Lymph node flap transfer for patients with secondary lower limb lymphedema.

BACKGROUND: Previous authors have shown benefits from the use of lymph node flap transfer (LNFT) to treat lymphedema of the arms, but there is little evidence for its use for lower limb lymphedema. We performed a retrospective analysis of a series of patients suffering from secondary lower limb lymphedema treated with a free LNFT. METHODS: 52 cases of LNFT to treat 41 legs in 38 patients with secondary lymphedema were retrospectively reviewed. The causes of the lymphedema included lymphedema secondary to hysterectomy for uterine cancer, melanoma resections on the leg, lymphoma treatment and testicular cancer, cosmetic surgery to the limb, lipoma resection at the inguinal region, and a saphenectomy. Patients had been suffering with lymphedema for an average of 9.1 ± 7.3 years at the time of LNFT. RESULTS: Eleven patients (28.9%) presented with minor complications treated conservatively. For 23 legs there was enough data to follow limb volume evolution after a single LNFT. Total volume reduction in eight legs (two patients with no measures of the healthy limb and three bilateral) was 7.1 ± 8.6%. Another group of 15 patients with unilateral lymphedema had an average 46.3 ± 34.7% reduction of excess volume. Better results (>30% REV) were associated with smaller preoperative excess volume (P = 0.045). CONCLUSION: Patients with secondary leg lymphedema can benefit from LNFT. Results in patients with mild presentations seem to be better than in more severe cases. © 2014 Wiley Periodicals, Inc. Microsurgery 37:29-33, 2017.

[Oncologic outcome of 11.6 lipofilling procedures for reconstructive breast surgery]. / Injection de graisse autologue purifiée en chirurgie reconstructrice mammaire. Suivi carcinologique à 3 ans à propos de 116 cas.

AIMS OF THE STUDY: Autologous fat graft injection has been systematically used by our team since 2001 in order to enhance the esthetic outcome of breast reconstruction. However, this technique remains controversial, notably in France. This study evaluated oncologic outcomes at 3 years among 110 patients operated on and monitored by two surgeons. PATIENTS AND METHODS: 116fat graft injections in 110 patients who required reconstructive breast surgery between January 2001 and December 2011 were included in the analysis of oncologic outcomes. The AJCC (American Joint Committee on Staging) stages were: stage 0 (18 %), stage I (44 %), stage II (26.7 %), and stage III (11.3 %). Mean follow-up was 6.3 years (9 months to 17 years) after initial breast cancer surgery, and 3 years (6 months to 9.5 years) after the last lipofilling procedure. RESULTS: The majority of patients (91.8 %) are alive and recurrence-free. Remote metastases occurred in 8.2 % of patients: one patient had a local and systemic recurrence, one patient had a local, regional and systemic recurrence. CONCLUSION: Although confirmation is needed from multicenter randomized trials with longer follow-up, a larger group of patients and a control group matched for the cancer status of the lipofilling group, our results support the view that lipofilling has little or no effect on the risk of locoregional recurrence of breast cancer.

"What's This Bug?" Questions from the Public Provide Relevant Information on Species Distribution and Human-Insect Interactions.

In general, insects and arthropods polarizing: they either fascinate people, disgust people, or both, and they generate lots of questions. Museums are perceived as reliable sources of information and, as such, a go-to destination for the public to receive answers. Since its opening in 1990, the Montreal Insectarium has offered an entomological information service, allowing the public to send questions, photographs, and specimens for identification. All requests are answered by entomologists. Spatiotemporal variations in taxonomic, geographic, and thematic profiles of the 4163 requests received in 2010-2011 and 2017-2018 were analyzed. Requests came from 35 countries, and most of those requests came from Canada. The majority of requests were identification requests. Representing 25% of identification requests, the five most frequent species were the eastern dobsonfly Corydalus cornutus, the masked hunter Reduvius personatus, the giant water bug Lethocerus americanus, the western conifer-seed bug Leptoglossus occidentalis, and the Japanese beetle Popillia japonica. A comparison with the data from the citizen science platform iNaturalist shows that the EIS can be a valuable tool for invasive species detection. Frequent subjects included school projects, entomophagy (eating insects), and wasp and bee nests. Finally, we discuss the role of entomologists in providing scientific information but also in addressing common concerns regarding cohabitation with arthropods.

