Treatment of facial haemangiomas: the present status of surgery.

Although conservative management is usually proposed for haemangiomas occurring in infancy, the presence of these tumours on the face may result in severe complications and provide an indication for treatment. In this paper, we report 35 patients who underwent surgical treatment for facial haemangiomas. The series consists of 23 females and 12 males, ranging in age from 2.5 months to 35 years. In six patients early surgery, before the age of 2 years, was performed because of severe complications, including visual occlusion, repeated bleeding and distortion of adjacent structures. In 16 children surgical resection of haemangiomas was carried out between 2 and 5 years of age, before complete involution. In 13 patients persisting haemangiomas were surgically treated at an older age. The operative technique depended on the location and size of the lesion, and focused on resection of the tumour and reconstruction of the adjacent structures when necessary. The postoperative outcomes were very satisfactory. Early surgery is mandatory in the management of large periocular haemangiomas, to prevent secondary amblyopia, and proliferative labial tumours, which are prone to bleeding and cause difficulty while eating. Early surgical treatment is also recommended for nasal-tip haemangiomas, which regress very slowly and may result in severe distortion of the cartilaginous framework. In conclusion, facial haemangiomas causing functional disturbance or serious psychological distress deserve surgical excision before the age of expected spontaneous regression; surgery can provide active treatment with excellent results and minimal morbidity.

Lower limb soft tissue reconstruction using microsurgical techniques.

Trauma is the main cause of lower limb soft tissue defects followed by tumor resection, vascular disease and osteomyelitis. 17 patients were operated on using microsurgical techniques during the last 10 years. 9 of the patients had traumatic defects, 5 had various malignant tumors, 2 patients had arterial insufficiency and finally 1 patient had chronic osteomyelitis. The latissimus dorsi either as muscle flap with a split thickness skin graft or as a musculocutaneous flap was used the most frequently in our series. Other flaps, including the radial forearm neurovascular flap, the rectus abdominis flap, the scapular flap, the groin and the dorsalis pedis flaps were used less often. Delayed primary cover was used, except in 1 case with an opened knee joint trauma, where emergency repair was performed. Complications included: 2 partial skin graft necroses which required revision and 2 flap necroses caused by venous thrombosis. With follow-up more than 4 years in all but 2 patients, functional results were found satisfactory. Cosmetic results, however, were less satisfactory.

Bone growth after replantation in children.

Bone growth and the development of epiphyseal plates are disturbed after the replantation of amputated extremities in children, but the potential for continued skeletal growth is almost always maintained in the replanted part. In this reported series of 12 children, all younger than 15 years old, 13 amputated parts of the upper limb have been successfully replanted. After long-term follow-up (from 21 to 216 months), bone growth of the replanted parts was clinically and radiologically evaluated. Two different growing segments were distinguished: the proximal bone segment, directly injured from the initial trauma, and the distal replanted part. Average longitudinal growth recorded was 94.5 percent and 92.7 percent, respectively. Two young patients demonstrated overgrowth of the proximal bone segment, which attained 110 percent and 118 percent of expected growth. Although it is difficult to determine all the parameters affecting the prognosis of post-traumatic reactions in growing cartilaginous plates, the level of amputation is considered to be a significant prognostic factor for the epiphyseal growth of the replanted part.

[Post-traumatic enophthalmos. Pathogenic, diagnostic and therapeutic approaches]. / Enophtalmie post-traumatique. Approches pathogénique, diagnostique et thérapeutique.

Post-traumatic enophthalmos has a complex pathogenesis, resulting from injuries to the bony walls of the orbit or to the intraorbital contents. Computed tomography allows specifying this pathogenesis by locating displaced bone, fat leakage or muscle incarceration, as well as calculating the volumes of the orbit and of the soft tissues. This assessment guides surgery (most often bone grafts), but correction remains limited by scar retraction, especially around the orbit. The prognosis of enophthalmos mainly depends on a general initial treatment after the trauma.

[Enophthalmos of the enucleated eye]. / Enophtalmie de l'énucléé.

Even when it is corrected by an ocular prosthesis, enucleation often causes enophthalmos. After studying the integrality of the walls of the orbits with CT, the presence and position of the intraorbital implant must be controlled and the enophthalmos treated by compensating for the residual volume loss of the orbital content (bone or biomaterials) and, sometimes, filling up the upper palpebral space (dermal graft, galea flaps or biomaterials). The retraction of palpebral scars limits the possibilities of correction.