Cécile Philandrianos

Comparison of five dermal substitutes in full-thickness skin wound healing in a porcine model.

The wound healing attributes of five acellular dermal skin substitutes were compared, in a two-step procedure, in a porcine model. Ten pigs were included in this experimental and randomized study. During the first step, dermal substitutes (Integra(®), ProDerm(®), Renoskin(®), Matriderm(®) 2mm and Hyalomatrix(®) PA) were implanted into full-thickness skin wounds and the epidermis was reconstructed during a second step procedure at day 21 using autologous split-thickness skin graft or cultured epithelial autograft. Seven pigs were followed-up for 2 months and 3 pigs for 6 months. Dermal substitute incorporation, epidermal graft takes, wound contraction and Vancouver scale were assessed, and histological study of the wounds was performed. Results showed significant differences between groups in dermis incorporation and in early wound contraction, but there was no difference in wound contraction and in Vancouver scale after 2 and 6 months of healing. We conclude there was no long-term difference of scar qualities in our study between the different artificial dermis. More, there was no difference between artificial dermis and the control group. This study makes us ask questions about the benefit of artificial dermis used in a two-step procedure.

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.

Microsurgical Replantation of a Two-Segment Total Scalp Avulsion.

AbstractTotal scalp avulsion is a rare and severe injury that may be life threatening and can result in devastating disfigurement and psychological trauma. Microsurgical hair-bearing scalp replantation is considered the procedure of choice and should be performed by a skilled surgical team. Replantation of a multifragmented scalp is even rarer and shows random results. Only 2 patients have been reported, resulting in partial or total necrosis of implanted fragments. The authors describe the successful replantation of a totally avulsed 2-segment scalp in a 63-year-old woman whose hair was entrapped in the propeller shaft of a ship. The avulsed scalp involved both eyebrows, the frontal region, the upper part of both ears, and most of the occipital portion. After initial management including correction of hemorrhagic shock, the patient underwent emergency scalp replantation by microsurgical anastomosis of 3 arteries and 4 veins and the use of 2 vein grafts.According to authors’ experience, multifragmented scalp avulsion imposes emergency relocation using as many microsurgical sutures as possible and implementation of vein grafts to ensure optimal revascularization of the avulsed scalp.

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.

Combined PRP and microfat graft for facial disability in systemic sclerosis

Introduction Systemic sclerosis (SSc) is a rare autoimmune disease characterized by fibrosis and microvascular damage. Facial signs are frequent and include perioral skin thickening, facial atrophy and microstomia. Facial handicap is overlooked by physicians but when patients are questioned, they frequently declare discomfort and distress due to their facial disability and appearance. As ideal autologous filler, fat graft has previously been considered in the treatment of facial handicap in SSc. To enhance fat graft survival, we combined fat graft and autologous platelet-rich plasma. Cases Description Two patients suffering from SSc with facial disability, facial skin thickening and aesthetic discomfort were treated with combined subcutaneous microinjection of autologous fat and platelet-rich plasma. Conclusions Regular follow-up until 12 months showed that facial disability decreased, skin texture appeared softer, and mouth opening increased. Patients declared to be very satisfied from a functional and aesthetic point of view until their last follow-up at 12 months. Fat grafting is beneficial in the improvement of facial symptoms of patients with SSc, and the addition of platelet-rich plasma is a feasible, simple and safe method. Further studies are required to better assess the advantage on fat graft retention, trophicity and the lasting effect offered by this combined therapy.

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.

Treatment of keloid scars with a 1210-nm diode laser in an animal model

A temperature increase can improve wound healing by activation of heat shock protein 70 and stimulation of fibroblasts. Since keloids are a dysfunction of collagen fiber synthesis and organization, this study aimed to evaluate if a 1,210 nm diode laser could have effects in a new animal model of keloid scars.

Treatment of ischial pressure sores. Our experience of 99 patients with 108 sores

BackgroundIschial pressure sores concern patients in the sitting position and particularly the rehabilitated patients. Spontaneous healing may be very difficult without surgery, and ischial pressure sores have the highest recurrence rate among other decubitus. Furthermore, there is no consensus concerning the ideal surgical technique in order to definitely treat the patients. This is a retrospective analysis of the surgical treatment of ischial pressure sores aiming to identify the ulcer recurrence rate per surgical technique and describe the early complications.MethodsThis was a retrospective study that was conducted in Marseille, France, between 1988 and 2007. The medical records concerning patients with ischial pressure sores were collected and analyzed. The main objective was to identify the ulcer recurrence rate after ischial pressure sore surgical treatment. The secondary objective was the identification and description of early complications.ResultsNinety-nine patients were finally selected and analyzed for 108 ischial pressure sore treatments. Primary endpoint analysis identified 25 recurrences for 108 sores (23.14 %). Hamstring V-Y advancement flap had 71 % recurrence rate. Wound dehiscence was the primary complication. Six out of seven hamstring V-Y advancement flaps had early complications.ConclusionsPressure sore treatment can be difficult and challenging. In this retrospective study, we have found that the hamstring V-Y advancement flaps have a much higher recurrence rate and a higher rate of complications. Our results may be limited by the retrospective nature of this study but they imply that the V-Y advancement flaps should not be used as a first choice for ischial pressure sore treatment.Level of Evidence: Level IV, therapeutic study.