Annales De Chirurgie Plastique Esthetique最新文献

{"title":"Anatomie de la région frontale","authors":"C. Vacher , G. Rosano , L. Nokovitch","doi":"10.1016/j.anplas.2024.06.015","DOIUrl":"10.1016/j.anplas.2024.06.015","url":null,"abstract":"<div><div>La région frontale est une région anatomique limitée en haut par la ligne d’implantation des cheveux, en bas par les sourcils et la glabelle et latéralement par le bord antérieur des fosses temporales. Sa situation verticale, due à la croissance du télencéphale, est caractéristique de l’espèce humaine. De la superficie à la profondeur, il est décrit dans cet article d’abord la peau et les tissus sous-cutanés qui présentent des compartiments adipeux. Le plan musculaire est représenté surtout par les muscles frontaux élévateurs de la peau du front et des sourcils et les muscles abaisseurs de la peau du front et du sourcils qui sont de la superficie à la profondeur les muscles <em>procerus</em> et orbiculaires de l’œil, puis le muscle abaisseur du sourcil, puis le muscle corrugateur du sourcil. La galea aponévrotique située sous les muscles frontaux est une lame fibreuse qui reçoit à sa périphérie les insertions musculaires des muscles du crâne. Le périoste est adhérent à l’os frontal qui présente un dimorphisme sexuel. Chez l’homme, le front est plat avec des rebords orbitaires supérieurs accentués alors que chez la femme le front est galbé et l’os frontal ne présente pratiquement pas de rebords orbitaires supérieurs. La vascularisation est formée par un pédicule antérieur constitué essentiellement par les artères supra-orbitaires et supra-trochléaires, qui sont des branches de l’artère ophtalmique, et leurs veines satellites et un pédicule latéral formé par les branches antérieures de l’artère et de la veine temporale superficielle. L’innervation sensitive provient du nerf ophtalmique (de Whillis) qui donne le nerf frontal, le nerf naso-ciliaire et le nerf lacrymal. L’innervation motrice est assurée par le rameau temporal du nerf facial qui après être passé latéralement par rapport à l’arcade zygomatique chemine dans l’espace épicrânien et innerve le muscle frontal et les muscles <em>corrugator</em> et <em>procerus</em>.</div></div><div><div>The forehead is an anatomic region located between the frontal hairline cranially, the eyebrow and the glabella caudally, and the anterior border of the temporal fossa laterally on both sides. Its vertical situation, due to the telencephalon growth, is specific of the human species. From surface to deep planes, the skin and sub-cutaneous fat pads are described first. The muscular plane is constituted of the frontal muscles elevators of the forehead and the eyebrow, and the depressors which are the procerus and orbicularis oculi muscles superficially, the depressor supercilii muscle, and the corrugator supercilii in a deep plane. The galea aponeurotica, located deep to the frontal muscles, is a fibrous lamina on which the muscles of the skull insert. There is a sexual dimorphism of the frontal bone. The male forehead has extensive supraorbital bossing, and above this there is often a flat area, in teh femalethe supraorbital bossing is often nonexistent and above, there is a continous mild curvature. B","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":"69 6","pages":"Pages 482-488"},"PeriodicalIF":0.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Techniques chirurgicales avancées dans la féminisation du front et la redéfinition de la ligne des cheveux chez les patientes transgenres","authors":"I.L. Labrot-Moreno,&nbsp;L. Capitán,&nbsp;D. Simon,&nbsp;F. Capitán-Cañadas","doi":"10.1016/j.anplas.2024.06.014","DOIUrl":"10.1016/j.anplas.2024.06.014","url":null,"abstract":"<div><div>Facial Gender-Affirming Surgery (FGAS) has emerged as a transformative option for individuals who wish to align their external appearance with their asserted gender identity. This article delves into the surgical techniques employed in forehead feminization and hairline redefinition, highlighting the nuanced approaches used to modify specific facial characteristics to achieve the desired feminizing outcomes. Our extensive experience, encompassing over 2300 forehead feminization surgeries conducted over the past 16 years, provides a robust foundation for understanding the complexities and intricacies of these procedures. This knowledge is crucial for maxillofacial and plastic surgeons, as well as other healthcare professionals involved in comprehensive gender-affirming care, ensuring they are well-equipped to deliver optimal results for their patients.</div></div>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":"69 6","pages":"Pages 634-640"},"PeriodicalIF":0.