Baptiste Bertrand

Short Leukocyte Telomere Length Precedes Clinical Expression of AtherosclerosisNovelty and Significance: The Blood-and-Muscle Model

Rationale: Short telomere length (TL) in leukocytes is associated with atherosclerotic cardiovascular disease (ASCVD). It is unknown whether this relationship stems from having inherently short leukocyte TL (LTL) at birth or a faster LTL attrition thereafter. LTL represents TL in the highly proliferative hematopoietic system, whereas TL in skeletal muscle represents a minimally replicative tissue. Objective: We measured LTL and muscle TL (MTL) in the same individuals with a view to obtain comparative metrics for lifelong LTL attrition and learn about the temporal association of LTL with ASCVD. Methods and Results: Our Discovery Cohort comprised 259 individuals aged 63±14 years (mean±SD), undergoing surgery with (n=131) or without (n=128) clinical manifestation of ASCVD. In all subjects, MTL adjusted for muscle biopsy site (MTLA) was longer than LTL and the LTL-MTLA gap similarly widened with age in ASCVD patients and controls. Age- and sex-adjusted LTL (P=0.005), but not MTLA (P=0.90), was shorter in patients with ASCVD than controls. The TL gap between leukocytes and muscle (LTL-MTLA) was wider (P=0.0003), and the TL ratio between leukocytes and muscle (LTL/MTLA) was smaller (P=0.0001) in ASCVD than in controls. Findings were replicated in a cohort comprising 143 individuals. Conclusions: This first study to apply the blood-and-muscle TL model shows more pronounced LTL attrition in ASCVD patients than controls. The difference in LTL attrition was not associated with age during adulthood suggesting that increased attrition in early life is more likely to be a major explanation of the shorter LTL in ASCVD patients. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02176941.

Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps

Background When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures. Methods We performed a single‐center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow‐up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long‐term outcomes (functional and aesthetic) were studied and compared according to the type of flap. Results A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long‐term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor‐site morbidity, reconstruction using the ALT free flap had significantly better results (p < 0.05). Conclusions In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long‐term functional outcomes. The ALT flap provides better cosmetic results than LD.

Total Upper and Lower Eyelid Reconstruction: A Rare Procedure--A Report of Two Cases.

Summary: Reconstruction after total amputation of the upper and lower eyelids with preserved globe is rare. The primary goal is immediate corneal protection. The second goal is to restore mobility, occlusion, and facial symmetry. Two women had full-thickness excision of both upper and lower eyelids to treat a melanoma. The reconstruction method required four steps over a period of 5 months. A buccal mucosal graft was used to recreate the conjunctival lining, and an oblique forehead flap was used to recreate the skin. Resection of the flap and replacement by a full-thickness skin graft made it possible to recreate a thin and mobile upper eyelid. Visual acuity remained unchanged, and the eyelids remained functional despite a degree of ptosis and lower eyelid retraction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Autologous adipose-derived stromal vascular fraction and scarred vocal folds: first clinical case report

Patients with scarred vocal folds (congenitally or following phonosurgery) are currently difficult to treat and present a dysphonia, often disabling in daily life. Several therapies are available on the market but the results of these are often disappointing. The autologous adipose-derived stromal vascular fraction (ADSVF) is recognized as an easily accessible source of cells with angiogenic, anti-inflammatory, immunomodulatory, and regenerative properties. We present here the case of a 43-year-old woman who had a severe dysphonia associated with scarred vocal folds after a phonosurgery and was resistant to conventional medical and surgical treatments. She received a local administration of autologous ADSVF. The protocol involved, on the same day, adipose tissue extraction, ADSVF preparation, and then local injection (0.45ml of ADSVF in each vocal fold, for a total of 12.2 million ADSVF viable cells). No serious adverse events have been described. One year following the surgery, the laryngoscopic aspect and the majority of voice parameters had improved, in particular the Voice Handicap Index decreasing from 75 to 9. The perceptual analysis found the voice to be less hoarse and more stable, without breathiness. The case of this patient highlights the therapeutic potential of ADSVF for such applications (trial registration, ClinicalTrials.gov NCT02622464; registered 4 December 2015).

Free antero-lateral thigh flap for total knee prosthesis coverage after infection complicating malignant tumour resection

BACKGROUNDnInfection is a common complication of major lower limb-sparing surgery with massive total knee prosthesis (MTKP) reconstruction after extensive tumour resection. When free tissue transfer is required to cover the prosthesis, musculo-cutaneous flaps are usually preferred based on proven efficacy when used in both one-stage and two-stage procedures. The use of a free fascio-cutaneous antero-lateral thigh (FC-ALT) flap in 3 patients with infected knee reconstructions is reported here.nnnMATERIAL AND METHODnA retrospective study was performed of 3 patients in whom a free FC-ALT flap was used during a two-stage procedure to treat MTKP infection after femoral sarcoma resection.nnnRESULTSnFree FC-ALT flap transfer and exchange arthroplasty were successful in all 3 patients. Two years after the procedure, no patient had required amputation or experienced recurrent infection.nnnCONCLUSIONnA free FC-ALT flap can provide adequate coverage of infected MTKP and deserves to be viewed as a valid alternative to free muscle flaps.

