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1. Breast Reconstruction in a Postbariatric Patient Using a Fleur-de-lis Free Deep Inferior Epigastric Artery Perforator Flap: A Mini-review

Author

Yanis Berkane, MD, MSc, Tristan Beaufils, MD, Mohammad Alabdulkareem, MD, Alla Abu Qasida, MD, Anna Scarabosio, MD, Paul Girard, MD, MSc, Eric Watier, MD, PhD, and Nicolas Bertheuil, MD, PhD

Subjects
Surgery, RD1-811
Abstract

Summary:. Breast reconstruction in postbariatric patients presents unique challenges due to substantial weight loss–induced body deformities. We present the case of a 51-year-old woman with massive lower abdominal deformities who underwent a mastectomy treatment followed by a temporary expander-based reconstruction. A year later, a fleur-de-lis-shaped free deep inferior epigastric artery perforator flap and abdominoplasty were performed for autologous reconstruction and abdominal contouring. This design addressed both purposes while allowing a voluminous flap to be harvested on periumbilical perforators. No postoperative complications were found, and the outcomes were favorable. Although deep inferior epigastric artery perforator flaps are standard in autologous breast reconstruction, our case demonstrates the utility of the fleur-de-lis design in massive weight loss patients for vascular safety and volume enhancement. Finally, we discuss this rarely described approach and compare it with other variants, showcasing versatility in addressing complex reconstruction needs in this particular patient population.

Published
2024
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2. Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management

Author

Mohammad Alabdulkareem, MD, Yanis Berkane, MD, MSc, Enna Le Bras, MD, Etienne Rousson, MD, Theodoros Chrelias, MD, Tristan Beaufils, MD, Franck-Marie Leclere, MD, PhD, Eric Watier, MD, PhD, and Nicolas Bertheuil, MD, PhD

Subjects
Surgery, RD1-811
Abstract

Background:. Axillary hidradenitis suppurativa (HS) can result in significant functional impairment in both personal and professional lives. Stage 3 HS requires radical surgical treatment. Flap reconstruction allows for faster healing and better functional and aesthetic outcomes. We compared the results of thoracodorsal artery perforator (TDAP) and propeller inner arm artery perforator (IAAP) flap reconstructions after radical surgical treatment of axillary HS. Methods:. We conducted a retrospective study that included 13 consecutive patients who underwent stage 3 axillary HS treatment between August 2015 and January 2023. Seven patients underwent reconstruction by islanded TDAP flaps, whereas six patients underwent reconstruction by propeller IAAP flaps, with one patient undergoing bilateral reconstruction. The data collected from the patient records included age, gender, smoking status, body mass index, comorbidities, operative time, defect size, flap size, hospital stay, and complications. Results:. Although not statistically significant (P = 0.1923), a higher rate of flap complications is reported here with propeller IAAP flaps (42.86 %), whereas islanded TDAP flaps had no flap complications (0%). We found a statistically significant difference in operative time (P = 0.0006), defect size (P = 0.0064), and flap size (P = 0.0012) between the two groups. All patients exhibited satisfactory functional and aesthetic outcomes. Fourteen flaps were performed in total; only one case exhibited recurrence (7.14%). Conclusion:. After radical surgical management, both islanded TDAP and propeller IAAP flap reconstructions offer excellent outcomes for stage 3 axillary HS. We strongly encourage our peers to consider performing perforator flaps over secondary healing for these patients with a major functional impairment.

Published
2023
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3. Modified nanofat grafting: Stromal vascular fraction simple and efficient mechanical isolation technique and perspectives in clinical recellularization applications

Author

Paul Girard, Joelle Dulong, Jerome Duisit, Camille Mocquard, Simon Le Gallou, Benoit Chaput, Elise Lupon, Eric Watier, Audrey Varin, Karin Tarte, and Nicolas Bertheuil

Subjects
mechanical isolation, adipose tissue, SVF, recellularization, clinical applicability, adipose derived stem cells, Biotechnology, TP248.13-248.65
Abstract

Background: Nanofat grafting (NG) is a simple and cost-effective method of lipoaspirates with inter-syringe passages, to produce stromal vascular fraction (SVF) and isolate adipose-derived stem cells (ASCs). This represents a tremendous interest in the future clinical needs of tissue engineering. In this study, we optimized the NG technique to increase the yield of ASC extractions.Methods: We analyzed three groups of SVF obtained by 20, 30, and 40 inter-syringe passages. The control group was an SVF obtained by enzymatic digestion with Celase. We studied their cell composition by flow cytometry, observed their architecture by confocal microscopy, and observed immunomodulatory properties of the ASCs from each of the SVFs by measuring inflammatory markers of macrophages obtained by an ASC monocyte co-culture.Results: We have established the first cell mapping of the stromal vascular fraction of adipose tissue. The results showed that SVF obtained by 20 inter-syringe passages contains more statistically significant total cells, more cells expressing the ASC phenotype, more endothelial cells, and produces more CFU-F than the SVF obtained by 30 and 40 passages and by enzymatic digestion. Confocal microscopy showed the presence of residual adipocytes in SVF obtained by inter-syringe passages but not by enzymatic digestion. The functional study indicates an orientation toward a more anti-inflammatory profile and homogenization of their immunomodulatory properties.Conclusion: This study places mechanically dissociated SVF in the center of approaches to easily extract ASCs and a wide variety and number of other progenitor cells, immediately available in a clinical setting to provide both the amount and quality of cells required for decellularized tissues.

Published
2022
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4. The Lipo-Body Lift: Operative Technique

Author

Nicolas Bertheuil, MD, PhD, Benoit Chaput, MD, PhD, Damien Bergeat, MD, Christophe Morvan, Camille Mocquard, MD, and Eric Watier, MD, PhD

Subjects
Surgery, RD1-811
Abstract

Summary:. Bariatric surgery induces massive weight loss, which results in global and complex skin deformities. Lower body lift procedure has become the gold standard for lower trunk reconstruction. The authors describe in this video the lipo-body lift technique in detail. The video is divided into 4 parts: part 1, indications and preoperative markings; part 2, posterior contouring; part 3, anterior contouring; and part 4, preoperative and postoperative results. Patient selection and technical key points of the technique are discussed. The lipo-body lift method is an important component of reconstructive strategies and should be widely offered to patients who experienced massive weight loss.

Published
2019
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5. In vivo identification of solar radiation-responsive gene network: role of the p38 stress-dependent kinase.

Author

Nicolas Mouchet, Henri Adamski, Régis Bouvet, Sébastien Corre, Yann Courbebaisse, Eric Watier, Jean Mosser, Christophe Chesné, and Marie-Dominique Galibert

Subjects
Medicine, Science
Abstract

Solar radiation is one of the most common threats to the skin, with exposure eliciting a specific protective cellular response. To decrypt the underlying mechanism, we used whole genome microarrays (Agilent 44K) to study epidermis gene expression in vivo in skin exposed to simulated solar radiation (SSR). We procured epidermis samples from healthy Caucasian patients, with phototypes II or III, and used two different SSR doses (2 and 4 J/cm(2)), the lower of which corresponded to the minimal erythemal dose. Analyses were carried out five hours after irradiation to identify early gene expression events in the photoprotective response. About 1.5% of genes from the human genome showed significant changes in gene expression. The annotations of these affected genes were assessed. They indicated a strengthening of the inflammation process and up-regulation of the JAK-STAT pathway and other pathways. Parallel to the p53 pathway, the p38 stress-responsive pathway was affected, supporting and mediating p53 function. We used an ex vivo assay with a specific inhibitor of p38 (SB203580) to investigate genes the expression of which was associated with active p38 kinase. We identified new direct p38 target genes and further characterized the role of p38. Our findings provide further insight into the physiological response to UV, including cell-cell interactions and cross-talk effects.

Published
2010
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6. Merkel cell polyomavirus small T antigen mRNA level is increased following in vivo UV-radiation.

Author

Ariane Mogha, Alain Fautrel, Nicolas Mouchet, Na Guo, Sébastien Corre, Henri Adamski, Eric Watier, Laurent Misery, and Marie-Dominique Galibert

Subjects
Medicine, Science
Abstract

Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer involving Merkel cells. Recently, a new human polyomavirus was implicated in MCC, being present in 80% of the samples analyzed. In virus-positive MCC, the Merkel cell polyomavirus (MCPyV) is clonally integrated into the patients DNA, and carries mutations in its large T antigen, leading to a truncated protein. In non-symptomatic tissue MCPyV can reside at very low levels. MCC is also associated with older age, immunosuppression and sun exposure. However, the link with solar exposure remains unknown, as the precise mechanism and steps involved between time of infection by MCPyV and the development of MCC. We thus investigated the potential impact of solar simulated radiation (SSR) on MCPyV transcriptional activity. We screened skin samples of 20 healthy patients enrolled in a photodermatological protocol based on in vivo-administered 2 and 4 J/cm(2) SSR. Two patients were infected with two new variants of MCPyV, present in their episomal form and RT-QPCR analyses on SSR-irradiated skin samples showed a specific and unique dose-dependent increase of MCPyV small t antigen transcript. A luciferase based in vitro assay confirmed that small t promoter is indeed UV-inducible. These findings demonstrate that solar radiation has an impact on MCPyV mRNA levels that may explain the association between MCC and solar exposure.

Published
2010
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7. Gluteal Propeller Perforator Flaps: A Paradigm Shift in Abdominoperineal Amputation Reconstruction

Author

Bertheuil, Theodoros Chrelias, Yanis Berkane, Etienne Rousson, Korkut Uygun, Bernard Meunier, Alex Kartheuser, Eric Watier, Jérôme Duisit, and Nicolas

Subjects
abdominoperineal amputation, perineal reconstruction, pelvis, perforator flaps, propeller flaps
Abstract

Abdominoperineal amputation (AAP) is a gold standard procedure treating advanced abdominal and pelvic cancers. The defect resulting from this extensive surgery must be reconstructed to avoid complications, such as infection, dehiscence, delayed healing, or even death. Several approaches can be chosen depending on the patient. Muscle-based reconstructions are a reliable solution but are responsible for additional morbidity for these fragile patients. We present and discuss our experience in AAP reconstruction using gluteal-artery-based propeller perforator flaps (G-PPF) in a case series. Between January 2017 and March 2021, 20 patients received G-PPF reconstruction in two centers. Either superior gluteal artery (SGAP)- or inferior artery (IGAP)-based perforator flaps were performed depending on the best configuration. Preoperative, intraoperative, and postoperative data were collected. A total of 23 G-PPF were performed—12 SGAP and 11 IGAP flaps. Final defect coverage was achieved in 100% of cases. Eleven patients experienced at least one complication (55%), amongst whom six patients (30%) had delayed healing, and three patients (15%) had at least one flap complication. One patient underwent a new surgery at 4 months for a perineal abscess under the flap, and three patients died from disease recurrence. Gluteal-artery-based propeller perforator flaps are an effective and modern surgical procedure for AAP reconstruction. Their mechanic properties, in addition to their low morbidity, make them an optimal technique for this purpose; however, technical skills are needed, and closer surveillance with patient compliance is critical to ensure success. G-PPF should be widely used in specialized centers and considered a modern alternative to muscle-based reconstructions.

