The current abdominoperineal resection: oncological problems and surgical modifications for low rectal cancer.

Abdominoperineal resection is the one of the oldest surgical procedures for rectal cancer. Outcome after abdominoperineal resection for rectal carcinoma is not as good as anterior resection as the risk of local recurrence is higher and survival is poorer. During abdominoperineal resection, the rate of rectal perforation is high and the circumferential margin is often involved. Recently the concept of cylindrical abdominoperineal resection has been reintroduced. It allows a large excision and the initial results are encouraging. The purpose of this article was to analyse the oncological results of abdominoperineal resection and to develop the potential technical modifications of the procedure.

[Reconstruction of hand dorsum soft tissue defect using anterolateral thigh perforator flap: description, case study and review of literature]. / Couverture d'une perte de substance de la face dorsale de la main par lambeau antérolatéral de cuisse : description, cas clinique et revue de la littérature.

Reconstruction of hand dorsum soft tissue defect usually requires a flap. The dorsal skin is thin and the underlying structures require coverage by vascularised tissue. We have been using perforator flaps in these cases, especially the anterolateral thigh perforator flap. After a description of the technique, we present a case report in which this flap, in a free version, was used to reconstruct a dorsal hand defect after failure of a posterior interosseous flap. The fascia underlying the flap was used to create a sliding interface for extensor tendons. Postoperative care was without complications. The indications of this flap are numerous but after a review of international literature, we found that its use was seldom reported in France compared to other countries. However, we think that its trophic qualities and minor donor site morbidity make it ideal for coverage of hand dorsum soft tissue defects.

[About perforator flaps 20 years later]. / À propos des lambeaux perforants 20 ans après.

Despite the birth of reconstructive surgery 2000 years ago, the main advances in this field appeared in the second half of the 20th century. Born in Asia, it is from that same continent that the last improvement has occurred through the perforator flap concept. Combining advances in the understanding of cutaneous blood supply and advances in surgical instrumentation to optimize the reconstruction while reducing morbidity is gradually becoming a reality. Twenty years after the first perforator flap described by Koshima and Soeda, the authors review the history, the concept and nomenclature of these flaps. Furthermore, through an analyze of the international literature, the authors attempt to achieve an assessment of the reliability and morbidity of perforator flaps after 2 decades of existence.

[From Tansini to Angrigiani: improvement and refinement of the thoracodorsal flap]. / De Tansini à Angrigiani : amélioration et raffinements du lambeau thoracodorsal.

Flap surgery is the art of transposing an autonomous vascularised tissue, from a donor site to a distant recipient site. It was born 2000 years ago in India, evolving from random flaps to microsurgical flaps with a skeletonised vascular pedicle. This evolution was possible through the knowledge of cutaneous vascularisation and allows today the spreading field of perforator flaps. Writing the story of any particular flap is, in fact, looking back to understand the global concept and evolution of flaps surgery. Therefore the authors detail every step of the development and technical improvement of the thoracodorsal flap from the classical musculocutaneous latissimus dorsi flap to one of its latest achievement, the thoracodorsal perforator flap. This story helps us to appreciate the armamentarium of thin and low donor site morbidity flap that perforator flaps offer to us.

Reconstruction of a full-thickness abdominal wall defect using an anterolateral thigh free flap.

We present an original case of reconstruction of the abdominal wall after full-thickness parietal resection using an anterolateral thigh flap harvested with its aponeurosis; we describe the advantages of this technique which has seldom been used for this indication. A 49-year-old male presented with a recurrent dermatofibrosarcoma protuberans involving the full thickness of the upper anterior abdominal wall; after excision, a 20 x 17 cm full-thickness defect was reconstructed with an omentoplasty, a bi-layered parietal prosthesis, and a fasciocutaneous free flap with its muscular aponeurosis from the anterolateral thigh. The postoperative course was uncomplicated. Functional and aesthetic results were satisfactory. There was no tumor recurrence or postoperative incisional hernia. Many reconstructive options have been proposed, but the anterolateral thigh free flap offers the advantage of an integral reconstruction of the abdominal wall without resultant donor site morbidity and with a satisfactory cosmetic result. In our hands, this flap is the ideal choice for reconstruction of the abdominal wall after loss of substance.

Perforator flaps: a new option in perineal reconstruction.

Over the past few decades, methodological progress and better anatomical knowledge have reduced the morbidity of reconstructive surgery. Muscle-sparing flaps and perforator flaps provide the surgeon with additional options for reconstruction. Based on a review of the local flaps used for perineal reconstruction, this article describes these new solutions and presents a decision tree (based on whether abdominal incision is required or not). If laparotomy is required, abdominal flaps should be preferred. If surgical excision is performed with the patient in the prone position, then gluteal and pudendal donor sites are recommended.

