Franck Duteille

Safety concern between autologous fat graft, mesenchymal stem cell and osteosarcoma recurrence.

Background Osteosarcoma is the most common malignant primary bone tumour in young adult treated by neo adjuvant chemotherapy, surgical tumor removal and adjuvant multidrug chemotherapy. For correction of soft tissue defect consecutive to surgery and/or tumor treatment, autologous fat graft has been proposed in plastic and reconstructive surgery. Principal Findings We report here a case of a late local recurrence of osteosarcoma which occurred 13 years after the initial pathology and 18 months after a lipofilling procedure. Because such recurrence was highly unexpected, we investigated the possible relationship of tumor growth with fat injections and with mesenchymal stem/stromal cell like cells which are largely found in fatty tissue. Results obtained in osteosarcoma pre-clinical models show that fat grafts or progenitor cells promoted tumor growth. Significance These observations and results raise the question of whether autologous fat grafting is a safe reconstructive procedure in a known post neoplasic context.

Free flap coverage of upper and lower limb tissue defects in children: a series of 22 patients.

Free tissue transfer has become the most important means of limb salvage treatment after severe trauma. This one-step procedure shortens healing and hospitalization time and minimizes the danger of infection. However, very few studies have considered the use of free tissue transfer for the reconstruction of traumatic limb injuries in children. This study reports 22 such cases treated in the authors’ unit between 1993 and 2000 (17 boys and 5 girls; mean age, 8.9 years; age range, 18 months–15 years; 16 lower and 6 upper limbs). All flaps were indicated for repair of acute traumatic defects (20–500 cm2). Five different flaps were used: 12 scapular, 4 latissimus dorsi, 4 serratus anterior, 1 groin, and 1 temporalis fascia. All were successful, except for partial necrosis with the free groin flap. Three flaps requiring reexploration for venous insufficiency had a successful outcome. The microsurgical success rate in this pediatric population is very high, and the state and size of the donor site and recipient vessels have caused no problems. No long-term complications have been noted (mean follow-up, 3.8 years).

Arthrodèse carpienne des quatre os versus arthrodèse capitolunaire. À propos de 40 patients

Fourty patients with limited carpal fusion have been retrospectively reviewed. The aim of this study was to compare the results of four bone fusions (30 wrists) versus capitolunate fusion (11 wrists). Follow-up averaged 30 months with a range of 15-96 months. Twelve patients presented SLAC-wrist (scapho-lunate advanced collapse) and fourteen with SNAC-wrist (sapho-non union advanced collapse). There were seven cases of primitive wrist arthritis, one mid-carpal instability, one sequella of Fentons syndrome, one Preisers disease and two Kienbocks disease. All 40 patients were evaluated by the same observer. In terms of range of motion, the capito-lunate fusion led to better results than the four bone fusions with a gain of 10 degrees in volar flexion and 12 degrees in radial deviation. Results in term of post operative pain are similar in the two groups of patients with 90% painless wrist in four bone fusion and 81% with capito-lunate fusion. Results for strength were equivalent. Radiological bone fusion was obtained within nine weeks. Absence of fusion was observed in two patients with capito-lunate fusion. Our result in terms of joint motion and strength are similar to those found in the literature. Correction or not of the DISI deformity during the procedure did not affect the results (on 19 patients). The Four bone fusion procedure is still a good treatment in SLAC or SNAC wrist. Capito-lunate fusion remains a good choice, despite the risk of non-fusion.

Malignant Blue Nevus: Three New Cases and a Review of the Literature

Three patients with malignant blue nevus are reported-one on the right side of the body, one on the right arm, and one on the face. The criteria and difficulty of histopathological diagnosis are considered as well as the differential diagnoses for this tumor. The therapy is described, and the possible relations between malignant blue nevus and certain other tumors (e.g., atypical or locally aggressive cellular blue nevus) are explored. A review of the literature reveals that there is current disagreement about the exact prognosis for these tumors and indicates the need to collect data for all patients observed.

Non-union fractures of the scaphoid and carpal bones in children: surgical treatment.

Carpal bone fractures in children are rare. This study reports a series of 16 cases: 12 fractures of the scaphoid (11 non-union), two of the trapezium, one (non-union) of the hamatum, and one of the triquetrum. Only three of these fractures (triquetrum, trapezium and hamatum) were seen at an early stage. The non-union cases involving the scaphoid and hamatum were treated by bone graft. The scaphoid fracture seen early and the triquetrum fracture were treated orthopaedically. One trapezium fracture was treated by osteosynthesis with wires, and the other (seen at the defective callus stage) was not treated because of a total absence of symptomatology. All fractures or non-union cases consolidated. After a minimum follow-up of 1 year, all patients except one have regained strength and mobility comparable to that of the contralateral limb, with a near total absence of pain. Only the patient with an articular fracture of the trapezium has lost 30% of strength compared with the uninjured limb.