Published
2023
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8. Abdominoplasty and lower body lift surgery improves the quality of life after massive weight loss: a prospective multicenter study

Author

Yanis Berkane, François Saget, Elise Lupon, Camille Mocquard, Isabelle Pluvy, Eric Watier, Alexandre G. Lellouch, Jérôme Duisit, Benoit Chaput, Nicolas Bertheuil, Massachusetts General Hospital [Boston, MA, USA], Harvard Medical School [Boston] (HMS), Hôpital Sud [CHU Rennes], CHU Pontchaillou [Rennes], Hôpital Pasteur [Nice] (CHU), Microenvironment and B-cells: Immunopathology,Cell Differentiation, and Cancer (MOBIDIC), Université de Rennes (UR)-Etablissement français du sang [Rennes] (EFS Bretagne)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)

Subjects
[SDV]Life Sciences [q-bio], Surgery
Abstract

International audience; BACKGROUND: This study was conducted to assess the impact of abdominoplasty and lower body lift surgery following massive weight loss on both the general quality of life and the sexual life of patients. METHODS: We performed a multicenter prospective study on the quality of life after massive weight loss using three scoring questionnaires: The Short Form 36 questionnaire, the Female Sexual Function Index questionnaire, and the Moorehead-Ardelt Quality of Life Questionnaire. Seventy-two patients who underwent lower body lift and 57 patients who underwent abdominoplasty in three centers with pre and post-operative evaluation were included. RESULTS: The mean age of the patients was 43.2 ± 13.2 years. All categories of the SF36 questionnaire were statistically significant at 6 months, and all categories except health change were significantly improved at 12 months post-operative. Overall, the Moorehead-Ardelt questionnaire showed a higher quality of life in general (1.78 ± 0.92 and 1.64 ± 1.03, at 6 and 12 months respectively) and in all domains (self-esteem, physical activity, social relationships, work performance, and sexual activity). Interestingly, global sexual activity improved at 6 months but not at 12 months. Some domains of sexual life improved at 6 months (desire, arousal, lubrication, satisfaction), but only the desire stayed improved at 12 months. CONCLUSION: Abdominoplasty and lower body lift improve the quality of life of patients after massive weight loss as well as the sexual quality of life. This should be an additional valid reason for promoting reconstructive surgery for massive weight loss patients.

Published
2023
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9. Medial Thighplasty Improves Patient's Quality of Life After Massive Weight Loss: a Prospective Multicentric Study

Author

Silvia Gandolfi, Nicolas Bertheuil, Isabelle Pluvy, Eric Watier, Benoit Chaput, Maarten M. Hoogbergen, Camille Mocquard, CHU Pontchaillou [Rennes], Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Orthopedic, Traumatology, Plastic Reconstructive and Hand Surgery Unit (CHU Besançon), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), CHU Casselardit - Junod, CHU Rouen, Normandie Université (NU), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Adult, Plastic surgery, Reconstructive surgery, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Health change, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Weight loss, Weight Loss, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Medial thighplasty, Retrospective Studies, 2. Zero hunger, Nutrition and Dietetics, business.industry, Middle Aged, Obesity, Morbid, 3. Good health, Female sexual function, Quality of Life, Physical therapy, Massive weight loss, Female, Surgery, medicine.symptom, business, Body mass index, 030217 neurology & neurosurgery, Post bariatric
Abstract

International audience; Background The aim of this study was to assess the impact of medial thighplasty following massive weight loss on the quality of life of patients and on their sexual life. Methods We performed a multicentric, prospective study on the quality of life after massive weight loss using the Short-Form 36 questionnaire, the Female Sexual Function Index questionnaire, and the Moorehead-Ardelt Quality of life questionnaire. Forty-nine patients who underwent medial thighplasty were included in three centers and evaluation was made pre- and post-operatively. Results The mean age of the patients was 44 +/- 12.5 years. The average pre-medial thighplasty body mass index was 27 +/- 3.8 kg/m(2). All the categories of the SF36 questionnaire scored higher after surgery apart from "health change" but only the "role limitations due to emotional problems" category was significantly improved (p= 0.0081). Similarly, the MooreheadArdelt questionnaire showed a positive impact of the surgery on the quality of life in general (mean total score 1.04 +/- 1.37) and on self- esteem, physical activity, social relationships, and work performance. Interestingly, sexual activity was not improved by the surgery and this result is in line with the FSFI, which showed no effect of medial thighplasty on sexual life. Conclusions Medial thighplasty improves the quality of life of patients after massive weight loss but does not seem to modify the sexual quality of life. These results clearly indicate that this surgery should be widely offered to patients seeking reconstruction of massive weight sequelae.

Published
2021
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10. Risk Factors for Complications after J Medial Thighplasty following Massive Weight Loss: A Multivariate Analysis of 94 Consecutive Patients

Author

Farid Bekara, Silvia Gandolfi, Damien Bergeat, Jérôme Duisit, Nicolas Bertheuil, Eric Watier, CHU Pontchaillou [Rennes], Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Ecosystèmes, biodiversité, évolution [Rennes] (ECOBIO), Centre National de la Recherche Scientifique (CNRS)-Observatoire des Sciences de l'Univers de Rennes (OSUR)-Institut Ecologie et Environnement (INEE), Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Cliniques Universitaires Saint-Luc [Bruxelles], Université Catholique de Louvain = Catholic University of Louvain (UCL), Service de médecine nucléaire [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Médecine Interne [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de chirurgie plastique, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)

Subjects
Adult, medicine.medical_specialty, Multivariate analysis, [SDV]Life Sciences [q-bio], Preoperative risk, Bariatric Surgery, 030230 surgery, Medial compartment of thigh, Severity of Illness Index, Body Mass Index, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Quality of life, Weight loss, Risk Factors, Weight Loss, medicine, Humans, Prospective Studies, 2. Zero hunger, business.industry, Medical record, Age Factors, Middle Aged, Body Contouring, Single surgeon, 3. Good health, Surgery, Obesity, Morbid, Thigh, Multivariate Analysis, Female, medicine.symptom, business, Body mass index
Abstract

International audience; BACKGROUND: Bariatric surgery has increased the number of patients requiring medial thighplasty after massive weight loss. However, despite the various complications, the procedure improves quality of life. The authors report postoperative complications of vertical J-shaped medial thigh lift in a series of patients and identify preoperative risk factors. METHODS: For almost 5 years, the details of all J medial thighplasties performed by a single surgeon were recorded; detailed medical records were also available. Complications can be major (e.g., need for early surgical revision or readmission) or minor (delayed wound healing). RESULTS: During the study period, 94 patients were treated and only minor complications were recorded (42.5 percent). On multivariate analysis, older age (OR, 1.05; 95 percent CI, 1.01 to 1.10) and a body mass index greater than or equal to 30 kg/m2 (OR, 2.82; 95 percent CI, 1.10 to 7.22) were independent risk factors for postoperative complications. CONCLUSIONS: As with other postbariatric operations, medial thighplasty is associated with significant morbidity, but the risk thereof can be easily established and managed. Specific algorithms for determining the risk of postoperative complications based on age and body mass index are needed to guide preoperative discussions with patients and perform patient selection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Published
2021
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11. Is Abdominoplasty and Concomitant Laparoscopic Umbilical Hernia Repair Feasible by a Plastic Surgeon?

Author

Damien Bergeat, Camille Mocquard, Nicolas Bertheuil, Eric Watier, Farid Bekara, CHU Pontchaillou [Rennes], Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Lapeyronie [Montpellier] (CHU), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
medicine.medical_specialty, Umbilical surgery, medicine.medical_treatment, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030230 surgery, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Umbilical hernia repair, medicine, Humans, Hernia, Laparoscopy, ComputingMilieux_MISCELLANEOUS, Surgeons, Abdominoplasty, medicine.diagnostic_test, business.industry, General Medicine, medicine.disease, 3. Good health, Surgery, Plastic surgery, Concomitant, business, Hernia, Umbilical
Abstract

International audience

Published
2019
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12. Lifting della faccia interna della coscia o cruroplastica

Author

N Isola, Jean-Louis Grolleau, Benoit Chaput, Eric Watier, and Nicolas Bertheuil

Subjects
03 medical and health sciences, 0302 clinical medicine, 030208 emergency & critical care medicine, 030230 surgery
Abstract

L’eccesso cutaneo che interessa l’interno della coscia, legato all’invecchiamento della pelle o, il piu delle volte, secondario alla perdita di peso, e un problema che ogni chirurgo plastico deve affrontare nella sua pratica clinica quotidiana. La gestione chirurgica comporta il lifting della faccia interna della coscia, comunemente chiamato “cruroplastica”. Questo intervento, che e stato praticato per cinque decenni, ha beneficiato di numerosi sviluppi tecnici che gli hanno permesso di prosperare. L’obesita e una vera e propria piaga che colpisce molti paesi sviluppati, con un impatto socioeconomico significativo. Le tecniche di chirurgia bariatrica, in pieno sviluppo negli ultimi anni, forniscono una massiccia perdita di peso sotto controllo medico e consentono una chirurgia della silhouette, una volta che il peso si e stabilizzato. Questa chirurgia postbariatrica fa ormai parte dell’arsenale terapeutico indispensabile per il chirurgo plastico per soddisfare al meglio le esigenze dei pazienti. Gli obiettivi di questo articolo sono esporre le tecniche moderne di lifting della faccia interna della coscia, specificare i risultati attesi con i loro limiti ed evidenziare le varie complicanze con la loro gestione.