[Custom made chest-wall implant and Poland's syndrome: Between art and science]. / Prothèse sur mesure et syndrome de Poland : entre art et science.

Poland's syndrome is a well-described congenital thoracic deformity with mostly only an aesthetic damage. We report the case of a chest-wall correction of a young male patient by a custom made silicone implant, detailing the original process of manufacturing, and justifying the choice not to use a conventional technique of reconstruction. This alternative enhances the surgeon's therapeutic arsenal, so that he can provide a customized answer, adapted to the requirements and the morphological characteristics of each patient.

[Evaluation of 3D numerisation with structured light projection in breast surgery]. / Evaluation de l'imagerie tridimensionnelle acquise par une technique de projection de lumière structurée en chirurgie mammaire.

INTRODUCTION: Breast plastic surgery still remains subjective with no objective measurement tool to evaluate and to predict our results. In this aim, we did an evaluation of a new 3D surface measurement tool using the structured projected light technology (Inspeck) in breast surgery. MATERIAL AND METHOD: We evaluated the different measurement tools available (euclidean distance, projected on the surface distance, and volume measurement) with the numerisation system on distance and silicone prosthesis of known length and volume. These measurements were done experimentally and on patients. We also numerised more than 50 patients to evaluate the feasibility of this technology in current practice. RESULTS: We manage to highlight the advantages of this technology compared to other technology in terms of feasibility, restrictions, harmlessness and reproducibility. This tool is well adapted for a use in current practice. Only the volume measurement tool has to be improved. CONCLUSION: The perspectives of 3D numerisation with structured light projection are wide in clinical practice. It could bring a bit of objectivity in breast plastic surgery.

[French plastic surgeons: update in 2007]. / Chirurgiens plasticiens français: état des lieux en 2007.

French medical demography is a true public health issue. The medicine doctor's scarcity announced by many will not appear for the plastic surgeons. In this speciality, problems are an excess staff and irregular sharing out. The aim of the study was to make a very sharp update of the speciality thanks to an actual demographic descriptive and analytic study compared with the one realised in 1998 including a French plastic surgeon's activity study. In 2007, there were 889 plastic surgeons in France, so 235 surgeons more than in 1998 and an average of 26 new plastic surgeons a year. The plastic surgeon's density was 1 for 71,174 people, much more important than the recommended value. The distribution of these surgeons is still unequal and the excess staff is getting worse. The plastic surgeon's activity study based on the Information System Medicalisation Program (ISMP) between 2004 and 2006, including 13 classic plastic surgery's procedures, showed an important decrease of the activity especially for the private sector. The analytic study put together the data concerning the demography and the activity considering the economic side of esthetic surgery. Thanks to these data, plastic surgeons will now be able to choose their working area not only based on geographic reasons but also depending on the activity they want and on the importance of the competition. This work stands for a help for plastic surgeons, in the hope of a fair sharing out of these practioners.

[Role of the association artificial dermis and negative pressure therapy: about two cases]. / Intérêt de l'association derme artificiel et thérapie par pression négative : à propos de deux cas.

In our modern health system, the improvement of the medical care cannot come along with an increase of expenses. In this purpose, we tried to bring to light the medical and economic, direct and indirect, benefits which exist with the association of an artificial dermis, Integra, and negative pressure therapy as the vacuum assisted closure (VAC) for wound which would have been treated by Integra alone. While preserving the aesthetic and functional qualities obtained by the artificial dermis alone followed by a skin graft after 21 days of treatment, the association of the negative pressure allows to perform the skin graft after only 10 days of treatment. This gain of time is a financial economy for the medical centers which have to shorten the durations of stay to be profitable. The patient benefits of a shorter hospitalization and will manage to return to work earlier. The quality of the treatment is not only improved by the absentia of immobilization of the patient but also by the decrease of the complications and the infectious risks due to the use of artificial dermis. The results so obtained highlight that in spite of the initial expense caused by this association the advantages are such that the use of the artificial dermis alone will not have interest any more.

[Primary cutaneous mucormycosis: a case report]. / Mucormycose cutanée primaire: à propos d'un cas.

The authors report the clinical history of a patient having presented a cutaneous mucormycosis at the waning of a traumatic dilapidation post of the left lower limb. Mucormycosis is an opportunistic fungal infection due to fungi of the group of mucorales present in the environment. There are various clinical forms of the disease; it occurs generally in a predisposed environment. The diagnosis is based on the mycologic and pathologic examination. The therapeutic approach must be multidisciplinary; the vital and functional prognosis depends on early diagnosis and treatment.

[Chromic acid burns: systematic prevention of systemic toxicity]. / Brûlure par acide chromique: prévention systématique de la toxicité systémique.