Reconstruction of columellar defects: Which surgical technique to choose? A retrospective study of 18 patients

The reconstruction of the columella is challenging and poorly evaluated in the literature. Our study aimed to evaluate retrospectively the different techniques used in our center and to propose an algorithm of reconstruction adapted to each patient. We report a retrospective cohort study included 18 patients (9 men and 9 women; 53 years-old in average) with columellar reconstruction treated from 1999 through 2014. Six different techniques were used: chondrocutaneous graft, nasolabial flap, paramedian forehead flap and scalping flap according to the Converse technique or the Raulo technique. Four independent plastic surgeons evaluated the aesthetic result on a 10u202fcm visual analogue scale comparing the patients photographs before and after the reconstruction. Furthermore, we asked the patients to perform the same evaluation, and to evaluate their level of satisfaction. The mean follow-up was 4 years. Three chondrocutaneous grafts were performed to reconstruct partial defects (Surgical Evaluation (SE): 7.9, Patient Evaluation (PE): 8.3).Three bilateral nasolabial flaps (SE: 6.1, PE: 6.7), 5 paramedian forehead flap (SE: 6.9, PE: 7.3) 6 Converse scalping flap (SE: 4.9, PE: 5.4) and 1 Raulo scalping flap (SE: 6,1, PE: 6,3) were performed to reconstruct total defects exceeding the columella. The use of composite graft was the most satisfactory procedure for partial defects. Paramedian forehead flaps and Raulo scalping flap were the most satisfactory procedures for extended defects. Nasolabial flap was the most adapted procedure for patients with general anesthesia contraindication or for defects extended to the lip.

Post-Bariatric Buttock Contouring With Gluteal Implants During Circumferential Body Lift: Step-By-Step Video Description and 1-Year Results

The number of massive weight loss (MWL) patients is increasing worldwide. Body contouring is essential to improve these patients’ quality of life1 and long-term weight control.2 Circumferential body lift (CBL) is currently the gold standard procedure to correct excess abdominal and dorsal skin.3 However, a major disadvantage of CBL is flattening of the buttocks. Buttock flaps and lipofilling have been used to correct the decrease in buttock projection seen after MWL.4-6 However, the results are disappointing for many MWL patients. For such patients, use of gluteal implants seems to be a better method for restoring buttock contours.7 The combined CBL-gluteal implantation technique has rarely been reported8-10 and remains controversial. Here, we detail this combined technique in a step-by-step manner and describe the results of the procedure in one of our patients.

Chirurgie mammaire de réassignation vers le sexe masculin : étude rétrospective de la satisfaction des patients transsexuels après mastectomie

BACKGROUNDnMammaplasty in gender reassignment surgery is often poorly understood, due to a lack of information about this condition and its therapy. The aim of this work was to evaluate patient satisfaction following bilateral mastectomy for female-to-male gender reassignment.nnnMETHODSnWe contacted 22xa0patients who underwent mammaplasty for female-to-male gender reassignment between January 2012 and March 2013 in our university hospital. Patients were sent postal questionnaires. A modified Q-breast questionnaire adapted for gender reassignment surgery enabled us to objectively evaluate patient aesthetic and psychological satisfaction. An overall score superior to 320 was considered as very satisfied for the patient.nnnRESULTSnA total of 73% of the patients answered the questionnaire. The mean score was 332/378. This score corresponded to very satisfied on our questionnaire. The psychological score was 54.5/60.nnnCONCLUSIONnThis study showed that a real benefit was obtained in terms of patient quality of life and self-confidence. The high level of patient satisfaction confirmed that gender reassignment mastectomy is a useful and valid procedure, which enables these patients to reclaim their place in society. It can only be considered if it is within the framework of structures that ensure comprehensive and pluridisciplinary treatment for the patient.

Technical refinement of Stenström otoplasty procedure

INTRODUCTIONnSurgical correction of prominent ears is a common aesthetic procedure in young children. Stenström technique is widely performed in France. We present some technical refinements that may be associated to this technique in order to allow for a simple correction of the majority of deformations.nnnTECHNICAL NOTEnThe first step of the Stenström technique is the treatment of the unfolded antihelix if necessary. Our first modification consists in introducing the rasp by an anterior approach, hidden under the upper plication of the helix, allowing for a better control. A second modification consists in a resection of the concha by a posterior approach in case of conchal hypertrophy. A third modification is the burying of the concha by suture to the mastoid periosteum after posterior auricular muscle resection in case of obtuse conchoscaphal angle. These refinements can be performed either separately or in combination according to the deformities to be corrected.nnnDISCUSSIONnThe technical refinements presented may correct almost all the ear deformities. The suture-less technique allows for a natural aspect of the antihelix plication.

The temporoparietal fascia flap folded into a ball in the treatment of retroauricular cerebrospinal fluid fistulae after posterior fossa surgery.

BackgroundSkull base and posterior fossa surgeries are sometimes complicated by cerebrospinal fluid (CSF) fistulae, which may be challenging to treat. They can lead to meningitis, increasing global morbidity and mortality. In case of failed medical treatment, revision surgery may be required. “Fat packing” (adipose tissue grafts) is usually used to close the communication between the intracranial contents and the cutaneous tissue, and to fill the dead space created by the skull base surgery. Vascularised flaps can also be used. They seem more efficient, especially in multi-operated patients or after radiotherapy, when cutaneous tissue is adhesive and fragile.MethodsTemporoparietal fascia (TPF) flap is a regional flap; it has reliable blood supply and can cover temporal and retroauricular defects. Folded into a ball, it can fill small dead spaces and can be skin grafted in case of cutaneous defect.Results and ConclusionsWe present a simple surgical solution to manage recurrent retroauricular CSF fistulae after posterior fossa surgery using a pedicled TPF flap folded into a ball.