Published
2019
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13. Fleur-de-lys abdominal body contouring surgery following massive weight loss

Author

François Saget, Silvia Gandolfi, Yanis Berkane, Nicolas Bertheuil, Eric Watier, Théodoros Chrelias, CHU Pontchaillou [Rennes], CHU Rouen, Normandie Université (NU), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Jonchère, Laurent

Subjects
medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, business.industry, Abdominoplasty, MEDLINE, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030230 surgery, Body Contouring, 3. Good health, Body contouring surgery, Surgery, 03 medical and health sciences, 0302 clinical medicine, Weight loss, 030220 oncology & carcinogenesis, Abdomen, Weight Loss, medicine, Humans, medicine.symptom, business, Abdominal Muscles
Abstract

International audience; Refers to: DeSerres, J. J., Quaife, T., Morzycki, A., Curran, M. W., & Toy, J. (2021). Safety of fleur-de-lys abdominoplasty after massive weight loss. Journal of Plastic, Reconstructive & Aesthetic Surgery, 74(1), 223-243.

Published
2021
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14. Superior epigastric artery perforator flap for reconstruction of deep sternal wound infection

Author

Erwan Flecher, Franck-Marie Leclere, Jérôme Duisit, Eric Watier, Farid Bekara, Nicolas Bertheuil, CHU Pontchaillou [Rennes], Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cliniques Universitaires Saint-Luc [Bruxelles], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Chard-Hutchinson, Xavier, UCL - SSS/IREC/SLUC - Pôle St.-Luc, and UCL - (SLuc) Service de chirurgie plastique

Subjects
Sternum, medicine.medical_specialty, Reconstructive surgery, Soft Tissue Injuries, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Superior epigastric artery, [SDV]Life Sciences [q-bio], Skin flap, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, medicine, Humans, Inframammary fold, Reconstructive Surgical Procedures, Mammary Arteries, Aged, Aged, 80 and over, business.industry, Mediastinum, Pedicled Flap, Middle Aged, Plastic Surgery Procedures, Epigastric Arteries, Wound infection, eye diseases, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Sternal infection, Wound Infection, business, Perforator Flap
Abstract

National audience; Background The treatment of deep wound sternal infection requires loco-regional pedicled flaps, usually with muscular flaps. Perforator propeller flaps represent the ultimate progress in the history of reconstructive surgery. We report here our experience with the superior epigastric artery perforator (SEAP) flaps to repair sternal defect. Patients and methods Six patients presenting deep sternal wounds infection were treated with SEAP propeller flap, between March 2015 and June 2017. The mean age was 71.5 (range 53-83) years. The mean length and width of the defect were 16.2 x 7 cm (ranging 8-20 x 4-10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90 degrees to cover the defect. Results All SEAP flaps achieved a successful entire coverage of the defect. The mean size of the skin paddle of the flap was 20.2 x 7.3 cm (ranging 14-27 x 6-9). All flaps were able to provide a complete sternal wound cover. Venous congestion was present in five cases and adequately treated by leech therapy; necrosis was distal in one case, and interesting the entire superficial flap in two cases but with deep tissues remaining viable and able to cover the mediastinum: an infected flap required revision. Satisfyingly, at 2-years postoperative follow-up all-patients were alive with a successful mediastinal cover. Conclusions The SEAP Perforator propeller flap is an alternative to muscle flaps to achieve treatment of deep and large sternal wound infection.

Published
2021
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15. Use of a skin perforator flap pedicled by the intercostal muscle for reconstruction of a posterior cervical defect

Author

Nicolas Bertheuil, B. Menardais, F.M. Leclère, Jérôme Duisit, P. J. Le Reste, Eric Watier, CHU Pontchaillou [Rennes], Université Catholique de Louvain = Catholic University of Louvain (UCL), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] (EFS Bretagne), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Jonchère, Laurent, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, and UCL - (SLuc) Service de chirurgie plastique

Subjects
medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Reconstruction tête et cou, Intercostal Muscles, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030230 surgery, Metastatic Squamous Cell Lung Carcinoma, 03 medical and health sciences, Head and neck, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Perte de substance cervicale postérieure, Humans, Medicine, In patient, Cervical defect, Lambeau perforant, Adjuvant radiotherapy, business.industry, Osteomyelitis, Occipital bone, Occiput, Skin Transplantation, Plastic Surgery Procedures, medicine.disease, Perforator flap, Intercostal muscle flap, Spine, 3. Good health, Surgery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Lambeau de muscles intercostaux, business, Neck, Intercostal muscle
Abstract

A posterior cervical defect featuring exposed spinal and occipital bone can be covered in various ways. The “ideal” flap should be a low-morbidity, pedicled locoregional flap that can reach the occiput. Cervical adjuvant radiation therapy may limit the coverage options, because many pedicles are located in areas that are often irradiated. Here, we describe a new surgical technique; we used a skin perforator flap pedicled by the intercostal muscle to cover a posterior cervical defect in a patient with metastatic squamous cell lung carcinoma. This technique is a valuable option; the flap originated from outside the irradiated area and reached the occiput. It adds to the options for cervical coverage in patients who require head-and-neck reconstruction.Evidence-Based MedicineLevel V: opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees., Les pertes de substances cervicales postérieures avec exposition osseuse peuvent être couvertes par plusieurs techniques. Le lambeau idéal doit avoir une faible morbidité, réalisable facilement, être un lambeau pédiculé locorégional et pouvoir atteindre l’occiput. En cas de radiothérapie cervicale, certains lambeaux classiques permettant de couvrir ce type de perte de substance peuvent avoir leur pédicule endommagé. Dans cet article, nous rapportons l’utilisation d’un lambeau perforant thoracique latéral pédiculé par les muscles intercostaux pour couvrir un defect cervical postérieur dans les suites d’une ostéosynthèse d’une métastase d’un carcinome pulmonaire. Ce lambeau est une alternative aux lambeaux traditionnels dont le pédicule est en dehors du champ d’irradiation. Il offre une option supplémentaire pour traiter ces defects.

Published
2021
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16. The Use of Pedicled Perforator Flaps in Chest Reconstruction

Author

Benoit Chaput, Anne-Sophie Florczak, Nicolas Bertheuil, Eric Watier, Christian Herlin, and Pascal Rousseau

Subjects
medicine.medical_specialty, Thoracic Surgical Procedure, business.industry, Plastic Surgery Procedures, Thoracic Surgical Procedures, 030230 surgery, eye diseases, Surgery, 03 medical and health sciences, Plastic surgery, 0302 clinical medicine, 030220 oncology & carcinogenesis, Humans, Medicine, business, Perforator Flap, Reliability (statistics), Perforator flaps
Abstract

In recent years, pedicled perforator flaps have revolutionized plastic surgery by reducing donor site morbidity and ensuring larger and deeper reconstructions with local pedicled cutaneous flaps. The aim of the study was to make a systematic review of perforator pedicled propeller flaps (PPPFs) in chest reconstruction.Pubmed and Cochrane databases were searched from 1989 to October 2016 for articles describing the use of PPPFs in chest reconstruction. The preferred reporting items for systematic reviews and meta analyses statement was used in the selection process. The review was registered on international prospective register of systematic reviews. Furthermore, operative technique, indications and complications were searched.Twenty-four articles were selected (174 patients and 182 flaps). Oncological surgery was the first etiology (34.5%), followed by infections (11.5%), chest keloid scars (6.23%), malformations (4.6%), burns (3.4%), chronic ulcers (2.3%), Verneuil disease (1.8%), and acute wounds (1.8%). The arc of rotation was between 90° and 120° in 24.2%. The mean surface of flaps was 127.45 ± 123.11 cm. Dissection was subfascial in 78.5% of the cases. Complications were found in 9.9% of patients and included mainly wound dehiscence (4.4%) and hematoma/seroma (2.2%). One case of total necrosis (0.5%) and 2 cases of partial necrosis (1.1%) were found.The possibility of numerous pedicles makes it possible for PPPFs to offset most areas of wall chest defects. Furthermore, this surgical technique is reliable and reproducible, with lower donor site morbidity than that in the case of muscular flaps, which are classically used in this location.

Published
2018
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17. Upper body lift and breast reshaping with lateral chest wall perforator propeller flap following massive weight loss

Author

Eric Watier, Benoit Chaput, N Isola, Nicolas Bertheuil, S. Aillet, Christian Herlin, CHU Pontchaillou [Rennes], Hôpital Lapeyronie [Montpellier] (CHU), STROMALab, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), CCSD, Accord Elsevier, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), and Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
Reconstruction mammaire, medicine.medical_treatment, Mammaplasty, Breast reshaping, Chirurgie post-bariatrique, 030230 surgery, Mastopexy, Body Mass Index, 0302 clinical medicine, Postoperative Complications, Weight loss, Lambeau perforant, ComputingMilieux_MISCELLANEOUS, 2. Zero hunger, Lateral chest wall, Contouring, Hematoma, Propeller, Middle Aged, Body Contouring, Mastopexie, Augmentation mammaire autologue, medicine.anatomical_structure, Patient Satisfaction, Tissue and Organ Harvesting, Massive weight loss, Female, medicine.symptom, Adult, Reoperation, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, Upper trunk, [SDV.CAN] Life Sciences [q-bio]/Cancer, Weight Loss, medicine, Humans, Thoracic Wall, Bodylift supérieur, Bariatric surgery, business.industry, Perte de poids massive, Autologous breast augmention, Perforator flap, Surgery, Upper body lift, business, Body mass index, Perforator flaps, Follow-Up Studies
Abstract

Summary Background After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues. Objectives To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL). Methods Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure. Results Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3 ± 10.9 kg/m2, with a mean preoperative pre-UBL BMI of 28.7 ± 3.6 kg/m2. The average weight loss before surgery was 67.7 ± 22.4 kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9 ± 8.4 months. The patients’ satisfaction with their improved breast shapes and chest wall contours was “good”, with an aesthetic outcome mean ranked 3.8 ± 0.8 (out of 5). Conclusions After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping.

