[Case report: squamous cell carcinoma, radial forearm flap and Huriez syndrome. Focus on a rare pathology]. / Cas clinique : carcinome épidermoïde, lambeau antébrachial radial et syndrome d'Huriez. Mise au point sur une pathologie rare.

Huriez disease is a rare autosomal dominant pathology characterized by the triad hypoplastic nail, hyperkeratosis and scleroatrophy of distal extremities. One of its most principal complications is the development of an aggressive squamous cell carcinoma. We present a case of a 62-year old patient who had an acute two hands scleroatrophy associated with recurrent squamous cell carcinoma treated by large excision and covered by trophic and thick radial forearm flap. This flap allowed us to treat the wound and the sclerosis shrinkage with aim to give back the functional benefit to the patient. It also gave the patient an oncological treatment despite aggressive management in one step surgery. Furthermore, one year later we did not observe cutaneous flap histological modification that could have degenerated into cancer. A multidisciplinary approach with dermatologists, geneticists and plastic surgeons is essential in addition with close medical supervision because of high cancer risks.

[The "double clock" or how to learn microsurgery without animal]. / La "double horloge" ou comment apprendre la microchirurgie sans animal.

Animal experimentation is the most common way to learn microsurgery. However, this practice should be performed according to ethical rules and financial cost. This study has a triple aim: improving students' skills in microsurgery, respecting ethics and reducing costs by using fewer animals. We propose an ethical, practical and inexpensive training method that uses sewing needles. This training consists in microsurgery wire's passages in the eye of sewing needles arranged into circle. Specifically, 24 needles were arranged into two circles on a polystyrene block representing a "double clock". A specific scorecard for this exercise was made to evaluate the students. In total, between November 2010 and June 2011, fifteen residents followed the university degree in microsurgery provided by the faculty of medicine Henri Warembourg (Lille, France). The "double clock" was added to the eight already existing microsurgical manipulations. All of the participants were tested and this exercise was found to be effective as a teaching procedure. Also, each student used an average of 20 rats per year. This year we have reduced our animal control by 10% or about 30 rats. Our goals were achieved as we have improved student's microsurgical skills and also limiting cost by using fewer animals.

[Evidence-based medicine and prevention of thrombosis in microsurgery. Critical review]. / Médecine factuelle et prévention de la thrombose en microchirurgie. Revue critique de la littérature.

Prevention of thrombosis in microsurgery was the point of numerous publications without any referenced protocol. The question of this article was to know if it existed, for a patient who needed a microsurgical procedure, any medical treatment used, proved to lower the thrombotic risk. Using principles of evidence-based medicine, we observed that none of the medical treatments proved efficiency on preventing vascular thrombosis, arterial or venous. The low molecular weight heparins (LMWH) could be used on postoperatives to prevent the deep venous thrombosis of lower limbs but not to lower specially the microvascular thrombosis rate. Aspirin did not improve the positive rates and its adjunction to LMWH increased the bleeding. The evidence-based medicine, as we used it here, permits to conclude that the microsurgeon should not wait any miracle of the medical treatments. Until scientific studies prove efficacity of a treatment, the surgeon has to make a personal choice: keeping habits or following evidence-based medicine. The experience of the surgeon, of the anesthetist and of the paramedical team seem to be the main point to decrease the thrombotic risk during the multidisciplinary healing care of the patient.

[Multicentric study of thrombosis prevention in upper-extremity microsurgery. Survey at the Fesum centers]. / Etude multicentrique sur la prévention de la thrombose en microchirurgie du membre supérieur. Enquête auprès de la Fesum.

Thrombosis is still the first cause of microsurgery failure. Lots of publications have been made but no consensus exists. We first analysed the results of our study in 53 French expert surgeons, then we compared them with the last published datas, most of all, with the similar surveys. If a big majority (81 %) of the surgeons use a preventing method, we observed majors variations between them and also compared to the anglosaxons surgeons habits. This survey permits to make the point on today's practice and to show that some of them are based on low proof level and something even done without any medical references. After datas analysis, we observed that none of the medical treatments proved efficiency on preventing vascular thrombosis. The low molecular weight heparins (LMWH) could be used on postops without increase bleeding but not to lower specially the microvascular thrombosis rate. Aspirin did not improve the positive rates and its adjonction to LMWH increased the bleeding. Until scientific studies prove efficacy of a treatment, the surgeon has to make a personal choice: keeping habits or following evidence-based medicine.