[Locally advanced soft-tissue sarcomas. An innovating triad to avoid amputation: isolated limb perfusion, TNFalpha, and free microsurgical flap]. / Sauvetage des membres atteints de sarcome localement evolué. La triade innovante: perfusion de membre isole sous CEC, TNFalpha, et transplant microchirurgical.

We retrospectively studied the benefits of isolated limb perfusion combined with TNFalpha administration and free flap reconstruction in locally advanced soft-tissue sarcomas of the limbs. Between 2000 and 2008, we treated 37 patients (22 women and 15 men) with locally advanced soft tissue sarcomas. The sarcomas were located in the lower and upper limbs in respectively 26 and 11 cases, and had a mean diameter of 15 cm and 12 cm, respectively. They were multifocal in 8 cases and recurrent in 15 cases. Seventeen patients received neoadjuvant chemotherapy. Sarcoma excision was combined with a complementary procedure in 10 patients (vascular graft or nerve anastomosis). Reconstruction was performed with free flaps of the latissimus dorsi (n = 31), transverse rectus abdominis myocutaneous flaps (n = 4) or free forearm flaps (n = 2). Early postoperative radiotherapy was administered in 25 cases. Three major improvements were made in recent years, namely isolated limb perfusion, TNFalpha administration, and free flap reconstruction two months after resection of residual sarcoma. There were no early postoperative deaths. The procedure lasted a median of 7 hours. Two free flaps necrotized, and a new free flap was created with success. Tumor excision was stage R0 in 29 cases (clean margins), R1 in 7 cases (microscopic residue), and R2 in one case (macroscopic residue). With a median follow-up of 5 years, there were no local recurrences in R0 patients, and the overall survival rate was 65%. The limb was preserved in 78% of cases. Thirteen patients developed pulmonary metastases and seven of them died between the first and fifth years of follow-up. Isolated limb perfusion and free flap reconstruction permitted more extensive tumor excision. Amputation was avoided in 78% of our 37 patients, and early postoperative radiotherapy was possible in 25 cases.

[Rene Leriche, pioneer of modern surgery]. / René Leriche Pionnier de la chirurgie moderne.

René Leriche (1879-1955) is not unknowned, but he has an important place in surgery. He is one of the glory of the contemporary surgery. He has dominated the French surgery during more than thirty years. The life of Leriche is specified: Lyon, medical career, marriage, military service, first world war, Strasbourg, Collage de France, second world war, Académie des Sciences; he was president of the Académie de Chirurgie, chief of the surgical department of the American Hospital; retirement, and death. His scientific work is eminent: surgery of pain, of the sympathic system, vascular surgery, experimental surgery, medical teaching in France, and the Ordre des Mêdecins. Leriche was a fervent patriot and served France to the best of his ability in peace, in war and during occupation by the enemy.

[The Boucicaut hospital: a century of history]. / L'hôpital Boucicaut: une histoire centenaire.

Hospital Boucicaut opened on November 22, 1897. This hospital is dominated by Mrs Boucicaut. The main activity at the beginning was tuberculosis. Many doctors became famous: Maurice Letulle for histopathology, Jean Lenegre for cardiology; Leroux Robert for laryngeal operations; Raymond Vilain for SOS Mains; Jacques Lissac for reanimation. The hospital was old and had to be transferred into the new European Hospital Georges Pompidou in 2000.

The impact of treatment on criminalized substance addicts.

The objective of this research is to evaluate the impact of a treatment program specialized with criminalized addicts. In all, 119 criminalized addicts were admitted to the experimental procedure (specialized treatment) while 30 were admitted to a comparison group (general treatment). Both groups were contacted at five, eight, and eleven month intervals following the onset of the treatment process. Results showed that both groups improved. Those admitted to the unspecialized treatment improved earlier (in the first five months) than clients referred to the specialized treatment facility, however, after eight months, the improvement was similar for both groups.

[25 years review of vascular microsurgery evaluation--perspectives]. / Les transplants libres: 25 ans de microchirurgie vasculaire--bilan--perspectives.