Published
2020
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18. Circumferential Contouring of the Lower Trunk: Indications, Operative Techniques, and Outcomes—A Systematic Review

Author

Benoit Chaput, Nicolas Bertheuil, Raphael Carloni, Christian Herlin, Paul Girard, Antoine De Runz, Eric Watier, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Universitaire de Rangueil, Department of Plastic and Craniofacial Pediatric Surgery, Hôpital Lapeyronie [Montpellier] (CHU), Médialab (Sciences Po) (Médialab), Sciences Po (Sciences Po), Microenvironnement et cancer (MiCa), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] (EFS Bretagne), STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), médialab (Sciences Po) (médialab), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Chard-Hutchinson, Xavier, Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), and Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, massive-weight-loss, medicine.medical_treatment, Belt lipectomy, lower-body lift, 030230 surgery, 0302 clinical medicine, Quality of life, Medicine, Abdominoplasty, Torso, nutritional deficiency, Middle Aged, Obesity, Morbid, 3. Good health, Treatment Outcome, loss patient, Waistline, Thigh, Patient Satisfaction, 030220 oncology & carcinogenesis, Body Composition, Female, thigh-buttock lift, Adult, medicine.medical_specialty, Esthetics, bariatric surgery, venous thromboembolism, [SDV.CAN]Life Sciences [q-bio]/Cancer, autologous gluteal augmentation, 03 medical and health sciences, Patient satisfaction, [SDV.CAN] Life Sciences [q-bio]/Cancer, Weight Loss, Humans, Surgery, Plastic, Postoperative Care, business.industry, Wound dehiscence, Evidence-based medicine, medicine.disease, belt lipectomy, high-lateral-tension, Surgery, Otorhinolaryngology, Quality of Life, Buttocks, business
Abstract

International audience; Background - Increasing obesity prevalence and development of bariatric surgery have led to the development of skin re-draping techniques. Several contouring techniques have been described for treating the circumferential excess of the lower trunk. Materials and methods - We performed a systematic review to summarize surgical indications, operative techniques, peri-operative management (nutritional supplementation, antibiotic prophylaxis, thrombo-prophylaxis), outcomes, complications, patient satisfaction, and impact on quality of life of circumferential contouring of the lower trunk procedures. A systematic review, based on the PRISMA criteria, was conducted using the Pubmed and Cochrane databases. Results - The review included 42 articles and 1748 operated patients. Two studies only were graded as level of evidence II; the others were graded as levels III to V. The most frequently reported indication was massive weight loss. All the described techniques derived either from belt lipectomy or lower bodylift. Belt lipectomy resulted in a posterior scar situated at the waistline and allowed a better correction of hip back rolls, whereas lower bodylift was more effective on buttock and lateral thigh ptosis. The most reported complication was wound dehiscence. Patient satisfaction and quality of life scores were high in all studies. Conclusions - This review included a majority of low-level evidence studies that limit extrapolability of the results. Future randomized prospective studies may generate stronger evidence, with a standardization of surgical indications and operative techniques. Level of evidence iii - This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Published
2016
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19. Medial Thigh Lift for Patients Following Massive Weight Loss: Our Postbariatric Experience

Author

Nicolas Bertheuil, Nicolas Isola, and Eric Watier

Subjects
Thigh surgery, medicine.medical_specialty, business.industry, Lift (data mining), Dermatologic Surgical Procedures, Bariatric Surgery, General Medicine, 030230 surgery, Medial compartment of thigh, Surgery, 03 medical and health sciences, 0302 clinical medicine, Thigh, Weight loss, 030220 oncology & carcinogenesis, Weight Loss, Humans, Medicine, medicine.symptom, business
Published
2018
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20. Skin Perforator Flap Pedicled by Intercostal Muscle for Repair of a Tracheobronchoesophageal Fistula

Author

Bernard Meunier, Eric Watier, Cécile Meal, C. Cusumano, Nicolas Bertheuil, Yann Harnoy, Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-hôpital Sud, Microenvironnement et cancer (MiCa), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de Chirurgie Hépatobiliaire et Digestive, and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Esophageal Neoplasms, Fistula, medicine.medical_treatment, Intercostal Muscles, [SDV.CAN]Life Sciences [q-bio]/Cancer, Context (language use), Tracheoesophageal fistula, 030230 surgery, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine, Carcinoma, Humans, business.industry, Middle Aged, medicine.disease, Bronchial Fistula, 3. Good health, Surgery, Esophagectomy, Radiation therapy, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Carcinoma, Squamous Cell, [SDV.IMM]Life Sciences [q-bio]/Immunology, Esophageal Squamous Cell Carcinoma, Cardiology and Cardiovascular Medicine, business, Perforator Flap, Tracheoesophageal Fistula, Intercostal muscle
Abstract

International audience; A tracheobronchial fistula (TBF) is a rare complication when an operation is performed to treat esophageal carcinoma; no consensus treatment strategy has emerged. We describe a surgical interposition strategy, using a new flap, to repair a TBF that arose when esophageal squamous cell carcinoma was treated with neoadjuvant chemoradiation and minimally invasive esophagectomy (the 3-stage McKeown procedure). We performed a skin perforator flap pedicled by the intercostal muscle. It is a valuable option that may be the optimal first-line treatment, especially in the context of neoadjuvant radiation therapy. Furthermore, this strategy affords new options for intrathoracic reconstruction.

Published
2017
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21. Risk Factors for Postoperative Complications After Abdominal Panniculectomy and the Contribution of Plastic Surgeons on Reconstruction Following Massive Weight Loss

Author

Damien Bergeat, Eric Watier, Isabelle Pluvy, Camille Mocquard, Nicolas Bertheuil, Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, MEDLINE, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Weight loss, Risk Factors, Weight Loss, medicine, Humans, 030223 otorhinolaryngology, ComputingMilieux_MISCELLANEOUS, Surgeons, Nutrition and Dietetics, Abdominoplasty, business.industry, 3. Good health, Surgery, Abdominal Panniculectomy, Obesity, Morbid, 030220 oncology & carcinogenesis, medicine.symptom, business
Abstract

International audience; [No abstract available]

Published
2019
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22. Adipose mesenchymal stromal cells Definition, immunomodulatory properties, mechanical isolation and interest for plastic surgery

Author

Benoit Chaput, Eric Watier, Cédric Ménard, Audrey Varin, Karin Tarte, Jérôme Laloze, Nicolas Bertheuil, Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), STROMALab, Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), and CCSD, Accord Elsevier

Subjects
medicine.medical_specialty, Adipose stromal cells, Nanofat grafting, Adipose tissue, Tissu adipeux, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030230 surgery, Mesenchymal Stem Cell Transplantation, Regenerative Medicine, Regenerative medicine, Immunomodulation, 03 medical and health sciences, Paracrine signalling, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Fat grafting, Humans, Medicine, business.industry, Mesenchymal stem cell, Mesenchymal Stem Cells, Immunomodulatory properties, Stromal vascular fraction, Clinical routine, Adipose stem cells, 3. Good health, Plastic surgery, Adipose Tissue, Cellules souches, Cancer research, Surgery, business, Cellules stromales mésenchymateuses du tissu adipeux
Abstract

International audience; Ever since their discovery in 2001, adipose mesenchymal stromal cells (ASC) have profoundly modified clinical indications and our practice of plastic surgery, thereby placing our discipline at the forefront of regenerative medicine. These cells act through paracrine signaling by synthesizing immunosuppressive and pro-angiogenic factors. They are of key importance with regard to the regenerative properties of autologously grafted adipose tissue (AT). Taken together, they make up the stromal vascular fraction (SVF) comprising all AT cells except for adipocytes. As our knowledge evolves, we are moving from fat grafting towards SVF grafting, of which the essential sought-after effect is tissue regeneration. The objective of the present review is to synthesize present-day information on ASCs and their immunomodulatory properties and, from a practical standpoint, to indicate present-day and future steps towards establishment of clinical routine, particularly through application of techniques favoring mechanical digestion of adipose tissue.

Published
2019
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23. The Lipo-Body Lift Operative Technique

Author

Camille Mocquard, Damien Bergeat, Benoit Chaput, Nicolas Bertheuil, Christophe Morvan, Eric Watier, Jonchère, Laurent, CHU Pontchaillou [Rennes], Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), STROMALab, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de Rangueil, CHU Toulouse [Toulouse], Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), and Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
Contouring, medicine.medical_specialty, Lift (data mining), business.industry, Gold standard, lcsh:Surgery, Video, [SDV.CAN]Life Sciences [q-bio]/Cancer, lcsh:RD1-811, 030230 surgery, Surgery, 03 medical and health sciences, 0302 clinical medicine, Lower body, [SDV.CAN] Life Sciences [q-bio]/Cancer, Weight loss, 030220 oncology & carcinogenesis, medicine, Postoperative results, medicine.symptom, business, Lower trunk
Abstract

International audience; Bariatric surgery induces massive weight loss, which results in global and complex skin deformities. Lower body lift procedure has become the gold standard for lower trunk reconstruction. The authors describe in this video the lipo-body lift technique in detail. The video is divided into 4 parts part 1, indications and preoperative markings; part 2, posterior contouring; part 3, anterior contouring; and part 4, preoperative and postoperative results. Patient selection and technical key points of the technique are discussed. The lipo-body lift method is an important component of reconstructive strategies and should be widely offered to patients who experienced massive weight loss.

