Publications by authors named "Albert De Mey"

13 Publications

  • Page 1 of 1

Managing Complications in Vertical Mammaplasty.

Clin Plast Surg 2016 Apr 3;43(2):359-63. Epub 2016 Feb 3.

Clinique du Parc Léopold, Rue Froissart 38, 1040 Brussels, Belgium.

In this paper, we describe our experience with the Lejour vertical scar mammaplasty from its description throughout 25 years of practice. Our work aims to focus on reducing vertical scar mammaplasty complications by examining results, studying how to avoid unfavorable consequences, and providing new tips to improve the technique and shorten its learning curve. Complications can be related to patient characteristics and habits, but adhering to a strict surgical protocol is essential to limit other factors. The importance of recognizing and being able to manage the complications is mandatory to have a successful final result and a satisfied patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cps.2015.12.014DOI Listing
April 2016

Free intra-osseous muscle transfer for treatment of chronic osteomyelitis.

J Plast Surg Hand Surg 2015 Oct 10;49(5):306-310. Epub 2015 Jun 10.

b 2 Department of Plastic Surgery, Brugmann University Hospital, Free University of Brussels, Brussels , Belgium.

Background: Chronic osteomyelitis is still a big reconstructive challenge. Even with standard care, therapeutic failures and recurrences are common. Multiple techniques of tissue transfer have increased the success rate. This study recommends free muscle transfers into the intramedullary bone cavities for treatment of chronic osteomyelitis.

Patients And Methods: The review included 29 patients that were treated for chronic osteomyelitis. Osteomyelitis was located at the femur in four patients, the tibia in 22 patients, and the foot in three patients. Dead bone and scar tissue were replaced with durable free muscle flap with special attention to fill the dead space.

Results: The average age of these patients was 48.5 years old (range = 23-70 years old). The average duration of osteomyelitis was 8.2 years (range = 1-45 years). Gracilis was applied in 20 cases (69%), latissimus dorsi was used in five cases (17.2%), and rectus abdominis was performed in four cases (13.8%). There was one flap failure, one partial superficial flap necrosis, two arterial thrombosis, and one venous thrombosis. All the remaining 28 muscle flaps survived. From 1-10 years follow-up, there was one recurrence of the osteomyelitis in the distal end of the intra-medullary cavity of a femur after reconstructing using the gracilis flap.

Conclusion: The present study demonstrated that free intramedullary muscle transfers are effective in providing a high rate of success in the treatment of chronic osteomyelitis. The secondary filling of the intramedullary cavity after extensive removal of all infected bony sequesters has proven to give a long-term arrest of chronic osteomyelitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/2000656X.2015.1049952DOI Listing
October 2015

Vascularized fibular transfer in longstanding and infected large bone defects.

Acta Orthop Belg 2014 Mar;80(1):50-5

The reconstruction of large bone defects in the infectious environment is still a big challenge for limb salvage because of disturbance in bacterial flora, bacterial resistance and limitation of blood supply at scarred tissue. This retrospective study was to evaluate long-term outcomes in patients who were performed vascularized fibular transfers for treatment of large bone defects in the infectious environment. The review included 26 patients with an average age of 27 years old. Bone defects were located at the arm in 1 patient, the forearm in 2 patients, the thigh in 6 patients and the leg in 17 patients. The cause of the bone defects included high-energy trauma in 14 cases, chronic osteomyelitis in 7 cases, infected non-union in 5 cases. All patients had had several previous operative procedures. The average length of fibular vascularized graft was 16.6 cm (range, 10-22 cm), and the average size of the associated fasciocutaneous component in 16 patients was 3.6 x 8.5 cm. Three patients had partial necrosis of skin paddle. Three patients, who were stabilized by screw and external fixator, had an infection at the distal part of the fibular graft and pin tracts. 25 fibular grafts (96%) showed complete bone union. This review has showed that the vascularized fibular transfer can be effective for management of large segmental bone defects in the infectious environment.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2014

Early one-stage repair of complete unilateral cleft lip and palate.

J Craniofac Surg 2009 Sep;20 Suppl 2:1723-8

Department of Plastic Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium.

Background: The purpose of this prospective study was to evaluate craniofacial morphology in children with complete unilateral cleft lip and palate treated at the Brussels cleft center after a 1-stage complete closure at 3 months and compare the results with a series of children operated on at 3 and 6 months of age according to the Malek surgical protocol.

