Publications by authors named "Nicolas Bertheuil"

83 Publications

Autologous Gluteal Augmentation with Parasacral Perforator-Pedicled Propeller Flaps.

Plast Reconstr Surg 2022 06 5;149(6):1114e-1117e. Epub 2022 Apr 5.

From the Department of Plastic and Reconstructive Surgery, Wound Healing and Burn Units, Lapeyronie University Hospital; Department of Plastic and Reconstructive Surgery, Rangueil University Hospital; Department of Maxillofacial Surgery, Gui de Chauliac University Hospital; Department of Plastic and Reconstructive Surgery and Burn Units, Saint Louis University Hospital; and Department of Plastic and Reconstructive Surgery, South Hospital, University of Rennes.

Background: De-epithelialized flaps have been used in gluteal contouring over the last three decades, but most improve the projection rather than the upper quadrants. The authors provide a detailed description of their method of gluteal augmentation using parasacral perforator-pedicled propeller flaps. This technique achieves a volumetric increase and maximal buttock projection at the midlevel and in the medial half of the buttocks.

Methods: Between January and December of 2019, a series of 18 patients on whom a lower body lift with a parasacral perforator-pedicled propeller flap had been performed by the senior author (F.B.) were prospectively evaluated. Postoperatively, the satisfaction rate was assessed using a 10-point analog scale (1 = unsatisfied, 10 = very satisfied) by the patient and by two independent surgeons based on photographs taken 1 year after surgery.

Results: Eighteen patients underwent this procedure. Their mean age was 32.2 ± 5.6 years (range, 24 to 40 years). The mean flap length was 20.3 cm, their mean width was 10.4 cm, and the mean thickness was 3.4 cm. The authors noted only two minor complications, one seroma and two skin dehiscences that healed without surgery. The rate of satisfaction as assessed by the patients was 8.3 out of 10 (±1.1), and by surgeons, 7.9 and 8.1.

Conclusion: This article describes a gluteal autoaugmentation flap technique using parasacral perforator-pedicled propeller flaps to increase projection and volume in the inferomedial gluteal region after lower body lift.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000009161DOI Listing
June 2022

CD40L-expressing CD4 T cells prime adipose-derived stromal cells to produce inflammatory chemokines.

Cytotherapy 2022 05 23;24(5):500-507. Epub 2022 Feb 23.

UMR 1236, Univ Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France; SITI Laboratory, Etablissement Français du Sang Bretagne, CHU Rennes, Rennes, France; Pôle Biologie, CHU Rennes, Rennes, France. Electronic address:

The therapeutic potential of culture-adapted adipose-derived stromal cells (ASCs) is largely related to their production of immunosuppressive factors that are inducible in vitro by priming with inflammatory stimuli, in particular tumor necrosis factor-α (TNFα) and interferon-γ (IFNγ). In vivo, obesity is associated with chronic inflammation of white adipose tissue, including accumulation of neutrophils, infiltration by IFNγ/TNFα-producing immune cells, and ASC dysfunction. In the current study, we identified in obese patients a simultaneous upregulation of CD40Lin the adipose tissue stroma vascular fraction (AT-SVF), correlated with the Th1 gene signature, and an overexpression of CD40 by native ASCs. Moreover, activated CD4 T cells upregulated CD40 on culture-expanded ASCs and triggered their production of IL-8 in a CD40L-dependent manner, leading to an increased capacity to recruit neutrophils. Finally, activation of ASCs by sCD40L or CD40L-expressing CD4 T cells relies on both canonical and non-canonical NF-κB pathways, and IL-8 was found to be coregulated with NF-κB family members in AT-SVF. These data identify the CD40-CD40L axis as a priming mechanism of ASCs, able to modulate their cross talk with neutrophils in an inflammatory context, and their functional capacity for therapeutic applications.
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http://dx.doi.org/10.1016/j.jcyt.2022.01.006DOI Listing
May 2022

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

Plast Reconstr Surg 2021 Oct;148(4):540e-547e

From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, INSERM U1236, and Department of Hepatobiliary and Digestive Surgery, University of Rennes 1; SITI Laboratory, Rennes University Hospital; Department of Plastic, Reconstructive, and Aesthetic Surgery, Cliniques Universitaires Saint-Luc; and Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU of Montpellier.