Published
2019
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24. Lower Body Lift in the Massive Weight Loss Patient A New Classification and Algorithm for Gluteal Augmentation

Author

Benoit Chaput, Nathalie Kerfant, Eric Watier, Benoist Menardais, Isabelle Pluvy, Nicolas Bertheuil, CHU Pontchaillou [Rennes], Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), and Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, Lift (data mining), business.industry, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030230 surgery, Surgical Flaps, Surgery, 03 medical and health sciences, 0302 clinical medicine, Lower body, medicine.anatomical_structure, Weight loss, 030220 oncology & carcinogenesis, Weight Loss, Buttocks, Humans, Medicine, medicine.symptom, business, Algorithms, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2018
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25. Thoracotomy and esophageal surgery: Key points to preserve the possibilities of flaps

Author

B Meunier, S Rouze, D Bergeat, Camille Mocquard, Eric Watier, Nicolas Bertheuil, N Isola, Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
medicine.medical_specialty, Esophageal Neoplasms, medicine.medical_treatment, Esophageal cancer, Tracheoesophageal fistula, [SDV.CAN]Life Sciences [q-bio]/Cancer, Anastomotic Leak, Cancer de l’œsophage, 030230 surgery, Surgical Flaps, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Medical Illustration, Medicine, Humans, Lambeaux perforants, Thoracotomy, Esophageal surgery, Medical Errors, business.industry, Wound Closure Techniques, Chirurgie de l’œsophage, Lambeaux, medicine.disease, Perforator flap, Intercostal muscle flap, Flap, Surgery, Esophagectomy, Lambeau des muscles intercostaux, Thoracotomie, Anastomotic leakage, Superficial Back Muscles, Salvage surgery, business, Organ Sparing Treatments, Tracheoesophageal Fistula
Abstract

International audience; Anastomotic leakage frequently complicates esophagectomy and can trigger a rare life- threatening complication, a tracheoesophageal fistula. No guideline has yet addressed this complication. Plastic surgeons play a crucial role for salvage surgery. When a re-operation is chosen the possibilities of flap interposition depend on how the thoracotomy was initially performed. This study tried to identify key techniques in order help thoracic or general surgeons to preserve all the local flaps available for TEF if it occurs. These techniques improve flap conservation, helping plastic surgeons when a later transposition flap is required.

Published
2018
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27. Medial thighplasty: Current concepts and practices

Author

Benoit Chaput, A. De Runz, Eric Watier, Pascal Girard, Nicolas Bertheuil, Raphael Carloni, and Christian Herlin

Subjects
medicine.medical_specialty, Post bariatric surgery, business.industry, Bariatric Surgery, Context (language use), Thigh lift, Plastic Surgery Procedures, 030230 surgery, Medial compartment of thigh, Surgery, 030207 dermatology & venereal diseases, 03 medical and health sciences, Postoperative Complications, Treatment Outcome, 0302 clinical medicine, Thigh, Weight Loss, Body contouring, medicine, Operations management, business
Abstract

Medial thighplasty, also known as medial thigh lift, is a procedure that has been carried out for five decades. The original "Lewis" technique has undergone many changes, and thereby been rendered widely available to plastic surgeons. Given the increasingly high number of surgical reconstructions after massive weight loss, this technique is now an integral part of a surgeon's therapeutic arsenal as he strives to meet the evolving demands of patients. The objective of this article, which is based on a comprehensive review of the literature, is to summarize current knowledge on medial thighplasty and thereby allow plastic surgeons to adopt the operating technique best suited to the deformations presented by their patients and to the overall context. The different techniques, outcomes and complications are successively discussed.

Published
2016
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28. Gangrène gazeuse périnéo-fessière à extension cervico-faciale. À propos d’un cas exceptionnel

Author

D. Goga, Eric Watier, N Isola, L. Pechevy, Raphael Carloni, L. Vidal, and Nicolas Bertheuil

Subjects
Gangrene, medicine.medical_specialty, business.industry, Mediastinum, 030230 surgery, medicine.disease, 3. Good health, Perineum, Surgery, body regions, Abdominal wall, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Lumbar, 030202 anesthesiology, medicine, medicine.symptom, Complication, business, Subcutaneous emphysema, Right Thigh
Abstract

Fournier's gangrene is a fearsome disease with a bad prognosis and a mortality rate ranging between 10 and 80% according to the literature. It is extensive in 13 to 54% of cases. Up to date, cervico-facial extension has never been reported. We describe the case of a 51-year-old overweighed woman with a history of type 2 diabetes and a narrow lumbar canal who was referred to our institution for significant fatigue and increasingly painful legs. A diagnosis of Fournier's gangrene was made after correlating the physical findings with the results of a full body scan. Diffuse subcutaneous emphysema involving the face, neck, mediastinum, abdominal wall, right buttock, perineum and the right thigh was identified. Treatment included multiple surgical debridements, admission to intensive care unit, and an efficient antibiotic therapy that enabled preservation of the patient's life. To our knowledge, this is the first case of cervical and mediastinal extension of Fournier's gangrene to be reported. No clear guidelines exit on the management of this complication (cervico-facial and mediastinal drainage). We share our experience of this unusual case.

Published
2016
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29. Liposuction Preserves the Morphological Integrity of the Microvascular Network: Flow Cytometry and Confocal Microscopy Evidence in a Controlled Study

Author

Cédric Ménard, Eric Watier, Benoit Chaput, Jean-Louis Grolleau, Frédéric Mourcin, Karin Tarte, Audrey Varin, Sandra Berger-Müller, Ignacio Garrido, Nicolas Bertheuil, Luc Sensebé, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], EFS, Microenvironnement et cancer (MiCa), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement Français du Sang Bretagne, Service de Chirurgie Plastique, Chirurgie plastique, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service de Chirurgie Oncologique, Institut Claudius Regaud, Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), ANR-10-IBHU-0005, European Center for Transplantation Sciences and Immunotherapy, Médaille d'or from Rennes University Hospital, ANR-10-IBHU-0005,CESTI (TSI-IHU),Centre Européen des Sciences de la Transplantation et de l'Immunothérapie (TSI-IHU)(2010), Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service Chirurgie plastique - brûlés [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), and Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, CD31, medicine.medical_specialty, Pathology, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Urology, Adipose tissue, 030230 surgery, Flow cytometry, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Lipectomy, Confocal microscopy, law, Adipocyte, Adipocytes, medicine, Humans, Microscopy, Confocal, medicine.diagnostic_test, business.industry, Abdominoplasty, Endothelial Cells, General Medicine, Middle Aged, Flow Cytometry, Plastic surgery, Microvascular Network, Adipose Tissue, chemistry, 030220 oncology & carcinogenesis, Liposuction, Microvessels, Female, Surgery, business
Abstract

International audience; BACKGROUND: Liposuction is a very popular technique in plastic surgery that allows for the taking adipose tissue (AT) on large surfaces with little risk of morbidity. Although liposuction was previously shown to preserve large perforator vessels, little is known about the effects of liposuction on the microvasculature network. OBJECTIVES: The aim of this study was to analyze the effect of liposuction on the preservation of microvessels at tissue and cellular levels by flow cytometry and confocal microscopy following abdominoplasty procedure. METHODS: Percentage of endothelial cells in AT from liposuction and en bloc AT was determined by multicolor flow cytometry. Moreover, vessel density and adipocyte content were analyzed in situ in 3 different types of AT (en bloc, from liposuction, and residual AT after liposuction) by confocal microscopy. RESULTS: Flow cytometric analysis showed that en bloc AT contained 30.6% ± 12.9% and AT from liposuction 21.6% ± 9.9% of endothelial cells (CD31(pos)/CD45(neg)/CD235a(neg)/CD11b(neg)) (P = .009). Moreover, analysis of paired AT from the same patients (n = 5) confirmed a lower percentage of endothelial cells in AT from liposuction compared to en bloc AT (17.7% ± 4.5% vs 21.9% ± 3.3%, P = .031). Likewise, confocal microscopy showed that en bloc AT contained 8.2% ± 6.3%, AT from liposuction only 1.6% ± 1.0% (P \textless .0001), and AT after liposuction 8.9% ± 4.1% (P = .111) of CD31(pos) vessels. Conversely, adipocyte content was 39.5% ± 14.5% in the en bloc AT, 45% ± 18.4% in AT from liposuction (P = .390), and 18.8 ± 14.8% in AT after liposuction (P = .011). CONCLUSIONS: For the first time, we demonstrate that liposuction preserves the microvascular network. Indeed, a low percentage of endothelial cells was found in AT from liposuction and we confirm the persistence of microvessels in the tissue after liposuction

Published
2015
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30. Safe monsplasty technique

Author

Antoine De Runz, Audrey Patoué, S. Aillet, Raphael Carloni, Nicolas Bertheuil, Eric Watier, CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), CHU Rouen, Normandie Université (NU), Microenvironnement et cancer (MiCa), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), and Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, medicine.medical_specialty, Esthetics, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Bariatric Surgery, 030230 surgery, Patient Positioning, bodylift, Cohort Studies, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Weight loss, plastic surgery, Weight Loss, pubic lift, Medicine, Humans, Surgery, Plastic, Mons pubis, Pubic Bone, Retrospective Studies, mons pubis, Abdominoplasty, business.industry, Monsplasty, Middle Aged, Body Contouring, 3. Good health, Surgery, Obesity, Morbid, Plastic surgery, medicine.anatomical_structure, Patient Satisfaction, Quality of Life, Female, abdominoplasty, Patient Safety, medicine.symptom, business
Abstract

International audience; Introduction - To improve their health and quality of life, obese patients undergo consultation after weight loss. In these patients, the sub-umbilical abdominal and pubic regions are often characterized by redundant skin, creating aesthetic and functional discomfort. Monsplasty is an important step in abdominoplasty or bodylift procedures. We report on an original technique used to correct deformity in the pubic region following weight loss. Methods - All interventions were performed by the same surgeon between April and December 2015. On stretched skin, we drew two lines 5 cm lateral to the median line on both sides and connected them with the arc of a circle placed 7 cm from the vulvar fork. Then, monsplasty marks extend to abdominal fold. During lower abdominal contouring, we performed monsplasty with three separate stitches between the camper fascia and aponeurosis of the abdominal muscle. The aim was to bring tension to the pubic region without additional surgical procedure. Results - We report on 21 consecutive cases of monsplasty following lower trunk contouring. No reoperation was performed due to complication or aesthetic demand (no under- or over-correction occurred). No complication (e.g. edema, seroma, disturbance of sensibility) was observed in the pubic area. The results were stable 1 year after surgery. Conclusions - We report on a simple, rapid, and reproducible monsplasty technique for all stages of Pittsburgh classifications, which achieved favorable results with no complication. We recommend performance of this effective technique simultaneously with abdominoplasty or bodylift procedures. Level of evidence - IV.

Published
2018
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31. Outpatient Circumferential Lower Body Lift: Is the Lipo-Body Lift an Ideal Method?

