X. Chaufour

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

Are you X. Chaufour?

Claim your profile

Publications (22)16.81 Total impact


  • No preview · Article · Aug 2015 · Annals of Vascular Surgery

  • No preview · Article · Aug 2015 · Annals of Vascular Surgery

  • No preview · Article · Aug 2014 · Annals of Vascular Surgery

  • No preview · Article · Aug 2014 · Annals of Vascular Surgery

  • No preview · Article · Oct 2013 · Journal des Maladies Vasculaires

  • No preview · Article · Sep 2012 · Journal des Maladies Vasculaires

  • No preview · Article · Sep 2012 · Journal des Maladies Vasculaires

  • No preview · Article · Sep 2012 · Journal des Maladies Vasculaires
  • [Show abstract] [Hide abstract]
    ABSTRACT: Les luxations du coude sont les plus fréquentes après les luxations d’épaule. Dans une grande majorité des cas, ce traumatisme est uniquement articulaire et d’un bon pronostic, la proximité anatomique des structures neurovasculaires pourrait être responsable de lésions associées qui en fait se révèlent très rares. La prise en charge de ces traumatismes est discutée. Le but de cette étude était d’analyser rétrospectivement les résultats de neuf cas de luxations du coude compliquées de lésion de l’artère brachiale et de proposer, à la lumière d’une analyse critique de cette série continue, une attitude pratique cohérente.
    No preview · Article · Sep 2009 · Revue de Chirurgie Orthopédique et Traumatologique
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Elbow dislocations are the most frequently encountered dislocations after shoulder dislocations. In their vast majority these injuries involve only the joint and carry a good prognosis. Close anatomic proximity to the joint of neurovascular structures put them at risk of concomitant injury but this occurrence remains, actually very rare. The objective of this study is to retrospectively analyze the results of nine cases of elbow dislocations with brachial artery complications and to propose coherent therapeutic guidelines derived from this experience.
    Full-text · Article · Aug 2009 · Orthopaedics & Traumatology Surgery & Research
  • P Bonnevialle · X Chaufour · O Loustau · P Mansat · L Pidhorz · M Mansat
    [Show abstract] [Hide abstract]
    ABSTRACT: Complex femorotibial dislocation of the knee joint generally results from high-energy trauma caused by a traffic or a contact sport accident. Besides disruption of the cruciate ligaments, in 10-25% of patients present concomitant palsy of the common peroneal nerve and more rarely disruption of the popliteal artery. The purpose of this work was to assess outcome in a monocentric consecutive series of knee dislocations with ischemia due to disruption of the popliteal artery and to focus on specific aspects of management. This retrospective series included eleven men and three women, aged 18 to 74 years (mean 47 years). The right knee was injured in five and the left knee in six. Trauma resulted from a farm accident in six patients, fall from a high level in two, a traffic accident in three and a skiing accident (fall) in one. Two other patients with morbid obesity were fall victims. Nine patients had a single injury, two presented an associated serious head injury, one a severe chest injury, and one multiple trauma with coma, chest contusion, and abdominal lesions. One patient had a fracture of the distal femur with associated ischemia. Five knee dislocations were open with a popliteal wound for three and a posteromedial wound for two. Four patients presented total sciatic nerve palsy and nine palsy of the common peroneal nerve. The dislocation was documented in ten cases: lateral (n=1), anterior (n=4), posterior (n=5). For four patients, the dislocation had been reduced during pre-hospital care. Preoperative arteriography was available for eight patients and confirmed the disruption of the popliteal artery; the diagnosis was obvious in six other patients who were directed immediately to the operative theatre without pre-operative imaging. Revascularization was achieved with a upper popliteal-lower popliteal bypass using an inverted saphenous graft. The graft was harvested from the homolateral greater saphenous vein in eight patients and the contralateral vein in six. On average, limb revascularization was achieved after 10.07 hours ischemia. Intravenous heparin was instituted for 810 days followed by low-molecular-weight heparin. The dislocation was stabilized by a femorotibial fixator in nine patients and a cruropedious cast in five. An incision was made in the anterolateral and posterior leg compartments in twelve patients. A revision procedure was necessary on day one in one patient because of recurrent ischemia; a second bypass using an autologous venous graft was successful. One other 75-year-old patient also presented recurrent ischemia on day five; the bypass was reconstructed but the patient died from multiple injuries. Seven thin skin grafts were used to cover the aponeurotomy surfaces. Mean duration of the external fixator was 3.4 months. The five