Pr CAMUZARD Olivier

Posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery: A case report

Alexandra Maertens, Frederica Jessie Tchoungui Ritz, Marie Anne Poumellec, Olivier Camuzard, Thierry Balaguer

https://pubmed.ncbi.nlm.nih.gov/32980701/

Abstract

Introduction: Hand and Upper limb pseudoaneurysms are uncommon and misdiagnosed. The delayed diagnostic and treatment lead to severe vascular and nerve complications. Many mechanisms are involved like acute injury, chronic micro traumatism of the hand, with specific clinic and para clinic signs.

Presentation of case: The patient was a 30-years old woman, right-handed, admitted at the emergencies for a penetrating hand injury at the junction of the middle third – distal third of the left forearm, palmar surface, with a good radial and ulnar pulse, without sensory or motor deficit. No vessels injuries observed per operatively. A post-operative worsened pain opposite to the scar with a purplish pulsatile swelling appeared after 20 days of complete wound healing. A needle puncture with a red blood contain, motivated an US Doppler revealing a pseudoaneurysm of a superficial artery of the ulnar artery, surgically resected, without complication.

Discussion: Two main mechanisms are involved in upper limb especially hand pseudoaneurysm: penetrating trauma and repeated micro traumatism. Superficial vessels are rarely damaged compare to deep subfascial vessels according to Laplace law. The diagnostic is clinical confirmed with the medical imaging. A pseudoaneurysm is suspected in front of a pulsatile painful tumefaction following a vessel path, with medical imaging in favor. A delayed misdiagnosis lead to a delayed care with severe complications as thrombosis, embolism and vessel. The therapeutic care is mainly surgical.

Conclusion: This case reports a delayed diagnostic of posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery, managed with a surgical resection.

Keywords: Case report; Hand injury; Pseudoaneurysm; Ulnar artery.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Neoadjuvant isolated limb perfusion in newly diagnosed untreated patients with locally advanced soft tissue sarcomas of the extremities: the Gustave Roussy experience

T Assi, A Cavalcanti, A Le Cesne, M Faron, J F Honart, A Hadiji, O Camuzard, T Ibrahim, C LePéchoux, O Mir, S Dumont, P Terrier, J Adam, C Honoré

https://pubmed.ncbi.nlm.nih.gov/30656606/

Abstract

Background: Limb-sparing surgery in locally advanced soft tissue sarcomas (LA STS) is challenging. The aim of this study is to evaluate upfront isolated limb perfusion (ILP) in untreated patients with LA STS.

Methods: All consecutive patients with LA STS of the limbs deemed borderline or unresectable and treated with upfront ILP as induction treatment between 2003 and 2016 were included. Demographic, clinical and long-term characteristics were obtained and retrospectively analyzed.

Results: 41 patients (pts), with a median age of 51 years [range 21-76], were identified (lower limb 68%, upper limb 32%). Liposarcoma and undifferentiated pleomorphic sarcoma were the most common subtypes (27% and 22%, respectively). Acute toxicities, using Wieberdink classification, were grade II (35 pts, 85%), grade III (2 pts, 5%) and no grade IV-V. Local control rate was 98%. 32 pts had limb-sparing surgery (78%). 1 pt had an early amputation due to progressive disease after ILP. 8 pts were not operated (four had RT alone, one had distant metastases, two had a complete response and one died 3 months after ILP of a pulmonary embolism). 36 pts (84%) received postoperative RT. After a median follow-up of 43 months, 18 pts (47%) relapsed. Median disease-free survival (DFS) was 6.7 years. The median overall survival (OS) was not reached. The 1-year, 5-year and 10-year DFS and OS rates were, respectively, 75%, 50% and 45%, and 90%, 63% and 55%.

Conclusion: Upfront ILP is an efficient and well-tolerated limb-sparing procedure in borderline or unresectable LA STS without hampering OS.

Keywords: Chemotherapy; Isolated limb perfusion; Limb salvage; Neoadjuvant treatment; Soft tissue sarcoma.