Author

Nicolas Bertheuil, Eric Watier, Isabelle Pluvy, Marie Panouilleres, Benoit Chaput, D. Feuvrier, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Rangueil, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], Etablissement français du sang [Rennes] (EFS Bretagne), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Lower body, Lift (data mining), business.industry, Mechanical engineering, Medicine, Surgery, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030230 surgery, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2018
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32. Quality-of-Life Assessment after Medial Thighplasty in Patients following Massive Weight Loss

Author

Sophie Thienot, Nicolas Bertheuil, Audrey Varin, Eric Watier, and Benoit Chaput

Subjects
Adult, Male, medicine.medical_specialty, Thigh, Quality of life, Weight loss, Surveys and Questionnaires, Weight Loss, Humans, Medicine, In patient, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Middle Aged, Plastic Surgery Procedures, medicine.disease, Obesity, Surgery, medicine.anatomical_structure, Sex life, Quality of Life, Female, medicine.symptom, business, Body mass index
Abstract

Background The improvement of medial thighplasty techniques has greatly reduced the morbidity of these interventions and participated in their democratization among surgeons and patients. The aim of this study was to evaluate the beneficial effect of medial thighplasty on quality of life in patients following massive weight loss. Methods The quality of life following massive weight loss after diet or bariatric surgery of 21 patients was measured using the Moorehead-Ardelt Quality of Life Questionnaire. Patients who underwent medial thighplasty following a percentage of weight loss greater than 20 percent of the body weight were included. Results The mean age of the patients was 49.9 ± 8.7 years. The average pre-medial thighplasty body mass index was 28.4 ± 4.8 kg/m and the average weight loss before surgery was 46 ± 17.1 kg. In our study, medial thighplasty improved the quality of life of patients (mean quality-of-life scores, 1.49 ± 1.3; e.g., self-esteem, physical status, social life, and improved labor conditions of patients). However, the quality of the sex life of the patient was not improved by this operation. No difference was found in quality-of-life results between patients according to the number of months since they had undergone surgery (p = 0.7252). Conclusions Medial thighplasty improves the aesthetic and functional outcome of the thigh. The authors report, for the first time, that medial thighplasty improves quality of life of patients with massive weight loss. With the worldwide development of obesity, this study demonstrated that the operation should be widely proposed to patients with massive weight loss to improve quality of life. Clinical question/level of evidence Therapeutic, V.

Published
2015
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33. Postero-Inferior Pedicle Surgical Technique for the Treatment of Grade III Gynecomastia

Author

Sophie Thienot, Cécile Meal, Nicolas Bertheuil, R. Carloni, S. Aillet, Christian Herlin, Eric Watier, Etablissement français du sang [Rennes] (EFS Bretagne), Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Department of Plastic and Craniofacial Pediatric Surgery, Hôpital Lapeyronie [Montpellier] (CHU), chirurgie plastique, reconstructrice et esthétique, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Male, medicine.medical_treatment, Mammaplasty, 030230 surgery, Severity of Illness Index, Surgical Flaps, Body Mass Index, Cohort Studies, 030207 dermatology & venereal diseases, 0302 clinical medicine, skin and connective tissue diseases, Areola, health care economics and organizations, Graft Survival, Middle Aged, Plastic surgery, medicine.anatomical_structure, Treatment Outcome, Gynecomastia, Patient Satisfaction, 030220 oncology & carcinogenesis, Nipples, [SDV.IMM]Life Sciences [q-bio]/Immunology, France, Mastectomy, Adult, musculoskeletal diseases, medicine.medical_specialty, Esthetics, education, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, Risk Assessment, 03 medical and health sciences, Young Adult, Lipectomy, medicine, Humans, Retrospective Studies, Wound Healing, business.industry, Plastic Surgery Procedures, medicine.disease, Neurovascular bundle, Surgery, Transplantation, stomatognathic diseases, Otorhinolaryngology, Liposuction, business
Abstract

Surgical treatment of Grade III gynecomastia generally utilizes mastectomy techniques and free transplantation of the nipple–areola complex. Moreover, with rising obesity rates and the development of bariatric surgery, an increasing demand for correctional surgery for pseudogynecomastia has been observed, which is comparable to Grade III gynecomastia in terms of its surgical management. Here, we describe an innovative technique to deal with these new demands: fascio-cutaneous flap by postero-inferior pedicle. All patients in the Department of Plastic Surgery from our University Hospital suffering from Grade III gynecomastia or pseudogynecomastia underwent surgery via the postero-inferior pedicle flap technique. Briefly, we performed extensive liposuction of the infero-internal and infero-external mammary quadrants followed by liposuction of the deep tissues of the superior quadrants, except in the area of the pedicle. After removing the skin just above the dermis of the inferior quadrants and performing de-epithelialization of the postero-inferior pedicle flap, the thoracic flap was lowered and the areola transposed. Nine patients underwent surgery between March 2015 and March 2016, and their results were collected prospectively. The mean patient age was 46.6 years, the mean weight was 94.2 kg, and the mean body mass index was 30.8 kg/m2. In addition, the mean operative time was 132 min, the mean liposuction volume was 633 mL, the excised weight was 586 g, and the mean hospitalization and drainage durations were 3.8 days. No major complications occurred, no re-intervention was required, and no recurrence was found. We report a new operative technique using a postero-inferior pedicle. Its main advantage is preservation of neurovascular function, which makes this a promising technique for patients who wish to maintain nipple sensitivity. This surgery is reliable and reproducible. We recommend it as the first line treatment for Grade III gynecomastia because of its low rate of major complications and favorable functional and esthetic results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Published
2017
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35. Modified Lipoabdominoplasty: Updating Concepts-Our Postbariatric Experience

Author

Raphael Carloni, Christian Herlin, Nicolas Bertheuil, Eric Watier, Audrey Patoué, Benoit Chaput, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], Department of Plastic and Craniofacial Pediatric Surgery, Hôpital Lapeyronie [Montpellier] (CHU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] (EFS Bretagne), Centre Hospitalier Universitaire de Rangueil, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Information retrieval, business.industry, Abdominoplasty, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Lipectomy, 030220 oncology & carcinogenesis, Humans, Medicine, Surgery, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience; no abstract

Published
2017
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36. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia

Author

Eric Watier, Nicolas Bertheuil, M Gérard, M Robert, Vincent Dellière, Y Harnois, and Sophie Thienot

Subjects
medicine.medical_specialty, necrotizing fasciitis, medicine.medical_treatment, Perforation (oil well), lcsh:Surgery, Necrotising fasciitis, Case Report, negative pressure large wound therapy, Descending colon, Abdominal wall, liposuction, medicine, Fasciitis, Septic shock, business.industry, Bowel perforation, lcsh:RD1-811, medicine.disease, digestive system diseases, Surgery, lumbar hernia, medicine.anatomical_structure, Liposuction, Complication, business
Abstract

We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.

Published
2014
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37. Quality of life and female sexual function after skinning vulvectomy with split-thickness skin graft in women with vulvar intraepithelial neoplasia or vulvar Paget disease

Author

Eric Watier, Karine Morcel, Sébastien Henno, Jean Levêque, Habiba Mesbah, A. Lemarrec, Vincent Lavoué, N. Bertheuil, Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], CRLCC Eugène Marquis (CRLCC), Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], Service d'anatomie et cytologie pathologiques [Rennes] = Anatomy and Cytopathology [Rennes], and Le Corre, Morgane

Subjects
MESH: Sexual Behavior, medicine.medical_treatment, MESH: Paget Disease, Extramammary, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, MESH: Aged, education.field_of_study, MESH: Middle Aged, 030219 obstetrics & reproductive medicine, Vulvar Neoplasms, Incidence (epidemiology), Skin Transplantation, General Medicine, Middle Aged, Vulvar Paget disease, 3. Good health, Paget Disease, Extramammary, Oncology, 030220 oncology & carcinogenesis, Vulvectomy, Population study, Female, MESH: Neoplasm Recurrence, Local, Carcinoma in Situ, Adult, Skin graft, medicine.medical_specialty, Sexual Behavior, Population, Disease-Free Survival, 03 medical and health sciences, Vulvar intraepithelial neoplasia, medicine, Humans, education, Aged, Retrospective Studies, MESH: Carcinoma in Situ, MESH: Humans, business.industry, MESH: Questionnaires, MESH: Quality of Life, MESH: Adult, MESH: Retrospective Studies, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Retrospective cohort study, medicine.disease, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, MESH: Vulvar Neoplasms, Surgery, MESH: Disease-Free Survival, MESH: Skin Transplantation, Neoplasm Recurrence, Local, Sexual function, business, MESH: Female
Abstract

International audience; OBJECTIVE: Vulvar intraepithelial neoplasia (VIN) and vulvar Paget disease are managed with either vulvectomy, destructive treatments (laser, antimitotic drugs) or immunostimulants. All these options are associated with functional complications. The purpose of this study was to evaluate the surgical technique consisting of skinning vulvectomy with split-thickness skin graft, and its effect on overall quality of life and sexual function. METHODS: A retrospective study was conducted on thirteen patients who underwent skinning vulvectomy with split-thickness skin graft between 1999 and 2009. Overall quality of life and sexual function were assessed with the Medical Outcome Study Short Form 36 (MOS SF-36) and Female Sexual Function Index (FSFI), respectively. RESULTS: The median age of patients was 54 (range: 33-77) years. Three patients had Paget disease and 10 patients had VIN lesions. The excision margins were clear in 46% of cases. The incidence of occult cancer was 31%. The mean follow-up period was 77 (±35) months. Four patients experienced a relapse of their intraepithelial disease. The mean disease-free survival was 58 (±44) months. There was no significant difference in MOS SF-36 scores between the study population and the general population. The patients assessed with the FSFI regained normal sexual function after the surgical procedure. CONCLUSION: Skinning vulvectomy with split-thickness skin graft is a feasible technique yielding good results in terms of quality of life and sexual function. It enables occult cancer to be diagnosed in patients with VIN or Paget disease.

Published
2013
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38. Contribution of Lower Body Lift in the Correction of Medial Thigh Deformity following Massive Weight Loss

Author

Eric Watier, Paul Girard, Benoit Chaput, Nicolas Bertheuil, Antoine De Runz, Raphael Carloni, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Lift (data mining), business.industry, Dermatologic Surgical Procedures, [SDV.CAN]Life Sciences [q-bio]/Cancer, Anatomy, Plastic Surgery Procedures, 030230 surgery, Medial compartment of thigh, 03 medical and health sciences, 0302 clinical medicine, Lower body, Lipectomy, Thigh, Weight loss, 030220 oncology & carcinogenesis, Weight Loss, medicine, Deformity, Humans, Surgery, medicine.symptom, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience; [No abstract available]

Published
2017
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39. Comments on 'What is Wrong With Systematic Reviews and Meta-Analyses: If You Want the Right Answer, Ask the Right Question!'