patients treated with a plaster case were immobilized for 2.7 months on average. Ligament repair was performed in three patients (one lateral reconstruction and one double reconstruction of the central pivot for the two others). A total prosthesis with a rotating hinge was implanted in two patients aged 67 and 74 years after removal of the external fixator at six and seven months. Failure of the ligament repair also led to arthroplasty in a third patient. Blood supply to the lower limb was successfully restored as proven by the renewed coloration of the teguments and-or presence of distal pulses in 13 patients. Transient acute renal failure required dialysis in one patient. Four patients developed pin track discharges and there was one case of septic arthritis of the knee joint which was cured after arthrotomy for wash-out and adapted antibiotics. Outcome was assessed a minimum 18 months follow-up (average 22 months) for the 13 survivors. The three sciatic palsies recovered partially at five and six months in the tibial territory but with persistent paralysis in the territory of the common peroneal nerve. The nine cases of common peroneal nerve palsy noted initially regressed completely or nearly completely in three patients, partially in three and remained unchanged in three. The results were assessed as a function of the final knee procedure: outcome was satisfactory for the patients with a total knee arthroplasty. Outcome of the three ligamentoplasties was good in one, fair in one, and a failure in one (revision arthroplasty). Patients treated by immobilization without a second surgical procedure complained of joint instability with a variable clinical impact; their knee retained active flexion greater than 90 degrees and complete extension. An analysis of the literature and the critical review of our clinical experience was conducted to propose a coherent therapeutic attitude for patients presenting this type of trauma. The prevalence of disruption of the popliteal vascular supply in patients with knee dislocation is between 4 and 20%. The rate is closely related to that of injury to nerves and soft tissue. Ischemia should be immediately suspected in all cases of knee dislocation. The pedious and tibial pulses must be carefully noted before and after reduction of the dislocation to determine whether or not there is an organic arterial lesion. If the pulses are absent initially, they should be expected to reappear strong, rapidly and permanently after reduction. Otherwise, arteriography should be performed. Dislocation stretches the artery between two points of relative anchorage in the adductor ring and the soleus arcade to the point of rupture. Repair requires a bypass between the upper popliteal artery and the tibioperoneal trunk using an inverted saphenous graft because the walls are torn over several centimeters. The traumatology and vascular surgical teams must work in concert from the beginning of the surgical work-up in order to establish a coherent operative strategy founded on primary reduction of the dislocation, installation of a fixator and then vascular repair and aponeurotomy incisions. It would be preferable to wait until the bypass is proven patent and wound healing is complete before proposing ligament repair. This should be done after a precise anatomic work-up to assess each ligament lesion. Bony avulsion or simple disinsertion can however be repaired in the emergency setting at the time of the bypass as well as any ligament rupture which is obvious and-or situated on the medial collateral approach. Secondarily, elements of the central pivot can be repaired in young patients with an important functional demand. Arthroplasty is not warranted except in the elderly patient. Dissection of the popliteal fossa or debridement of the wound enables a careful anatomic assessment of the nerve trunks. In the event of a peroneal nerve disruption, it is advisable to fix the nerve ends to avoid retraction. Beyond three months without clinical or electromyography recovery, surgical exploration is indicated. In the event more than 15 cm is lost, there is no hope for a successful graft. Complete knee dislocation is extremely rare. It can be caused by high-energy trauma associated with several ligament ruptures, particularly rupture of the central pivot observed in 10-25% of cases with common peroneal nerve palsy. Compression, contusion or disruption of the popliteal artery is very rarely caused by the displacement of the femur or the tibia. Limb survival may be compromised. Mandatory emergency restoration of blood supply will modify immediate and subsequent surgical strategies. There has not however been any study exclusively devoted to double joint and vascular involvement. Our objective was to present a critical retrospective analysis of a consecutive series of knee dislocations with ischemia due to disruption of the common popliteal artery treated in a single center and to describe the specific features of management strategies for a coherent diagnostic and therapeutic approach.
