V. Pinsolle

Autologous fat injection in Poland's syndrome

Polands syndrome is a deformity of the breast and sometimes of the chest wall. Several techniques, which may be combined if necessary, are generally used to treat the forms involving both the breast and chest wall (breast implants, customised chest wall implants, latissimus dorsi pedicled flap). For some years, we have also grafted autologous fat cells according to Colemans method to treat this rare disorder. We report the preliminary results of this technique and demonstrate its value in the treatment of Polands syndrome. We studied patients treated for Polands syndrome by autologous fat injection between 1 January 2003 and 31 December 2005. We recorded their age, gender, the other surgical techniques used, and grade of Polands syndrome according to the classification of Foucras. Concerning fat injections, we recorded the number of sessions, volumes injected and complications. The series was composed of seven women and one man, mean age 25 years (range 13 to 40 years). Four patients were grade I, three were grade II and one grade III. The mean number of fat injection sessions was 2.1 (range 1-5) and mean volume injected 96 cc (range 25-200 cc). Lipofilling was used alone in one case and associated with other reconstruction techniques in seven. We had one complication, fat necrosis which progressed favourably after surgical drainage. Autologous fat injection appears to us to be a treatment which can be used alone, or more often associated with traditional reconstruction techniques in all grades of Polands syndrome. This technique is useful to add volume and especially to correct the contour defects of this syndrome such as the subclavicular hollow and absence of anterior axillary fold.

Complications des réductions mammaires à propos de 715 seins

BACKGROUND Breast reduction is one of the most frequent operations in elective plastic surgery. The main objective of this study was to describe complications due to breast reduction, and to determine the risk factors. METHODS Our comparative retrospective study reviewed the medical files of 715 operated breasts between 2004 and 2009. Statistical analyses were performed with bivariate analyses and multivariable analysis. RESULTS Smoking, resected mammary gland mass and stretch marks were the three risk factors associated with complications after breast reduction. Smoking was also associated with a high risk of hypertrophics carring. Body-mass index was not associated with a risk of general complications but with a risk of wound dehiscence. The superior pedicle and free nipple graft surgical techniques presented a higher complication rate than the postero-superior and postero-inferior pedicle techniques. CONCLUSIONS These results incite us to postpone and even contraindicate breast reduction surgery in obese and smoking patients. These results also incite us to prefer surgical techniques with optimum security in terms of vascular supply. Complications of breast reduction about 715 breasts.

Article originalComplications des réductions mammaires à propos de 715 seinsComplications of breast reduction about 715 breasts

BACKGROUND Breast reduction is one of the most frequent operations in elective plastic surgery. The main objective of this study was to describe complications due to breast reduction, and to determine the risk factors. METHODS Our comparative retrospective study reviewed the medical files of 715 operated breasts between 2004 and 2009. Statistical analyses were performed with bivariate analyses and multivariable analysis. RESULTS Smoking, resected mammary gland mass and stretch marks were the three risk factors associated with complications after breast reduction. Smoking was also associated with a high risk of hypertrophics carring. Body-mass index was not associated with a risk of general complications but with a risk of wound dehiscence. The superior pedicle and free nipple graft surgical techniques presented a higher complication rate than the postero-superior and postero-inferior pedicle techniques. CONCLUSIONS These results incite us to postpone and even contraindicate breast reduction surgery in obese and smoking patients. These results also incite us to prefer surgical techniques with optimum security in terms of vascular supply. Complications of breast reduction about 715 breasts.

Anatomical study of the palmar intermetacarpal perforator flap.

The authors present an anatomical study of a small flap that may be harvested from any of the palmar intermetacarpal spaces while performing fasciectomy in Dupuytren’s contracture. The flap is diamond-shaped, vascularised by two perforating branches originating from the underlying true digital arteries and may be rotated through 90° to 180° in either direction to provide skin cover and subcutaneous padding over the distal palm and/or the base of the finger.