Role of autophagy in osteosarcoma

Olivier Camuzard, Sabine Santucci-Darmanin, Georges F Carle, Valérie Pierrefite-Carle

https://pubmed.ncbi.nlm.nih.gov/31011524/

Abstract

Osteosarcoma (OS) is the most common primary bone tumour in children and adolescents. It is a highly aggressive tumor with a tendency to spread to the lungs, which are the most common site of metastasis. Advanced osteosarcoma patients with metastasis share a poor prognosis. Despite the use of chemotherapy to treat OS, the 5-year overall survival rate for patients has remained unchanged at 65-70% for the past 20 years. In addition, the 5-year survival of patients with a metastatic disease is around 20%, highlighting the need for novel therapeutic targets. Autophagy is an intracellular degradation process which eliminates and recycles damaged proteins and organelles to improve cell lifespan. In the context of cancer, numerous studies have demonstrated that autophagy is used by tumor cells to repress initial steps of carcinogenesis and/or support the survival and growth of established tumors. In osteosarcoma, autophagy appears to be deregulated and could also act both as a pro or anti-tumoral process. In this manuscript, we aim to review these major findings regarding the role of autophagy in osteosarcoma.

Keywords: Autophagy; Cell death; Osteosarcoma; Survival.

Autophagy Involvement in Aseptic Loosening of Arthroplasty Components.

Camuzard, Olivier MD; Breuil, Véronique MD, PhD; Carle, Georges F. PhD; Pierrefite-Carle, Valérie PhD

https://pubmed.ncbi.nlm.nih.gov/30845042/

The infraorbital artery: From descriptive anatomy to mucosal perforator flap design

Katharina Hufschmidt, Olivier Camuzard, Thierry Balaguer, Patrick Baqué, Fernand de Peretti, Joseph Santini, Nicolas Bronsard, Quentin Qassemyar

https://pubmed.ncbi.nlm.nih.gov/30684276/

Abstract

Background: The terminal and perforating branches of the infraorbital artery (IOA) are poorly described. Its anatomical situation and mucosal component could provide an interesting donor site for mucosal reconstruction. The aims of the following study were to establish an anatomical description and to assess the feasibility of mucosal perforator flaps for eyelid and nasal reconstruction.

Methods: Twenty-three fresh cadaver hemifaces were studied in order to perform an IOA anatomical classification by recording the artery’s characteristics, its course, number, type, and diameter of terminal branches. We also examined the feasibility of local flaps for facial reconstruction.

Results: We highlighted five different types of courses. All cadavers had at least one superior vestibular branch with a caliber of ≥0.4 mm. A pedicled flap arising from the vestibular branch was raised in all dissections.

Conclusion: The vestibular perforator flap based on the IOA seems to be a reliable flap in reconstruction of mucosal defects.

Keywords: eyelid repair; infraorbital artery; mucosal reconstruction; nostril repair; perforator flap.

© 2019 Wiley Periodicals, Inc.

Ultrasound-guided percutaneous release of the carpal tunnel: comparison of the learning curves of a senior versus a junior operator. A cadaveric study

Chloé Dekimpe, Olivier Andreani, Olivier Camuzard, Charles Raffaelli, David Petrover, Pauline Foti, Nicolas Amoretti

https://pubmed.ncbi.nlm.nih.gov/31114970/

Abstract

Objective: The purpose was to evaluate, in a cadaveric cohort, the feasibility and the learning curve of ultrasound-guided percutaneous carpal tunnel release.

Materials and methods: Fourteen carpal tunnel releases were carried out on unembalmed cadavers by a senior and a junior radiologist. Procedures were realized with an 18-MHz linear probe. An anatomical evaluation was first performed using ultrasound to detect any anatomical variant. After hydrodissection of the carpal tunnel with lidocaine, a 3-mm hook knife was introduced into the security zone to perform a retrograde section of the transverse carpal ligament (TCL) under ultrasound guidance. Anatomical dissection was performed for each wrist. The main evaluation criterion was the complete TCL section. The procedure duration (minutes), skin incision size (millimeters), the integrity of the median nerve, thenar motor branch, and palmar vascular arch were also evaluated.

Results: The senior operator was able to perform a complete release after training on three specimens and the junior operator after four specimens (p > 0.05). In most of the cases when complete release was not achieved, it was due to an incomplete section of the distal TCL (10 mm missing section on average). Mean duration time of procedure was 14 min (11 min for the senior versus 17 min for the junior, p > 0.05). Damage of neither the median nerve nor the vascular structure was observed. Mean size of the skin incision was 3 mm.

Conclusion: The ultrasound-guided percutaneous release of the carpal tunnel is demonstrated to be a procedure with a rapid learning curve.

Keywords: Cadaver; Carpal tunnel syndrome; Learning curve; Median nerve; Ultrasound.

