N Verhelle's research while affiliated with Centre Hospitalier Universitaire de Liège and other places

Publications (22)

Article
Microsurgery continues to be considered as a demanding and risky surgical procedure, especially in old people. Moreover, some surgeons are afraid to perform microsurgery in the elderly, because of fear of additional preoperative and postoperative complications. However, in selected cases a microsurgical reconstruction by free tissue transfer is the...
Article
In lower leg defects with bone, hardware, or articular exposure, a free tissue transfer is often the only valuable option. However, in well-selected clinical cases, pedicled flaps are still indicated because they provide an alternative for the more demanding and risky microsurgical procedure. The medial adipose-fascial flap of the leg represents an...
Article
Although defects in the weight bearing area of the heel can be covered by local flaps, radiodermatitis is a contraindication to these flaps. Thin free flaps, as grafted fascial or muscles flaps and thin fasciocutaneous flaps, are usually the option of choice in these particular defects. These reconstructions are prone to shearing strains resulting...
Article
Despite recent advances in microsurgical techniques, coverage of lower leg defects by locoregional flaps remains indicated in selected cases. The interest in these types of flaps has improved because recent clinical work advocates that fascial and fasciocutaneous flaps can be well indicated for bone coverage. The anatomical study of the medial adip...
Article
Although unexplained thrombotic failures still exist, the majority of free-flap failures are due to identifiable technical failures, indicating that an excellent operative technique remains the key point. However, some clinical circumstances, such as damaged or deeply located vessels, are related to a higher thrombotic risks, demanding refinements...
Article
Diabetic patients, presenting with both peripheral vascular disease and large soft-tissue defects, are too often treated by primary amputation. A combined revascularization and free-tissue transfer procedure can extend limb salvage in these patients. The authors report their experience over 4 years with 19 diabetic patients with peripheral vascular...
Article
In 60 consecutive cases, a gracilis free muscle flap was used to reconstruct defects in the lower extremity. Although the harvest of the gracilis free flap is straightforward, the flap is not frequently considered as a valid option for reconstruction because of its "gracile" shape. Hence, it is not considered voluminous enough to cover defects of s...
Article
A case of bilateral abdominal aplasia cutis congenita without skull defect is reported and was treated successfully by a combination of allografts and growth factors delivered by allogenic cultured keratinocytes.
Chapter
Even though precision and careful execution are essential during the operative procedure, an optimal result is achievable only with an optimal post-operative care. Obviously, skin grafts, flaps and free flaps follow this basic rule. In this field, as in many others, an optimal result implies functional and cosmetic concerns. Hence, the major intere...
Article
The authors present an overview of the various techniques which can be used to achieve coverage of exposed bone, particularly in cases of bone exposure associated with an underlying fracture or osteomyelitis. Adequate debridement, possibly in several stages, is necessary in all cases to prepare the receptor site for the next step which is soft tiss...
Chapter
Due to major advances in local wound care, superficial or small-sized wounds can be managed by secondary healing. However, more complex defects necessitate other treatment options because secondary healing will not provide an adequate and stable scar. Some of these more complex defects consist frequently in bone, tendinous or articular exposure, an...
Article
The coverage of defects is a broad field with which the plastic surgeon is confronted daily within traumatic, tumoral or other context. The various techniques used are skin graft and flaps, forming both heterogeneous groups. Indeed, there are various types of skin graft although a common denominator is the need for a good recipient site in order to...
Article
The authors report on 8 cases of free flaps with vascular pedicle disruption that were encountered between postoperative days 8 to 18. In one case, the inflow disappeared 18 months after the transfer without any trouble. This resulted in 2 partial and one complete flap losses. The 4 other flaps survived completely. This complete survival is related...
Article
Benign symmetric lipomatosis is a rare form of typical fat distribution in the shoulders, the arms, and the neck that can compromise the respiratory, nutritional, and psychological status of the patient. Alcoholism, malignant tumors of the upper airways, endocrine tumors, hypothyroidism, diabetes, and hypertriglyceridemia are often associated with...
Article
The authors report on 8 cases of free flaps with vascular pedicle disruption that were encountered between postoperative days 8 to 18. In one case, the inflow disappeared 18 months after the transfer without any trouble. This resulted in 2 partial and one complete flap losses. The 4 other flaps survived completely. This complete survival is related...
Article
Bone exposure constitutes a frequent and difficult problem in burn patients. Where free flaps remain indicated in tibial osteomyelitis, a pedicled fascial or adipofascial flap provides an excellent alternative for coverage of simple tibial crest exposure. In fact, the adipofascial tissue of the anteromedial aspect of the leg can be mobilized over t...
Article
Association between deep venous thrombosis (DVT) and pulmonary embolism is probably an underestimated problem in the thermally injured patients. However, those patients display important risk factors according to Virchow's triad. This article reports on three unrecognised DVT's accompanying burns which were characterized by absence of healing or ed...
Article
Severe limb ischemia is a common problem encountered in medical practice. Aggressive attempts at revascularization have extended the limits of limb salvage. However, in certain cases, extended tissue loss compromises the healing process. It often results in amputation despite bypass graft patency. Microvascular free tissue transfer combined with ar...
Article
The authors report on two cases of factitious disorders in the field of surgery. The discussion is focused on the different aspects of this pathology that are encountered by a plastic surgeon, in order to provide him with more confidence when dealing with this too-often ignored disease.
Article
The hypothenar hammer syndrome is an uncommon but underestimated lesion of the cubital artery caused by repetitive trauma at the level of the hamate bone. It characteristically occurs in patients with a history of manual work as metal workers, carpenters and motor mechanics. We present a case of a patient who developed this syndrome following inten...