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.
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http://dx.doi.org/10.1097/PRS.0000000000008386DOI Listing
October 2021

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

Obes Surg 2021 11 11;31(11):4985-4992. Epub 2021 Aug 11.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.

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. 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 Moorehead-Ardelt 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.
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http://dx.doi.org/10.1007/s11695-021-05654-wDOI Listing
November 2021

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

J Plast Reconstr Aesthet Surg 2021 08 9;74(8):1931-1971. Epub 2021 Jun 9.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France; INSERM U1236, University of Rennes 1, Rennes, France; SITI Laboratory, Rennes University Hospital, Rennes, France.

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http://dx.doi.org/10.1016/j.bjps.2021.05.032DOI Listing
August 2021

Invited Response on: Comment on "Lipo-Body Lift Reconstruction Following Massive Weight Loss-Our Experience with 100 Consecutive Cases".

Aesthetic Plast Surg 2022 02 26;46(1):579-580. Epub 2021 May 26.

Department of Plastic, Reconstructive and Aesthetic Surgery, Southern Hospital, CHU Rennes, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.

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http://dx.doi.org/10.1007/s00266-021-02316-1DOI Listing
February 2022

An Update on Cryopreservation of Adipose Tissue.

Plast Reconstr Surg 2021 05;147(5):880e-881e

Department of Plastic and Reconstructive Surgery, Pontchaillou University Hospital, Rennes, France.

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http://dx.doi.org/10.1097/PRS.0000000000007817DOI Listing
May 2021

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

Microsurgery 2021 Jul 12;41(5):405-411. Epub 2021 Apr 12.

Department of Plastic, Reconstructive and Aesthetic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

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 × 7 cm (ranging 8-20 × 4-10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90° 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 × 7.3 cm (ranging 14-27 × 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.
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http://dx.doi.org/10.1002/micr.30743DOI Listing
July 2021

Perforator-Based Intercostal Artery Muscle Flap: A Novel Approach for the Treatment of Tracheoesophageal or Bronchoesophageal Fistulas.

Plast Reconstr Surg 2021 May;147(5):795e-800e

From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, INSERM U1236, and the Department of Hepatobiliary and Digestive Surgery, University of Rennes 1; SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Cliniques Universitaires Saint-Luc.

Summary: Postoperative tracheoesophageal or bronchoesophageal fistulas represent a major surgical challenge. The authors report the description of an original perforator-based intercostal artery muscle flap, aiming to cover all types of intrathoracic fistulas, from any location, in difficult cases such as postoperative fistulas after esophagectomy in an irradiated field. Between June of 2016 and January of 2019, eight male patients were treated with a perforator-based intercostal artery muscle flap. All had previous surgery for esophageal cancer and developed a tracheoesophageal or bronchoesophageal fistula during the perioperative course. The mean patient age was 55.9 ± 8.8 years. All patients received neoadjuvant chemotherapy and seven received neoadjuvant radiation therapy. A perforator-based intercostal artery muscle flap, with a mean skin paddle size of 9.86 × 5 cm, was harvested. The median operative time was 426.50 minutes. The tracheoesophageal or bronchoesophageal fistula was successfully and definitively occluded in three patients; two patients experienced recurrence; and one patient underwent re operation. At 1 year, five patients were alive (62.5 percent), and among them, three (37.5 percent) were free from any intrathoracic complications. Three patients died, because of massive digestive bleeding, mesenteric ischemia, and multiorgan failure, respectively. The perforator-based intercostal artery muscle flap, like the Taylor flap in abdominoperineal reconstruction, could become a workhorse flap for all intrathoracic reconstructions, as it can always be harvested, even if a previous thoracotomy has ruined most of the options. This surgical technique, easily feasible, reliable, and reproducible, became our first option for all postoperative tracheoesophageal or bronchoesophageal fistula patients during the postoperative course following esophagectomy.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000007892DOI Listing
May 2021

Lipo-Bodylift Reconstruction Following Massive Weight Loss: Our Experience with 100 Consecutive Cases.

