[Optimized negative pressure therapy. Case report]. / Thérapie par pression négative optimisée. A propos d'un cas.

Our patient showed major abdominal cutaneous necrosis. Detersion removed the entire thickness of half of the right-hand wall of the abdomen. We are going to explain how, by combining well known procedures, we conducted this closure. This deals with a patient aged 53, with a long case history of dermatomyositis and highly debilitating sub-cutaneous calcinosis. This patient has been treated with Imurel and high doses of corticoids since 1997. In the face of the much debilitated terrain of the patient, it was not certain that a local flap or even a pediculated flap could be made to cover this loss of substance with a minimum of risk. A cutaneous extension was then envisaged using a system of Wisebands fillets. To protect the parietal plate, accelerate its growth and reduce the skin tension, we used in combination a system of foam dressing with negative pressure therapy (NPT). The optimized NPT was used for 2 weeks. The Wisebands were installed for 1 month. The treatment lasted for 50 days and required five short sessions of general anaesthesia. The histopathological interpretation revealed an EBV lymphoma. The assessment of the extension and the therapeutic treatment of the lymphoma contributed to the duration of hospitalisation and the number of general anaesthesia sessions. The synergy effect of these two associated procedures have allowed a faster skin closure; 18 months later, no complications have occurred. The wound has closed totally and the abdominal wall is solid in spite of not having resorted to a flap or separation.

Composite cervicofacial flap for reconstruction of complex cheek defects.

The authors present the reconstructive technique for complex cheek defects using the composite cervicofacial flap and study the possibilities, advantages, disadvantages, and results that can be expected. The design follows the classic outline of Mustardé's flap. The skin is undermined for 2 cm anterior to the ear, then after incision of the superficial musculoaponeurotic system (SMAS), undermining is continued below the plane of the SMAS, level with the facial nerve branches. It is continued forward to the facial vessels, which give rise to branches that ensure the blood supply of this composite flap and contribute to its high reliability. In the cervical region, undermining is done beneath the platysma, which is transected transversely in the lower cervical region to allow good upward mobility and satisfactory transposition of the flap. The flap is adapted to the defect and the medial suture line is placed as near as possible to the medial limit of the cheek aesthetic unit. The authors carried out a retrospective study of 7 patients with complex facial reconstruction after excision of malignant lesions. The defects measured from 4x4 cm to 9x7 cm. In 4 patients excision included the periosteum, and in 1 patient excision involved the entire thickness and removed the entire anterior half of the cheek. In 4 patients reconstruction involved the cheek and eyelid. In spite of the advanced age of the patients (88, 69, 91, 67, 70, 82, and 59 years), there was no distal edge necrosis. The only complication was a single case of facial paresis, which resolved spontaneously. The results were considered very good in all 7 patients. The authors conclude that the composite flap increases the possibilities of the cervicofacial flap. It is more mobile, more reliable, thicker, and more adaptable. It can be used in complex cheek defects that involve the periosteum, or even in full-thickness defects. The quality of the results obtained using this flap represents a considerable advance in facial reconstruction.

[Posterior thoracic reconstruction with latissimus dorsi flap after partial amputation of the latissimus dorsi muscle for sarcoma of the back. Report of four cases]. / Reconstruction thoracique postérieure par lambeau de grand dorsal après amputation partielle du muscle grand dorsal pour sarcome du dos. A propos de quatre cas.

Malignant fibrous histiocytomas (MFH) arising from the subcutaneous tissues of the posterior thoracic wall require wide, but usually non-transfixing, resection to ensure adequate resection margins, the only way to reduce the local recurrent rate. Due to its size and position, the Latissimus dorsi muscle usually requires partial amputation. However, its vascular anatomy allows it to be used as a musculocutaneous flap of the residual muscle to fill the defects created. Four clinical cases are reported. This technique reduces the complication rate and simplifies the postoperative course.

[Mammaplasty with an L-shaped scar and a pre-established design. Apropos of 80 cases]. / Plastie mammaire à cicatrice en L et à dessin pré-établi. A propos de 80 cas.

Over recent years, surgeons have tried to reduce the reduction mammaplasty scar. In this context, we use a surgical technique described by J.P. Chavoin, privileging "the remaining breast". Three advantages of this surgical method are derived from its technical choices: a superior dermal pedicle for preservation of the areolar nipple complex, preoperative drawing and finally a short incision with an inverted L scar. A retrospective study of 80 patients with 27 months of follow-up defines the advantages and disadvantages of this technique. Discomfort, indications, quality of results are evaluated with charts. Preoperative drawing and technique are described. This study shows this to be a reliable technique with good and constant results. Lastly, its indication is described in comparison with other techniques designed to achieve. Its preferential indication is moderately severe hypertrophy (500 g), which represents the majority of patients consulting us, but it can also be used in severe hypertrophy or even gigantomastia. Reduction of asymmetry also constitutes a good indication, facilitated by rigorous skin drawing based on precise anatomical landmarks. In addition to its broad indications, its advantages are marked vascular safety, rapid execution, constant results, while preserving the median part of the thorax from any scars.