Reliability of Color Doppler Ultrasound Imaging for the Assessment of Anterolateral Thigh Flap Perforators: A Prospective Study of 30 Perforators

Alexandre Debelmas, Olivier Camuzard, Paola Aguilar, Quentin Qassemyar

https://pubmed.ncbi.nlm.nih.gov/29481406/

Abstract

Despite numerous advantages, the anterolateral thigh perforator flap suffers from the variable position and nature of its perforators. The aim of the authors’ study was to assess the reliability of preoperative color Doppler ultrasound imaging for the exploration of perforator location and course of anterolateral thigh perforator flaps. A prospective cohort study involving patients for whom head and neck reconstruction was planned with thin anterolateral thigh perforator flaps was conducted. Each patient underwent a color Doppler ultrasound exploration of the thighs, in the operating room, immediately before surgery. The sonographer was the surgeon who raised the flaps. Perforators were sought according to surgical needs, and the same location protocol was followed for all of the cases, using an orthonormal coordinate system to report the passages of the perforators through the vastus lateralis aponeurosis. Between January of 2016 and January of 2017, 22 thin anterolateral thigh perforator flaps were successfully harvested. Thirty perforators were located and used. The median distance between the preoperative color Doppler ultrasound planning and the final location of the perforators was 5 mm, statistically smaller than a 10-mm threshold (p = 0.002). Color Doppler ultrasound effectively predicted the nature of the perforators in 90 percent of the cases. The median duration for perforator color Doppler ultrasound location was 3 minutes, statistically shorter than 10 minutes (p = 0.0001). Preoperative color Doppler ultrasound seems to be reliable, accurate, and compatible with a quick routine assessment during patient setup for the elevation of thin anterolateral thigh perforator flaps.

Clinical question/level of evidence: Diagnostic, II.

Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application

Olivier Camuzard, Rémi Foissac, Cyril Clerico, Jonathan Fernandez, Thierry Balaguer, Tarik Ihrai, Fernand de Peretti, Patrick Baqué, Pascal Boileau, Charalambos Georgiou, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/26984913/

Abstract

Background: Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow.

Methods: Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators.

Results: A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months.

Conclusions: The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction.

Clinical relevance: The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.

Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Sex-specific autophagy modulation in osteoblastic lineage: a critical function to counteract bone loss in female

Olivier Camuzard, Sabine Santucci-Darmanin, Véronique Breuil, Chantal Cros, Tatiana Gritsaenko, Sophie Pagnotta, Laurence Cailleteau 5, Séverine Battaglia, Patricia Panaïa-Ferrari, Dominique Heymann, Georges F Carle, Valérie Pierrefite-Carle

https://pubmed.ncbi.nlm.nih.gov/27634908/

Abstract

Age-related bone loss is associated with an increased oxidative stress which is worsened by estrogen fall during menauposis. This observation has drawn attention to autophagy, a major cellular catabolic process, able to alleviate oxidative stress in osteoblasts (OB) and osteocytes (OST), two key bone cell types. Moreover, an autophagy decline can be associated with aging, suggesting that an age-related autophagy deficiency in OB and/or OST could contribute to skeletal aging and osteoporosis onset.In the present work, autophagy activity was analyzed in OST and OB in male and female mice according to their age and hormonal status. In OST, autophagy decreases with aging in both sexes. In OB, although a 95% decrease in autophagy is observed in OB derived from old females, this activity remains unchanged in males. In addition, while ovariectomy has no effect on OB autophagy levels, orchidectomy appears to stimulate this process. An inverse correlation between autophagy and the oxidative stress level was observed in OB derived from males or females. Finally, using OB-specific autophagy-deficient mice, we showed that autophagy deficiency aggravates the bone loss associated with aging and estrogen deprivation.Taken together, our data indicate that autophagic modulation in bone cells differs according to sex and cell type. The lowering of autophagy in female OB, which is associated with an increased oxidative stress, could play a role in osteoporosis pathophysiology and suggests that autophagy could be a new therapeutic target for osteoporosis in women.

Keywords: Gerotarget; aging; autophagy; osteoblast; osteocyte; osteoporosis.

