[Emergency free flap in reconstruction of the lower limb. Thirty-five years of experience]. / Reconstruction des pertes de substance de membres inférieurs par lambeau libre en urgence. À propos de 35ans d'expérience.

Authors analyzed 89 cases (86 patients) of lower limb extensive soft tissue defects reconstruction during 1978 to 2013. The mean age is 37 years and 2 months old (range: 5-84 years old). A total of 71 males and 15 female were included. Free flaps were used in emergency in 23 cases for principally covering Gustilo 3B open lower limb fracture and in a later stage for 66 cases all referred from their center for coverage of exposed bone, with frequently osteomyelitis. About the selection of free flaps, in 47 cases we used a latissimus dorsi flaps, 12 cases of epiploon free transfer (in septic area), 10 cases of gracilis transfer and 10 serratus anterior flaps. There are one medial gastrocnemius flap, 2 composite soleus and fibular free flap, 2 antebrachial flap, one inguinal myoosteocutaneous flap, 1 transferred from the other lower limb and one inguinal cutaneous flap. There are 18 free flap losses: one in emergency and 17 after delayed reconstruction. Authors retrospectively analyzed the results (complications, osteomyelitis) according to the timing for lower extremity reconstruction. They found a low infection and flap failure rates (4%) when the coverage is made in the same operating time than initial fracture fixation, they increase to 60% for osteomyelitis and to 23% for flap failure when the reconstruction is delayed.

[Abdominal perforator flap (DIEP) and autologous latissimus dorsi in breast reconstruction. A retrospective comparative study about the first 60 cases of a same surgeon]. / Le lambeau perforant abdominal (DIEP) et grand dorsal autologue en reconstruction mammaire. Étude rétrospective comparative à propos des 60 premières patientes d'un même opérateur.

INTRODUCTION: Autologous techniques for breast reconstruction get the best cosmetic results. Aesthetic satisfaction with breast reconstruction is an important evaluation criterion. The indication is based on technical criteria (morphological, medical history) and the wishes of the patient. A rigorous evaluation of the results is necessary to assist the patients in their choice of reconstruction. METHODS: Thirty-three DIEP and 27 latissimus dorsi were involved. A satisfaction questionnaire was sent to patients to collect the aesthetic evaluation of their reconstructed breast, sequelae at the donor site of the flap as well as their overall satisfaction. Post-operative photographs of the patients were subject to aesthetical evaluation by two groups of observers. Complications were analyzed. RESULTS: The DIEP tends to get higher aesthetic satisfaction regarding the symmetry of the breasts and the volume of the reconstructed breast (P=0.05), and a better overall satisfaction (P=0.02). The uniformity of the colour of the reconstructed breast was considered superior by observers in the latissimus dorsi group (P=0.005). Donor site scar of DIEP was considered more unsightly while the latissimus dorsi was considered more painful (P=0.04) and uncomfortable, with more frequently contour abnormalities (P=0.03). We noted two total flap necrosis and three partial necrosis in the group DIEP, and two partial flap necrosis in the group latissimus dorsi. CONCLUSION: This study provides evidence that can guide the patient and the surgeon in the complex process of therapeutic decision, without exempting the latter from a careful selection of indications.

[Volar dislocation of four ulnar metacarpals: one case report]. / Luxation carpométacarpienne palmaire de tous les doigts longs: à propos d'un cas.

We report a case of volar dislocation of four ulnar carpometacarpals. It's a very rare injury, especially as it affects all long fingers, it is volar and has no fractures. The treatment consisted in open-reduction with pinning carpometacarpal according to intraoperative stability. No complications was noted. The follow-up was a radiological evaluation (pain, strength, mobility) between 6th week and 6th month. The recovery was complete at 6 months without pain. We believe that open reduction allows carpometacarpal osteosynthesis to be the less invasive as possible, depending on the stability visualized and thus can reduce stiffness and residual pain.