Aesthetic Plast Surg 2021 10 25;45(5):2220-2228. Epub 2021 Jan 25.

Department of Plastic, Reconstructive and Aesthetic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

Background: We report our experience using the Lipo-Bodylift technique for circumferential lower trunk reconstruction following massive weight loss.

Methods: The procedure combines extensive circular liposuction with circular skin resection immediately under the dermis. We classify lower trunk deformities using three parameters: (1) excess skin (in the horizontal direction, or both horizontally and vertically); (2) the body mass index (BMI); and, (3) skin quality (hyperlaxity or a normal tone). All patients can be divided into four groups, of whom groups I and II are the best candidates for the Lipo-Bodylift procedure. We also describe our perioperative management and patient outcomes, with a focus on postoperative complications.

Results: Between January 2015 and January 2020, 100 patients underwent Lipo-Bodylift treatment. The median patient age was 41 years. The median preoperative BMI was 26.3 kg/m. The median drainage duration and hospital stay were both 3 days. Of all patients, 30% experienced at least one complication, 2% of which were major. Of the minor complications, 27 patients evidenced wound dehiscence. Only (positive) smoking status was significantly associated with postoperative complications (p < 0.001).

Conclusion: We developed the Lipo-Bodylift technique after analyzing changes in the skin and subcutaneous fat after massive weight loss. The technique completes the arsenal of body contouring techniques, appears to be less invasive than the undermining that is usually performed during circumferential reconstruction of the lower trunk, and is associated with a lower rate of major complications.

Level Of Evidence Iv: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-020-02118-xDOI Listing
October 2021

Reply to: "The effect of intradermal botulinum toxin on androgenetic alopecia and its possible mechanism".

J Am Acad Dermatol 2020 12 29;83(6):e435-e436. Epub 2020 Jul 29.

Department of Plastic, Reconstructive and Aesthetic Surgery, Estuaire Private Hospital, Le Havre, France.

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http://dx.doi.org/10.1016/j.jaad.2020.07.092DOI Listing
December 2020

ALGINATE versus NPWT in the Preparation of Surgical Excisions for an STSG: ATEC Trial.

Plast Reconstr Surg Glob Open 2020 Mar 27;8(3):e2691. Epub 2020 Mar 27.

Department of Plastic, Cosmetic and Reconstructive Surgery, Hospital Tenon, Paris, France.

A calcium alginate dressing (ALGINATE) and negative pressure wound therapy (NPWT) are frequently used to treat wounds which heal by secondary intention. This trial compared the healing efficacy and safety of these 2 treatments.

Methods: This randomized, non-inferiority trial enrolled patients who underwent skin excision (>30 cm), which was left open to heal by secondary intention. They received ALGINATE or NPWT by a centralized randomization. Follow-up was performed weekly until optimal granulation tissue was obtained. The primary outcome was time to obtain optimal granulation tissue for a split thickness skin graft take (non-inferiority margin: 4 days). Secondary outcomes were occurrence of adverse events (AEs) and impact of the treatments on the patient's daily life.

Results: ALGINATE and NPWT were applied to 47 and 48 patients, respectively. The mean time to optimal granulation was 19.98 days (95% CI, 17.7-22.3) with ALGINATE and 20.54 (95% CI, 17.6-23.5) with NPWT. Between group difference was -0.56 days (95% CI -4.22 to 3.10). The non-inferiority of ALGINATE versus NPWT was demonstrated. No AE related to the treatment occurred with ALGINATE versus 14 AEs with NPWT. There was no difference in the impact of the treatments on the patient's daily life.

Conclusion: This trial demonstrates that ALGINATE has a similar healing efficacy to that of NPWT and that is markedly better with regard to patient safety.
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http://dx.doi.org/10.1097/GOX.0000000000002691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253249PMC
March 2020

The gluteal butterfly flap: Use of a para-sacral artery perforator propeller flap in gluteal augmentation.

