Vladimir Mitz

Background Facial rejuvenation procedures have been in existence for over a century. Since its first introduction, it improved anatomical understanding and clinical implications and gave rise to numerous techniques and re-ideations of the original face-lift. The increase in popularity of face-lift procedures attracts patients of various ages and wi...

The reconstruction of the 2 contiguous breast pillars during a mammoplasty for reduction or treatment of ptosis represents an essential time to define a satisfactory breast curve, to avoid sub-mammary disunions postoperatively, and to contribute to the projection of the nipple areola thus stabilized. The pillars of the breast are the two glandular...

The use of the SMAS structure, since the 1980s, has led surgeons to perform biplane face liftings with increasing undermining, both at the level of the skin and at the level of deeper structures such as SMAS.

Le concept de SMAS est né en 1973; il résulte de travaux effectués au laboratoire d’anatomie de la Faculté des Saints-Pères à Paris, par le docteur Vladimir Mitz, qui était à l’époque l’interne du Professeur Paul Tessier à l’hôpital Foch; ce fut un travail de groupe missionné pour étudier ce que j’appelais à l’époque le Squelette FIbreux de la Face...

The recent history of facelifts has undergone a major revolution with the development of biplane facelifting operations, based on a good anatomical knowledge of the SMAS fibromuscular structure. The anatomical studies practiced in France by VLADIMIR MITZ since 1973 have been accelerated, in 1974, thanks to the impetus of Professor Paul Tessier, wit...

Résumé La demande pour des liftings plus légers que le grand lifting cervico-facial biplan avec grands décollements a significativement augmenté ces dernières années. Cela explique la popularité des méthodes de lifting « médical » basées sur les fils tenseurs. Une alternative chirurgicale est néanmoins possible en développant une technique dérivée...

Different vectors for skin and superficial musculoaponeurotic system (SMAS) redraping are useful in order to achieve an efficient and natural face lift. Our technique fulfills the rotation and advancement concept described by Millard [16] for cleft-lip repair. In the cure of a double-chin pelican's neck, the SMAS is rotated up and inward, the platy...

Vascular leiomyoma is a benign painful tumour that occurs most frequently in the lower extremity. We report an uncommon case in the hand. Only surgical removal of the tumour allows establishing the diagnosis histologically. A review of the literature confirms the rarity of the tumour in the hand. The purpose of this case report is furthermore to co...

Vascular leiomyoma is a benign painful tumour that occurs most frequently in the lower extremity. We report an uncommon case in the hand. Only surgical removal of the tumour allows establishing the diagnosis histologically. A review of the literature confirms the rarity of the tumour in the hand. The purpose of this case report is furthermore to co...

Reduction of the weight in obese patients is a pre-condition for the aesthetic improvement of obesity or its after effects by plastic surgery. The aim of this study was to evaluate the effectiveness and advantages of gastric banding, using a ring positioned under laparoscopic guidance. Thirty-nine patients with morbid obesity were operated on. For...

Morbid obesity: laparoscopic gastroplasty before plastic surgery.Objectives: Reduction of the weight in obese patients is a pre-condition for the aesthetic improvement of obesity or its after effects by plastic surgery. The aim of this study was to evaluate the effectiveness and advantages of gastric banding, using a ring positioned under laparosco...

Recently, the superficial musculoaponeurotic system (SMAS) was found to be a composite tissue comprising collagen, elastic fibers, and fat cells in an extracellular viscous matrix. Both SMAS and facial skin tissues exhibit viscoelastic properties, but SMAS tissue has delayed stress relaxation. As a consequence, SMAS is viewed as a firmer elastic fo...

The authors report a cases of breast implant infection, 40 years after augmentation mammoplasty. The infection developed 6 weeks after colonoscopy complicated by acute peritonitis due to colonic perforation. Bacteroides fragilis, a usual organism of the gastrointestinal tract flora, was identified in the two septic sites (peritoneal and periprosthe...

