[Evaluation of 106 free flaps. Analysis of the failures and the indications]. / Bilan de 106 lambeaux libres. Analyse des échecs et des indications.

Between April 1982 and April 1987, 106 free flaps were performed: 27 in the head and neck, 9 in the upper limbs and 60 in the lower limbs. 4 types of free flaps were essentially used: 42 latissimus dorsi flaps, 30 Chinese flaps, 18 temporalis flaps and 12 gracilis flaps. 14 free flaps were performed as a real emergency to cover defects of the upper limb in 4 cases and of the lower limb in 10 cases. The overall success rate was 87%, but this varied according to the recipient site, as the success rate was only 80% in the lower limb, and according to the type of flap, the latissimus dorsi flap ensured a success rate of 90%. Apart from one case of drepanocytosis, the failures observed could have been prevented. Rigorous intensive care as well as a strategy based on a precise preoperative assessment and appropriate selection of flaps should allow a considerable improvement in the results. Due to its reliability and its possibilities, we consider the latissimus dorsi flap to be the most useful flap. The Chinese flap retains a place in ENT surgery and in the case of emergency by-pass flaps. The gracilis and temporalis flaps may be proposed in certain cases because of their surface area and their minimal scars.

Analysis of sequelae secondary to the radial forearm flap. A study of twenty-six cases.

The radial forearm flap is used extensively in hand and reconstructive surgery. We have performed 31 radial forearm flaps (15 free and 16 pedicled flaps) in 25 adults and 5 children. This series was analyzed in an attempt to minimize the sequelae of the upper limb and provide more specific indications for this flap. Vascular sequelae were assessed by Doppler and thermography examinations. The functional sequelae were appreciated by wrist motion and grasp strength examinations. Cutaneous sequelae were evaluated according to the time of healing and the quality of the scars. Several technical modifications may be proposed in order to try to minimize sequelae. As shown by our study, cutaneous sequelae are the most important and they must always be considered in the indication of this flap.

[Bilateral lunato-triquetral synostosis with bilateral fracture of the scaphoid bone]. / Synostose bilatérale semi-lunaire-pyramidal avec fracture bilatérale des scaphoïdes.

The authors have treated a case of bilateral fracture of the scaphoid bone in a young man who had complete and bilateral lunato-triquetral synostosis, without any other associated congenital condition. Consolidation was obtained by orthopedic treatment on one side, but a Matti-Russe operation was necessary on the other. The authors emphasize but then rule out the hypothesis of a congenital bipartite scaphoid associated with the synostosis. A review of the literature on lunato-triquetral synostoses sums up the main points. The condition is rare in whites and occurs more frequently in blacks. It is sometimes associated with other congenital conditions. Four anatomic and radiologic types have been described. The pathogenic hypotheses, based on embryology, are summarized.