J Plast Reconstr Aesthet Surg 2020 07 19;73(7):1357-1404. Epub 2020 Feb 19.

Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France.

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http://dx.doi.org/10.1016/j.bjps.2020.02.026DOI Listing
July 2020

Does Medial Thighplasty Improve the Sexual Quality of Life of Patient After Massive Weight Sequelae?

Obes Surg 2020 03;30(3):1147-1149

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.

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http://dx.doi.org/10.1007/s11695-019-04376-4DOI Listing
March 2020

Is Abdominoplasty and Concomitant Laparoscopic Umbilical Hernia Repair Feasible by a Plastic Surgeon?

Aesthet Surg J 2019 10;39(11):NP448-NP451

Department of Hepatobiliary and Digestive Surgery, Rennes University Hospital, Rennes, France.

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http://dx.doi.org/10.1093/asj/sjz104DOI Listing
October 2019

Management of Pilonidal Sinus Disease with the Aesthetically Shaped Parasacral Perforator Flap: Multicenter Evaluation of 228 Patients.

Plast Reconstr Surg 2019 10;144(4):971-980

From the Department of Plastic, Reconstructive, Aesthetic Surgery and Burns, CHRU Rangueil; the Department of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie; the Department of Endoscopy and Gastroenterology, Limoges University Hospital; the Department of Plastic Reconstructive and Aesthetic Surgery, University Hospital of Picardie, Amiens Picardie University Hospital; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes.

Background: The management of pilonidal sinus disease is still not standardized. Currently, the two main procedures are a lay-open excision procedure with secondary healing or coverage with local flaps. The authors present their experience with a one-stage excision-coverage with an innovative parasacral artery perforator flap propeller designed to respect the aesthetic unity of the buttocks.

Methods: Study patients were managed with this procedure in the Toulouse, Montpellier, and Rennes university hospitals between 2012 and 2018. Data were collected on clinical and surgical details, immediate and late postoperative complications, and long-term recurrence. Aesthetic satisfaction was evaluated with a self-evaluation questionnaire.

Results: The authors operated on 228 consecutive patients for pilonidal sinus disease with an aesthetically shaped parasacral artery perforator flap. The median patient age was 23.5 years, the median operative time was 46 minutes, the median flap length was 9.3 cm (range, 6.5 to 14 cm), and the median flap width was 4.1 cm (range, 4 to 6.5 cm). There were five distal necroses but no complete flap necrosis. There were six postoperative hematomas, 11 infections, and 18 wound dehiscences. The median follow-up period was 27.9 months. Median hospital length of stay was 4.2 days. Three recurrences of pilonidal sinus disease and six instances of hidradenitis suppurativa were detected. Approximately 82 percent of the women and more than 85 percent of the men were "satisfied" or "very satisfied" with the aesthetic outcome, without significant differences between the sexes (p = 0.901).

Conclusions: The aesthetically shaped parasacral artery perforator flap combines very satisfactory results regarding recurrence and postoperative recovery with cosmetic outcome. This procedure is technically more demanding than other flap procedures, although it is accessible to numerous surgeons as the first-line treatment for pilonidal sinus disease after initial learning.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000006087DOI Listing
October 2019

Integrated transcriptomic, phenotypic, and functional study reveals tissue-specific immune properties of mesenchymal stromal cells.

Stem Cells 2020 01 10;38(1):146-159. Epub 2019 Sep 10.

UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France.

Clinical-grade mesenchymal stromal cells (MSCs) can be expanded from bone marrow and adipose tissue to treat inflammatory diseases and degenerative disorders. However, the influence of their tissue of origin on their functional properties, including their immunosuppressive activity, remains unsolved. In this study, we produced paired bone marrow-derived mesenchymal stromal cell (BM-MSC) and adipose-derived stromal cell (ASC) batches from 14 healthy donors. We then compared them using transcriptomic, phenotypic, and functional analyses and validated our results on purified native MSCs to infer which differences were really endowed by tissue of origin. Cultured MSCs segregated together owing to their tissue of origin based on their gene expression profile analyzed using differential expression and weighted gene coexpression network analysis. This translated into distinct immune-related gene signatures, phenotypes, and functional cell interactions. Importantly, sorted native BM-MSCs and ASCs essentially displayed the same distinctive patterns than their in vitro-expanded counterparts. As a whole, ASCs exhibited an immune profile consistent with a stronger inhibition of immune response and a lower immunogenicity, supporting the use of adipose tissue as a valuable source for clinical applications.
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http://dx.doi.org/10.1002/stem.3077DOI Listing
January 2020