Author

Eric Watier, Nicolas Bertheuil, Raphael Carloni, and Florian Naudet

Subjects
medicine.medical_specialty, Evidence-Based Medicine, business.industry, Alternative medicine, Subject (documents), General Medicine, Evidence-based medicine, 030230 surgery, Clinical Practice, 03 medical and health sciences, 0302 clinical medicine, Systematic review, Ask price, medicine, Humans, Surgery, Engineering ethics, 030212 general & internal medicine, business, Research question, Lower trunk
Abstract

We read with great interest the recently published Evidence Based Medicine (EBM) Hub article entitled “What is Wrong With Systematic Reviews and Meta-Analyses: If You Want the Right Answer, Ask the Right Question!” by Thoma and Eaves.1 We agree with most of the comments on the limitations of our study.2 Indeed, their didactic article drew attention to important methodologies that need to be adopted when appraising systematic reviews and meta-analyses. These methodologies allow non-statisticians to become more familiar with such papers, which are being published with increasing frequency in plastic surgery journals. For every scientific paper, it is important to be able to understand the research question, and to identify shortcomings in the methods used to generate the results; doing so might be useful for clinical practice or further research. Thoma and Eaves1 provide guidance for novice plastic surgeons, who want to perform a meta-analysis on a specific subject, on how to improve their methodology and choose the right research question before starting a large-scale, time-consuming study. This would avoid the wasted effort associated with not asking an appropriate research question. As an example, they argue that our research question “What are the rates and potential predictive risk factors for complications in circumferential contouring of the lower trunk?” was not completely …

Published
2017

40. The Lipo-Body Lift: A New Circumferential Body-Contouring Technique Useful after Bariatric Surgery

Author

Eric Watier, Antoine De Runz, Nicolas Bertheuil, Benoit Chaput, Paul Girard, Raphael Carloni, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Etablissement français du sang [Rennes] (EFS Bretagne), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), and Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
2. Zero hunger, medicine.medical_specialty, business.industry, Wound dehiscence, medicine.medical_treatment, [SDV.CAN]Life Sciences [q-bio]/Cancer, Perioperative, 030230 surgery, medicine.disease, 3. Good health, Surgery, 03 medical and health sciences, 0302 clinical medicine, Hematoma, Weight loss, 030220 oncology & carcinogenesis, Liposuction, Body contouring, medicine, Fat necrosis, medicine.symptom, business, Body mass index
Abstract

International audience; Background: After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo-body lift method. The authors describe their experience with this novel, safe procedure. Methods: Twenty-five abdominal body-contouring reconstructions following massive weight loss were treated by means of circumferential lipo-body lift. The authors describe the indications for the procedure and their perioperative and postoperative management. Results: The mean patient age was 39.4 years. The mean pre-body lift body mass index was 26.71 kg/m2; the average weight loss before surgery was 56.6 kg, with a mean delta body mass index loss of 20.82 kg/m2. The average hospital stay was 3.52 days and the drainage duration 3.56 days. No patient experienced any major complication (e.g., hematoma, thromboembolism, bleeding, skin necrosis, or a need for revision surgery to treat complications). Minor complications including wound dehiscence, wound infection, and fat necrosis were reported in 40 percent of patients. The occurrence of complications was associated with smoking status (p = 0.0280), the volume of liposuction (p = 0.0399), and the liposuction volume per unit of body mass index (p = 0.0071). Conclusions: The authors' novel technique is less invasive than the traditional lower body-lifting method, as shown by the absence of major complications, and allows excellent conservation of connective tissue and vessels; undermining is minimal. As obesity becomes a major problem worldwide, lifting procedures that are safe and effective are important components of reconstructive strategies and should be widely offered to patients who experience massive weight loss. Copyright © 2016 American Society of Plastic Surgeons.

Published
2017
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41. Scalp Tissue Expansion Above a Custom-Made Hydroxyapatite Cranial Implant to Correct Sequelar Alopecia on a Transposition Flap

Author

Eric Watier, Nicolas Bertheuil, R. Carloni, Benoit Chaput, Christian Herlin, Antoine De Runz, Hôpital Charles Nicolle [Rouen], CHU Pontchaillou [Rennes], Hôpital Lapeyronie [Montpellier] (CHU), STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Pratiques professionnelles : aspects méthodologiques, éthiques et juridiques (ETHOS), Université de Lorraine (UL), Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], Microenvironnement et cancer (MiCa), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] (EFS Bretagne), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Male, Skin Neoplasms, medicine.medical_treatment, Surgical Flaps, MESH: Transposition flap, 0302 clinical medicine, Medicine, Soft tissue, Prostheses and Implants, Skin Transplantation, Cranioplasty, Calvarial reconstruction, 3. Good health, medicine.anatomical_structure, Head and Neck Neoplasms, 030220 oncology & carcinogenesis, MESH: Tissue, Transposition flap, MESH: Alopecia, Craniotomy, Adult, medicine.medical_specialty, Skull Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Calvarial reconstruction, Resection, Prosthesis Implantation, 03 medical and health sciences, MESH: expansion, Humans, Neoplasm Invasiveness, Scalp, business.industry, Dermatofibrosarcoma, Skull, Alopecia, Plastic Surgery Procedures, Vertex (anatomy), Surgery, Durapatite, Tissue expansion, MESH: Cranioplasty, Neurology (clinical), Implant, business, 030217 neurology & neurosurgery, Cranial implant
Abstract

International audience; Background:Resection of cranial tumors involving both bone and scalp tissue may require the recruitment of soft tissue using a flap above the bone reconstruction. When a transposition flap has been chosen, the alopecia zone on the donor site may be difficult to treat afterward. Scalp expansion is the gold standard in these situations, but this has never been described above cranial implants. We report the first case of a patient who underwent a scalp tissue expansion above a custom-made hydroxyapatite cranial implant to correct sequelar alopecia.Case Description: A 30-year-old man presented with a dermatofibrosarcoma of the scalp with bone invasion. A cranioplasty with a custom-made hydroxyapatite implant and a transposition flap were performed. Although healing was achieved, the donor site of the transposition flap left a 9 × 13 cm sequelar alopecia area on the vertex. To correct it, a rectangular 340-cm3 expander was partially placed above the cranial implant and under the transposition flap. A second 120-cm3 expander was put on the contralateral temporal region. The expansion was successful. No expander infection, cranial implant displacement, or fracture on imaging performed during the follow-up period was detected. The alopecia zone was entirely excised. The patient was very satisfied with the cosmetic result.Conclusions: Tissue expansion above hydroxyapatite implants may be of concern to the physician because of the risk of infection and rupture of the cranial implant. With this clinical case, we emphasize some precautions to prevent these issues.

Published
2016
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42. Are There Factors Predictive of Postoperative Complications in Circumferential Contouring of the Lower Trunk? A Meta-Analysis

Author

Antoine De Runz, Raphael Carloni, Christian Herlin, Florian Naudet, Nicolas Bertheuil, Paul Girard, Eric Watier, Benoit Chaput, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Rangueil, Department of Plastic and Craniofacial Pediatric Surgery, Hôpital Lapeyronie [Montpellier] (CHU), Médialab (Sciences Po) (Médialab), Sciences Po (Sciences Po), Microenvironnement et cancer (MiCa), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] (EFS Bretagne), STROMALab, Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), médialab (Sciences Po) (médialab), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), and Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, massive-weight-loss, Breast surgery, medicine.medical_treatment, Belt lipectomy, bariatric surgery, [SDV.CAN]Life Sciences [q-bio]/Cancer, lower-body lift, Cosmetic Techniques, 030230 surgery, outcomes, Risk Assessment, autologous gluteal augmentation, law.invention, 03 medical and health sciences, 0302 clinical medicine, Hematoma, Postoperative Complications, Randomized controlled trial, Weight loss, law, Risk Factors, Weight Loss, medicine, Humans, consecutive abdominoplasties, risk-factors, business.industry, Torso, General Medicine, breast surgery, Plastic Surgery Procedures, medicine.disease, belt lipectomy, 3. Good health, Surgery, loss patient, Treatment Outcome, 030220 oncology & carcinogenesis, Meta-analysis, medicine.symptom, Complication, Risk assessment, business
Abstract

Background The massive weight loss patient may require a circumferential contouring of the lower trunk. Objectives To summarize the complication rates and explore the possibility of predictive risk factors for complications. Methods We performed a systematic review using the PubMed and Cochrane databases to identify published articles on the topic. Random effects meta-analyses and meta-regression were conducted to synthesize the data gathered. Results The analysis included 28 studies and 1380 patients. All but one were retrospective cohorts or case studies. Circumferential contouring of the lower trunk resulted in 37% [95%-CI 30%; 44%] overall complications; 17% [95%-CI 12%; 24%] wound dehiscences; 4% [95%-CI 3%; 5%] skin necrosis; 5% [95%-CI 3%; 9%] infections; 3% [95%-CI 2%; 4%] hematomas; 13% [95%-CI 9%; 18%] seromas; 12% [95%-CI 7%; 21%] scar irregularities; 3% [95%-CI 2%; 5%] thromboembolism; and 5% [95%-CI 3%; 8%] revisions for complications. Lower body lift-related techniques were associated with a higher rate of overall complications than belt lipectomy-related techniques ( P = .002). No difference in complication rate was shown when performing a gluteal augmentation with flap. Due to insufficient data reported in the studies, risk factors for postoperative complications could not be assessed. Conclusions The whole literature provides very low reliable information. Confusion factors could not be ruled out to explain the increased complications rate for the lower body lift compared to the belt lipectomy. This finding needs to be confirmed in randomized trials. Collaborative efforts must be made to improve the evidence level of our practices and to serve patients in an optimal way. Level of Evidence 3 ![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gif

Published
2016
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43. Eyelid fat grafting: indications, operative technique and complications; a systematic review