The subject of this experimental study is a cylindrical device, with a gauge adjusted to the vessel lumen, which disintegrates in a few minutes. The goal of this device is to increase the reliability of vascular microanastomosis. This study was designed to assess the efficacy and drawbacks of the device. The device is a cylindrical sugar stick, 5 m...

Facial fasciitis or non infectious facial retractions are rare and surprising events after a facelift performed at any age. The signs are firm retraction located on one or both sides of the face or neck. They differ from salivary fistula, localised oedema, and limited hematoma, which may be the initial factor responsible for this curious outcome. W...

To ameliorate the cervicomental angle, most surgeons suggest different techniques of platysmaplasty. The aim of this anatomic study is to find a simple answer to the following question: Is suturing of the anterior edges of the platysma muscles during platysmaplasty the best procedure to use to obtain the best concave anterior neck angle? Three diff...

A study was undertaken to determine the physical properties and microscopic structure of the superficial musculoaponeurotic system (SMAS) tissue. Forty virginal specimens and eight reoperated specimens were examined. The following findings were discovered. 1) Microscopic appearance shows the SMAS to consist of collagen fibers, a relatively high con...

Based on a series of 74 patients, the authors report their experience of reoperation on unsatisfactory breast implants by the implant replacement technique using silicone prefilled implants. In 92 (57.8%) of the 160 cases, the implant was modified because of a peri-implant capsule, with a satisfactory aesthetic result after only a single operation....

It is difficult to evaluate the medium and long-term results of facelift due to loss to follow-up of a large number of patients. The authors developed a questionnaire which they sent to their patients. 148 patients (143 women and 5 men) answers this questionnaire and 54 patients returned for review. This subjective evaluation of the results neverth...

This study proposes intraarterial in situ thrombolysis for the treatment of microthrombi occurring after tissue crushing. In order to assess the efficacy of the thrombolytic, the authors assayed the serum creatine phosphokinase (CPK) level in the crushed muscle capillary bed. The action of thrombolytics has now been clearly established. In contrast...

The thenar flap is a satisfactory reconstruction technique for the treatment of extensive loss of the distal phalanx of the index and middle fingers. As we observed in this series of 20 patients, this flap is reliable and provides tissue that closely matches the missing finger pulp. Flap sensibility is good (average Weber of 6.5 mm). Transferring a...

Because of the widespread reliance on SMAS tightening procedures in present-day face lift surgery, a study was undertaken to examine the physical properties and microscopic structure of both virginal (40 specimens) and reoperated (8 specimens) SMAS tissue. The findings could be of practical value to the surgeon and are reported herewith: First, the...

The elegance of the cervical region is due to a certain balance between concave and convex surfaces, and is based on the presence of a well-defined cervicomental angle, generally between 90 degrees to 110 degrees. An excessively wide-open cervicomental angle makes the cervical profile inelegant. Numerous surgical techniques can improve this angle....

The scaphal cartilaginous area is a most suitable anatomic site for cartilaginous graft harvesting. These grafts allow reconstruction of a flat dorsum, or a rounded dome, or alar cartilages or can be used for an extended tip graft. In some cases, both scaphes may be harvested. Raising of the grafts does not leave any sequelae when performed correct...

The authors report their experience of digital pulp reconstruction by free toe pulp transfer. Fifteen patients were treated with the lateral great toe hemipulp. 15 cases of post-traumatic finger tip reconstruction were reviewed including 9 thumbs, 5 index, 2 medius, and one ring finger. There were 6 emergency cases and 9 secondary reconstructions (...

The principle of cardiomyoplasty is chronic electrostimulation of the latissimus dorsi muscle (LDM) flap wrapped around the heart to obtain a phasic activity that can be integrated to ventricular kinetics. In clinical cardiomyoplasty procedures, a complete wrap of both ventricles by the LDM cannot always be obtained in cases of extremely dilated he...

Total scalp avulsion is an uncommon and dramatic accident. Replantation is the only way for acceptable aesthetic final results. However, partial loss of tissue can result, and secondary procedures can be required. A total avulsion of a scalp involving the upper part of the right ear and both eyebrows was replanted after a long delay in our departme...