[Choice of free composite flap in the reconstruction of loss of substance in the mandible. Apropos of 28 cases]. / Le choix du transplant libre composé avec os dans la reconstruction des pertes de substance interruptrices de la mandibule. A propos de 28 cas.

The retrospective analysis of 56 mandibular defects, 28 of which were reconstructed by free revascularised bone flaps, and the difficulties of their reconstruction led the authors to propose a new anatomosurgical bony classification of mandibular defects. This classification, a theoretical transcription of traumatic and oncological realities, distinguishes more or less extensive anterior defects (Aa and Ab), lateral defects (La), lateroterminal defects (Lb) and defects exceeding the hemimandible (T). These bony imperatives, either alone or associated with skin lesions, depending on the traumatic or neoplastic aetiology, influence the indication for microsurgical reconstruction and the choice of particular bone and integument combined or composite flaps. The authors have deliberately adopted the option of one-stage multiple tissue reconstruction by the same composite flap and propose a justification for this microsurgical choice based on the proposed classification as well as the the theoretical and practical advantages and disadvantages of the various composite free revascularised bone flaps. Two donor sites appear to be particularly suitable: iliac and fibular.

[Fascia superficialis temporalis in facial reconstructive surgery. Apropos of 35 cases]. / Le fascia superficalis temporalis en chirurgie reconstructrice faciale. A propos de trente-cinq cas.

The fascia superficialis temporalis (FST), one of the planes of cranial cover, can be raised to form an axial pedicle flap or a vascular island flap on superficial temporal vessels. Its fibrovascular structure, the area able to be raised and the possible addition of other superficial tissues (scalp, forehead skin) and deep tissues (calvarial bone) mean that this flap can be used in surgery of the external and intracavitary facial contours and shapes. The authors report their experience of 35 facial reconstructions: 7 ear reconstructions, 5 suspensions of a paralysed labial commissure, 10 conjuctivo-palpebral revisions, repair of 5 subcutaneous defects, 3 haired resurfacings, 1 inferior labial, 1 cheela, 1 orbitomalar reconstruction, 1 malo-commissuro-labial repair, 1 prefabricated free flap. The donor site sequelae were considered to be negligible: 1 case of temporal anaesthesia with dysaesthesiae, 4 cases of band alopecia. The analysis of these 35 reconstructions reveals the quality of all cases of defect repair, especially palpebral; the ease and persistence of suspensions of the labial commissure; the value of FST as a conjunctival and buccal mucosal substitute; the density of the hair contribution. However, total or partial ear reconstruction using this technique constitutes a more limited indication.

[Cheek-commissuro-labial reconstruction using a fascia superficialis temporalis composite island flap. Apropos of a clinical case]. / Reconstruction jugo-commissuro-labiale par lambeau composite en îlot de fascia superficialis temporalis. A propos d'un cas clinique.

Management of full thickness defects of cheek and lips area is a challenge with both aesthetic and functional aims. Many surgical procedures can be proposed. A composite island temporal flap gathering fascia superficialis temporalis, an heary portion and a beardless skin paddle is a very interesting alternative. Surgical procedure and results are explained, concerning a gun shot injury clinical case.

[Dedifferentiated chondrosarcoma with maxillary involvement. An anatomo-clinical study, surgical treatment and prosthetic rehabilitation. Apropos of a case]. / Chondrosarcome dédifférencié à localisation maxillaire. Etude anatomo-clinique, traitement chirurgical et réhabilitation prothétique. A propos d'un cas.

A 19 year old girl presented with a dedifferentiated chondrosarcoma of maxilla. The recurring tumor, diagnosed initially from the provoked pain, appeared on the scan image as a heterogeneous mass containing numerous calcifications. Histology showed, within a well differentiated chondrosarcoma, an anaplastic sarcomatous zone of the malignant fibrous histiocytoma (MFH) type. This histologic appearance is consistent with a poorer clinical prognosis. Radical surgery of the 4th tumor recurrence was combined with maxillofacial prosthetic rehabilitation. This appears to be first reported case of a dedifferentiated chondrosarcoma of the MFH type located in the maxilla.

[Temporomandibular joint dysfunction and neurofibromatosis. Apropos of a case]. / Dysfonctionnement des A.T.M. et neurofibromatose. A propos d'un cas.

The authors report one case of Von Recklinghausen's disease localized to the temporomandibular joint capsule and unilaterally associated with other cephalic manifestations. Although no other study, notably a CAT-scan, showed this tumor localization, surgical exploration was imperative and led to exeresis of the lesion which proved to be the treatment of choice.