[Two anomalous muscles of a forearm revealed by ulnar nerve compressions, a Double Crush syndrome]. / Malformation musculaire associée à une variation anatomique de l'avant-bras révélées par des compressions étagées du nerf ulnaire (Double Crush syndrome).

This article describes the concomitant presence of two anomalous muscles on a left forearm in a 40-year-old man. The anconeus epitrochlearis muscle was responsible for a cubital tunnel syndrome and the unusual origin of the flexor digiti minimi brevis muscle was responsible for a compartment syndrome with ulnar nerve compression at the level of Guyon's canal during effort diagnosed by MRI. Resection of these muscles relieved the symptoms and allowed the patient to return to work.

[Role of the plastic surgeon in the management of ecthyma gangrenosum in children: clinical example]. / Rôle du chirurgien plasticien dans la prise en charge de l'ecthyma gangrenosum chez l'enfant : exemple clinique.

Ecthyma gangrenosum is a cutaneous infection, which result from a Pseudomonas aeruginosa septicemia, encountered in most of the case in immunocompromised people. Authors demonstrate the important role of the plastic surgeon in the diagnosis and therapeutic management of the disease in children. An eight-month-old infant has been hospitalized for acute leukaemia. She developed an extensive painful macule in the buttocks and perineal area in a septic context. A multidisciplinary management allowed to set up an adapted antibiotherapy, an early escharrotomy, a protection of the wound by digestive and urine derivation and a reconstruction with wound healing by second intention and split thickness skin graft, which lead to a good quality cure and wound healing at the end of 37 days of evolution. This case demonstrates the importance of the surgical management in the treatment of ecthyma gangrenosum. The wound healing associated with a split thickness skin graft seems to be the less invasive solution in a frail patient and the fastest to re-start the chemotherapy.

[A new technique of intrafocal pinning for phalangeal neck fractures in children]. / Une nouvelle technique d'embrochage intrafocal des fractures de cols de phalanges chez l'enfant.

INTRODUCTION: Phalangeal neck fractures are unusual, occurring mainly in children. This study aims at assessing the results of treatment of this type of fracture and presents a new technique for displaced fractures namely intrafocal pinning. PATIENTS AND METHODS: From January 2001 to January 2007, we treated 49 children (32 boys and 17 girls) with 52 phalangeal neck fractures. The patients were aged between three months and 14 years (average seven years). Five fractures were open but without nerve, artery or tendon damage. The 32 undisplaced or minimally displaced fractures were treated by closed methods. Thirteen displaced fractures (of which three were secondary displacements) were treated with an intrafocal pinning technique inspired by the Kapandji technique for distal radius fractures. Seven fractures (five open and two closed but displaced) were treated using standard osteosynthesis techniques (temporary arthrodesis, crossed K wires or cerclage). RESULTS: We reviewed the patients an average of 18 months later. We classified the results according to Barton's classification: excellent, good, fair and bad. Among the 13 fractures treated with an intrafocal pinning technique, 11 gave excellent results and two gave good results. We did not find any infection, tendon rupture, phalangeal head osteonecrosis or nonunion. We had to reoperate on one proximal phalanx thumb fracture because of delayed consolidation. DISCUSSION: Percutaneous reduction of the displacement and pinning seems to give the best results for the treatment of displaced fractures. The surgeon aims at getting the best anatomical result whilst limiting soft tissue damage. The proposed technique seems to give good results as it allows a percutaneous reduction of the displacement and an effective means of holding the reduction. Open fractures have a poorer prognosis.

[The lymphatic malformations: clinical aspects and evolution]. / Les malformations lymphatiques: aspects cliniques et évolution.

Lymphatic malformations (LM) are the most frequent vascular malformations. There are three types of lesions involving lymphatic development that must be included in LM: vascular anomalies and knots (truncal malformations [TLM]); cystic anomalies, superficial or deep, uni- or multicystic (extratruncal malformations [ETLM]) and hemolymphatic anomalies which combine venous, arterial, or capillary malformations with LM. ETLM can be ubiquitously distributed but most are located in the cervical or axillary regions. Most ETLM are diagnosed at birth and in 80-90% of the cases before the age of 2. The clinical aspects are extremely variable: superficial ETLM (vesicular) and deep ETLM, localised or diffuse, mono- or multicystic. TLM are generally located on a lower limb with neonatal lymphatic oedema (often in a polymalformation context). All forms of the hemolymphatic combination can be identified. They are generally located on the limbs and are often unilateral. They are usually sporadic but can also be can be found in polymalformation syndromes (Klippel-Trénaunay, Parkes-Weber, Protée, Maffucci). ETLM generally tend to increase in volume and spread with age with stabilisation at puberty. They do not tend to spontaneously regress. Specific local complications can have serious consequences. They are linked to haemorrhaging, infections and compression phenomena. There can also be complications such as skeletal and soft tissue hypertrophy.