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les brûlures du front","authors":"D. Voulliaume,&nbsp;P. Curings,&nbsp;M. Vantomme,&nbsp;G. Henry,&nbsp;R. Bayoux,&nbsp;C. Barani","doi":"10.1016/j.anplas.2024.06.021","DOIUrl":"10.1016/j.anplas.2024.06.021","url":null,"abstract":"<div><div>Les brûlures graves du front sont rares ; un traitement chirurgical initial bien conduit limite par ailleurs l’apparition des séquelles. Les indications de réparation du front sont donc le fait de brûlures complexes souvent étendues aux unités adjacentes. Les techniques de réparation dépendent de la localisation et de la taille des lésions, de l’atteinte voisine associée, et de la capacité du patient à supporter la lourdeur du traitement. La prise en charge au stade aigu conditionne les séquelles ; l’excision-greffe dermoépidermique est le traitement de référence mais il ne donne de bons résultats que si les principes fondamentaux de la réparation sont respectés : délai d’intervention entre le 10^e et 15^e jour post-brûlure, prélèvement des greffes à l’extrémité céphalique ou à la partie supérieure du thorax et des bras, respect de l’unité frontale. La prise en charge des séquelles répond aux mêmes impératifs et nécessite en règle une expansion cutanée : expansion frontale pour réalisation de lambeaux cutanés s’il persiste assez de peau frontale disponible, expansion thoracique haute pour réalisation de greffes de peau totale si la cicatrice frontale est trop étendue. Les excellents résultats obtenus ne doivent cependant pas faire oublier les contraintes importantes liées à l’expansion cutanée. Les techniques alternatives sont peu nombreuses et donnent des résultats inconstants.</div></div><div><div>Severe burns on the forehead are rare; well-conducted initial surgical treatment also limits the occurrence of sequelae. Therefore, indications for repairing the forehead arise from complex burns often extending to adjacent units. Repair techniques depend on the location and size of the lesions, associated nearby damage, and the patient's ability to withstand the burden of treatment. Management at the acute stage determines the sequelae; excision-grafting is the standard treatment, but it yields good results only if the fundamental principles of repair are respected: intervention within the 10th and 15th days post-burn, graft harvesting from the cephalic extremity or the upper part of the thorax and arms, and respect for the frontal unit. Sequelae management follows the same imperatives and typically requires skin expansion: front expansion for skin flaps if enough frontal skin is still available, upper thorax expansion for full thickness skin grafts if the frontal scar is too extensive. However, the excellent results obtained should not conceal the significant constraints associated with skin expansion.</div></div>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":"69 6","pages":"Pages 570-579"},"PeriodicalIF":0.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le front traumatique","authors":"A. Paasche ,&nbsp;A. Destrez ,&nbsp;S. Dakpe ,&nbsp;S. Testelin ,&nbsp;B. Devauchelle","doi":"10.1016/j.anplas.2024.06.022","DOIUrl":"10.1016/j.anplas.2024.06.022","url":null,"abstract":"<div><div>Les lésions traumatiques du front sont fréquentes et souvent associées à des traumatismes crâniens. Dans tous les cas, l’enjeu neurologique est au premier plan, mais ces lésions présentent également des enjeux fonctionnels (pour la ventilation sinusienne et la fonction motrice frontale) et des enjeux esthétiques. Les fractures de la voûte crânienne frontale nécessitent des traitements différents en fonction de la présence d’une rhinoliquorrhée associée, d’une atteinte sinusienne ou de leur extension à la base du crâne ou au massif facial. Elles nécessitent parfois, de ce fait, une collaboration pluridisciplinaire. Elles peuvent, dans certains cas, être responsables de complications à long terme qui justifie un suivi prolongé dans le temps. De par les séquelles dont peuvent être responsables l’ensemble des traumatismes de la région frontale, la minutie de la prise en charge initiale est capitale.</div></div><div><div>Forehead traumatic injuries are frequently associated with head trauma. The primary concern in such cases is the neurological aspect, but these injuries also have significant functional (such as sinus ventilation and frontal movement) and aesthetic implications. Fractures of the frontal cranial vault differ based on the presence of associated rhinoliquorrhea, sinus involvement, or extension to the skull base or facial mass. Some cases could even require a multidisciplinary approach. Some fractures may lead to long-term complications, necessitating prolonged follow-up. Given the potential sequelae of all forehead injuries, meticulous initial management is crucial.</div></div>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":"69 6","pages":"Pages 559-569"},"PeriodicalIF":0.