Tearing of a finger caught by a ring or by another similar mechanism is a rare but spectacular accident. The lesions vary from simple cutaneous erosion to complete separation of the extremity, which is the most spectacular and most difficult to treat. Reimplantation techniques are now well developed and involve very long vascular by pass to perform...

Directed healing is a therapeutic process that Raymond Vilain conceived as a sequence of: cleaning, granulation and formation of the epidermis. He suggested, to aid healing, the use of sofra-tulle and washing with isotonic solution or tap water, we have added the use of a hair dryer, in order to decrease the exudation from the wound. Such directed...

In 18 cases the authors used a free tissue transfer during the first 24 hours of the treatment of a complex trauma of the upper limb involving osteoarticular and neurovascular loss combined with loss of skin cover. The various flaps include: lateral arm flap (8 cases), latissimus dorsi flap (4 cases), toe to hand transfer (4 cases), radial forearm...

Large open elbow fractures with extensive soft-tissue loss must be treated as an emergency. Vessels and nerves are often alvulsed. One stage reconstruction is very challenging. Ischemia of the distal part of the upper extremity is limited by a synthetic arterial shunt (SAS). After debridement, the authors install the SAS, then the complex procedure...

Total scalp avulsion is an uncommon accident. Three recent cases illustrate our surgical procedure. Small and central hair-bearing avulsed scalps can be treated by secondary scalp expansion (1 case). Large hair-bearing scalp (> 400 cm2) or including aesthetic relief should be treated by microsurgical reimplantation. Venous grafts allow vascular ana...

Endoscopy during rhinoplasty is an advance that permits the surgeon to obtain better results in cartilage and bony resections. It should decrease the number of secondary nasal revisions for small cartilaginous or bony irregularities. From May 1993, 30 patients have undergone primary and secondary rhinoplasties with complementary resections in all c...

Los autores relacionan su experiencia de 3 años de utilización del colgajo antebraquial externo en la reconstrucción del miembro superior. Esta serie de 11 casos hace parte de una serie de 22 colgajos utilizados a nivel de los miembros. A nivel de los miembros los colgajos han sido posicionados : 7 veces en la mano, 2 veces en el antebrazo, 2 veces...

The authors report the use of a new polyurethane dressing, studied in 20 patients undergoing breast surgery. Based on objective criteria, this study analyses the contribution of this dressing in the postoperative course.

Since 1989, we have operated 38 patients with breast ptosis with or without hypertrophy according to a technique which leaves a periareolar scar. The principles of this technique are: periareolar skin resection, dissection between the skin and gland over the entire surface of the gland, mastopexy, insertion of an absorbable mesh onto the anterior s...

During the last three years, eleven lateral upper arm flaps were used in the reconstruction of skin defects of the upper limb. These flaps were applied: 7 times on the hand; 2 times on the fore-arm; 2 times on the elbow. Ten flaps had a free transfer, one was vascularised by the distal pedicle. In 4 cases we used an emergency free transfer in the t...

Dix-huit patients ayant présenté une raideur de l'interphalangienne proximale (IPP) en extension ont été traités par téno-arthrolyse dorsale (19 doigts). Les étiologies sont représentées par trois fractures de P1, 2 fractures de P2, 2 sections de l'extenseur au dos de P1, 8 lésions associant fracture et section tendineuse, 2 traumatismes fermés de...

18 patients suffering from PIP stiffness in extension were treated by dorsal teno-arthrolysis. PIP joint stiffness was due to 3 cases of fracture of P1, 2 cases of fracture of P2, 2 cases of extensor tendons, 8 fractures of P1 associated with section of the extensor tendon, 2 cases of PIP closed trauma (1 sprain, 1 dislocation), and 2 crush injurie...

Lors de l'étude de pouces reconstruits par transfert du deuxième orteil, un nouveau test a été mis au point : le « test des 5 allumettesou « Take Five Test . Il s'agit d'un test standardisé de ramassage chronométré et comparatif de cinq objets fins (allumettes), qui permet une évaluation simple, rapide, chiffrée et objective de la dextérité dans le...