Methods: A series of 72 consecutive patients who were operated on for nonsyndromic complete unilateral cleft lip and palate were included in this study at approximately the age of 10 years. Thirty-four were treated according to the Malek surgical treatment protocol: the soft palate was closed at a mean (SD) age of 3.04 (0.20) months, followed by simultaneous repair of the lip and hard palate at 6.15 (0.67) months. Thirty-eight underwent 1-stage all-in-one (AIO) closure of the lip and hard and soft palates at 2.98 (0.16) months. Craniofacial morphology was evaluated by means of a digital cephalometric analysis. Cephalometric data were compared with a noncleft control group (n = 40) matched according to age. The same 2 series of children were followed up until 15 years of age, and the results were again compared.

Results: Statistical analysis (analysis of variance with post hoc Tukey test) showed in both groups who were operated on a decreased anteroposterior growth compared with the children without cleft at 10 years but the AIO group only was not different from the group without cleft. The maxillary (MxPI/SN) plane was significantly (P = 0.002) increased in the Malek cleft group compared with the AIO group with cleft. At 15 years of age, a difference was not observed anymore between the 2 groups for the anteroposterior growth or for the maxillary plane inclination.

Conclusions: One-stage AIO closure based on the Malek surgical principles provided good anteroposterior midfacial morphology and resulted in less opening of the maxillary plane to the anterior cranial base.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0b013e3181b3ef71DOI Listing
September 2009

Vertical scar mammaplasty in gigantomastia: retrospective study of 115 patients treated using the modified lejour technique.

Aesthetic Plast Surg 2007 May-Jun;31(3):294-8

Department of Plastic, Aesthetic, and Reconstructive Surgery, Brugmann University Hospital, Place Van Gehuchten, Brussels, Belgium.

Since 1996, the original technique of superior pedicle vertical scar mammaplasty described by Lejour has been modified by decreasing skin and glandular undermining, limiting liposuction, avoiding tight glandular stitches, and adding a small horizontal scar for very large breasts. Between 1996 and 2002, 115 consecutive patients underwent a bilateral reduction mammaplasty of more than 500 g per breast using the modified Lejour technique. The early, late, and delayed complications were studied according to four parameters: glandular resection, age, smoking habits, and body mass index (BMI). There was no difference in terms of complications according to the glandular resection. Patients with a high BMI were found to have a higher rate of wound dehiscence. The occurrence of partial areolar necrosis proved to be related to smoking habits. Patients younger than 20 years presented a lower rate of seroma. The modified Lejour technique has proved to be safe and effective for large breasts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00266-006-0227-0DOI Listing
September 2007

Primary cutaneous marginal zone B-cell lymphoma of MALT type in a child.

Pediatr Dev Pathol 2006 Nov-Dec;9(6):468-73

Department of Anatomic Pathology, Centre Hospitalier Universitaire Saint-Pierre/Institut Jules Bordet, Institut Jules Bordet, 1 rue Héger-Bordet, 1000 Brussels, Belgium.

Marginal zone B-cell lymphoma (MZBCL) of mucosa-associated lymphoid tissue type is a peculiar variant of B-cell neoplasm showing distinct clinical and pathologic features. Its occurrence in children or adolescents is extremely uncommon. We describe the case of an 11-year-old boy who developed such a lymphomatous process involving primarily the skin. The tumor was characterized by a maturing plasma cell population that included immunoblasts, heavy-chain but not light-chain restriction suggestive of monoclonality, and a prevalent, focally granulomatous component of histiocytes. As an additional interesting feature, a trisomy 3 was demonstrated by fluorescence in situ hybridization analysis. The clinical, morphological, phenotypic, and genetic characteristics seen in our patient do not differ significantly from those described in primary cutaneous MZBCL occurring in adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2350/06-01-0006.1DOI Listing
January 2007

Study of changes in nasal morphology in children with complete unilateral cleft lip and palate after secondary bone grafting measured with image analysis.

Scand J Plast Reconstr Surg Hand Surg 2006 ;40(6):345-51

Plastic Surgery Department, Brugmann University Hospital, University of Brussels, Belgium.

We aimed to evaluate retrospectively changes in the nasal appearance after secondary bone grafting in children with complete unilateral cleft lip and palate in 41 consecutive patients. Basal view photographs were analysed by a software program (ASYMNOS, for asymmetry of nostrils, available on simple request) that computes comparative functions between both nostrils and gives an objective score. These data were compared with those of a control group. The measurements and scores were calculated for each group, and then the global objective scores were correlated with the subjective scores that resulted from an independent external panel that ranked the aesthetic aspects of the nostrils. There was a significant improvement in the nasal symmetry postoperatively that resulted from a decrease in height between the nostrils, and a positive correlation between the objective and subjective scores.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02844310601029928DOI Listing
March 2007

New digital method for quantitative assessment of nasal morphology.

