Oversized lotus petal flap for reconstruction of extensive perineal defects following abdomino perineal resection.

INTRODUCTION: Abdominoperineal resection (APR) of low rectal and anal tumors are performed for optimal oncological outcome but results in large defects in the perineum. Although vertical rectus abdominus (VRAM) flap is commonly employed for extensive perineal reconstruction, donor site morbidity remains problematic. The fascio-cutaneous "lotus petal" flap is an appealing option for reconstructing perineal defects as it may benefit from less donor site morbidity than other techniques. The purpose of this study is to demonstrate that the lotus flap should not only be limited to small and moderate sized defects, but can also be applied to extensive APR. MATERIAL AND METHODS: A systematic review of the literature on the outcomes and dimensions of the lotus flap was performed. Articles with clear anatomical landmarks and internal pudendal artery flaps dimensions were identified. Afterwards, the lotus flap technique was applied on a series of patients with extensive perineal defects following APR treated in our center. RESULTS: Four articles on internal pudendal artery perforator flap were selected. The average reported size of this flap was 13cm×6cm. In our center, reconstruction of the perineum with oversized lotus flaps was performed on 10 consecutive patients. None had partial/complete flap loss or donor-site morbidity. The use of a Jack-Knife surgical position, indocyanide green fluorescence imaging, and preservation of a proximal skin bridge can extend the size of a secure flap to up to 20cm in length. CONCLUSION: The oversized lotus flap is a reliable option for reconstruction after extensive APR.

[Impact of Facebook patient groups in the surgical decision making process: The example of Biocell® macro-textured implants recall]. / Impact des groupes de patientes Facebook dans le processus décisionnel chirurgical : l'exemple du rappel des implants macro-texturés Biocell®.

BACKGROUND: The use of social media, has been a major upheaval in our lifestyles in the last decade. At the forefront in the crisis of BIA-ALCL, as soon as February 2019, our university centre took steps to identify and contact all patients with macro-textured implants. The purpose of this recall was to educate patients and establish a monitoring system. The purpose of this work is to analyse the patients' decision-making process. METHODS: A retrospective study of patients, who requested and attended appointments with a surgeon, was made. The number of patients with clinical symptoms of BIA-ALCL, the number of patients who requested implant removal surgery, the histological diagnoses found after surgery were collected. We then calculated the proportion of Facebook group members among patients who required implant removal in the absence of a diagnosis or even warning signs. RESULTS: Seven hundred and seventy women requested an appointment with one of the surgeons in our department. Of all the women who requested consultation, 497 (64.55%) had symptoms. 199 patients were members or had attended one of the Facebook groups of patients. At the end of the consultation with their surgeon, almost 25% of patients made a decision to have the implant removed against medical advice. Among these patients, 67% were part of a group of patients on the Facebook network. To date, no patient has been diagnosed with BIA-ALCL. CONCLUSIONS: These results support the hypothesis that belonging to Facebook groups of patients becomes, for some, a key element in the decision-making process beyond expert opinion. In the future, preliminary work with patient groups on social networks should be done in order to obtain additional health efficiency.

Comparison of venous couplers versus hand-sewn technique in free flap breast reconstruction.

INTRODUCTION: Despite positive outcomes reported in the literature, some surgeons remain reluctant to the systematic use of venous couplers in free flap tissue transfer. In our institution, the use of the coupler devices for venous anastomosis in free flap breast reconstruction has yet to be adopted by all surgeons. The purpose of the study was to compare postoperative outcomes of coupler-assisted venous anastomoses with hand-sewn techniques in free flap breast reconstruction. METHODS: An analysis of collected data was performed on cases of breast reconstruction with free tissue transfer after mastectomy in breast cancer or BRCA-positive patients from 2010 to 2016. Patients were divided into two groups: coupler device and hand-sewn. The primary outcome was survival rate of free flaps. Secondary outcomes included potential complications, as well as surgical characteristics (recipient artery/vein, coupler size, type of hand-sewn anastomosis, size of sutures, number of venous anastomoses, ischemia time, operative time) RESULTS: We included 289 cases in our study. There were no significant differences between groups in terms of post-operative complications or survival rate of the free flaps. Ischemia time was significantly lower in both immediate and delayed reconstruction cases. Operative and anesthesia times were significantly lower only in immediate unilateral cases. CONCLUSION: Although ischemia time was reduced in the coupler group, we didn't find any significant difference in the operative and anesthesia time in the subgroup analysis, except for the group of immediate unilateral breast reconstruction. Couplers are safe and efficient; nevertheless, our study shows that their qualities cannot yet justify the disappearance of the manual sutures.

