Le pilier implantaire " anatomique " en prothèse fixée (les critères de choix, assisté par ordinateur ou préfabriqué adaptable)

PARIS7-Odontologie (751062104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Le lambeau mammaire interne (une nouvelle technique de reconstruction)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Early Venous Occlusion Detection in a Free Flap Using Real-time Laser Doppler Imaging

Summary: Early detection of venous occlusion in free flaps is particularly difficult to identify, and its duration is known to be directly proportional to flap mortality. Here, we report a case of deep inferior epigastric perforator based breast reconstruction in which the intraoperative use of a perfusion camera enabled identifying a venous occlusion based on microcirculatory pulsation dynamics in real time. The sensitivity of our proposed method suggests that in certain cases in which the onset of venous occlusion begins in the operating room we can detect and treat occlusion before sending the patient to recovery. Further development of this technique will allow for earlier and more objective decision making with regard to venous occlusion detection in free tissue transfer

Repair of a symptomatic true radial artery aneurysm at the anatomic snuff box with interposition great saphenous vein graft

Radial artery aneurysms are exceedingly rare, with only a few reported cases of surgical revascularization. We describe a 25-year-old man who presented with severe ischemia of the right hand secondary to an idiopathic true radial artery aneurysm at the anatomic snuff box. The patient had embolic occlusions in his hand and fingers that were treated with catheter-directed thrombolysis. During angiography, the blood supply to the affected hand was determined to be radial artery dominant, and therefore the aneurysm was resected and revascularized using an interposition great saphenous vein graft. The patient denied ischemic symptoms postoperatively, and duplex ultrasound examination at a 10-month follow-up showed patent interposition graft. Keywords: Peripheral radial aneurysm, Interposition, Revascularization, Ischemi

Comparison of the Explantation Rate of Poly Implant Prothèse, Allergan, and Pérouse Silicone Breast Implants within the First Four Years after Reconstructive Surgery before the Poly Implant Prothèse Alert by the French Regulatory Authority

Background. In March 2010, ANSM (Agence Nationale de Sécurité du Medicament), the French Medical Regulatory Authority, withdrew Poly Implant Prothèse (PIP) breast implants from the market due to the use of non-medical-grade silicone gel. The aim of this study was to compare the removal rate (and reasons thereof) of breast implants produced by different manufacturers before the ANSM alert. Materials and Methods. From October 2006 to January 2010, 652 women received 944 implants after breast cancer surgery at the Gustave Roussy Comprehensive Cancer Center, Paris (France). The complications and removal rates of the different implant brands used (PIP, Allergan, and Pérouse) were evaluated and compared. Results. PIP implants represented 50.6% of the used implants, Allergan 33.4%, and Pérouse 16%. The main reasons for implant removal were patient dissatisfaction due to aesthetic problems (43.2%), infection (22.2%), and capsular contracture (13.6%). Two years after implantation, 82% of Pérouse implants, 79% of PIP, and 79% of Allergan were still in situ. There was no difference in removal rate among implant brands. Conclusion. Before the ANSM alert concerning the higher rupture rate of PIP breast implants, our implant removal rate did not predict PIP implant failure related to the use of nonapproved silicone gel

Quilting sutures reduces seroma in mastectomy

Background Drainage duration and seroma formation occurring after mastectomy with or without axillary surgery lengthens hospitalization and delays adjuvant treatment. The aim of the study was to evaluate the effect of quilting in the prevention of seroma after mastectomy for breast cancer. Patients and Methods Eighty-two breast cancer patients about to undergo mastectomy with or without axillary surgery lymphadenectomy were enrolled in the study. We conducted an observational comparison between 41 patients in whom quilting with closed suction drainage was used and 41 patients in whom drainage only was used. Results The mean drained volume was significantly lower in the quilting group compared with the control group on days 1 and 2 (day 1: 107.1 mL vs. 156.5 mL; P =.02; day 2: 108.4 mL vs. 162.8 mL; P =.01). The mean drainage period was shorter in the quilting group (4.6 vs. 5.3 days; P =.046). There were fewer needle aspirations for seroma in the padding group (n = 14, 34.1% vs. n = 24, 58.5%; P =.03). Conclusion The use of padding after mastectomy seems to reduce seroma formation, volume drained, and length of drainage tim