Microsurgical reconstruction of the nail.

Very often, post-traumatic defects involve multiple tissues. Microsurgical techniques can reconstruct them with tissues taken from a toe: from the nail complex alone to compound osteo-onychocutaneous flaps. Several techniques have been reported since the 1980s. This paper describes techniques and indications for microsurgical nail reconstruction. Technique differs according to the deficit, and first and foremost whether only the nail complex is involved or whether other components of the fingertip important for the normal growth of the nail, such as the phalanx bone or the finger pad, are also missing (toenail flaps and the custom-made osteo-onychocutaneous flaps). For most patients the absence of a fingernail is an esthetic rather than functional concern, and the outcomes of microsurgical reconstruction are far from ideal in this regard. We prefer to reserve reconstruction for symptomatic patients with functional impairment.

Treating a rare mid-term complication of transapical transcatheter aortic valve implantation (TAVI): a case report.

We report the case of a patient who underwent transcatheter aortic valve implantation via left anterior mini-thoracotomy in whom a periapical subcutaneous collection appeared in the anterior thoracic wall 18 months after the procedure. The tissue defect was efficaciously repaired via intercostal artery perforator flap, preserving the thoracodorsal and internal mammary arteries.

Prepectoral Implant-Based Breast Reconstruction Using Meshed ADM.

Prepectoral prosthetic breast reconstruction has been widely reassessed in recent years and is taking on an increasingly important role in the field of immediate breast reconstruction. We report here a case series of 32 patients who underwent nipple-sparing mastectomy for breast carcinoma and prepectoral breast reconstruction involving an acellular dermal matrix (ADM) treated by means of a skin-graft mesher in our hospital from January 2015 to March 2016. The indications for this type of reconstruction were body mass index (BMI) less than 30 kg/m2; no history of radiotherapy; no active smokers; moderate grade breast; and good viability of mastectomy flap: normal skin colour, active bleeding at the fresh cut edges, and thicker than 1 cm mastectomy flaps; the viability of lower thicknesses was ascertained by the fluorescent dye indocyanine green xenon-based imaging technology (4 patients). The mean age of the patients was 56.4 years (range: 39-77 years). Their mean BMI was 27.4 kg/m2. Until the end of follow-up (mean: 17 months), major complications requiring reoperation occurred in 9% of patients and minor complications in 22% of patients. The mean of the 3 pain visual analogue scale scores taken in the first 24 hours after surgery was 1.8. Mean duration of hospital stay has been 2.2 days. Our complication rate was similar to those reported in other studies on prepectoral breast reconstruction featuring total ADM coverage of the implant.

La reconstruction par prothèse mammaire prépectorale a été largement réévaluée ces dernières années et joue un rôle de plus en plus important dans le cadre des reconstructions mammaires immédiates. Les auteurs rendent compte d'une série de 32 patientes qui ont subi une mastectomie d'épargne cutanée à cause d'un carcinome du sein et d'une reconstruction mammaire prépectorale touchant la matrice du derme acellulaire traitée par une ampligreffe à l'hôpital entre janvier 2015 et mars 2016. Les indications pour ce type de reconstruction étaient un indice de masse corporelle inférieur à 30 kg/m2, aucun antécédent de radiothérapie, aucun tabagisme actif, des seins de dimension modérée, une bonne viabilité du lambeau de mastectomie, une couleur normale de la peau, un saignement actif aux bordures fraîchement coupées et des lambeaux de mastectomie de plus de 1 cm. La viabilité de l'épaisseur inférieure était évaluée par la technologie d'imagerie par fluorescence du vert d'indocyanine à base de xénon (chez quatre patientes). Les patientes avaient un âge moyen de 56,4 ans (moyenne de 39 à 77 ans) et avaient un indice de masse corporelle moyen de 27,4 kg/m2. Jusqu'à la fin du suivi (moyenne de 17 mois), 9 % des patientes ont souffert de complications majeures exigeant une réopération, et 22 % ont subi des complications mineures. La moyenne de trois scores de douleur sur l'échelle analogique visuelle calculés dans les 24 heures suivant l'opération s'élevait à 1,8. Le séjour hospitalier était d'une durée moyenne de 2,2 jours. Le taux de complication était semblable à celui déclaré dans d'autres études sur la reconstruction mammaire prépectorale touchant l'intégralité de la matrice dermique acellulaire de l'implant.

Posterior lamellar reconstruction: a comprehensive review of the literature.

The aim of the review is to describe the different techniques and materials available to reconstruct the tarsoconjunctival layer of the eyelid; to analyze their indications, advantages, and disadvantages. We searched the Cochrane, PubMed, and Ovid MEDLINE databases for English articles published between January 1990 and January 2017 using variations of the following key words: "posterior lamella," "eyelid reconstruction," "tarsoconjunctival," "flap," and "graft." Two reviewers checked the abstracts of the articles found to eliminate redundant or not relevant articles. The references of the identified articles were screened manually to include relevant works not found through the initial search. The search identified 174 articles. Only a few articles with a therapeutic level of evidence were found. Techniques for the posterior lamellar reconstruction can be categorized as local, regional, and distant flaps; tarsoconjunctival, heterotopic, homologous, and heterologous grafts. Several techniques and variations on the techniques exist to reconstruct the posterior lamella, and, for similar indications, there's no evidence of the primacy of one over the other. Defect size and location as well as patient features must guide the oculoplastic surgeon's choice. The use of biomaterials can avoid possible complications of the donor site.

Experience with gluteal V-Y fasciocutaneous advancement flaps in vulvar reconstruction after oncological resection and a modification to the marking: Playing with tension lines.

Many post-vulvectomy vulvar reconstruction solutions, using local fasciocutaneous flaps where possible, have been proposed. We report the use of V-Y advancement flaps from the gluteal fold in medium to large vulvar reconstructions and a simple modification we made to the technique in order to minimise wound-related complications. Between 2006 and 2016, 30 vulvar reconstructions were performed via a total of 59 flaps, 24 of which were raised using the proposed modification to the plasty design. Short- and long-term (24 months) follow-up data were analysed, postoperative flap sensitivity was tested, and any arising complications were recorded. The mean age of patients treated was 75.3 years (51-92 years). The mean monolateral defect dimensions were 7.5 × 4.7 × 2.8 cm. Minor complications were recorded in 23% of patients (14% of flaps). One case of ostial stenosis occurred. Micturition and ambulation recovery was rapid, and flap sensitivity was fully restored 24 months after reconstruction. Scars were well hidden by natural soft tissue folds. The outcomes in this case series confirm that the gluteal V-Y advancement fasciocutaneous flap is a useful and simple technique for reconstructing even large vulvar defects. It has a low functional and aesthetic impact and enables rapid return to autonomy. Moreover, the simple modification to the V-Y flap proposed, designed to reduce tension at the apical part of the wound, appears to reduce the complication rate.