Scand J Plast Reconstr Surg Hand Surg 2006 ;40(6):335-44

Plastic Surgery Department, Brugmann University Hospital, University of Brussels, Belgium.

Our aim was to develop and validate a new method to assess objectively and quantitatively the morphology of the nostrils after nasal or nasolabial surgery. We used digital analysis using specific mathematical algorithms to assess several geometric measurements, particularly of facial asymmetry, expressed in adimensional units. Forty-five patients with no facial anomalies (control group) were used initially to evaluate the method and to obtain variables for statistical reference. Thirty-five patients operated on for unilateral cleft lip and palate (cleft group) were then analysed and compared with the control group. Individual scores were obtained for each patient, computed, and correlated with those established by a lay panel. Statistical analysis showed good sensitivity and reliability (R>0.8).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02844310601029837DOI Listing
March 2007

Textured saline-filled breast implants for augmentation mammaplasty: does overfilling prevent deflation? A long-term follow-up.

Plast Reconstr Surg 2006 Jul;118(1):215-22; discussion 223

Department of Plastic Surgery, C.H.U. Brugmann, Brussels 1020, Belgium.

Background: Augmentation mammaplasty is the second most commonly performed aesthetic operation. Since the moratorium on gel-filled devices in 1992, saline-filled devices have become the prosthesis of choice in the United States. Although inflatable breast implants have been available since 1965, high rates of complete implant deflation have been reported. In this retrospective study, the authors highlight the effect of filling volume on the incidence of implant deflation, other implant-related trade-offs, and implant survival.

Methods: Forty-nine women who had undergone aesthetic augmentation mammaplasty were followed up for up to 139 months. Twelve implants were underfilled (group 1), 47 devices were filled within the recommended volume (group 2), and 37 implants were overfilled beyond the manufacturer's maximum recommended volume (group 3). All the implants used were of the same type and from the same manufacturer (Siltex by Mentor, 2600). Through an inframammary approach, subpectoral placement of the device was used exclusively.

Results: Nineteen women experienced complete deflation of their implants, with an overall implant complete deflation rate of 19.79 percent. This complication occurred in 16.6 percent of group 1 patients, 21.2 percent of group 2, and 18.9 percent of group 3. Skin wrinkling and rippling were encountered in 50 percent of group 1, 29.78 percent of group 2, and 43.2 percent of group 3, with an overall incidence of 37.5 percent. In this series, the authors could not find a protective effect of overfilling on complete deflation (p = 0.925) nor on the avoidance of rippling and wrinkling (p = 0.285). Moreover, overfilling by more than 25 ml beyond the maximum recommended dose showed no statistical significance for the frequency of complete deflation (p = 0.982) or for the incidence of wrinkling and rippling (p = 0.828). However, Kaplan-Meier survival analysis revealed that overfilling the implants prolonged their longevity and had a statistically significant effect on the implants' 10-year survival rate. Of the 49 women, 34 (69.3 percent) needed a secondary surgical procedure, mainly for complete deflation (38.7 percent) and skin wrinkling/rippling (20.4 percent). At the end of the current study, eight of 49 women, representing 15 implants, retained their original implants for more than 120 months.

Conclusions: Use of Mentor 2600 prostheses for aesthetic breast augmentation led to a very high incidence of complete deflation and skin wrinkling and a high reoperation rate. Filling the implants within the recommended range or overfilling them increased device longevity and had a statistically significant effect on the implants' 10-year survival rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.prs.0000220478.38646.9fDOI Listing
July 2006

A new method of 3-D cephalometry Part I: the anatomic Cartesian 3-D reference system.

J Craniofac Surg 2006 Mar;17(2):314-25

Department of Plastic Surgery, University Hospital Brugmann, ULB, Brussels, Belgium.

The purpose of this study was to present a new innovative three-dimensional (3-D) cephalometric method. Part I deals with the set-up and validation of a voxel-based semi-automatic 3-D cephalometric reference system. The CT data (DICOM 3.0 files) of 20 control patients with normal skeletal relationships were used for this study. To investigate accuracy and reliability of the 3-D cephalometric reference system (Maxilimtrade mark, version 1.3.0) a total of 42 (14 horizontal, 14 vertical and 14 transversal) orthogonal measurements were performed on each patient twice by each of two investigators. The intra-observer measurement error was less then 0.88 mm, 0.76 mm and 0.84 mm for horizontal, vertical and transversal orthogonal measurements, respectively. The inter-observer measurement error was less as 0.78 mm, 0.86 mm and 1.26 mm for horizontal, vertical and transversal orthogonal measurements, respectively. Squared correlation coefficients showed a high intra-observer and inter-observer reliability. The presented 3-D cephalometric reference system proved to be accurate and reliable and can therefore be used for 3-D cephalometric hard and soft tissue analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/00001665-200603000-00019DOI Listing
March 2006

Rehabilitation of a patient with cleft lip and palate with an extremely edentulous atrophied posterior maxilla using zygomatic implants: case report.