    No preview · Article · Jan 2007 · Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
  • [Show abstract] [Hide abstract]
    ABSTRACT: Quatorze luxations du genou avec interruption de l’axe artériel poplité ont été rétrospectivement analysées. Les circonstances du traumatisme étaient 6 accidents agricoles, 2 chutes d’un lieu élevé, 3 accidents de la voie publique et une chute à ski. Deux patientes, victimes d’une simple chute présentaient une obésité morbide. Neuf étaient mono traumatisés, 4 polytraumatisés et un patient présentait une fracture du fémur opposé. Cinq des luxations étaient ouvertes et 13 s’accompagnaient d’une paralysie partielle ou totale dans le territoire sciatique. Une luxation était latérale, 4 antérieures et 5 postérieures. Dans quatre cas, elle avait été réduite sur place. Huit artériographies préopératoires ont été réalisées. En moyenne, la revascularisation s’est faite en 10,07 heures après pontage poplité haut-poplité bas avec un greffon veineux saphénien. La luxation a été stabilisée par 9 fixateurs externes fémoro-tibiaux et par plâtre 5 fois. Des aponévrotomies des loges antéro-latérales et postérieures de jambe ont été pratiquées 12 fois. Deux patients ont présenté une récidive de l’ischémie : un patient a bénéficié avec succès d’un nouveau pontage, le second est décédé de son polytraumatisme. Les 3 syndromes paralytiques sciatiques totaux n’ont partiellement récupéré que dans le territoire tibial postérieur ; les 9 paralysies initiales du fibulaire commun n’ont régressé complètement que 3 fois et partiellement 3 fois. Une réparation ligamentaire a été effectuée chez 3 patients et une arthroplasties à charnière rotatoire chez 3 patients, deux en programmé chez deux hommes de 67 et 74 ans, l’autre après échec de la réparation ligamentaire. Parmi les patients traités uniquement par immobilisation, 5 se plaignaient d’une instabilité. Une analyse de la littérature et la révision critique des dossiers ont abouti à proposer une attitude cohérente devant ce type de traumatisme qui réclame une prise en charge multidisciplinaire, des indications larges de l’artériographie et doit intégrer dans les décisions thérapeutiques l’âge, les demandes fonctionnelles et la récupération neurologique.
    No preview · Article · Dec 2006 · Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
  • F Accadbled · M-A Marachet · J-M Laffosse · X Chaufour · J Puget
    [Show abstract] [Hide abstract]
    ABSTRACT: We report the case of traffic accident victim who suffered multiple injuries after being ejected from the vehicle. The patient suffered blunt trauma of the pelvis followed by acute ischemia of the lower limb. The initial work-up revealed minimally displaced fractures of the right and left obturator rings and the left sacral wing, as well as a non-displaced fracture of the anterior wall of the acetabulum. Computed tomography eliminated a compressive retroperitoneal hematoma. The mechanism of the injury was direct blunt trauma rupturing an atheroma plaque which led to thrombosis of the left common femoral artery. Thrombectomy three hours 30 minutes after onset of ischemia enabled complete sensorial and motor recovery. Awareness of this unusual type of injury can be helpful in conducting a rigorous physical examination to ensure rapid diagnosis and treatment.
    No preview · Article · Mar 2006 · Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report the case of traffic accident victim who suffered multiple injuries after being ejected from the vehicle. The patient suffered blunt trauma of the pelvis followed by acute ischemia of the lower limb. The initial work-up revealed minimally displaced fractures of the right and left obturator rings and the left sacral wing, as well as a non-displaced fracture of the anterior wall of the acetabulum. Computed tomography eliminated a compressive retroperitoneal hematoma. The mechanism of the injury was direct blunt trauma rupturing an atheroma plaque which led to thrombosis of the left common femoral artery. Thrombectomy three hours 30 minutes after onset of ischemia enabled complete sensorial and motor recovery. Awareness of this unusual type of injury can be helpful in conducting a rigorous physical examination to ensure rapid diagnosis and treatment.
    No preview · Article · Jan 2006 · Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although elbow dislocations are common orthopaedic lesions, vascular complications remain rare. We report the cases of three patients who presented with a rupture of the brachial artery after closed posterior dislocation, which is even more uncommon. Arteriograms were performed in all cases because of the persistent absence of pulses at the wrist after emergency reduction. In each patient, the treatment consisted of the insertion of reversed end-to-end saphenous bridges. None of them presented mid-term vascular complications (mean follow-up, 17 months). Brachial artery disruption can result from closed posterior elbow dislocation and responds well to vascular repair.
    Full-text · Article · Jan 2006 · Journal of Vascular Surgery