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le front dans les déformations toulousaines du crâne","authors":"R.H. Khonsari","doi":"10.1016/j.anplas.2024.06.020","DOIUrl":"10.1016/j.anplas.2024.06.020","url":null,"abstract":"<div><div>La déformation artificielle du crâne est une pratique ubiquitaire qui consiste à utiliser des dispositifs externes pour modifier la forme de la tête des nouveau-nés. Les deux principaux types de déformation sont les déformations antéropostérieures (« têtes plates ») et les déformations circonférentielles (« têtes longues »). Les outils de déformation exercent principalement des forces mécaniques sur le front et l’occiput. La forme du front est ainsi au premier plan dans le diagnostic, la classification et la compréhension des motifs culturels motivant ces pratiques. Les déformations intentionnelles du crâne ont aujourd’hui disparu mais elles ont persisté jusqu’au début du vingtième siècle, notamment en France. De nombreuses données anthropologiques et historiques sont disponibles et permettent d’explorer l’origine, la nature, les motivations et les conséquences de ces pratiques dans notre pays.</div></div><div><div>Artificial skull deformations were performed in all cultures since Prehistoric times using external devices, to permanently modify the shape of the head of newborns. Two types of deformations are reported: (1) antero-posterior deformations (“flat heads”) and (2) circumferential deformations (“long heads”). Deformation devices exert mechanical forces on the forehead and the occiput: forehead shape is thus a major source of information for diagnosis, classification and on the culture significance of artificial skull deformations. France was the major European country for artificial skull deformations, and Toulouse was the epicenter of this practice. Numerous dry skulls and exceptional historical data are available to explore the origins, the mechanisms, the motivations, and the consequences of “Toulouse” artificial skull deformations.</div></div>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":"69 6","pages":"Pages 508-518"},"PeriodicalIF":0.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le front des craniosténoses","authors":"E. Arnaud ,&nbsp;R.H. Khonsari ,&nbsp;S. James ,&nbsp;G. Paternoster","doi":"10.1016/j.anplas.2024.06.027","DOIUrl":"10.1016/j.anplas.2024.06.027","url":null,"abstract":"<div><div>Le front est la partie crânienne de la face et représente une composante importante de l’esthétique faciale. Les déformations liées aux craniosténoses sont typiques par les modifications en hauteur, en largeur et en angulation du front. Les traitements chirurgicaux crâniofaciaux sont codifiés et basés sur une découpe osseuse frontale suivie de son repositionnement avec ostéosynthèse résorbable chez l’enfant. Les techniques ont peu changé depuis les descriptions princeps. Aujourd’hui, la distraction ou les ressorts permettent des remodelages précoces avec des morbidités faibles. Les séquelles sont essentiellement liées à des défauts de croissance à la jonction frontotemporale et sont corrigées le plus souvent par greffe de graisse autologue. L’existence de mutations génétiques associées à la craniosténose augmente le risque de reprise chirurgicale dans les six premières années de vie.</div></div><div><div>The forehead is the cranial part of the forehead, and represents an important component of facial esthetics. The deformations linked to craniosynostoses are characterized by modifications in height, width, and angulation. Their surgical correction during childhood is based on well-established techniques of remodeling using resorbable osteosynthesis. Today, distraction and springs allow less invasive procedures with good outcomes. Sequellae mainly correspond to hypotrophies of the temporal region, corrected with fat grafting. The presence of a mutation increases the risk of reoperation in the first six years of life.</div></div>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":"69 6","pages":"Pages 519-531"},"PeriodicalIF":0.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Méningo-encéphalocèles sincipitaux : considérations cliniques et chirurgicales","authors":"F. Lauwers ,&nbsp;F.