Cleft Palate Craniofac J 2004 Sep;41(5):571-4

Erasmus Hospital, Université Libre de Bruxelles, Department of Oral and Maxillofacial Surgery, 808 Route de Lennik, 1070 Brussels, Belgium.

Objective: This case report describes the clinical and surgical management of a patient with a unilateral alveolar cleft and associated extremely atrophied totally edentulous maxilla.

Method: Two zygomatic implants and four endosseous oral implants were placed under general anesthesia in a compromised maxilla to rehabilitate a 33-year-old patient with cleft lip and palate. The two specially designed zygomatic implants were utilized to avoid the need for bone grafting in the patient. The final prosthetic rehabilitation was an esthetic and functional maxillary overdenture prosthesis supported by implants.

Results: Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar cleft are a reliable possibility in the dental rehabilitation of this malformation.

Conclusion: The use of zygomatic implants may be considered a reliable alternative to more resource-demanding techniques such as bone grafting in patients with cleft palate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1597/03-105.1DOI Listing
September 2004

Mandibular morphology in complete unilateral cleft lip and palate.

Cleft Palate Craniofac J 2004 Jul;41(4):403-9

Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.

Objective: The purpose of this study was to evaluate and compare mandibular morphology and spatial position in children with complete unilateral cleft lip and palate (UCLP) treated at two different cleft centers (Hannover and Brussels) following different surgical treatment protocols.

Patients: A total of 62 Caucasian children (40 boys, 22 girls) with nonsyndromic complete unilateral cleft lip and palate (UCLP) were evaluated by means of conventional cephalometric analysis at approximately the age of 10 years. Data of both cleft groups were compared with a control, noncleft group (n = 40) matched according to age and sex.

Interventions: The Hannover children with cleft (n = 36) underwent lip repair at a mean age of 5.83 +/- 1.16 months. The hard and soft palates were closed at a mean age of 29.08 +/- 4.68 and 32.25 +/- 4.29 months, respectively. The Brussels children with cleft (n = 26) were treated according to the Malek surgical protocol with soft palate repair at a mean age of 3.04 +/- 0.20 months and simultaneous lip and hard palate repair at a mean age of 6.15 +/- 0.68 months.

Results: Statistical analysis (analysis of variance with post hoc Tukey's test) showed a significant (p =.001) smaller mandibular ramus length (Co-Go) in the Brussels cleft group, compared with the control group. The Hannover-Brussels comparison data revealed that the S-N-B angle was significantly (p =.047) less in the Brussels cleft group.

Conclusions: The influence of surgical procedures in patients with UCLP might not be restricted to the maxilla but could influence mandibular spatial position to the cranial base. Because of these positional changes of the mandible, both cleft groups showed facial balance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1597/02-165.1DOI Listing
July 2004

The vertical mammaplasty: a reappraisal of the technique and its complications.

Plast Reconstr Surg 2003 Jun;111(7):2192-9; discussion 2200-2

Department of Plastic and Reconstructive Surgery, Brugmann University Hospital, Brussels, Belgium.

Since 1989, superior pedicle vertical scar mammaplasty as described by Lejour has been used in the authors' department as the only technique for breast reduction. From 1991 through 1994, a series of 170 consecutive patients (330 breasts) underwent an operation. In these patients, minor complications were observed in 30 percent of the patients and major complications in 15 percent. Surgical revision for scar or volume corrections was necessary in 28 percent of the breasts, which seemed unacceptable. Therefore, the original technique was modified by decreasing the skin undermining and avoiding liposuction in the breast. Primary skin excision was performed in the submammary fold at the end of the operation if the skin could not be puckered adequately. This modified technique was used from 1996 through 1999 in 138 consecutive patients (227 breasts). In the second series, minor complications were observed in 15 percent of the patients and major complications in 5 percent. However, the technical modifications did not significantly change the rate of secondary scar and volume corrections, which were still necessary in 22 percent of the breasts. In large breasts, the addition of a horizontal scar at the end of the operation did not change the rate of secondary revision, which however compares favorably with the figures obtained with the inverted T, superior pedicle mammaplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.PRS.0000062621.83706.88DOI Listing
June 2003