Citations

... Most of them were case reports, although some sporadic cases were identified in retrospective studies of breast reconstruction with the use of free flaps. 5,[12][13][14][15][16][17] Vascular pedicle avulsion was encountered in four different types of free flaps used for breast reconstruction. In four cases both the artery and vein of the pedicle were avulsed, [13][14][15][16] while in three only the artery. ...
... In a study overlooking 58 free flaps in 54 patients with a mean age of 75 years, Verhelle and colleagues found that higher ASA classes and longer OT increased the risk for postoperative surgical and medical complications. 12 Similarly, patients with higher ASA status were at a significantly higher risk to require intensive care monitoring in our collective. To avoid complications, the investigators suggested to "keep the operative time as short as possible" and limit flap choice to "easily accessible flaps". ...
... Despite the paucity of reported cases, we think HHS might not be as rare as people think. 4 If we consider the type of individual who might develop it: a male younger than 50 years of age, whose occupation or hobby for a considerable time involved using one or two hands for striking, hammering, twisting, push-ing… It would be necessary to keep in mind as one more of the differential diagnoses in the syndromes of digital ischemia of the upper-extremities. ...
... The size of our reverse saphenous neurocutaneous flaps ranged from 5-7 to 10-14 cm 2 . Usually, reverse flaps can extend from the medial edge of the tibia to the posterior midline of the calf between the knee and the lowermost perforator [20][21][22]. We strictly restricted the anterior margin of the flap 1-1.5 cm medial to the tibial crest. ...
... Our case is unique compared with those described in the literature, given that, to the best of our knowledge, no pediatric burn patient with thromboembolism in this age group has been described. Mullins et al. described multiple coagulation derangements in burn patients, including elevated platelets, fibrinogen, factor V, and factor VIII, which could contribute to a pro-coagulable state (6).Since burn patients often fulfill all components of the Virchow's triad, namely stasis, local injury, and hypercoagulability, it does not seem unreasonable that burn patients may be at increased risk for PTE(7).Among the risk factors, long-term immobilization was associated with increased risk of PTE. Regarding the risk factors for PTE, Gülcü et al. reported immobilization in 41.9% of their patients and recent surgery in 32.3% (8). ...
... Free flaps rarely survive completely to post-operative resection of its vascular pedicle, while favourable outcomes are mainly reported in early post-op [1][2][3][4][5] ( Table 1). A TRAM flap lost after 100 d was reported by Salgado, [1] while the division of the vascular pedicle 3 years after the transfer of a DIEP flap in a smoker, resulted in subtotal necrosis to Moolenburgh. ...
... Flap surgery can be used to create substantial volume for areas of deficiency, usually those arising from trauma (injury or surgery), tumor removal, and burns [4,23]. For example, in breast reconstruction, the latissimus dorsi muscle flap can be used without significant loss of function. ...
... In resource-limited settings specifically, two important factors to consider are the surgeons' skill and the facility in which they operate. 5,6 There are limited techniques available to bridge femoral defects in children, particularly those exceeding 5 cm in length. Conventional bone grafting has been used, especially to fill small defects, while vascularized fibula flap (VFF) and distraction osteogenesis represent valid options for larger defects. ...
... In the interim, we needed a temporary solution for coverage and to allow more robust CEA take. Options explored included artificial skin substitutes 15 17-19 51 and parental allografts, [12][13][14] both of which have been used for ACC in the literature. We decided to proceed with CEA to minimise morbidity in the baby's parents, reduce risk of rejection and to circumvent ethical considerations. ...
... Aceiasi procedură se poate de utilizat pentru tratamentul de Lipomatoză simetrică benignă, însă din cauza ca nu este o procedura pe larg folosită sunt puține date despre eficacitatea acestei proceduri. Liposucția este avantajoasă prin simplitate, invazivitate minimală și morbiditate redusa însă din cele mai importante neajunsuri este compoziția densa și fibroasa a lipomatozei [9], care îngreunează această procedură, posibila traumare a vaselor sanguine și înlăturarea incompletă. Bassetto și colaboratorii propun utilizarea liposucția asistată de ultrasunet pentru a preveni traumarea structurile învecinate ca nervi și vase sanguine. ...