[Maxillofacial reconstruction with radial forearm osteofasciocutaneous free flap]. / Le lambeau ostéo-fascio-cutané antébrachial radial dans la reconstruction maxillo-faciale.

INTRODUCTION: Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. MATERIALS AND METHODS: We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. RESULTS: The mean age of the 10 patients was 60.2 years. The average length of bone defect was 8 cm. The average cutaneous defect area was 36.8 cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no reconstruction failure. Three patients had mild speech disorders, five had moderate speech disorders, and two major speech disorders. Four patients had a normal food intake, three patients needed mixed food, and three patients liquid food. DISCUSSION: The indications of radial forearm osteofasciocutaneous free flap for complex maxillofacial reconstructions should be extended. Its vascularization is less compromised by arteritis. Its pedicle may be long and adequate for a contralateral anastomosis. It is reliable and easy to harvest. But the bone quality is not as good as fibula.

[Autologous fat grafting to the postmastectomy irradiated chest wall prior to breast implant reconstruction: a series of 68 patients]. / Transfert de tissu adipeux autologue préalable à la reconstruction mammaire par implant après mastectomie et irradiation : à propos d'une série de 68 cas.

INTRODUCTION: After radiotherapy, breast reconstruction with an implant carries a high risk of failure and complication. Clinical and experimental studies have demonstrated that grafting adipose tissue (lipofilling) in an irradiated area enhances skin trophicity. Thus, we have started performing preliminary fat grafting to the irradiated chest wall prior to implant reconstruction in order to limit complications and failure risk. PATIENTS AND METHODS: Patients were included in this study from 2007 to 2011. All patients had had mastectomy and irradiation for breast cancer. They all had one or more sessions of lipofilling prior to breast implant reconstruction. These patients were prospectively followed up in order to collect the following data: postoperative complications; cosmetic result; local breast cancer recurrences. RESULTS: Sixty-eight patients were included. The mean number of fat grafting sessions was 2.3 (range 1-6). An average volume of 115mL (70-275) was injected each time. The mean volume of breast implants was 300mL (185-400). The mean follow-up was 23months (450). No breast cancer local recurrence was diagnosed during follow-up. Implant explantation was performed in one case (1.47%) The mean cosmetic result was 4.5/5. CONCLUSION: Fat grafting to the irradiated chest wall prior to implant placement might be an alternative to flap reconstruction for patients who are not suitable or who refuse this option.

[Complications associated with sentinel lymph node biopsy for cutaneous melanoma. A retrospective study of 127 patients]. / Les complications liées à la technique du ganglion sentinelle dans le mélanome cutané. Étude rétrospective à partir de 127 cas.

BACKGROUND: Sentinel lymph node (SLN) biopsy for patients with cutaneous melanoma has become a routine procedure. Its purpose is to confirm the potential presence of micrometastases in the first lymph node basin. Therefore, staging of the melanoma can be determined. Somehow, only few studies assess the morbidity of this procedure. Our study was performed in order to list and analyze SLN biopsy-related complications in melanoma-affected patients. PATIENTS AND METHODS: This mono-institutional, retrospective study enrolled patients, operated on from May 2001 until August 2008, who had undergone SLN biopsy that found no metastatic colonization. Patients with positive SLN biopsy underwent subsequent completion lymph node dissection (CLND) and, therefore, were not included in this study. Thus, CLND-related complications did not interfere with SLN biopsy-related ones. Median follow-up was 19 months. RESULTS: One hundred and twenty-seven patients, 58 men and 69 women were evaluated. Nine patients (7,1%) were diagnosed with one complication. We noticed seven early complications occurring during the first month (four seromas, one lymphocele, one infection with dehiscence of wound, one deep veinous thrombosis) and two late complications occurring beyond this period (one neuroma, one cicatricial bridle). Four (44%) among these complications arose in the groin. CONCLUSION: SLN biopsy is known as a simple and minimally invasive surgical technique. Somehow, some potentially severe complications may arise. These must be clearly explained to obtain the patient's informed consent prior to surgery.

[Postoperative necrotizing neutrophilic dermo-hypodermitis of the hand. A diagnosis not to miss]. / Dermo-hypodermites nécrosantes neutrophiliques postopératoires de la main. Un diagnostic à ne pas rater.

