Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results.

A retrospective study was done on a population of 258 women who had undergone surgery for abdominal dermolipectomy between January of 1991 and May of 1996. The postoperative complications and flaws seen at long-term follow-up are discussed. The surgical techniques used, with or without lipoaspiration, were the infraumbilical plasty and full plasties with horizontal or inverted T scars. Six types of postoperative complications were noted: hemorrhage in 1.2 percent, lymphorrhea in 10.9 percent, infection in 7 percent, skin necrosis in 6.6 percent, secondary dehiscence of the scar in 2.3 percent, and thromboembolic accidents in 1.2 percent. No significant difference was found in the rate of necrosis development between patients who did and did not undergo lipoaspiration. However, a statistically significant difference was seen in the rate of skin necrosis between the T-type plasty (35.5 percent) and the other two procedures (1.43 percent for infraumbilical plasties and 4.60 percent for full plasties with horizontal scar). With regard to the flaws found at long-term follow-up, the rate of above-scar fat folds and/or dog-ears was 27.9 percent, and the rate of defective scars was 26 percent. No significant difference was found with regard to the rate of flaws. The rate of all secondary surgical procedures was 29.1 percent, but performance of secondary procedures depended on the willingness of the patient and on the surgeon's judgment. Abdominoplasty procedures involve a high risk of early complications. The rate of skin necrosis is clearly augmented in cases of T-type plasty. The need for secondary surgical correction is frequent, and the patient should be reminded of this possibility during preoperative consultation.

[Circulatory arrest after splanchnic neurolysis with phenol in unresectable cancer of the pancreas]. / Arrêt circulatoire après neurolyse splanchnique au phénol pour cancer du pancréas non reséquable.

One of the treatments for pain in patients with unresectable pancreatic cancer is chemical splanchnicectomy by phenol. We report two cases of severe cardiac arrhythmia followed by circulatory arrest, during intraoperative chemical splanchnicectomy. The cardiac toxicity of phenol is known in plastic surgery (face peeling). The reasons for this toxicity are not well known. We recommend that phenol be replaced by alcohol during chemical splanchnicectomy, because of its safety.

[Cerebral protection in carotid artery surgery. The role of the intraluminal shunt. Results of a national survey]. / Protection cérébrale en chirurgie carotidienne. Place du shunt intraluminal. Résultats d'une enquête nationale.

Clamping of the carotid artery made necessary by surgery of that vessel produces haemodynamic disturbances which may result in a neurological deficit accident at recovery from anaesthesia. Evaluating the patient's tolerance to carotid clamping and using brain protection methods during clamping increase the safety of the operation. The different methods of protection used in France were examined in an enquiry conducted among members of the French college of vascular surgery, with special attention to measurement of residual pressure in the clamped internal carotid artery (performed by 60 p. 100 of surgeons) and its corollary which is intraluminal shunting in case of hypotension. This type of enquiry concerning controverted technical procedures should provide information on the best way of improving surgical results.

[Anesthesia for cataract surgery. Result of a national survey]. / Anesthésie pour chirurgie de la cataracte. Resultat d'une enquête nationale.

OBJECTIVES: In order to evaluate the impact of recent progress in anesthesia and cataract surgery, we conducted a national survey in France to determine which techniques are used. METHODS: A questionnaire was sent to the most representative French ophthalmology teams: 66 teams participated in the survey. RESULTS: Seventy-one percent of the surgeons routinely used phacoemulsification: 91% of the anesthesists prefer locoregional anesthesia: contraindications most often involved general health status (89%). Ambulatory anesthesia was preferred by 16.7% of the teams. CONCLUSION: Phacoemulsification under peribulbal anesthesia is currently the technique most frequently used in cataract surgery in France. Ambulatory anesthesia is not yet widely used for this type of surgery.

[Indications of intraluminal shunt. In carotid surgery]. / Les indications du shunt intra-luminal. En chirurgie carotidienne.

The essential clamping during carotid artery surgery requires different procedures for cerebral protection. Most surgeons prefer the use of an intra-luminal shunt allowing conservation of a part of the proximal carotid artery. A study was conducted to compare two statistically similar series of 50 patients (with a residual pressure of less than 50 mmHg) treated or not by intra-luminal shunts. Results showed a significant difference with respect to early postoperative neurologic accidents between the groups operated without (8% accidents) and with (0%) shunts. Precise indications for the use of this procedure are discussed in relation to pre- and peri-operative findings, with the aim of reducing the incidence of postoperative neurologic complications.

[In vitro bench tests of caval umbrella filters]. / Banc d'essai in vitro des filtres ombrelles caves.

Seven ombrelles percutaneous cava filters, now available, are tested on hydraulic testing ground. Measurements are concerned with the blocking function of filters and pressure changes induced in the cava flow and the cava track wall of the testing ground. A statistical analysis of the results (100 measurements per filter) shows homogeneous reactions of each filter when faced with different situations imposed by variations of the testing ground. Greenfield's filter, a reference, is compared with other models. This one and the L.G. filter show satisfactory filtering qualities. Two other filters, Cardial and Vascor, offer a highest filtering power. Other models give poor filtering results.