Pulp reconstructions use numerous techniques ranging from simple debridement to local and microsurgical flaps. The authors analyse the various treatments, in which directed healing still retains numerous indications. Local flaps have a definite place, but they are not devoid of risks (iatrogenic stiffness). The indications are presented schematical...

El fin de la operación es preservar la sensibilidad pulpar, cada vez que un dedo deber ser amputado. Hemos revisado 9 pacientes que fueron operados según esta técnica, en una serie de 14 pacientes, quienes presentaban crochets, y en quienes una amputación o una artrodesis hiper acortante fueron discutidas. El retroceso de la pulpa permitiendo ajust...

Since 1976, anatomical studies intensively performed in France have demonstrated the surgical interest in using the superficial musculo-aponevrotic system in the face, and also a subperiosteal malar approach. The SMAS is mostly a surgical structure. It could be considered as a remnant of a primitive subcutaneous muscle which would have been located...

Pulp reconstructions use numerous techniques ranging from simple debridement to local and microsurgical flaps. The authors analyse the various treatments, in which directed healing still retains numerous indications. Local flaps have a definite place, but they are not devoid of risks (iatrogenic stiffness). The indications are presented schematical...

The aim of this operation is to preserve the sensitivity whenever when a finger has to be amputated. We have reviewed 9 patients operated according to this technique, out of 14 patients for whom an amputation or a shortening arthrodesis was discussed. The results of pulp recession were most encouraging. The incision were located on both sides of th...

The evaluation of 58 breast reconstructions operated in Boucicaut Hospital demonstrated positive result. The authors review the techniques used for contralateral breast symmetrization. The policy generally adapted has been to perform two sequential operations: 1st step: implantation of a prefilled prosthesis and contralateral breast symmetrization;...

After studying a series of thumbs reconstructed by 2nd toe transfer, we devised a new dexterity test: the "five matches test" or "Take Five Test" (R.S.). This test consists of the standardised timed and comparative pick-up of 5 identical fine objects (matches), permitting a simple and quick evaluation which objectively quantifies dexterity in fine...

The authors present a foot replantation case at the ankle level followed six months later by a tibial lengthening using the Ilizarov procedure. Performing the aforementioned lengthening following a replantation enables good nervous and vascular sutures, tension-free and ensures a satisfactory result.

The evaluation of 58 breast reconstructions operated in Boucicaut Hospital demonstrated positive result. The authors review the techniques used for contralateral breast symmetrization. The policy generally adapted has been to perform two sequential operations: 1st step: implantation of a prefilled prosthesis and contralateral breast symmetrization;...

Cold sensitivity often occurs after upper limb nerve injuries. 82 patients were reviewed retrospectively with an average follow-up of 42 months. Cold sensitivity occured after 50 % of median nerve injuries and after 75 % of ulnar nerve injuries. Symptoms are localized to the damaged sensory nerve territory, and are related to the level of the lesio...

The evolution of aesthetic surgery began centuries before the birth of Christ. Since Sushutra's first attempts, surgeons still try to achieve or reconstruct the perfection of individual beauty. Surgeons who are engaged in this field of plastic surgery are called cosmetic or aesthetic surgeons. Aesthetic surgery is not just a specialization concerne...

Cold sensitivity often occurs after upper limb nerve injuries. 82 patients were reviewed retrospectively with an average follow-up of 42 months. Cold sensitivity occurred after 50% of median nerve injuries and after 75% of ulnar nerve injuries. Symptoms are localized to the damaged sensory nerve territory, and are related to the level of the lesion...

77 patients with an isolated traumatic ulnar nerve lesion were operated on between 1972 and 1982. 40 patients with more than 18 months of follow-up were reviewed with a new clinical quoting. 37.5 p. cent of satisfactory results were achieved with nerve sutures done in emergency, 56.3 p. cent with secondary nerve grafting. Factors influencing the re...