Unilateral superficial external pudendal artery (SEPA) propeller perforator flap (PPF) for vulvar reconstruction after cancer treatment.

Eur J Obstet Gynecol Reprod Biol 2019 Oct 23;241:135-137. Epub 2019 Aug 23.

Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud, Rennes, France.

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http://dx.doi.org/10.1016/j.ejogrb.2019.08.006DOI Listing
October 2019

Impact of Lipo-Body Lift Compared to Classical Lower Body Lift on Postoperative Outcome and Patient's Satisfaction: A Retrospective Study.

Aesthetic Plast Surg 2020 04 1;44(2):464-472. Epub 2019 Jul 1.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.

Introduction: Lately, the growing number of bariatric procedures performed each year led to an increasing demand for lower trunk reconstruction. Our team previously described the lipo-body lift (LBL) technique into lower duration of drainage and therefore seromas and other complications. In this study, we compared the classical body lift (CBL) technique to the LBL procedure.

Materials And Methods: All patients who underwent a LBL or CBL after massive weight loss between November 2012 and October 2017 were included. Surgery outcome parameters were collected as well as patient satisfaction through a satisfaction score realized at least after 1 year postoperative. Comparisons between CBL and LBL were conducted to assess the surgery's safety and the patient's satisfaction.

Results: A total of 130 patients were included, 61 patients who had a LBL were compared to 69 patients who had a CBL. The mean patient age was 39.64 ± 9.97 (21-66) years old, the mean body mass index before plastic surgery was 26.83 ± 3.08 kg/m (19.83-32.69), and the average weight loss was 53.40 ± 17.37 kg. The two groups had comparable preoperative data. Duration of drainage and hospital stay was significantly lower in the LBL group than in the CBL (p < 0.0001 and p < 0.0001, respectively). Surgical outcomes were comparable between groups as well as patient satisfaction scores.

Conclusion: Lipo-body lift allows early discharge of the patient by reducing the duration of drainage without increasing the risk for complications. In our opinion, this technique should be used for type 1 and 2 patients with no contraindication for abdominal liposuction.

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.
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http://dx.doi.org/10.1007/s00266-019-01435-0DOI Listing
April 2020

The Lipo-Body Lift: Operative Technique.

Plast Reconstr Surg Glob Open 2019 Feb 25;7(2):e2156. Epub 2019 Feb 25.

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France.

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.
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http://dx.doi.org/10.1097/GOX.0000000000002156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416115PMC
February 2019

Modified Treatment Algorithm for Pseudogynecomastia After Massive Weight Loss.

Ann Plast Surg 2019 04;82(4):482-483

Department of Obstetrics and Gynecology Department of Plastic, Reconstructive and Aesthetic Surgery Hôpital Sud Rennes, France Department of Plastic, Reconstructive and Aesthetic Surgery Hôpital Sud Rennes, France.

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http://dx.doi.org/10.1097/SAP.0000000000001833DOI Listing
April 2019

The Assessment of a Predictive Risk and a Decrease Postoperative Complication Following Body-Contouring Surgery After Massive Weight Loss.

Obes Surg 2019 05;29(5):1644-1646

Department of Hepatobiliary and Digestive Surgery, University of Rennes 1, Rennes, France.

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http://dx.doi.org/10.1007/s11695-019-03742-6DOI Listing
May 2019

The Link Between Minimally Invasive Esophagectomy and Tracheobronchial Fistula Occurrence.

Ann Thorac Surg 2019 07 7;108(1):311. Epub 2019 Jan 7.

