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Article ; Online: Modern Approaches to Alternative Flap-Based Breast Reconstruction: Transverse Upper Gracilis Flap.

Blough, Jordan T / Saint-Cyr, Michel H

2023 Volume 50, Issue 2, Page(s) 313–323

Abstract: The transverse upper/myocutaneous gracilis is a medial thigh-based flap primarily reserved as a secondary choice for autologous reconstruction of small to moderate-sized breasts in women without a suitable abdominal donor site. Its consistent and ... ...

Abstract	The transverse upper/myocutaneous gracilis is a medial thigh-based flap primarily reserved as a secondary choice for autologous reconstruction of small to moderate-sized breasts in women without a suitable abdominal donor site. Its consistent and reliable anatomy based on the medial circumflex femoral artery permits expedient flap harvest with relatively low donor site morbidity. The primary disadvantage is the limited achievable volume, often necessitating augmentation such as extended flap modifications, autologous fat grafting, flap stacking, or even implant placement.
MeSH term(s)	Female ; Humans ; Mammaplasty ; Myocutaneous Flap/surgery ; Myocutaneous Flap/transplantation ; Breast/surgery ; Transplantation, Autologous ; Thigh/surgery
Language	English
Publishing date	2023-01-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193117-9
ISSN	1558-0504 ; 0094-1298
ISSN (online)	1558-0504
ISSN	0094-1298
DOI	10.1016/j.cps.2022.11.001
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Article ; Online: Microsurgery: Global Perspectives: An Update.

Tang, Jin Bo / Saint-Cyr, Michel

Clinics in plastic surgery

2020 Volume 47, Issue 4, Page(s) xiii

Language	English
Publishing date	2020-08-12
Publishing country	United States
Document type	Editorial
ZDB-ID	193117-9
ISSN	1558-0504 ; 0094-1298
ISSN (online)	1558-0504
ISSN	0094-1298
DOI	10.1016/j.cps.2020.07.003
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Article ; Online: Propeller Flaps in Lower Extremity Reconstruction.

Blough, Jordan T / Saint-Cyr, Michel H

Clinics in plastic surgery

2021 Volume 48, Issue 2, Page(s) 173–181

Abstract: Propeller flaps represent an outstanding alternative to conventional pedicled and free flap options in lower extremity reconstruction, offering significant advantages over the latter. An understanding of the perforasome concept, hot and cold perforator ... ...

Abstract	Propeller flaps represent an outstanding alternative to conventional pedicled and free flap options in lower extremity reconstruction, offering significant advantages over the latter. An understanding of the perforasome concept, hot and cold perforator locations, and basic flap design enable the surgeon to readily harvest flaps based on any clinically relevant perforator in freestyle fashion. The purpose of this article is to review fundamentals of propeller flap design and harvest in the lower extremity and discuss reconstructive strategies by level of injury.
MeSH term(s)	Humans ; Lower Extremity/injuries ; Lower Extremity/surgery ; Perforator Flap ; Reconstructive Surgical Procedures/methods
Language	English
Publishing date	2021-02-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193117-9
ISSN	1558-0504 ; 0094-1298
ISSN (online)	1558-0504
ISSN	0094-1298
DOI	10.1016/j.cps.2021.01.002
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Article ; Online: Flaps Based on the Dorsal Metacarpal Artery.

Webster, Nicholas / Saint-Cyr, Michel

Hand clinics

2019 Volume 36, Issue 1, Page(s) 75–83

Abstract: Dorsal metacarpal artery flaps have evolved with our knowledge of vascular anatomy of the hand. Since the description of the first transposition flap likely based on the first dorsal metacarpal artery in the 1950s until today, the indications and ... ...