The reimplanting activity initiated by Professor Raymond Vilain at Boucicaut Hospital in 1972 allowed emphasizing that, in addition to the reimplantation of a completely severed segment, there existed a parallel activity including microsurgical steps, bone surgery and skin plasties, all of which were gathered under the term of VBS, or Vessels-Bone-...

It is possible, in vitro, to break down human skin then reassemble the collagen fibres of the dermis, essentially type I collagen. The authors have developed a biophysical process for the manufacture of type I autocollagen. They present the electron microscopic study of this collagen. These healthy collagen fibres are compared with the fibres obtai...

It would appear to be impossible to compare completely different techniques of mammaplasty performed in very different clinical situations. However, we thought it would be useful to approach the result of mammaplasties from a more "orthopaedic" point of view. Such an approach distinguishes populations of patients with different results and in whom...

We advise dynamic extensor splintage put on as early as possible within the first 6 weeks after the diagnosis of boutonniere deformity. This splintage runs from the dorsal aspect of the hand to the DIP joint which is left free to flex actively. This apparatus is left on for at least six weeks post injury. Sixteen patients have been treated in this...

We advise dynamic extensor splintage put on as early as possible within the first 6 weeks after the diagnosis of boutonniere deformity. This splintage runs from the dorsal aspect of the hand to the DIP joint which is left free to flex actively. This apparatus is left on for at least six weeks post injury. Sixteen patients have been treated in this...

There are many techniques currently available for face lifting. The individual choice should be made based upon solid knowledge of anatomy and physiology as well as upon knowledge of long-term results in operated patients. In the absence of scientific information regarding deterioration of skin and muscle tension after operation, the only valid bas...

Fasciocutaneous flaps are available anywhere in the body, literally from head to foot. Some hair-bearing flaps, the parasternal flap, and some forearm and lower extremity flaps may be useful for coverage of soft tissue defects when a relatively simple one-stage procedure is preferred. The fasciocutaneous flaps described here are long and narrow, wi...

The consequences of postoperative infection at the site of microsurgical repair were studied. The experiment used 60 Wistar rats which were divided into 3 groups of 20 each. The femoral artery, vein, and nerve were transected unilaterally and repaired using microsurgical techniques. Staphylococcus aureus was then inoculated into the wound of group...

A second toe to hand transfer is described for thumb reconstruction which includes the extensor digitorum brevis as a simultaneous opponensplasty. This procedure was effective in a young man injured in a bomb explosion that completely destroyed the first ray. The second toe was dissected in continuity with the extensor digitorum brevis muscle, its...

This study was undertaken to examine the possibility of using the latissimus dorsi muscular flap, divided in two parts thus covering the surfaces of the heart, and inserting it into the thoracic cavity by means of a segmental resection of the second rib. After cadaver case studies, 15 operations were performed on 5 Beagle dogs. The first group of 5...

Progressive sequential stimulation of a skeletal muscle using trains of 30 Hz impulses with increasing frequencies from 20/min. to 80/min. within 3 months, allowed us to obtain in goats a transformation of the fast twitch glycolytic muscular fibers into fatigue resistant slow twitch oxidative muscular fibers. The conditioned muscle can be used in t...

The full picture of functional ulnar deficiency, following suture or grafting, was studied and analyzed by two of the authors, who followed this series of patients on a long-term basis. The patients were tested using sphygmometric rubber bulbs in other to determine the overall closing force of the hand (making a fist), and the force of the pinch be...

The full picture of functional ulnar deficiency, following suture or grafting, was studied and analyzed by two of the authors, who followed this series of patients on a long-term basis. The patients were tested using sphygmometric rubber bulbs in other to determine the overall closing force of the hand (making a fist), and the force of the pinch be...

Total reimplantation of rats' legs by microsurgical techniques is a useful means of creating experimental lymphedema. The phenomenon follows a cyclic course which lasts for about 3 weeks after surgery. In order to follow the evolution of the lymphedema quantitatively, precise measurements were carried out by indirect isotopic lymphography using rhe...