-E. Roux ,&nbsp;S. Boetto ,&nbsp;N. Oucheng ,&nbsp;F. Giroussens ,&nbsp;Z. Cavallier ,&nbsp;V. Poulet ,&nbsp;A. Prévost","doi":"10.1016/j.anplas.2024.07.008","DOIUrl":"10.1016/j.anplas.2024.07.008","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Les méningo-encéphalocèles (MEC) sincipitaux sont des malformations congénitales rares qui se manifestent par une hernie de tissu cérébral ou méningé à travers une ouverture dans l’étage antérieur de la base du crâne. Ces malformations touchent toujours l’os frontal, plus précisément la région glabellaire et l’angle naso-frontal. Une collaboration entre Médecins du Monde et le Children's Surgical Center de Phnom Penh a permis de prendre en charge plus de quatre cents cas sur vingt ans. Les patients n’ont généralement pas eu d’examens radiologiques, les stratégies chirurgicales étant basées sur les observations cliniques et peropératoires. Il existe plusieurs formes cliniques de MEC : naso-frontales, naso-ethmoïdales, et naso-orbitaires. La classification de Suwanwela de 1972 reste la plus pertinente. Les MEC naso-frontales sont souvent associés à une importante expansion cutanée sans déformation osseuse majeure, contrairement aux MEC naso-ethmoïdales, qui entraînent des déformations significatives et sont les plus fréquentes. Les MEC naso-orbitaires, plus rares, provoquent le plus souvent une augmentation du volume orbitaire. La nature du tissu hernié et le volume de la hernie sont déterminants pour la stratégie chirurgicale. La canthopexie, un élément clé de la reconstruction, doit être précise et répond à des règles strictes pour assurer un résultat esthétique. Le remodelage fronto-nasal finalise la réparation. La chirurgie des MEC suit des principes bien codifiés. Le contexte humanitaire influence la prise en charge, avec un accent sur la sécurité chirurgicale et la transmission des compétences. Le traitement repose sur une vision clinique plus que radiologique, même si les avancées en imagerie sont aujourd’hui disponibles au Cambodge. Le suivi à long terme, surtout chez les enfants, reste un défi à documenter pour évaluer les impacts sur la croissance et la stabilité des résultats chirurgicaux.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;div&gt;Sincipital meningoencephaloceles (MECs) are rare congenital malformations characterized by the herniation of brain or meningeal tissue through an opening in the anterior floor of the skull base. These malformations always affect the frontal bone, specifically the glabellar region and the naso-frontal angle. A collaboration between Médecins du Monde and the Children's Surgical Center in Phnom Penh has enabled the treatment of over four hundred cases over twenty years. Patients typically have not undergone radiological examinations, with surgical strategies based on clinical and intraoperative observations. There are several clinical forms of MECs: naso-frontal, naso-ethmoidal, and naso-orbital. The 1972 classification by Suwanwela remains the most relevant. Naso-frontal MECs are often associated with significant skin expansion without major bone deformity, unlike naso-ethmoidal MECs, which lead to significant deformities and are the most common. Naso-orbital MECs, being rarer, most frequently result in an increased orbital","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":"69 6","pages":"Pages 545-553"},"PeriodicalIF":0.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cutaneous and subcutaneous primary leiomyosarcoma: A retrospective cohort of 26 cases examining clinical data and treatments].","authors":"C Roy, L-R Le Nail, G De Pinieux, R Samargandi","doi":"10.1016/j.anplas.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.anplas.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>Superficial leiomyosarcoma is a rare malignant soft tissue tumor arising from smooth muscle cells, accounting for 2-3% of superficial sarcomas, with limited literature available on the subject. It is typically observed in patients aged 50-60 years and affects both men and women equally in the subcutaneous subtype, whereas the cutaneous subtype predominantly affects men.</p><p><strong>Objective: </strong>This study aims to examine the clinicopathological features and therapeutic outcomes of patients with leiomyosarcoma.</p><p><strong>Method: </strong>This is a descriptive retrospective study of 26 cases of cutaneous and subcutaneous leiomyosarcomas, with histological confirmation.</p><p><strong>Results: </strong>We identified 10 (38.5%) subcutaneous leiomyosarcomas and 16 (61.5%) cutaneous leiomyosarcomas. The majority of tumors were located in the lower limbs, accounting for 13 (50%) cases. During follow-up, 6 patients experienced recurrence, and 7 developed metastases, including 2 of the 7 patients who had R0 resection margins. Among these, 3 out of the 6 recurrent cases and 3 out of the 7 metastatic cases were subcutaneous leiomyosarcomas. The average time to recurrence was 6.2 years.</p><p><strong>Conclusion: </strong>The observed risk of metastases and recurrences, despite clear surgical margins, in both cutaneous and subcutaneous leiomyosarcomas, along with the delayed onset of these events, justifies prolonged patient follow-up. The lungs, bones and liver have been identified as the most common site of metastasis.</p>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Impact of the number of pregnancies on the venous outflow of DIEP flap in breast reconstruction: A clinical and CT-scan study].","authors":"I Hadji, G Roccaro, L Ferrero, F Pigneur, B Hersant, J-P Meningaud","doi":"10.1016/j.anplas.