[Aesthetic augmentation of the dorsum, mid-term results]. / Augmentation esthétique du dorsum, résultats à moyen terme.

PURPOSE OF THE STUDY: Dorsum aesthetic augmentation can be divided according to their objective, total and partial increase or camouflage. The objective of this original article is to define the valid techniques in each indication through a cohort study, clinical cases, and current data from the literature. PATIENT AND METHOD: It is a monocentric mono operator retrospective study from 2005 to 2010 included. On 171 rhinoplasties, 57 were augmentation rhinoplasties of which 40 were of interest to the dorsum. Excluded patients were bone grafts, lost and one patient operated on a active Wegener desease. Thus 26 rhinoplasties were analyzed by an independent observer. RESULTS: All grafts confused there were 11.5% of resorption which corresponds to the data from the literature, 17% of resorption in the camouflage indications and 7% in augmentation, as well as a higher resorption for crushed cartilage (33%) rate. There was more mobility in augmentation (28%) than in the camouflage (8%) and greater visibility of the banks of the graft in augmentation (35%) compared to the camouflage (8%). CONCLUSION: In the mild to severe saddle nose, the DCF is greater than cartilage monobloc or crushed in terms of stability and visibility, its indications could be expanded to harmonisation. Camouflage crushed cartilage is not sustainable and the temporal aponeurosis could it be preferred. Resorbable fillers can offer an alternative to surgery or improve its results.

[DC-F technique cartilage graft for nasal saddle correction]. / Correction des ensellures nasales par greffons cartilagineux selon la technique DC-F.

INTRODUCTION: Cartilage and bone graft are customarily used for dorsal augmentation in rhinoplasty. Daniel and Calvert described an original technique in 2004, using diced cartilage grafts wrapped in temporal fascia (DC-F). TECHNICAL NOTE: We describe the technical procedure used to correct severe nasal saddles with stable results. DISCUSSION: Diced cartilage grafts wrapped in temporal fascia is an interesting alternative in rhinoplasty with dorsal augmentation: this composite graft is malleable and can be used whatever the quality of the recipient site. It remains malleable postoperatively.

[Diced cartilage wrapped in deep temporal aponeurosis (DC-F): A new technique in augmentation rhinoplasty]. / Greffons cartilagineux en dés enroulés dans l'aponévrose temporale profonde (DC-F) : un nouveau procédé en rhinoplastie d'augmentation.

Diced cartilage rolled up in a fascia (DC-F) is a recent technique developed by Rollin K Daniel. It consists to tailor make a composite graft composed by pieces of cartilage cut in small dices wrapped in a layer of deep temporal aponeurosis. This initially malleable graft allows an effective dorsum augmentation (1 to 10 mm), adjustable until the end of the operation and even post operatively. The indications are all the primary and secondary augmentation rhinoplasties. However, the elective indications are the secondary augmentation rhinoplasties with cartilaginous donor site depletion, or when cartilaginous grafts are of poor quality (insufficient length, multifragmented...), or finally when the recipient site is uneven or asymmetrical. We report our experience of 20 patients operated in 2006 and 2007, with one year minimal follow-up. All the cases are relative or absolute saddle noses, idiopathic, post-traumatic or iatrogenic. Moreover, two patients also had a concomitant chin augmentation with DC-F. No case of displacement or resorption was noted. We modified certain technical points in order to make this technique even more powerful and predictable.

[Main abdominal flap donor sites]. / Lambeaux abdominaux. Principaux sites donneurs.

The main flaps derived from the abdominal wall are described, indicating the following points for each one: vascular anatomy, the cutaneous and/or muscle territory of the flap, the arc of rotation, the main applications and finally comments concerning certain specific anatomical or technical points. Rectus abdominis flaps are by far the most frequently used in routine clinical practice for mammary reconstruction and cover of the thorax, abdomen or groin areas. Groin flaps are also frequently used, either as pedicled flaps to cover defects of the upper extremity or abdomen, or as free flaps, especially for mandibular reconstructions.

[Abdominal wall: flaps donor site. Theoretical basis, blood supply and practical consequences]. / Paroi abdominale: site donneur de lambeaux. Bases théoriques, vascularisation et conséquences pratiques sur l'autonomisation.