[Is scanning electron microscopy a pertinent tool for the analysis of periprostethic breast capsules?]. / Le microscope électronique à balayage environnemental est-il un outil pertinent pour l'analyse des capsules périprothétiques mammaires ?

PURPOSE: Scanning electron microscopy (SEM) is a powerful analytical tool that allows the study of interactions between commonly used biomaterials and the human body. In conventional SEM (HiVac), hydrated biological samples cannot be analyzed in their natural state and must be dried and metallized. The primary goal of this study is to present recent developments in SEM, notably Environmental SEM (ESEM). The secondary objective is to define the potential utility of these new technologies in the study of periprosthetic breast capsules. MATERIALS AND METHODS: Our pilot study group prospectively included 10 patients with breast cancer undergoing 2-stage expander to implant reconstruction. Periprosthetic breast capsule specimens were sampled during expander removal. Each sample was analyzed using both HiVac and ESEM modalities. Energy dispersive X-ray (EDX) studies were also conducted in order to assess the chemical composition of the capsular tissue samples. Under each observation mode, comparisons of samples' three-dimensional surface relief, cellular composition and biofilm presence were made. For each image, a score from 1-3 on a Likert scale was attributed by three independent experts in electron microscopy. RESULTS: HiVac mode was found to be superior to ESEM for the assessment of the three main study parameters (surface relief, cellularity, biofilm). The quality of the EDX analysis was equivalent under both SEM modalities. CONCLUSION: HiVac mode was shown to be more appropriate than ESEM for the global analysis of periprosthetic breast capsules. EDX analysis permits the identification of atypical chemical elements in tissue samples.

[Interventional angioradiology as a solution for microsurgical flap failure]. / La radioangiologie interventionnelle comme solution de sauvetage en microchirurgie.

The microsurgical failure rate is almost constant for several decades. We present two case reports describing a novel method of free flap salvage using angioradiological techniques. Our first case shows the potential utility of in situ thrombolysis, our second case describes the first use of stents within a microsurgical anastomosis. In boths cases, the flap would have been lost immediately, because flap revisions failed. Thus, before abandoning on a flap, one could perform a simple angiography to evaluate further angioradiological salvage possibilities and hereby contribute to improve long term microsurgical failure rate.

Histopathologic changes of the spleen in suckling rats inoculated with Hantaan virus.

The purpose of this study is to delineate the histopathologic findings of the spleen after Hantaan viral inoculation, which is the largest lymphoid organ in rats, and to identify the viral location by anti-Hantaan virus (HTNV) monoclonal antibody. All the sixty one suckling rats of less than twenty four hours of age were used. Except twenty one rats of control group, twenty-five rats inoculated intracerebrally for the early change and fifteen suckling rats inoculated intramuscularly for the late change were uniformly susceptible to lethal infection with the ROK 84-105-1 strain of seed HTNV. The characteristic histopathologic findings were; appearance of macrophages below the splenic capsule on the 3rd day, small lymphocytes around the periarteriolar sheath on the 5th day increasing in numbers on the 7th day, and a markedly expanded marginal zone with some immunoblasts and plasma cells as well as decreased extramedullary hematopoiesis on the 9th and 14th days. Time of onset of histopathologic changes in spleen thickness, appearance of medium and large lymphocytes and degree of extramedullary hematopoiesis were influenced by inoculation route, whereas expansion of the marginal zone was affected by postnatal age.