Anatomical basis of the lateral superior gluteal artery perforator (LSGAP) flap and role in bilateral breast reconstruction

INTRODUCTION Deep inferior epigastric perforator (DIEP) flap is one of the gold standards in autologous breast reconstruction. When the abdominal tissue is not available, the superior gluteal artery perforator (SGAP) is often a second option with its drawback, especially the donor-site deformity. Reports have highlighted that a higher and more lateral SGAP flap can be harvested to overcome several drawbacks of the classical SGAP, allowing in the same procedure a body-contouring procedure. In order to set the anatomical basis of this flap, we proposed to study the characteristics of a reliable and easily identifiable superior and lateral perforator of the superior gluteal artery (lateral SGAP (LSGAP)) situated in the region of the lower body-lift resection allowing to perform bilateral breast reconstruction at the same time. MATERIAL AND METHOD The anatomical study of 50 scans (or 100 buttocks) allows us to set forth a diagnostic assumption on the localisation of the perforator with respect to osseous landmarks (coccyx, iliac crest and great trochanter) which will be verified during the dissection of 10 cadavers (or 20 buttocks) and during the 20 colour Doppler examination (or 40 buttocks). RESULTS In our computed tomography (CT) scan study, in 96% of cases, the perforator was situated in a circle with a radius≤3 cm with a 95% confidence interval and located at the junction of the proximal third-middle third of the distance summit of the posterior iliac crest (point B), most lateral point of the greater trochanter (point C). This assumption was verified by the cadaveric dissection and in vivo studies. CONCLUSION Our study sets the anatomical landmarks of the LSGAP flap. This option allows the raising of an SGAP flap avoiding the main drawbacks of this flap and allows harvesting a flap with the tissue that is often discarded during the body-lift procedure.

Lambeau perforant glutéal inférieur : étude anatomique en vue de son application en reconstruction mammaire

PURPOSE The inferior gluteal artery perforator flap, which is vascularised by perforator branches of the inferior gluteal artery (formerly ischiatic artery) is harvested in the gluteal crease. The purpose of this anatomical study was to clarify the anatomical features of this flap and locate the perforators of the inferior gluteal artery destined to the flap, in view to facilitate its surgical removal, as free flap for breast reconstruction. MATERIALS AND METHOD We performed 12 dissections on fresh cadavers, after selective injection of the inferior gluteal artery with a gelified solution. During harvesting, we located the perforators which arise from the inferior gluteal artery and perfuse the flap. RESULTS We distinguished four zones, defined relatively to anatomical landmarks of the region, according to the frequency of perforators. CONCLUSION This anatomical study makes possible an improvement of the technique to raise this flap in its free shape with view to use it for breast autologus reconstruction especially given its numerous advantages: a constant volume of fat even in thin patients and minimal donor site morbidity.

The palmar intermetacarpal flap in dupuytren's contracture

Patients presenting with Dupuytren’s contracture in which fasciectomy involves dissection of two or more digital rays are not uncommon. The cutaneous island located between the distal palmar crease and the web space, and limited by the incisions designed to treat the two adjacent fingers, constantly survives, despite possible concerns as to its viability. In some instances of single or multiple finger disease, we have used part of this skin island as a diamond shaped pedicled flap, based distally with the pivot point at the web space and rotated through 901, to cover the base of

Inferior Gluteal Artery Perforator Flap: Anatomic Study

The inferior gluteal artery perforator flap, which is vascularized by perforator branches of the inferior gluteal artery (formerly ischiatic artery) is harvested in the gluteal crease. The purpose of this anatomical study was to clarify the anatomical features of this flap and locate the perforators of the inferior gluteal artery destined to the flap, in view to facilitate its surgical removal, as free flap for breast reconstruction.. The authors performed 12 dissections on fresh cadavers, after selective injection of the inferior gluteal artery with a gelled solution. During harvesting the perforators were located which arise from the inferior gluteal artery and perfuse the flap. There are four zones, defined relatively to anatomical landmarks of the region, according to the frequency of perforators. This anatomical study enables to steer the surgical harvesting of this flap in its free shape for breast autologous reconstruction especially given its numerous advantages: a constant volume of fat even in thin patients and minimal donor site morbidity.