Relevance of a new rat model of osteoblastic metastases from prostate carcinoma for preclinical studies using zoledronic acid

Animal models that mimic osteoblastic metastases associated with prostate carcinoma are required to improve the therapeutic options in humans. A new model was then developed and characterized in immunocompetent rats. The bisphosphonate zoledronic acid (ZOL) was tested to validate this model as a therapeutic application. Rat AT6‐1 prostate tumor cells were characterized in vitro at the transcriptional (bone and epithelial markers) and functional (induction of mineralized nodules) levels. The bone lesions induced after their direct injection into the femur bone marrow were characterized by radiography, microscanner and histology analyses. ZOL effects were studied in vivo on bone lesion development and in vitro on AT6‐1 cell proliferation, apoptosis and cell cycle analysis. Apart from epithelial markers, AT6‐1 cells express an osteoblast phenotype as they express osteoblastic markers and are able to induce mineralized nodule formation in vitro. A disorganization of the trabecular bone at the growth zone level was observed in vivo after intraosseous AT6‐1 cell injection as well as cortical erosion. The tumor itself is associated with bone formation as revealed by SEM analysis and polarized light microscopy. ZOL prevents the development of such osteoblastic lesions, related to a direct inhibitory effect on tumor cell proliferation independent of caspase 3 activation, but associated with cell cycle arrest. A new rat model of osteoblastic bone metastases was validated in immunocompetent rats and used to show the relevance of using ZOL in such lesions, as this compound shows bifunctional effects on both bone remodelling and tumor cell proliferation.

A comparison between clinical results and electromyographic analysis after median or ulnar nerve injuries in children's wrists.

The purpose of this study was to analyze the results of median or ulnar nerve transections to the wrist in 14 children between 1994 and 1999. On sustaining their injury, all patients underwent treatment at the University Hospital of Nancy. They were all seen afterward for clinical and electromyographic evaluations. The clinical examination was mainly to judge the quality of sensory recovery, using the Weber and Dellon tests, as well as motor recovery. Electromyographic examination of the motor and sensory tissues was carried out systematically on each patient. The analysis of these results highlights discordance between the quality of the clinical results and nerve regrowth identified via electromyography. Good nerve regrowth does not necessarily mean a good sensory recovery.

Extraosseous bone formation obtained by association of mesenchymal stem cells with a periosteal flap in the rat

Background: Local bone cell therapy consists in grafting a large number of osteocompetent cells in the bone defect. Mesenchymal stem cells (MSC) have been demonstrated as an attractive cell source for tissue-engineering applications because of their ability to be easily isolated and expanded from adult bone marrow and their versatility for pluripotent differentiation into mesenchymal tissues. Methods: The purpose of our work was to evaluate in vitro the osteogenic potential (proliferation and differentiation) of rat MSC cultured in monolayer conditions and encapsulated in alginate beads and in vivo the osteogenic potential of encapsulated MSC implanted at an extraosseous site associated with a periosteal flap to obtain the equivalent of a vascularized bone autograft. Results: In vitro, the encapsulation of MSC in alginate beads maintains their degree of differentiation towards the osteoblastic lineage. In vivo, standard radiographs revealed “calcifications” adjacent to the area where alginate beads had been implanted in both groups (in the presence or the absence of MSC). In the group “beads alone,” histologic analysis showed that calcifications reflected only a peripheral calcification with no bone formation. On the contrary, in the group “beads + MSC,” a large mineralization process took place characterized by lamellar mature bone with osteocytes after 10 weeks.

Five-year Safety Data for Eurosilicone's Round and Anatomical Silicone Gel Breast Implants.

Background: Multicenter prospective studies assessing the safety and efficacy of silicone gel breast implants are relatively rare. Eurosilicone S.A.S. present their safety and efficacy data herein for the largest European silicone gel breast implant study published to date. Methods: One thousand and ten of Eurosilicone’s textured cohesive Cristalline Paragel range of mammary implants was implanted in women undergoing augmentation and reconstructive surgery at 17 centers throughout France. Physical examinations and complications were recorded by physicians at 3 months and annually thereafter until 10 years postimplantation. Descriptive statistics were used and key complications were analyzed using the Kaplan-Meier analysis method. Results: Two ruptures were observed within 5 years postimplantation, one of which was subject to mechanical trauma during reoperation and the other was identified during routine screening. Capsular contracture, one of the most common complications associated with breast implants, was reported in 6.6% implants across all indications through 5 years. The Kaplan-Meier risk of capsular contracture (Baker III/IV) was 10.7% (95% confidence interval, 7.2–14.2%) and 17.2% (95% confidence interval, 5.4–29%) in the primary augmentation and primary reconstruction patient cohorts, respectively. Implant removal (explantation/exchange) was 8.5% and 16.5% for primary augmentation and primary reconstruction cohorts, respectively. Rates of local complications including infection and seroma were low with risk rates of 0.6% and 0.2% by subject. Conclusions: Eurosilicone S.A.S. prospective study involving 1010 Eurosilicone silicone gel breast implants in both round and shaped profiles demonstrated a low rupture rate and an excellent safety profile through 5 years.

Risk factors and therapeutic strategy after failure of free flap coverage for lower-limb defects.

From 2004 to 2007, 148 limb free flaps were performed in a series of 138 patients at the University Hospital in Nantes, France. Flaps were successful in 127 instances (rate: 86%; group A) and failed in 21 (group B). An analysis of the various factors (pre-, intra-, and postoperative) in both groups that may have influenced the outcome of surgery identified the following: operating time, cold ischemia time, and the interval before reoperation. This report is based on our experience in managing 21 free flap failures during reconstructive surgery of the limbs. The causes of failure were analyzed, and possible therapeutic strategies defined (i.e., a second free flap procedure, a pedicle flap, coverage with artificial dermis, or amputation). In our opinion, careful analysis of the causes of flap failure is essential to an appropriate choice of subsequent therapeutic strategy.