Abstract	Dorsal metacarpal artery flaps have evolved with our knowledge of vascular anatomy of the hand. Since the description of the first transposition flap likely based on the first dorsal metacarpal artery in the 1950s until today, the indications and modifications of these flaps have greatly expanded. Reverse flow flaps have allowed coverage of the dorsum of each digit with vascularized tissue with minimal donor site morbidity and harvest of veins, bone, and tendon with them. This article reviews the history, anatomy, indications, and surgical techniques of this class of flaps and its numerous permutations.
MeSH term(s)	Arteries/anatomy & histology ; Contraindications, Procedure ; Finger Injuries/surgery ; Fingers/blood supply ; Fingers/surgery ; Humans ; Surgical Flaps/blood supply
Language	English
Publishing date	2019-11-19
Publishing country	United States
Document type	Journal Article ; Review ; Video-Audio Media
ZDB-ID	1315374-2
ISSN	1558-1969 ; 0749-0712
ISSN (online)	1558-1969
ISSN	0749-0712
DOI	10.1016/j.hcl.2019.09.001
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Article ; Online: Authors' reply to correspondence to "Mortality-related risk factors of inpatients with diabetes and COVID-19: A multicenter retrospective study in Belgium. Ann Endocrinol (Paris). 2023 Aug 31:S0003-4266(23)00685-6. doi: 10.1016/j.ando.2023.08.002".

Orioli, Laura / Servais, Thomas / Crenier, Laurent / Oriot, Philippe / Yombi, Jean Cyr / Hermans, Michel Paul

Annales d'endocrinologie

2023 Volume 84, Issue 6, Page(s) 790–791

Language	English
Publishing date	2023-10-17
Publishing country	France
Document type	Multicenter Study ; Letter ; Comment
ZDB-ID	299-9
ISSN	2213-3941 ; 0003-4266
ISSN (online)	2213-3941
ISSN	0003-4266
DOI	10.1016/j.ando.2023.10.001
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Article ; Online: Recent Advances in Microsurgery: An Update in the Past 4 Years.

Mohan, Anita T / Saint-Cyr, Michel

Clinics in plastic surgery

2020 Volume 47, Issue 4, Page(s) 663–677

Abstract: Microsurgery has broad applications in reconstructive surgery. As techniques, diagnostics, and advancing technology rapidly evolve, reconstructive microsurgeons can adapt to address new challenges and push the frontiers to achieve optimal functional and ... ...

Abstract	Microsurgery has broad applications in reconstructive surgery. As techniques, diagnostics, and advancing technology rapidly evolve, reconstructive microsurgeons can adapt to address new challenges and push the frontiers to achieve optimal functional and aesthetic reconstruction, and minimize donor site morbidity. This article briefly outlines some of the recent advances and innovations in microsurgery within the last 5 years in perforator flaps, breast, lymphedema surgery, extremity reconstruction, targeted muscle reinnervation, head and neck reconstruction, composite tissue allotransplantation, and robotic surgery.
MeSH term(s)	Breast/surgery ; Esthetics ; Extremities/surgery ; Female ; Humans ; Male ; Microsurgery/methods ; Perforator Flap/surgery ; Reconstructive Surgical Procedures/methods ; Surgery, Computer-Assisted
Language	English
Publishing date	2020-08-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193117-9
ISSN	1558-0504 ; 0094-1298
ISSN (online)	1558-0504
ISSN	0094-1298
DOI	10.1016/j.cps.2020.07.002
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Article ; Online: Decreasing Opioids in Outpatient Breast Surgery with an Enhanced Recovery after Surgery Program and Preoperative Education.

Wong, Stacy / Lombana, Nicholas F / Falola, Reuben A / Park, Peter / Saint-Cyr, Michel H

Plastic and reconstructive surgery

2022 Volume 151, Issue 5, Page(s) 941–947

Abstract: Background: Enhanced recovery after surgery (ERAS) programs have been detailed in the literature predominantly in the inpatient setting. The purpose of this study was to determine the effect of an ERAS protocol with a preoperative educational class on ... ...