Department of Digestive Surgery, Centre Hospitalo-Universitaire, Rennes, France.

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http://dx.doi.org/10.1016/j.athoracsur.2018.12.007DOI Listing
July 2019

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

Plast Reconstr Surg 2018 10;142(4):596e-598e

Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, INSERM U1236, University of Rennes 1, SITI Laboratory, Rennes University Hospital, Rennes, France.

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http://dx.doi.org/10.1097/PRS.0000000000004790DOI Listing
October 2018

Diagnosis, assessment, and management of surgical complications following esophagectomy.

Ann N Y Acad Sci 2018 12 8;1434(1):254-273. Epub 2018 Jul 8.

Department of Surgery, University of Michigan, Ann Arbor, Michigan.

Despite improvements in operative strategies for esophageal resection, anastomotic leaks, fistula, postoperative pulmonary complications, and chylothorax can occur. Our review seeks to identify potential risk factors, modalities for early diagnosis, and novel interventions that may ameliorate the potential adverse effects of these surgical complications following esophagectomy.
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http://dx.doi.org/10.1111/nyas.13920DOI Listing
December 2018

Distally Based Medial Plantar Flap: A Classification of the Surgical Techniques.

J Foot Ankle Surg 2018 Nov - Dec;57(6):1230-1237. Epub 2018 Jun 21.

Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil University Hospital, Toulouse, France. Electronic address:

The proximally based medial plantar flap is considered to be the reference standard for heel reconstruction. Although less well-studied, a distally based medial plantar flap is a suitable alternative when used to cover a distal foot defect, especially of the hallux, first metatarsal, or metatarsophalangeal joint. Our objective was to provide a complete description and propose a classification of the different surgical procedures used to harvest this flap. A review of the data reported in the MEDLINE database until May 2017 concerning the distally based medial plantar flap was performed. We have illustrated the different surgical procedures through a case series. Three approaches or "types" of flap have been described, and we have proposed a classification for reconstructive surgeons. In type 1, the plantar pedicle is ligatured before division into the medial and lateral plantar artery. In type 2, the medial plantar pedicle is cut proximally just after division. In type 3, the flap is harvested to include the fasciocutaneous perforator vessels, as an advancement flap or a propeller perforator flap. A distally based medial plantar flap affords adequate and reliable coverage of the weightbearing zone. Because the donor site drawbacks are minimal, this flap is a useful option for distal foot reconstruction, and reconstructive surgeons should remember this flap. The type 1 flap appears to be associated with a minimal risk of flap necrosis, even in those with diabetes or arteriopathy, and can cover even the most distal defect.
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http://dx.doi.org/10.1053/j.jfas.2018.03.027DOI Listing
February 2019

The Use of Pedicled Perforator Flaps in Chest Reconstruction: A Systematic Review of Outcomes and Reliability.

Ann Plast Surg 2018 10;81(4):487-494

Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, University of Rennes 1, Rennes.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.
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http://dx.doi.org/10.1097/SAP.0000000000001466DOI Listing
October 2018

Muscle versus Fasciocutaneous Free Flaps in Lower Extremity Traumatic Reconstruction: A Multicenter Outcomes Analysis.

Plast Reconstr Surg 2018 06;141(6):974e-975e

Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, University Paul Sabatier, Toulouse, France.

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http://dx.doi.org/10.1097/PRS.0000000000004398DOI Listing
June 2018

The Efficacy of Perforator Flaps in the Treatment of Chronic Osteomyelitis.

Plast Reconstr Surg 2018 03;141(3):460e-462e

Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, University Paul Sabatier, Toulouse, France.

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http://dx.doi.org/10.1097/PRS.0000000000004155DOI Listing
March 2018

Outpatient Circumferential Lower Body Lift: Is the Lipo-Body Lift an Ideal Method?

Plast Reconstr Surg 2018 03;141(3):453e-454e

Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, Rennes, France, INSERM U1236, University of Rennes 1, SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France.

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http://dx.doi.org/10.1097/PRS.0000000000004147DOI Listing
March 2018
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