A rare cause of ulnar nerve entrapment at the elbow area illustrated by six cases: The anconeus epitrochlearis muscle

J Fernandez, O Camuzard, M-O Gauci, M Winter

https://pubmed.ncbi.nlm.nih.gov/26545312/

Abstract

Ulnar nerve entrapment is the second most common compressive neuropathy after carpal tunnel syndrome. The accessory anconeus epitrochlearis muscle – present in 4% to 34% of the general population – is a known, but rare cause of ulnar nerve entrapment at the elbow. The aim of this article was to expand our knowledge about this condition based on six cases that we encountered at our hospital between 2011 and 2015. Every patient had a typical clinical presentation: hypoesthesia or sensory deficit in the fourth and fifth fingers; potential intrinsics atrophy of the fourth intermetacarpal space; loss of strength and difficulty with fifth finger abduction. Although it can be useful to have the patient undergo ultrasonography or MRI to aid in the diagnosis, only electromyography (EMG) was performed in our patients. EMG revealed clear compression in the ulnar groove, with conduction block and a large drop in nerve conduction velocity. Treatment typically consists of conservative treatment first (splint, analgesics). Surgical treatment should be considered when conservative treatment has failed or the patient presents severe neurological deficits. In all of our patients, the ulnar nerve was surgically released but not transposed. Five of the six patients had completely recovered after 0.5 to 4years follow-up. Ulnar nerve entrapment at the elbow by the anconeus epitrochlearis muscle is not common, but it must not be ignored. Only ultrasonography, MRI or, preferably, surgical exploration can establish the diagnosis. EMG findings such as reduced motor nerve conduction velocity in a short segment of the ulnar nerve provides evidence of anconeus epitrochlearis-induced neuropathy.

Keywords: Anconeus epitrochlearis muscle; Compression du nerf ulnaire; Compressive neuropathy; Muscle anconeus epitrochlearis; Neurolyse; Neurolysis; Neuropathie compressive; Ulnar nerve compression.

Copyright © 2015 SFCM. Published by Elsevier Masson SAS. All rights reserved.

A strange form of dysphonia… . Laryngeal paraganglioma

Etienne Berta, Olivier Camuzard, Gilles Poissonnet

https://pubmed.ncbi.nlm.nih.gov/26123571/

Contribution of breast skin elastometry measurement in breast augmentation surgery: A pilot study evaluating the correlation between skin elasticity and nipple-to-inframammary fold distance

Rémi Foissac, Olivier Camuzard, Charalambos Georgiou, Pauline Foty, Thierry Balaguer, Bérengère Chignon-Sicard, Dominique Casanova

https://pubmed.ncbi.nlm.nih.gov/26044089/

New cutaneous strategy in sural flap surgery and possibility to adapt this technique to other pedicled flaps

J Fernandez, C Clérico, O Camuzard, B Chignon-Sicard

https://pubmed.ncbi.nlm.nih.gov/25963526/

Abstract

Introduction: Therapeutic managements in losses of substance of the lower limb using sural flap give an important scar and, sometimes, an impossibility to close the flap donor site. That led us to think about an operative procedure that can reduce those scars without increasing the risk of necrosis of the cutaneous paddle.

Patients and method: We present this operative procedure which underwent in the plastic and reconstructive surgery service in our hospital. Classical flap procedure with two cutaneous parts was used. The cutaneous laxity was evaluated so as to close with one cutaneous part; the other cutaneous part was taken and used like a skin graft after the suture of the calf and the formation of a bursa on the donor site. The leg was closed with only one cutaneous flap.

Results: This technique is illustrated by a case report. Results at the 4th month are very interesting with an acceptable scar and a good result of the skin graft. However, with this technique, we don’t decrease the venous risk of this flap. We used this technique for an antebrachial flap.

Conclusion: This technique is an easy and reliable technique based on cutaneous laxity and that decreases scarring of this very useful flap: the neurocutaneous sural flap. We can have a diminution of the number of surgery, a diminution of the scar and good aesthetics results.

Keywords: Cutaneous laxity; Cutaneous strategy; Lambeau sural; Laxité cutanée; Neurocutaneous sural flap; Pedicled; Pédiculé; Rançon cicatricielle; Scar; Stratégie cutanée.

Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Severe granulomatous reaction associated with hypercalcemia occurring after silicone soft tissue augmentation of the buttocks: a case report

O Camuzard, P Dumas, R Foissac, J Fernandez, S David, T Balaguer, B Chignon-Sicard, C Dumontier

https://pubmed.ncbi.nlm.nih.gov/24281899/

Abstract

Liquid silicone is a permanent filler. Its use to augment soft tissues for aesthetic purposes was widespread worldwide in the 1960s. Although initially considered to be biologically inert, this substance may cause, after its injection, an inflammatory granulomatous effect of variable severity and, in very rare cases, a severe hypercalcemia, which can be life threatening. The reported case highlights the well-known physiopathology of hypercalcemia, and the various therapeutic options are discussed.

Level of evidence v: 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 .