Abstract	Background: Enhanced recovery after surgery (ERAS) programs have been detailed in the literature predominantly in the inpatient setting. The purpose of this study was to determine the effect of an ERAS protocol with a preoperative educational class on opioid prescribing and patient outcomes for outpatient breast surgery. Methods: An ERAS protocol was formulated focusing on preoperative education, multimodal pain control, and an intraoperative block. The study was conducted as an institutional review board-approved retrospective review. Women undergoing breast reconstruction revision, breast reduction, delayed insertion of prosthesis, tissue expander to implant exchange, and matching procedures were included. The patients were separated into pre-ERAS and ERAS cohorts. Data on demographic characteristics, postanesthesia care unit (PACU) length of stay, PACU oral morphine equivalent (OME) consumption, outpatient OME prescriptions, major and minor complications, and need for additional opioid prescriptions were collected. Analysis was performed with the Fisher exact test or chi-square test as appropriate. Results: Group 1 (pre-ERAS) and group 2 (ERAS) each included 68 patients. The cohorts had similar age, body mass index, diabetes status, and tobacco use. Group 1 was prescribed an average of 216 OMEs, compared with 126.4 OMEs for group 2, a 41.5% decrease ( P < 0.0001). The pre-ERAS group consumed an average of 23.3 OMEs in the PACU versus 16.6 OMEs in the ERAS group ( P = 0.005). Fewer patients in the ERAS group required additional prescriptions for narcotic pain medication at postoperative follow-up ( P = 0.116). No differences were seen in major or minor complications. Conclusion: An ERAS protocol that uses a multimodal approach to pain control and preoperative patient education is useful in the outpatient setting and can help decrease opioid consumption. Clinical question/level of evidence: Therapeutic, III.
MeSH term(s)	Humans ; Female ; Analgesics, Opioid/therapeutic use ; Outpatients ; Enhanced Recovery After Surgery ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Practice Patterns, Physicians' ; Retrospective Studies ; Morphine/therapeutic use ; Breast Neoplasms/complications ; Length of Stay
Chemical Substances	Analgesics, Opioid ; Morphine (76I7G6D29C)
Language	English
Publishing date	2022-12-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000010069
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Article: Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions.

Lombana, Nicholas F / Mehta, Ishan M / Zheng, Caiwei / Falola, Reuben A / Altman, Andrew M / Saint-Cyr, Michel H

Proceedings (Baylor University. Medical Center)

2023 Volume 36, Issue 4, Page(s) 501–509

Abstract: Introduction: Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay ... ...

Abstract	Introduction: Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay numbers have decreased significantly. This article provides an up-to-date review of current ERAS protocols in use, reviews individual aspects of ERAS protocols, and discusses future directions for the continual improvement of ERAS protocols and control of postoperative pain. Eras components: ERAS protocols have proven to be excellent methods of decreasing patient pain, opioid consumption, and postanesthesia care unit (PACU) and/or inpatient length of stay. ERAS protocols have three phases: preoperative education and pre-habilitation, intraoperative anesthetic blocks, and a postoperative multimodal analgesia regimen. Intraoperative blocks consist of local anesthetic field blocks and a variety of regional blocks, with lidocaine or lidocaine cocktails. Various studies throughout the surgical literature have demonstrated the efficacy of these aspects and their relevance to the overall goal of decreasing patient pain, both in plastic surgery and other surgical fields. In addition to the individual ERAS phases, ERAS protocols have shown promise in both the inpatient and outpatient sectors of plastic surgery of the breast. Conclusion: ERAS protocols have repeatedly been shown to provide improved patient pain control, decreased hospital or PACU length of stay, decreased opioid use, and cost savings. Although protocols have most commonly been utilized in inpatient plastic surgery procedures of the breast, emerging evidence points towards similar efficacy when used in outpatient procedures. Furthermore, this review demonstrates the efficacy of local anesthetic blocks in controlling patient pain.
Language	English
Publishing date	2023-05-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2703932-8
ISSN	1525-3252 ; 0899-8280
ISSN (online)	1525-3252
ISSN	0899-8280
DOI	10.1080/08998280.2023.2210036
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Article ; Online: Native low-density lipoproteins are priming signals of the NLRP3 inflammasome/interleukin-1β pathway in human adipose tissue and macrophages.

Bissonnette, Simon / Lamantia, Valérie / Ouimet, Benjamin / Cyr, Yannick / Devaux, Marie / Rabasa-Lhoret, Remi / Chrétien, Michel / Saleh, Maya / Faraj, May

Scientific reports

2023 Volume 13, Issue 1, Page(s) 18848

Abstract: Elevated plasma numbers of atherogenic apoB-lipoproteins (apoB), mostly as low-density lipoproteins (LDL), predict diabetes risk by unclear mechanisms. Upregulation of the NLRP3 inflammasome/interleukin-1 beta (IL-1β) system in white adipose tissue (WAT) ...