Free-tissue transfer has become an accepted method for reconstructing complex surgical defects. We review 25 years' experience of this approach. In France, microsurgery was first performed in 1974. I myself constructed 839 consecutive free flaps in 821 patients during a 25-year period. Here we distinguish between two different indications, namely malignant and benign lesions. In oncology, the patient recovers good quality of life even if the prognosis is poor. In contrast, the transplant offers permanent cure for patients with benign lesions. Microvascular anastomoses were constructed with separated stitches (90% of anastomoses); end-to-end anastomoses were preferred (85%). Manual suture with thread is the best technique. Post-operative flap monitoring included clinical observation, Doppler sonography, thermic probing, and endoscopy. The overall success rate of free flap reconstruction was 95.5%. In cancer patients, surviving flaps resulted in wound healing and did not delay post-operative irradiation or chemotherapy. The incidence of major complications (death 0.36%, necrosis 4.5%) and minor post operative complications (27.1%) was acceptable. The mean hospital stay was 20 days. Careful selection of the transplants yielded good reliability. Six donor sites were sufficient to reconstruct the majority of defects. Teaching of microsurgery is one of our main preoccupations. This is an indispensable technique in all fields of reconstruction. Rigorous training is necessary and much time must be spent before reaching a high level of reliability.

[Cervical cystic lymph-node metastases from epidermoid carcinoma]. / Les métastases ganglionnaires cervicales kystiques de carcinome épidermoïde.

Fifty-three cases of cystic nodal neck metastasis from squamous cell carcinoma were treated at the Institut Gustave Roussy over a 30 year period. In all cases the lesion presented as a cystic neck tumor with malignant cells found in the cyst wall on pathologic examination. A detailed physical examination of the upper aerodigestive tract mucosa revealed a small tumor located in Waldeyer's ring and often in the tonsil. Treatment consists of surgical resection of the tumor followed by external beam radiation therapy centered on the cervical lymph nodes and Waldeyer's ring. Prognosis is good, with 5-year actuarial overall survival rate of 77%.

Surgical treatment of congenital lymphedema.

Lymphedema is a pathologic condition that results from a disturbance of the lymphatic system, with localized fluid retention and tissue swelling. Primary lymphedema is a congenital disorder, caused by a malformation of lymph vessels or nodes. Major progress has been achieved in the radiologic diagnosis of patients affected by lymphedema. The ideal treatment of the affected limb should restore function and cosmetic appearance. Surgical treatment is an alternative method of controlling chronic lymphedema. Free lymph nodes autologous transplantation is a new approach for lymphatic reconstruction in hypoplastic forms of primary lymphedema. The transferred nodes pump extracellular liquid out of the affected limb and contain germinative cells that improve immune function.

Free vascularized fibula and reconstruction of long bones in the child--our evolution.

The aim is to show our evolution for reconstruction of long bones in the child with free vascularized fibula after tumoral resection. Between 1990 and 2004, 78 children were operated on for sarcoma of long bones and one girl with congenital pseudarthrosis. The main applications are illustrated: U-shaped fibular transplant, fibular epiphysis with growth plate and diaphysis transfer, fibular graft associated to massive allograft. Follow-up of the children was performed by clinical examination and standard X-ray. No post operative death occurred. Many benign complications for femoral reconstruction were observed. So our recent evolution is to use vascularized fibula associated with massive allograft; but resorption of allograft was observed 3 years later. Vascularized fibula for reconstruction of long bones is the ideal material. The result is definitive. The future for femur is perhaps vascularized fibula associated with osseous substitute.

Functional results with advanced hypopharyngeal carcinoma treated with circular near-total pharyngolaryngectomy and jejunal free-flap repair.

BACKGROUND: Patients treated by a circular pharyngolaryngectomy for advanced hypopharyngeal carcinoma have a poor prognosis and disappointing speech restoration. METHODS: Three carefully selected patients underwent a near-total laryngectomy circular pharyngectomy with jejunal free flap repair and dynamic tracheopharyngeal shunt for treatment of advanced hypopharyngeal carcinoma. They received induction chemotherapy and postoperative radiotherapy. We assessed the functional outcome. RESULTS: There was no major local complication. One year after the end of radiotherapy, all patients were able to eat solid diets. Two patients were able to speak immediately after the end of the treatment. After speech re-education, a high-quality tracheopharyngeal voice was restored in all three patients. Performance Status Scale for Head and Neck Cancer Patients (PSSHN) showed a mean score equal to 81/100 at 1 year. CONCLUSIONS: In selected patients, near-total laryngectomy circular pharyngectomy with tracheopharyngeal shunt and jejunal free-flap repair offers good voice rehabilitation without impairing swallowing function.