[Cranial-bone grafting under local anesthesia]. / Prélèvement crânien sous anesthésie locale.

Autogenous bone remains the gold standard for preimplant bone-grafting procedure. When important volumes must be grafted with cancellous bone, the calvarial-harvesting site must still be considered, due to the quality of this membranous bone and the safety of the procedure if the surgeon is experimented. To simplify the procedure, the author proposes calvarial-bone harvesting under local anesthesia with a mini-bone plane. This technique remains very comfortable for the patient and also safe because of the almost complete preservation of the outer calvarial table.

[First treatment of distal loss of tissue on lower limbs. About 15 cases]. / Stratégie thérapeutique initiale dans les pertes de substance distales du membre inférieur d'origine traumatique. A propos de 15 cas.

Distal extremity of lower limb sustains the complications of loss of tissue: problem of coverage (cutaneous and tendon necrosis, osteoarticular infection. The whole point of the surgery is to fight against the infection by repeated debridments, against the deformations or their correction by early osteosynthesis (pins and external fixation). The coverage is very important in this treatment: either with Vacuum-Assisted Closure (VAC) and skin graft or fasciocutaneous flap. In spite of this management, the after-effects are important although the conservative treatment is the determining factor of satisfaction.

[Vertical alveolar distraction osteogenesis of the posterior edentulous mandible: a case report]. / Distraction alvéolaire des secteurs postérieurs mandibulaires: à propos d'un cas clinique.

When it is necessary to increase the vertical height of the residual alveolar ridge, alveolar distraction osteogenesis has numerous advantages compared to other preprosthetic surgical procedures. It is frequently used for this purpose in the anterior region because of the obvious accessibility. The authors present a clinical case of edentulous posterior mandible, with insufficient vertical alveolar bone height, treated by alveolar distraction osteogenesis leading to three titanium fixtures. They explain their choice and discuss the preliminary results.

[Postoperative monitoring of free fibular grafts by dynamic magnetic resonance imaging. Preliminary results in three cases of mandibular reconstruction]. / Surveillance postopératoire des lambeaux libres osseux de péroné ou fibula par IRM dynamique. Résultats préliminaires à propos de trois cas en reconstruction mandibulaire.

The vascularized free fibular graft has been used in mandibular reconstructive surgery since 1975. This technique has been progressively developed, and it is now the procedure of choice for mandibular reconstruction although in certain postoperative circumstances it can be difficult if not impossible to monitor bone vitality. However, bone vascularization can be detected by dynamic magnetic resonance imaging (MRI), as this technique has been experimentally and clinically validated in the early diagnosis of osteonecrosis. The aim of this study was to evaluate the efficacy of MRI for the postoperative monitoring of vascularized free fibular grafts in human mandibular reconstruction. Dynamic contrast-enhanced MRI was used to study the variation in contrast over time following injection of gadolinium contrast medium, and to evaluate the degree of bone marrow perfusion of the fibular graft. This variation in signal intensity was visualized in the form of a curve, i.e., a perfusion curve for the bone marrow region. An examination was performed in three patients at different postoperative times and under different conditions. In one case, MRI confirmed the presence of fibula blood supply in spite of the necrosis of the adjacent fascio-adipose layer. In this article, the methodological difficulties have been discussed, particularly as regards data processing, and the present results have been compared with the findings in the literature. Dynamic MRI is a simple, reliable, non-invasive technique and its use in the postoperative monitoring of bone marrow perfusion and vascularized free fibular grafts permits a determination of the status of the latter following surgery, i.e., whether there is an adequate blood supply or not.