[Mechanical venous microanastomosis using a double ring eversion system in reconstructive surgery]. / Microanatomose mécanique veineuse par double éversion sur anneaux en chirurgie réparatrice.

INTRODUCTION: The major complications of free flap surgery are anastomotic obstructions. The coupler, mechanical anastomosis using a double ring eversion system, yields higher venous patency rates than sutured anastomoses, and requires less operating time. We present our initial experience with this coupler in free flap surgery. MATERIAL AND METHODS: We conducted this retrospective study between November 2011 and June 2012. We focused on complications having occurred in the first 10 patients having undergone free flap reconstruction (11 flaps) with end-to-end venous anastomosis using this coupler. Five flaps were used to fill cervico-facial defects in carcinologic surgery: one for mandibular osteoradionecrosis, one for cranioplasty coverage, one for cranial base reconstruction, two for skin defects in lower limb (heel, leg). One was an antebrachial radial flap, four anterolateral thigh flaps, five fibular flaps, and one latissimus dorsi flap. Fifteen veins were anastomosed. The diameters of the couplers used were 2.5 mm (3/15), 3 mm (6/15), and 3.5 mm (6/15). RESULTS: There were no venous complications. One flap failed because of arterial ischemia. DISCUSSION: The coupler is a fast and reliable alternative to usual sutures in free flap reconstructions, for head and neck as well as for limbs.

[Pneumomediastinum, a rare complication secondary to a minor maxillary fracture]. / Le pneumomédiastin, une complication rare d'une fracture mineure du maxillaire.

OBSERVATION: A pneumomediastinum was discovered fortuitously on a CT scan prescribed to a patient for facial and cranial trauma. Emphysema was attributed secondarily to an anterolateral maxillary wall fracture. The evolution was favorable after simple clinical and radiological surveillance. DISCUSSION: The observation of a pneumomediastinum should first be related to a tracheal or esophageal wound with a severe prognosis. Endoscopy under general anesthesia was not necessary for our patient thanks to CT scan with 3D reconstruction. There is no consensus for systematic antibioprophylaxis.