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.anplas.2024.10.001","url":null,"abstract":"<p><strong>Introduction: </strong>The DIEP (deep inferior epigastric perforator) flap is the \"gold standard\" for breast reconstruction after cancer, giving better benefits on the quality of life. The most common complication is the venous congestion, because of the dominance of superficial venous outflow while the flap is drained by the deep epigastric vein. Pregnancy, by its physiological and vascular modifications, can reduce the risk of the venous congestion. Few studies explored the impact of pregnancy on the DIEP vascularization.</p><p><strong>Material and methods: </strong>We studied the preoperative CT-scans of 104 patients who benefited reconstruction surgery by DIEP from January 2011 until March 2022. The patients were separated into 5 groups according to number of pregnancies. For each CT-scan, a concomitant vein of deep epigastric artery diameter/SIEV diameter ratio was performed on each side, to assess the relation between pregnancy and the reduction of venous complications.</p><p><strong>Results: </strong>The results showed an increase of this ratio with the number of pregnancies. Patients with no pregnancy (G0) have the highest complication rate, with 41.7% of venous congestion case. On the other hand, in the group of four pregnancies or more (G4), the complication rate was significantly lower, at 10%, and none venous congestion was observed. These results suggest the beneficial effects of pregnancy on vascularization and especially on venous drainage in the DIEP flap.</p><p><strong>Conclusion: </strong>This study highlights the benefit effect of the number of pregnancies on the DIEP vascularization, especially for the reduction of the venous congestion risk. The ratio DIEV/SIEV may be a useful help to predict the risk of venous complications in nullparous patients. These results open to new studies to deepen the understanding of the physiological effects of the pregnancy on the breast reconstruction surgery.</p>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating the porcine model for microsurgical perforator training: Can surgeons trained on pig perforator dissection successfully perform human DIEP flap procedures? A pilot study.","authors":"G A G Lombardo, A Stivala, R Cuomo, V Villani, A Nistor, F Rosatti","doi":"10.1016/j.anplas.2024.09.008","DOIUrl":"https://doi.org/10.1016/j.anplas.2024.09.008","url":null,"abstract":"<p><p>Autologous breast reconstruction, especially using the deep inferior epigastric artery perforator (DIEP) flap, is increasingly seen as a reliable, safe, and long-term alternative to implant-based reconstruction. Despite the recognized advantages of the DIEP flap for breast reconstruction, successful realization demands excellent anatomical knowledge, a thorough understanding of autologous breast reconstruction concepts and advanced microsurgical skills. Given that the porcine model is widely employed in microsurgical training, our study aims to assess this model using validated outcomes, with the objective of evaluating the enhancement in a surgeon's learning curve following training with this model. Forty DIEP flaps were harvested on 20 swines by a single surgeon in \"Pius Branzeu Center\" (Timisoara, RO) and \"Drazan Institute\" (University of veterinary of Brno, CZ) laboratories for microsurgical training in 6months (January 2015-June 2015). Then we analyzed data from 40 DIEP flaps harvested by the same surgeon on first 20 consecutive patients undergoing DIEP flap breast reconstruction. Perforator dissection time, surgeon-determined dissection difficulty score (DDS) and venous congestion rate were collected for each flap in porcine model and in patients, then compared and analyzed. The mean of DDS score analysis in first and second swines group dissection resulted as statistically significant (P-value 0.0001), while it was not statistically significant between those analyzed in the second group of swines dissected and patients (P-value 0.8037). Reduction in perforator dissection time between the two swines' groups and in venous congestion rates from the first swines groups to the second to the human group resulted statistically significant too (P-value respectively 0.0001 and 0.0079). The porcine model has been used for a long time together with other animal models for microsurgical training. Our study confirms and objective by validated scores that it is a valid and reliable model, comparable to the human one and which mimics the dissection of human perforating vessels.</p>","PeriodicalId":55512,"journal":{"name":"Annales De Chirurgie Plastique Esthetique","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}