Author

Benoit Chaput, Antoine De Runz, Bruno Mortemousque, Raphael Carloni, Christian Herlin, Frédéric Mouriaux, Sahar Bannani, Eric Watier, Nicolas Bertheuil, Elodie Boureaux, Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Centre Hospitalier Universitaire de Rangueil, Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pontchaillou [Rennes], Université de Rennes 1 - Faculté de Médecine (UR1 Médecine), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Microenvironnement et cancer (MiCa), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] (EFS Bretagne), STROMALab, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Rennes - Faculté de Médecine (UR Médecine), Université de Rennes (UR), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), and Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, fat transplantation, Facial rejuvenation, Grafting (decision trees), [SDV]Life Sciences [q-bio], Physical examination, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030230 surgery, Transplantation, Autologous, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, facial rejuvenation, medicine, Humans, Prospective Studies, Retrospective Studies, adipose-derived stem cell, Protocol (science), medicine.diagnostic_test, business.industry, cosmetic surgery, Eyelids, Plastic Surgery Procedures, lipofilling, 3. Good health, Surgery, Eyelid, medicine.anatomical_structure, Systematic review, Adipose Tissue, Otorhinolaryngology, Patient Satisfaction, Tissue and Organ Harvesting, 030221 ophthalmology & optometry, Oral Surgery, Complication, business, fat grafting
Abstract

International audience; Introduction - Many recent studies concerning autologous fat grafting in the eyelids have been published, mostly consisting of case reports and retrospective case series. However, no study on the overall complication or satisfaction rate associated with the various grafting techniques exists. We performed a comprehensive literature review to determine the outcomes and complications of eyelid fat grafting, as well as patient satisfaction.Methods - A systematic review of the literature using the PRISMA criteria was conducted. This protocol was registered at the Prospective Register of Systematic Reviews at the National Institute for Health Research.Results - Sixteen studies, representing 1,159 patients and published between June 2004 and December 2014, were included. Satisfactory results, judged by clinical examination, were observed in all studies. Few postoperative complications were reported.Conclusions - We demonstrated that the procedures were easy to perform, and achieved satisfactory and sustainable results with few complications in both reconstructive and cosmetic surgery. However, a wide disparity exists in the various fat harvesting, fat purification, and reinjection techniques. Further studies are required to assess the long-term outcomes. Our conclusions should be accepted cautiously due to the small number of articles and the lack of evidence in published studies.

Published
2016
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44. Knee Dermolipectomy: A Simple Operation With Significant Functional Improvement

Author

Nicolas Bertheuil, Eric Watier, Vincent Huguier, S. Aillet, and M. Beuzeboc

Subjects
medicine.medical_specialty, medicine.diagnostic_test, biology, business.industry, Physical examination, Recovery of Function, Evidence-based medicine, biology.organism_classification, Static disorder, Genu Valgum, Surgery, Plastic surgery, Valgus, Lipectomy, Otorhinolaryngology, Quality of life, medicine, Physical therapy, Humans, Female, Knee, Obesity, business, Aged
Abstract

Obesity is a major public health problem in Western societies. It may lead to difficulties in daily life that have an impact on quality of life and create psychological disorders. After failure of diet and exercise, patients can undergo bariatric surgery, but some obese patients are not motivated to undergo a bariatric procedure. For such patients, plastic surgeons can correct some excess fat to improve their quality of life. This report describes an original technique for correcting the excess fat at the medial part of the knees to regain a normal walking perimeter. A 68-year-old woman was admitted to the authors’ center for correction of a functional walking disorder. Indeed, her clinical examination found a static disorder, with a valgus knee morphotype related to a major excess of skin and fat in the medial part of the knees. She underwent a knee dermolipectomy to obtain a solely functional result. No complications were observed in the woman’s postoperative course. At this writing, the result is stable 18 months after the surgical procedure, with a minimal visible scar hidden in the internal face of the knees. The woman has experienced a loss of her genu valgum and regained a walking distance longer than 1 km. She also has lost 10 kg of weight. Knee dermolipectomy is a simple procedure with good results and few complications that improves the quality of life for obese patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Published
2012
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45. Exérèse des nævus congénitaux géants : jusqu’où aller avec la chirurgie ?

Author

J.-L. Heusse, Eric Watier, G. Verhoest, S. Aillet, and S. Cousin-Verhoest

Subjects
030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Surgery, 3. Good health
Abstract

Resume L’exerese des naevus congenitaux geants (NCG) est preconisee de principe pour des raisons dermatologiques. Leur risque de degenerescence en melanome est reel, mais son incidence est largement discutee. Leur exerese represente un defi chirurgical, mais elle est aussi un veritable parcours du combattant pour l’enfant et sa famille. Les rancons cicatricielles et les retombees psychologiques peuvent etre importantes. Une exerese incomplete pour limiter ces sequelles esthetiques et alleger le parcours chirurgical peut-elle etre acceptable ? Nous presentons le cas d’un enfant atteint d’un NCG de l’extremite cephalique dont l’exerese a ete partielle. Une revue de la litterature sur le risque degeneratif des NCG nous a permis de constater que celui-ci a tendance a etre surestime. Les avantages et inconvenients a pratiquer une exerese preventive, precoce et complete des NCG sont abordes. Nous discutons la possibilite de recourir a une exerese partielle dans certains cas delicats de reconstruction sous couvert d’une surveillance dermatologique stricte et rapprochee.

Published
2012
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46. Reply

Author

Paul Girard, Benoit Chaput, Eric Watier, Raphael Carloni, Antoine De Runz, and Nicolas Bertheuil

Subjects
Lift (force), 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, business.industry, 030220 oncology & carcinogenesis, Medicine, Surgery, 030230 surgery, business, Marine engineering
Published
2017
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47. Surgical management of subcutaneous fat necrosis of the newborn required due to a lack of improvement: a very rare case

Author

S. Aillet, V. Delliere, Eric Watier, Nicolas Bertheuil, M. Beuzeboc Gérard, and Sophie Thienot

Subjects
Reoperation, Back, medicine.medical_specialty, Necrosis, Hypercalcaemia, business.industry, Infant, Newborn, Subcutaneous Fat, Calcinosis, Nodule (medicine), Dermatology, Hypothermia, medicine.disease, Surgery, medicine, Humans, Subcutaneous fat necrosis of the newborn, Female, Fat necrosis, Fat Necrosis, medicine.symptom, business, Complication, Perfusion
Abstract

Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon and transient disease characterized by defined areas of fat necrosis and overlying cutaneous nodule lesions. It usually becomes apparent within the first 6 weeks of life in full-term or post-term infants. It is caused by generalized and/or local tissue hypoperfusion. The skin lesions of ScFN tend generally to improve spontaneously in a few weeks. We present a full-term newborn with birth distress. After therapeutic hypothermia, she presented voluminous and numerous subcutaneous fat necrosis with extensive calcifications. Surgical management was decided at her ninth month because of a total lack of regression. Hypercalcaemia, the most threatening complication, appeared only after this delayed surgery.

Published
2014
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48. Mise au point sur les techniques de nymphoplastie de réduction

Author

S. Cousin-Verhoest, S. Aillet, Eric Watier, and J.-L. Heusse

Subjects
Gynecology, medicine.medical_specialty, business.industry, Treatment outcome, Medicine, Surgery, business, Resection
Abstract

Resume Le but de cette etude est d’apprecier le retentissement psychologique et fonctionnel de l’hypertrophie des petites levres genitales. L’analyse de la litterature, a travers les differentes methodes chirurgicales connues a ce jour, nous a conduit a modifier notre approche technique. Patientes et methodes D’aout 2004 a juin 2007, nous avons opere 14 patientes par une technique de resection en secteur posterieur associee a une plastie en Z. Il s’agit d’une etude retrospective s’appuyant sur un questionnaire adresse a chaque patiente qui precise les motifs de consultation et leur degre de satisfaction vis-a-vis de l’intervention. Resultats Parmi les 12 patientes ayant repondu au questionnaire, la majorite etait satisfaite, voire tres satisfaite, tant sur le plan morphologique que fonctionnel et aucune d’entre-elles ne regrettait l’intervention. Discussion Nous assistons a une incidence croissante des demandes de correction morphologique vulvaire, que se soit pour des preoccupations esthetiques et/ou fonctionnelles. Sur le plan technique, la resection en secteur nous semble la plus satisfaisante. L’adjonction d’une plastie en Z avec le placement posterieur de la cicatrice previendrait, en outre, les dyspareunies et le risque de dechirure perpartum. Conclusion Au total, cette etude clinique preliminaire a permis de faire le point sur les differentes techniques de nymphoplastie de reduction, de mieux definir les attentes des patientes et, enfin, de valider notre technique.

Published
2009
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49. Dynamics of Gluteal Cleft Morphology in Lower Body Lift: Predictors of Unfavorable Outcomes

Author

Isabelle Auquit-Auckbur, Nicolas Bertheuil, Eric Watier, Benoit Chaput, and Raphael Carloni

Subjects
medicine.medical_specialty, business.industry, 030230 surgery, Surgical Flaps, Surgery, Lift (force), 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Lower body, 030220 oncology & carcinogenesis, medicine, Buttocks, Humans, business
Published
2016

50. Lower Body Lift after Massive Weight Loss: Autoaugmentation versus No Augmentation

Author

Nicolas Bertheuil, Eric Watier, Raphael Carloni, Christian Herlin, Benoit Chaput, Etablissement français du sang [Rennes] (EFS Bretagne), Service de chirurgie plastique, reconstructive et esthétique, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, STROMALab, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Microenvironnement et cancer (MiCa), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Department of Plastic and Craniofacial Pediatric Surgery, Hôpital Lapeyronie [Montpellier] (CHU), Centre Hospitalier Universitaire de Rangueil, Service de chirurgie plastique, reconstructive et esthétique [Rennes] = Cosmetic Reconstructive and Plastic surgery [Rennes], CHU Pontchaillou [Rennes], Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement Français du Sang-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Etablissement Français du Sang-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], 030230 surgery, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Lower body, Patient satisfaction, Weight loss, Weight Loss, medicine, Humans, Buttocks, ComputingMilieux_MISCELLANEOUS, Lift (data mining), business.industry, Plastic Surgery Procedures, medicine.anatomical_structure, Patient Satisfaction, 030220 oncology & carcinogenesis, Physical therapy, Female, Surgery, medicine.symptom, business
Abstract

International audience; no abstract

Published
2016
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