After recalling the anatomical and haemodynamic features of the venous and arterial blood supply in general, the authors consider the arterial blood supply of the anterior abdominal wall and analyse the practical consequences for the blood supply of flaps, particularly of the rectus abdominis myocutaneous flap.

[VCS microclip anastomosis on blood vessels of less than 2 millimeters in diameter. Preliminary experimental study in the rat]. / Anastomoses par microagrafes VCS sur des vaisseaux de diamètre inferieur à 2 millimètres. Etude expérimentale préliminaire chez le rat.

The aim of this work was to study the possibilities and limits of the vascular microanastomoses with VCS microclips. VCS Microclips are a new mechanical anastomotic device, allowing a single operator to perform anastomoses without microsutures. The two arcuate limbs of the titanium microclips do not penetrate the vascular intima. The microclip anastomosis technique is based on symmetric eversion of the vessel walls, facilitated by everting forceps. We studied the medium and small Autosuture VCS microclips on different vessels ranging from 0.3 to 2 millimeters in diameter: aorta, carotid artery, femoral artery and femoral vein. Thirty nine end-to-end or end-to-side anastomoses were performed on Wistar rats. These anastomoses were performed by a single operator without the use of sutures. Patency was studied by the "empty and refill" test immediately and at two months. Histologic analysis of the anastomosis was performed at two months (hematein-eosin and orcein stains on longitudinal sections). Four out of thirty nine anastomoses were occluded during the 15 minutes following clamp release. Failure was always due to a technical error and occurred during the first trials. The thirty five other anastomoses were patent immediately and at two months post-operatively, except for the by-pass which was not viable. These anastomoses were still patent 30 minutes post-operatively. Light microscopy analysis confirmed that the microclip extremities did not penetrate the lumen, although the internal media was usually very thin at the level of the microclip jaws, especially for the smallest vessels. For vessels larger than 1 mm in diameter, the microclip extremities were usually outside the internal elastic lamina. No anastomotic aneurysm was found. Vascular healing was comparable with microsutures at 2 months. Microvascular anastomoses performed with microclips have numerous advantages, compared to usual microsutures: they are two to three times quicker, they can be performed step by step without turning the clamp and they can be performed with the right or left hand. There is theoretically no thrombogenic risk. The drawbacks are the need for complementary training and the cost of microclips which is five to six times that of sutures. End-to-side anastomoses of small vessels are more difficult than end-to-end anastomoses. The recipient vessels must be larger than 1.5 mm in diameter, otherwise the anastomosis may become stenosed. Microclips are especially useful to save time, i.e. for multiple anastomoses and for anastomoses of vessels larger than 1 millimeter in diameter. Some modifications of the material could allow vascular or hollow organ anastomoses with endoscopic assistance.

Nonlinear analysis of arterial oscillated flow in experimental stenosis and microsurgical anastomosis.

BACKGROUND: Thrombotic vascular occlusion is one of the main complications that can occur during microsurgical anastomosis and is frequent when the blood becomes turbulent. The aim of this ex vivo study was to test the use of nonlinear mathematical tools to detect turbulence flow upstream and downstream of an arterial stenosis and of a microsurgical anastomosis technique in arteries with diameters in the range of microsurgical practice. MATERIALS AND METHODS: Rat carotid arteries (0.8 to 1.2 mm diameter) were transferred to a flow chamber and perfused with Krebs solution. An oscillated vascular flow was initiated with a peristaltic pump and a transit time flowmeter was used to measure flow with two probes. An arterial stenosis was created by a ligature and progressively increased ranging from 0 to 95%. For each flow signal three nonlinear analytical procedures were applied: time-delayed procedures, correlation dimension, and computing of the largest Lyapunov exponent. RESULTS: Our results indicated that the level of turbulence flow is correlated with the area reduction stenosis. In the range of 60-95% area reduction stenosis, we noted an experimental increase of turbulence flow. We also founded that a classical end-to-end anastomosis technique induced an increase of the turbulence flow in comparison with a control artery. CONCLUSIONS: Thus nonlinear analysis can be useful in characterizing the complexity of an oscillated flow in small arteries submitted to stenosis or microsurgical anastomosis and may have clinical uses in detecting high level turbulent flow after microsurgery.