Chromic acid burns can lead to systemic toxicity by cutaneous absorption of the chrome seen surfaces more than 1% of the total body surface area. In order to illustrate the necessity of anticipate systematically this toxicity by a specific treatment, we describe the case of a patient with systemic toxicity in the least severe situation of chromic acid burn: the chromic acid was diluted to 0,02%, the burn was superficial second degree, both thermic and chemical, on the forearm, and extended only to 1% of the total body surface area. In spite of the specific treatment, our patient had a blood transfer of the chrome, however without any consequences on the renal and hepatic functions. He cicatrised in 2 weeks, and his blood and urinary chromium levels were normalised in 3 weeks. Without this specific early treatment, what would have been the consequences of a systemic toxicity even more important?

[Abdomen pendulum and subcutaneous injections: the complications. Two case reports]. / Abdomen pendulum et injections sous-cutanées: les complications. A propos de deux cas.

The authors present the complications due to subcutaneous injections on two patients suffering from morbid obesity with an abdomen pendulum. In the first case, injections of heparin of low molecular weight at curative dose, for treatment of a pulmonary embolism, have been complicated with a giant abdominal wall haematoma, the biggest ever reported. The initial treatment was insufficient so we had to practice a dermolipectomy to take off the haematoma of four litters. In the second case, insulin injections were complicated with cellulitis of the abdominal wall and a surgical treatment has been practiced in emergency. The first case reminds us the importance to change the sites of injections and to accommodate the dose, surgical treatment staying as simple as possible. The second case allows us to report a rare complication, not often published but known with obese patients. These two cases illustrate the importance of therapeutic education of the patient and the fact that a simple injection can be life threatening.

[Evolution of the thyroid surgical treatment to the total thyroidectomy. Study of about 735 patients]. / Evolution de la chirurgie thyroïdienne vers la thyroïdectomie totale.

OBJECTIVES: To study the place of the total thyroïdectomy compared to the sub-total thyroidectomy and the lobectomy in benign nodular thyroid pathology, about complications and prevention of the recurrence. PATIENTS AND METHODS: The evolution of the number and the type of thyroïdectomy among the total thyroidectomy, subtotal thyroidectomy and the lobectomy was analyzed in a retrospective study including 735 patients in the service of Head and Neck Surgery in the University Hospital in Amiens, France over a 12 years period, for a multinodular goiter, a toxic and a nontoxic solitary nodule. The post-operative transient and permanent recurrent nerve paralysis and hypocalcemia of the total thyroidectomies were studied and compared with the other surgical procedures of the study and in a review of the literature in order to study benefit and risks. RESULTS: Multinodular goiters were the most thyroid pathologies (80%). The total thyroidectomy became gradually the most frequent surgical procedure, from 17% to nearly 70% of the surgical procedures over 12 years, with depend on the currently abandoned subtotal thyroidectomy and the lobectomy. No significant difference appeared concerning the recurrent and parathyroid complications between the 3 procedures. CONCLUSION: The post-operative morbidity is not statistically different between the total thyroidectomy and the other procedures. The total thyroidectomy prevents moreover nodular recurrences whose surgical treatment is difficult without benefit of the L-thyroxine treatment prevention. It implies a substitute opotherapy that the other surgical techniques cannot nevertheless always avoid. Nowadays, the total thyroidectomy is the gold treatment for surgical treatment of multinodular benign goiters. Many factors must be considered concerning the solitary nodules: the size, the evolutivity, the fine needle aspiration the aspect of the contralateral lobe. In all the cases, the decision will have to be consensual between the patient, the endocrinologist and the surgeon.

[A rare case of nasal and buccal obstruction in a child: the antrochoanal polyp of Killian]. / Un cas rare d'obstruction nasale et buccale chez l'enfant: le polype antrochoanal de Killian.

Nasal obstruction is a frequent symptom of consultation in paediatric otorhinolaryngology. Usually, adenoid hypertrophy is the cause. Sometimes the examination reveals the presence of polyps in the nose. The antrochoanal polyp of Killian is particularly frequent in childhood. The obstruction is usually unilateral, but the posterior extension of a bulky polyp to the oropharynx can cause a major discomfort, sometimes a respiratory distress. We report the observation of a 10-year-old patient presenting a bulky polyp of Killian, visible in the oropharynx and then discuss the features of this polyp in the literature.

[The lymphoepithelial carcinoma of the parotid gland: a rare tumor for an European patient]. / Le carcinome lymphoépithélial de la parotide: une tumeur rare chez un patient européen.

Lymphoepithelial carcinoma of the parotid is a rare and little known tumour The ethnic origin of the patients and the association with the Epstein-Barr virus are recognized but not invariable. The mechanism of the carcinogenesis thus remains an enigma. The authors report the observation of a patient which is remarkable because of his European origin and the positivity of serologies to the Epstein-Barr virus, and discuss the features of the lesion through the literature.