Pyoderma gangrenosum (PG) is an aseptic ulcerative dermatosis, belonging to the group of neutrophilic dermatoses, and could reveal a systemic blood disorders or inflammatory disease. This dermatosis could mimic rapidly extensive necrotizing dermo-hypodermitis in some clinical aspects. PG can be caused by tissue trauma as in surgical procedure. In this context, this pathology is easily confused with bacterial necrotizing dermo-hypodermitis, the treatment of which gives priority to survival rather than functional outcome, and causes rapid deterioration especially in the upper limb. This case report shows typical evolution of inappropriate treatment of postoperative PG. Faced with postoperative necrotizing dermo-hypodermitis, the diagnosis of PG must be considered, in order to favor good functional outcome.

[Sentinel node procedure in head and neck cutaneous melanoma]. / Ganglion sentinelle dans les mélanomes cutanés de l'extrémité cervicocéphalique.

INTRODUCTION: Sentinel lymph node (SLN) biopsy is frequently discussed in the management of cutaneous melanoma, especially in head and neck localizations where SLN biopsy is much more demanding. The benefits of SLN protocol are not proved yet. The aim of our study was to present our experience of SLN biopsy in head and neck cutaneous melanoma. PATIENTS AND METHODS: This retrospective study included all patients managed for head and neck malignant melanoma from 2002 to 2006. We reviewed the technique, implementation and difficulties of the procedure, postoperative outcome, and complications. RESULTS: Nineteen patients were included. An average of 2.2 lymph nodes were localized per patient using lymphoscintigraphy. Biopsy was impossible for one patient because the deep spinal node was not found. An average of 1.2 nodes was biopsied per patient. One patient presented with micrometastases. Another presented with lymphorrhea. DISCUSSION: Sentinel node biopsy is widely performed in the management of cutaneous melanoma but remains an option for these indications in the last update of the French Society of Dermatology. SLN biopsy is difficult to implement because of the complexity of head and neck lymphatic system.

[Orthopaedic treatment of extraarticular condylar fractures of the mandible: retrospective study of 39 unilateral cases]. / Traitement orthopédique des fractures extra-articulaires de la région condylienne de la mandibule : étude rétrospective de 39 fractures unifocales.

INTRODUCTION: Although for an increasing number of authors open reduction and internal fixation (ORIF) is becoming the standard of care for mandibular subcondylar fractures, functional treatment is still performed worldwide. The aim of this study was to evaluate the results of functional treatment in isolated mandibular subcondylar fractures. MATERIAL AND METHODS: Patients presenting with an isolated low subcondylar fracture between 1998 and 2004 were enrolled in a retrospective study. We focused on the epidemiology, type of fracture, degree of displacement, treatment protocol and short-term outcome. Patients were interviewed to evaluate long-term results. RESULTS: Thirty-nine patients were enrolled in this retrospective study. The mean displacement was 15 degrees of medial angulation and a shortening of the ramus ranging around 5mm. Thirty-one patients recovered normal mandibular function (mouth opening more than 45 mm, with no or minimal deviation). Sixteen presented with TMJ disorders, deemed minor by the patients themselves. None of them required any specific treatment. Eighteen had posttraumatic occlusal discomfort corrected by dentistry or prosthetic adaptation. Long-term follow-up X-rays showed minor residual condylar displacement. In all cases, patients estimated their treatment acceptable. DISCUSSION: The orthopedic treatment of low subcondylar fractures provides acceptable functional results. This technique is simple, safe and remains a valuable therapeutic option. In the future, experience with surgical management will probably lead to specific indications of both closed and open methods.

[Is withdrawal of antiplatelet therapy necessary prior to skin cancer surgery?]. / L'arrêt d'un traitement antiagrégant plaquettaire est-il nécessaire avant une chirurgie cutanée carcinologique?

AIM: The aim of this study was to assess the value of discontinuing antiplatelet treatment prior to surgery for skin cancer with loss of skin of up to 10 cm in diameter. The study hypothesis postulated equivalence between discontinuation of antiplatelet therapy and continuation of these drugs during the perioperative period with regard to risk of cutaneous complications. PATIENTS AND METHODS: This was a prospective, randomised study comparing two groups of patients on long-term antiplatelet treatment scheduled for surgery for skin carcinoma. In the first group, patients underwent surgery without change to their antiplatelet therapy while in the second, antiplatelet treatment was discontinued and substituted with either flurbiprofen or isocoagulant fractionated heparin or calcium heparin. Sixty patients took part in the study. Statistical analysis using ANOVA and Mann-Whitney non-parametric tests was performed to compare the following variables: age, sex, number of pre- and post-operative consultations, complications (haemorrhage, haematoma, separation and infection) and quality of wound healing. RESULTS: No statistically significant difference was seen between the two groups regarding either complications or quality of wound healing. CONCLUSION: There appear to be no rational grounds for discontinuing antiplatelet therapy in advance of skin cancer surgery involving loss of skin of up to 10 cm in diameter.