[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.

[Salmonella glenohumeral arthritis]. / Arthrite gléno-humérale à salmonella enteritidis.

We report the first case of glenohumeral Salmonella arthritis in an immunocompetent 86-year-old woman. There was no entry point. An empirical antibiotherapy was started then adapted according to culture results. Given the persistence of symptoms, an arthroscopy was performed at 72 hours for a joint lavage and synovectomy. Postoperative course was good. Apyrexia was obtained by 72 hours and inflammatory syndrome was normalized in 12 days. The patient was reviewed regularly until the 3rd month. She has no clinical sequelae. Her osteoarthritis remained stable throughout follow-up.

[Large diameter nerve conduits use in the upper limb: report of four cases and literature review]. / Utilisation des neurotubes de gros diamètre au membre supérieur : à propos de quatre cas et revue de la littérature.

UNLABELLED: Defects of the median, ulnar or radial nerves in the forearm, can be treated by conventional nerve grafts, or by interposing a synthetic guide such as nerve conduits. Wounds without nerve loss treated with simple suture may be supplemented by sleeving to prevent the nerve irritation symptoms using a nerve conduit or a vein sleeve. We studied the results of nerve conduits in both cases in a single-center retrospective study. PATIENTS AND METHODS: Four patients underwent surgery with placement of a nerve conduit in the forearm, between May 2007 and January 2011. All patients were reviewed by the same examiner. Pain, tenderness, motor (Medical Research Council classification, MRC), time to return to work and self-evaluation by the patient were measured. The averages of these data were calculated and compared with results of other studies in the literature, the nerve grafts for defects and the Socket joints for venous ulcers. RESULTS: The decrease is on average 30 months (2 years). The defect never exceeds 40mm and is 22mm on average. According to the classification MRC, sensitivity found after inserting nerve conduits in the forearm after a defect is excellent (S4) for two of three patients and good (S3) for the third. Motor results were very good (M4 and M3 for one patient) andM2 for the other. As for the insertion of a nerve conduit as a sleeve, the result is good in terms of sensitivity (S3) and excellent in terms of motor (M5) for our case in the study. For our small group of patients with neuroma we obtained, results similar to those published in the literature with conventional techniques. CONCLUSION: The nerve conduits seem to give results similar to conventional techniques, in situations of defects or neuromasin the forearm, with a diameter greater than 2mm, but defects of less than 30mm.

[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.