Abstract	Elevated plasma numbers of atherogenic apoB-lipoproteins (apoB), mostly as low-density lipoproteins (LDL), predict diabetes risk by unclear mechanisms. Upregulation of the NLRP3 inflammasome/interleukin-1 beta (IL-1β) system in white adipose tissue (WAT) is implicated in type 2 diabetes (T2D); however, metabolic signals that stimulate it remain unexplored. We hypothesized that (1) subjects with high-apoB have higher WAT IL-1β-secretion than subjects with low-apoB, (2) WAT IL-1β-secretion is associated with T2D risk factors, and (3) LDL prime and/or activate the WAT NLRP3 inflammasome. Forty non-diabetic subjects were assessed for T2D risk factors related to systemic and WAT glucose and fat metabolism. Regulation of the NLRP3 inflammasome was explored using LDL without/with the inflammasome's priming and activation controls (LPS and ATP). LDL induced IL1B-expression and IL-1β-secretion in the presence of ATP in WAT and macrophages. Subjects with high-apoB had higher WAT IL-1β-secretion independently of covariates. The direction of association of LDL-induced WAT IL-1β-secretion to T2D risk factors was consistently pathological in high-apoB subjects only. Adjustment for IL-1β-secretion eliminated the association of plasma apoB with T2D risk factors. In conclusion, subjects with high-apoB have higher WAT IL-1β-secretion that may explain their risk for T2D and may be related to LDL-induced priming of the NLRP3 inflammasome.ClinicalTrials.gov (NCT04496154): Omega-3 to Reduce Diabetes Risk in Subjects With High Number of Particles That Carry "Bad Cholesterol" in the Blood-Full Text View-ClinicalTrials.gov.
MeSH term(s)	Humans ; Inflammasomes/metabolism ; NLR Family, Pyrin Domain-Containing 3 Protein/genetics ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism ; Lipoproteins, LDL/pharmacology ; Interleukin-1beta/metabolism ; Diabetes Mellitus, Type 2/metabolism ; Macrophages/metabolism ; Apolipoproteins B ; Adipose Tissue, White/metabolism ; Adenosine Triphosphate
Chemical Substances	Inflammasomes ; NLR Family, Pyrin Domain-Containing 3 Protein ; Lipoproteins, LDL ; Interleukin-1beta ; Apolipoproteins B ; Adenosine Triphosphate (8L70Q75FXE)
Language	English
Publishing date	2023-11-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-45870-1
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Article ; Online: Autologous Breast Reconstruction in Low Body Mass Index Patients: Strategies for Maximizing Skin Envelope and Breast Volume.

Mohan, Anita T / Zhu, Lin / Vijayasekaran, Aparna / Saint-Cyr, Michel

Clinics in plastic surgery

2020 Volume 47, Issue 4, Page(s) 611–619

Abstract: Pure autologous breast reconstruction in thin patients creates challenges. This review highlights techniques to optimize the scarce donor tissue available, approaches to reconstruction, and microsurgical techniques. A systematic approach to maximize ... ...

Abstract	Pure autologous breast reconstruction in thin patients creates challenges. This review highlights techniques to optimize the scarce donor tissue available, approaches to reconstruction, and microsurgical techniques. A systematic approach to maximize breast volume and the skin envelope in patients who underwent pure autologous breast reconstruction by a single senior surgeon is presented with a clinical case series. Included in the study were 125 patients (217) with autologous breast reconstructions. Although DIEP flaps were the commonest flap used overall (79%), within in the low body mass index (<22) group, there was a greater use of Latissimus (32%), and thigh-based flaps (>50%).
MeSH term(s)	Adipose Tissue/transplantation ; Adult ; Aged ; Algorithms ; Autografts ; Body Mass Index ; Breast Implants ; Breast Neoplasms/surgery ; Female ; Humans ; Mammaplasty/methods ; Mastectomy/methods ; Middle Aged ; Perforator Flap ; Retrospective Studies ; Surgical Flaps ; Thinness ; Tissue Expansion
Language	English
Publishing date	2020-08-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	193117-9
ISSN	1558-0504 ; 0094-1298
ISSN (online)	1558-0504
ISSN	0094-1298
DOI	10.1016/j.cps.2020.07.001
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