[Prevention of the after-eff ects of severe skin infections, reconstruction and rehabilitation]. / Prévention des séquelles des infections cutanées graves, reconstruction et réhabilitation.

PREVENTION OF THE AFTER-EFFECTS OF SEVERE SKIN INFECTIONS, RECONSTRUCTION AND REHABILITATION. The management of necrotizing bacterial dermohypodermatitis and necrotizing fasciitis is surgical. The procedure is often very disfiguring, with a significant loss of substance, responsible for important sequelae. Surgical techniques (skin grafts and flaps) can improve the functionality of a limb, but non-surgical tools can moreover accelerate the healing process such as negative pressure therapy, and maintain a good functionality through functional rehabilitation, massage, cryotherapy, thermotherapy or electrotherapy.

PRÉVENTION DES SÉQUELLES DES INFECTIONS CUTANÉES GRAVES, RECONSTRUCTION ET RÉHABILITATION. La prise en charge des dermohypodermites bactériennes nécrosantes-fasciites nécrosantes est chirurgicale. Le geste est souvent très délabrant, entraînant une perte de substance conséquente, responsable de séquelles importantes. Les techniques chirurgicales (greffes de peau et de lambeaux) peuvent améliorer la fonctionnalité d'un membre, mais des outils non chirurgicaux permettent par ailleurs d'accélérer le processus de cicatrisation, comme la thérapie par pression négative, et de conserver une bonne fonctionnalité grâce à la rééducation fonctionnelle, les massages, la cryothérapie, la thermothérapie ou l'électrothérapie.

Spontaneous Lymph Flow Restoration in Free Flaps: A Pilot Study.

BACKGROUND: Oncologic excision and trauma can be responsible for major defects and lymphedema. Free flaps are commonly used for reconstruction. We aimed to determine if lymphatic flow between flap and recipient site can be restored without lymphatic surgery. METHODS: 15 free flaps were performed in different patients in our center. Infrared-based lymphography was used to plan surgery. Indocyanine green (ICG) was injected in the flap's subdermal tissue and also at the edges of the skin defect. Circumferential lymphatic channels were marked 5 min after the ICG injection. Fluorescent images were recorded with an infrared camera system. The flap inset was obtained by putting side to side the flap markings and the recipient site markings. Infrared-based lymphography was performed on every patient one year after surgery. Spontaneous lymph flow restoration was judged positive if lymphatic connections were observed between the flap and the recipient site. RESULTS: seven free ALT and eight DIEP flaps were performed. All ALT flaps were designed following the limb axis which is the lymphatic axiality. Spontaneous lymph flow restoration was observed for the seven ALT flaps. Eight DIEP flaps were designed upside down and one was designed following the lymph axiality. Spontaneous lymph flow restoration was only observed for the one designed following the lymph axiality. CONCLUSIONS: designing reconstructive free flap regarding lymph axiality seems to improve spontaneous lymph flow restoration between flap and recipient site without any specific lymphatic surgery.