Shoulder function after latissimus dorsi transfer in breast reconstruction

in Clinical Physiology & Functional Imaging (2010), 30(6), 406-412

Background ⁄ Aims: Latissimus dorsi (LD) transfer in the case of breast reconstruction remains frequently used because this muscle provides a good size source of tissue in reconstructive surgery. Given ... [more ▼]

Background ⁄ Aims: Latissimus dorsi (LD) transfer in the case of breast reconstruction remains frequently used because this muscle provides a good size source of tissue in reconstructive surgery. Given that, the consequences of the LD removal on shoulder function and the actual loss of maximal strength developed must be investigated. Methods: Twenty women (50 ± 7Æ5 years old) were evaluated before surgery, 3 and 6 months after an unilateral transfer of a pedicle flap of LD muscle used for breast reconstruction. Women performed a bilateral shoulder isokinetic assessment [for the internal rotators (IRs) and external rotators and for the abductor and adductor (ADD) muscles] allowing the establishment of bilateral muscular deficit status and the study of agonist ⁄ antagonist muscle ratios. The algofunctional and clinical status of the shoulders was analysed by the means of Constant score and specific shoulder clinical tests. The women did not perform any specific strengthening of muscle shoulder after surgery. Results: The isokinetic assessment showed a muscle weakness 3 and 6 months after LD transfer, mainly on the ADDs (33 ± 9% at 6 months) and on the IRs (16 ± 11% at 6 months). The Constant score significantly decreased after surgery on the operated shoulder. Women with a Constant score impairment showed pain during specific shoulder clinical tests. We also found a correlation between Constant score impairment and internal rotators weakness or rotator muscle imbalance. Conclusion: Given those results, we could advocate a specific shoulder strengthening after LD transfer, focused mainly on the IRs and ADDs. [less ▲]

Analgésie par blocs nerveux périphériques continus dans le cadre des soins de plaies cutanées

in Revue Médicale de Liège (2008), 63(1), 3-16

We present the case of a patient with a circumferential venous ulcer at the level of the calf. She is hospitalized for surgical treatment by continuous aspiration dressing and coverage with skin graft ... [more ▼]

We present the case of a patient with a circumferential venous ulcer at the level of the calf. She is hospitalized for surgical treatment by continuous aspiration dressing and coverage with skin graft. This patient presents a history of chronic pain, on which classical medications have few effects and are accompanied by side effects. After discussion with the patient, a double continuous peripheral nervous block (femoral and sciatic nerve) is set up to improve the tolerance to wound dressing. This technique presents favorable antalgic results. The indications and the different techniques of block performance (by electrostimulation or echo-guided) are described. The infectious risks related to the presence of catheter near cutaneous wounds are clarified according to recent data of literature. The relevance of these techniques in correlation with the development of chronic pain and on the trophicity of the wounds are also discussed. [less ▲]

Delayed reepithelialization and scarring deregulation following drug-induced toxic epidermal necrolysis.

in Burns (2007), 33(1), 100-4

A 51-year-old Caucasian woman developed severe drug-induced toxic epidermal necrolysis (TEN) due to allopurinol. The withdrawal of the culprit drug was unfortunately delayed, and dramatic retardation of ... [more ▼]

A 51-year-old Caucasian woman developed severe drug-induced toxic epidermal necrolysis (TEN) due to allopurinol. The withdrawal of the culprit drug was unfortunately delayed, and dramatic retardation of reepithelialization was observed. At that stage of disease evolution, an inflammatory cell infiltrate was present in the dermis. Coverage of eroded lesions by frozen cultured keratinocyte allografts failed to hasten reepithelialization compared to ungrafted sites. This unusual protracted TEN evolution was followed by the development of extensive hypertrophic and keloid scars. Several biopsies were taken over 6 months. The histologic presentation of the grafted and ungrafted eroded scar tissues looked similar. Both the number and size of the Factor XIIIa-positive dermal dendrocytes, as well as the number of alpha-actin-positive myofibroblasts showed a marked increase between weeks 2 and 12 after grafting. They were reduced after 6 months when the scarring process was stabilized. alpha1 [IV] collagen was never expressed over the eroded scars. Similar to burn patients, delayed reepithelialization might be a risk factor for abnormal scarring in TEN. Cultured keratinocyte allograft apparently offered no improvement in reepithelialization and did not prevent abnormal scarring in this TEN patient. [less ▲]

An outbreak of Absidia corymbifera infection associated with bandage contamination in a burns unit

in Journal of Hospital Infection (2005), 61(1), 88

Rupture of a Thoracic Aneurysm in the Left Bronchus

in Acta Chirurgica Belgica (2000), 100(2), 74-6

Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had ... [more ▼]

Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had suffered a car crash fifteen years ago, without any evidence of aortic rupture at the time. Thereafter, he developed an aortic isthmic dilation (36 mm in diameter). The patient suffered from long standing pulmonary insufficiency and emphysema and was admitted several times on an urgent basis for acute dyspnea. During an hospitalization for respiratory distress, he presented haemoptysis and left lung hyperinflation secondary to partial fistulization and extrinsic compression of the main left bronchus. Isthmic aortic resection and prosthetic grafting was performed and the left main bronchus was closed by an autologous pericardial patch. Ten days later, following an air-leak from the bronchial closure, a transposed latissimus dorsi flap was used by the plastic surgeon to repair the defect. Nevertheless, the patient died from multisystemic failure six weeks later. [less ▲]

Biochemical mediators in acute respiratory distress syndrome (ARDS) after burning injury

in Paubert-Braquet (Ed.) Lipids mediators in the immunology of shock (1987)