthesis was withdrawn from the market by the ANSM. In this study we review our experience with PIP(®) implants in breast reconstruction. We compare our complications with other types of breast implants used during the same period at our institution.
Patients and method:...
To assess the incidence and presentation of ipsilateral cancer recurrences (ICR) after deep inferior epigastric perforator (DIEP) flap reconstruction for breast cancer.
Data of 247 consecutive women with DIEP flap reconstruction after breast cancer in our institution between 1997 and 2009 were retrospectively reviewed.
Mean follow-up time was 4.1ye...
The authors conducted a retrospective study of breast reconstruction with DIEP free flap between 1994 and 2014 by a single team.
A retrospective analysis of all operative charts and hospitalization was conducted for the period from 1994 to 2014. The number of cases per year, the complication rate of the donor site and recipient site, and surgery ti...
Autologous breast reconstruction provides great cosmetic, functional and sustainable incomes. Various flaps have been described in autologous breast reconstruction, Deep Inferior Epigastric Perforator flap (DIEP) being the most frequent. For patients with a non-sufficient abdomen for a DIEP based breast reconstruction, the Profunda Artery Perforato...
This prospective study explored effectiveness and safety of Macrolane VRF30 for treatment of buttock lipoatrophy in HIV-infected subjects. Ten subjects who were unable to sit for more than 30 minutes because of pain were injected with a mean of 276 mL and followed for 18 months. The pain score was reduced, and the time that subjects could sit was i...
Patients with orbito-temporal neurofibromatosis (OTNF) bear a heavy burden of surgical care. We studied 47 consecutive patients with OTNF from the French Neurofibromatosis 1 Referral Center cohort (n > 900), over a 15-year period to determine the clinical features most likely to predict repeat surgery and longer duration of surgical care. Forty-sev...
Mucormycosis is a very rare infection caused by fungi from the order Mucorales, it rarely involves the skin. We report a case of necrotizing fasciitis of the upper limb which required an aggressive surgical debridement, antifungal therapy and coverage of the defect with a free DIEP flap, a review of the literature was also done regarding indication...
Résumé
Le cancer du sein est le premier cancer féminin, avec un diagnostic actuellement fait de façon précoce, avec souvent des lésions tumorales diagnostiquées de petite taille. Les traitements conservateurs sont donc majoritaires. Cependant, certaines lésions, de par leur taille, leur localisation, leur type histologique, la présence de plusieurs...
We thank Gaucher and Jarraya [1] for their comments on our study [2]. This first SAFB analysis of the strength and breadth of HLA sensitization (supporting information [2]) in extensively burned patients was initiated after facing reduced access to VCA transplants for burned candidates. We described its impact on future VCA access and addressed the...
Background
Extensively burned patients receive iterative blood transfusions and skin allografts that often lead to HLA sensitization, and potentially impede access to vascularized composite allotransplantation (VCA).Methods
In this retrospective, single center study, anti-HLA sensitization was measured by single-antigen-flow-bead analysis in patien...
The authors report on 11 cases of ulnar dislocation of the extensor pollicis longus (EPL) due to rupture of the dorsal aponeurosis at the thumb metacarpophalangeal (MCP) joint. This condition is rare. By performing a descriptive study of this injury, we were able to establish a classification system for thumb extensor tendon dislocation. The series...
The hallmark of neurofibromatosis type 1 (NF1) is the onset of dermal or plexiform neurofibromas, mainly composed of Schwann cells. Plexiform neurofibromas can transform into malignant peripheral nerve sheath tumors (MPNSTs) that are resistant to therapies. Experimental design: The aim of this study was to identify an additional pathway in the NF1-...
Aim
Vascularized composite allotransplantations (VCA) provide therapeutic options for functional or esthetic damage beyond conventional surgical reconstruction. The objectives of this study were to evaluate the immunological characteristics of patients treated for third degree burns who could benefited from reconstructive transplantation by VCA and...
: The application of a new approach is presented, Percutaneous Aponeurotomy and Lipo-Filling (PALF), which is a minimally invasive, incisionless alternative to traditional flap reconstructions.
PALF percutaneously punctures the restrictive subdermal cicatrix and/or endogenous aponeurosis around defects to produce staggered nicks similar to skin gra...
Neurofibromatosis type 1 (NF1) is a common dominant tumor predisposition syndrome affecting 1 in 3,500 individuals. The hallmarks of NF1 are the development of peripheral nerve sheath tumors either benign (dermal and plexiform neurofibromas) or malignant (MPNSTs).
To comprehensively characterize the role of microRNAs in NF1 tumorigenesis, we analyz...
Background:
Treatment options for congenital hypoplastic breast anomalies are often open, including radial scoring, parenchymal flaps, and insertion of expanders and implants. Drawbacks of open techniques involve scarring, the use of drains, and inpatient stays. The use of lipofilling to treat breast deformities is increasing, as more research is...
The face-grafting techniques are innovative and highly complex, requiring well-defined organization of all the teams involved. Subsequent to the first report in France in 2005, there have been 17 facial allograft transplantations performed worldwide. We describe anaesthesia and postoperative management, and the problems encountered, during the cour...
Unlabelled:
The performance of simultaneous vascularized composite allotransplantation procedures on patients requiring both the face and bilateral hands remains controversial. The authors present their separate institutional experiences with this challenging procedure in the interests of dispelling misconceptions regarding this intervention and f...
A 47 years old woman underwent autologous fat grafting to treat a 5 × 4 cm depression of the lower lid and the upper cheek secondary resection of squamous cell carcinoma and subsequent coverage by full thickness skin graft. 20 mL of autologous fat were harvested from lower abdomen, centrifuged and injected subcutaneously. The patient then gained a...
Venous thrombosis is the main cause of radial forearm flap failure, especially when recipient vessels are compromised by prior radiation therapy or neck dissection. In such conditions, semi-free radial forearm flap (SF-RFF) can be performed to reduce this risk.
We reviewed all SF-RFF procedures performed in our institution for head and neck reconst...
After organ retrieval, restoration of the donor is a legal and ethical necessity; this is particularly true in facial transplantation. However, very few data are available regarding this procedure.
This article reviews the seven facial masks produced during seven consecutive face transplants carried out at Henri Mondor Hospital in Paris, France. Th...
Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard.
To determine the val...
The internal mammary artery perforator (IMAP) flap represents the evolution from axially pedicled flaps (deltopectoral flap) to perforator flaps. Both flaps are typically used for neck and tracheostoma reconstruction in male patients. We present the case of a 68-year-old obese female patient with a right upper thoracic radionecrosis secondary to br...