  • No preview · Article · Jan 2006
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lower limb amputations related to progressive chronic occlusive arterial diseases have some specific patterns that differentiate them substantially from amputations due to traumas or tumours. Precise evaluation of the underlying arterial circulation, minimal surgical aggression, concern for the stump healing, nursing care, nutrition, diabetes and all risk factors control, are of up most importance in this disease; nevertheless, functional prognosis remains also an important concern. The goal is to determine the most adequate amputation level for preventing life-threatening infectious gangrene while preserving optimal functional status for walking, after a reinforcement and device fitting as rapid as possible.
    No preview · Article · Aug 2005 · EMC - Chirurgie
  • A. Barret · X. Chaufour · L. Casbas · J.-P. Bossavy
    [Show abstract] [Hide abstract]
    ABSTRACT: Upper thoracic sympathectomies, performed most of the time by coelioscopy, have become mildly aggressive interventions. Such procedure is primarily indicated for palmar and axillary hyperhidroses; it is also indicated in case of collagenosis-related disabling syndromes of Raynaud's disease, causalgias, distal arterial occlusions with thrombotic or embolic digital lesions, and lesions due to Buerger's disease. Thoracotomy is considered only in case of thoracoscopy failure or infeasibility. Other accesses are far less utilized. Ablation of the 2nd and 3rd thoracic sympathetic ganglia is sufficient for hand lesions; in case of axillary hyperhidrosis, further exeresis of the 4th and 5th ganglia is necessary. The only disadvantage related to this indication is the frequent postoperative compensatory hypersudation that involves both the thorax and the lumbar area, but which doesn't constitute a real complaint for the patients.
    No preview · Article · Aug 2005 · EMC - Chirurgie
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The bowel retractor used in this study consists of a net placed in racket-like fashion between two 30-cm-long preshaped flexible metal rods attached to an operating handle. The net is used to gather up and retract the bowel loops. The device is packed in a 10-cm-long, 1-cm-diameter sheath that passes easily through a 10-mm-diameter endoscopic trocar. Inside the sheath, the two blades are in contact on their convex edge. When the operator pushes the handle in, the rods exit the end of the sheath and assume their predefined shape (Fig 1). The net automatically deploys within the abdominal cavity.
    Preview · Article · Jun 2005 · Journal of Vascular Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Splenic artery aneurysm is a rare but serious vascular disease. The mortality risk is 36% when one is ruptured. Surgical therapy has traditionally consisted in resection through a laparotomy. The authors' experience of a case of laparoscopic exclusion of a splenic artery aneurysm is reported. This surgical approach is simple, safe, and minimally invasive. This procedure should increase the indication for surgical treatment of a splenic artery aneurysm.
    No preview · Article · Jul 2003 · Vascular and Endovascular Surgery