[The pedicled temporal fascia flap for facial defect coverage]. / Le lambeau de fascia superficialis temporalis pédiculé pour la couverture des pertes de substance de la face.

INTRODUCTION: The fascia superficialis temporalis (FST) can be used as a pedicled flap. Its span allows covering important head and neck defects. We present our experience with four patients. OBSERVATION: The FST flap, grafted with thin skin allowed covering: zygomatic defect after resection of Merkel cell carcinoma; the upper part of the right auricle after exeresis due to an arterial and venous malformation; the left orbital and palpebral region after exeresis of a basal cell carcinoma; the total auricle amputation site after exeresis of a squamous cell carcinoma. The cosmetic results were satisfactory in every case. DISCUSSION: The thinness and the plasticity of the FST make it an excellent flap for facial reconstruction. Rapid surgery and low rate of sampling morbidity are assets for reconstruction in patients often fragile and old.

[Leech-borne infection on a TRAM flap: a case report]. / Complication infectieuse d'un lambeau de TRAM liée aux sangsues: à propos d'un cas.

Leeches are used worldwide to treat venous congestion of flaps. Aeromonas hydrophila infections are recognized complications of leech use. We report a new case of delayed leech-borne infection in mammary reconstruction by a Transverse Rectus Abdominis Myocutaneous flap (TRAM), which caused the flap loss. The use of prophylactic antibiotics is a way to prevent A.hydrophila infection (third generation cephalosporin, ciprofloxacin). This antibioprophylaxy must be followed until wound closure of the venous congested tissue.

[Use of a vascularized fibula for spinal reconstruction in neurofibromatosis]. / Intérêt d'un péroné vascularisé pour la reconstruction du rachis dans le cadre d'une neurofibromatose de type 1.

We report a case of reconstruction of a dysplasic thoracic spine with vascularized fibula in Recklinghausen's disease. We present the case of a thirteen-year-old lady with neurofibromatosis type 1 who developed a dystrophic thoracic kyphoscoliosis. A T9 compression due to a severe scaloping of the thoracic spine caused an important deformation and a medullar compression (with dorsal pain, right sciatica and a pyramidal syndrome). The surgery consisted in medullar liberation by a T9-T10 corporectomy and an osteosynthesis with arthrodesis T3-L3. A free vascularized fibula bone graft, with an end-to-end anastomosis on a thoracic pedicle, was realized to fill the T8-T11 spinal defect. All the symptoms decreased after surgery and the patient could walk normally few months later. At one-year follow-up the radiographs showed a stable montage and a solid bony fusion. Analysing the literature, vascularized bone graft can be recommended to fill the bony spinal defect due to surgery in cases of tumor, infection, trauma or severe scoliosis. Compared to non-vascularized grafts, which are exposed to resorption, fatigue fracture and then instability, the vascularized fibula grafts provide a rapid fusion, a biomechanically stable and long-standing support with low risks of infection.

[Free-flap reconstruction in the elderly patient]. / La reconstruction par lambeau libre chez le sujet âgé

The objective of the study was to evaluate the safety and the efficacity of microsurgery in the elderly patient population. Between 2003 and 2005, 10 free-flaps were performed in 10 patients who were aged 70 years or older. One flap underwent reexploration, for an overall success rate of 100%. Medical complications in the postoperative period were further evaluated. Effects of American Society of Anesthesiologists (ASA) status, operation time, and age on complication rate were evaluated. Only ASA status was significant for the occurrence of postoperative medical complications; class 3 and 4 patients were at higher risk than class 1 and 2. Neither operation time nor age was predictive of postoperative complications. Microvascular free-tissue transfer is a safe and reliable option in the elderly population. The success rate of free-flaps is not different from that for other age groups. The rate of postoperative medical complications was 20%: most complications were in ASA class 3 and 4 patients.