Intra- and inter-individual variability in the mechanical properties of the human skin from in vivo measurements on 20 volunteers.

BACKGROUND/PURPOSE: The mechanical properties and behavior of the human skin in vivo are of medical importance, particularly to surgeons who have to consider the skin extension capabilities in the preparation of surgical acts. Variable data can be found in literature that result from diverse kinds of tests (in vivo, ex vivo, and postmortem) performed with different instruments. METHODS: This paper presents the results of in vivo measurements performed on a cohort of 20 healthy volunteers with an ultralight homemade uniaxial extensometer. Different anatomical zones were explored under different directions of solicitation in order to document inter- and intra-individual variability as well as skin anisotropy. RESULTS: The experimental data obtained are fitted with a phenomenological exponential model allowing the identification of three parameters characteristic of the tested skin behavior. These parameters can be related to the concept of skin extensibility used by surgeons. CONCLUSION: The inter- and intra-variability observed on that cohort confirms the need for a patient-specific approach based on the in vivo measurement of the mechanical behavior of the human skin of interest. Even the direction of higher skin stiffness is found to be individual-dependent. The capability of the extensometer used in this study to fulfill such measurement needs is also demonstrated.

[Nerve transfer between the intercostal nerves and the motor component of the musculocutaneous nerve. Anatomical study of feasibility]. / Transfert nerveux entre les nerfs intercostaux et la composante motrice du nerf musculocutané. Étude anatomique de faisabilité.

INTRODUCTION: The intercostal nerves (ICN) transfer to the musculocutaneous nerve (MCN) can restore elbow flexion in complete brachial plexus palsy. The last cases our service dealt with, allowed our staff to observe two different situations. In the 2 first patients, we were able to proceed with an intraneurodissection of the MCN motor component up to the axillary cavity level, while on the third case such dissection could not be performed as high. The aim of this work is to assess the feasibility of a transfer on the MCN's motor component. MATERIAL AND METHODOLOGY: We conducted a series of 5 cadaver dissections of the MCN and ICN on the anatomy laboratory. Using magnifying loupes to perform an intraneurodissection, we were able to split the motor and sensory fibers as they stood out. It would help motor recuperation avoiding directional error on sensitive component. RESULTS: The ICN can be sutured on the motor component of the MCN, provided the dissection is very minutious. DISCUSSION: The intraneurodissection of the MCN up to the axillary cavity level is possible as the interfascicular exchanges are scarce there. Publications already refer to the possibility of a nerve transfer between the ICN and the motor component of the MCN. Therefore, our researches suggest that such a procedure can be considered for routine procedures. CONCLUSION: The neurotization is one of the latest breakthroughs in terms of brachial plexus surgery. We are hopeful that anatomical researches could lead to optimization possibilities.

[Evaluation of the management of soft tissue sarcomas in Franche-Comté since the establishment of a multidisciplinary meeting at University Hospital. About 47 cases]. / Évaluation de la prise en charge des sarcomes des tissus mous en Franche-Comté depuis l'instauration d'une réunion de concertation pluridisciplinaire au CHRU. À propos de 47 cas.

GOALS OF STUDY: A multidisciplinary meeting (RCP) dedicated to the treatment of sarcoma was established in Franche-Comte in 2010. The goals of the study are: (a) To evaluate the treatment of sarcomas by confrontation with the existing literature; (b) To evaluate the influence of the multidisciplinary meeting on the management of sarcomas by hospitals at the regional level. MATERIALS AND METHODS: This is a retrospective single center study from 2010 to 2015 on patients with sarcoma and peripheral soft tissue drawn from a Netsarc database (National Network of sarcomas) and communicating cancer record. A database Cleanweb especially dedicated is created. RESULTS: Forty-seven patients were included: ten sarcomas at the upper member 26 to the lower limbs, 11 on the trunk. Forty patients were operated on: ten out of the university hospital, 28 at the university hospital and two in a coordinating center. Ninety percent of patients treated at the university hospital were in accordance with the recommandations. None of the patients operated out of the university hospital benefited from medical care in accordance to the recommendations. There is an increase in the number of files sent by the hospitals out of the university hospital discussed in multidisciplinary meeting, before treatment. CONCLUSION: The creation of a dedicated multidisciplinary meeting sarcoma improves the medical management of these tumors and decreases inappropriate medical managements thanks to a better education of the regional physicians.

[Use of indocyanine green angiography in reconstructive surgery: Brief review]. / Angiographie au vert d'indocyanine en chirurgie reconstructrice : revue de la littérature.

BACKGROUND: The success of flap surgery is highly dependant of vascularisation, according to the principle of dermal and subdermal perfusion. This principle requires compatible dimensions for the survival of the flap. Indocyanine green angiography (ICG), a technique enabling an assessment of vascularization by fluorescence, has received a considerable impetus during the last two decades. The purpose of this article was to conduct a review on this technique and to evaluate its relevance in flap surgery. METHOD: We reviewed all articles referenced on PubMed from 1995 till 2015 using a search combining the terms 'indocyanine green', 'flap', 'near-infrared', 'fluorescence', 'imaging' OR 'angiography'. RESULTS: One hundred fifty five articles were found and among those thirty-four were selected. ICG is a reliable technique to locate perforants vessels, to determine the outlines of the flat and evaluate its per- and postoperative viability and to appraise anastomoses. CONCLUSION: This technique allows a reliable and real-time assessment of potential necrotic areas and an improvement in the detection of complications compared to conventional techniques.

[An original "double-arched" radial forearm flap for soft palate reconstruction. Case report]. / Conformation du lambeau antébrachial en arche sur mesure pour la reconstruction du voile du palais. Cas clinique.

INTRODUCTION: Reconstruction of the soft palate after oncologic resection remains a surgical challenge. Speech and swallowing problems are the consequences of velopharyngeal incompetence following soft palate resection. Free tissue transfer like radial forearm flaps can be used in larger defects for complex reconstruction. The conformation of the flap in order to be closer to the shape of the soft palate improves the functional outcome. In the same way, we describe an original "double-arched" flap design. METHODS: A double arch of the exact length of the soft palate tumor resection is designed. After suturing, the flap spontaneously formed a double arch of the exact dimensions of the resected piece. RESULTS: The patient achieved good functional recovery without any surgical complications. CONCLUSION: The original "double-arched" forearm flap design allows a tailored reconstruction with exactly the same shape and dimensions, preserving the functional requirements of speech and deglutition.

[Surgical management of a series of pressure ulcers: Report of 61 cases]. / Prise en charge chirurgicale d'une série d'escarres : à propos de 61 cas.

INTRODUCTION: Retrospective study about pressure ulcers surgical treatments in a series of 61 in 43 patients. OBJECTIVE: To assess the management of pressure ulcers in spinal cord injury patients who had been operated in our institution. RESULTS: On the 61 pressure ulcers, location was ischial in 35 cases, sacral in 15 cases, trochanteric in 7 cases, lateral malleolar in 2 cases, on the heel in 1 case, and 1 was located lateral to the fibular head. Comorbidities were searched pre- and postoperatively. Fifty-five muscular, cutaneous flaps or myocutaneous, 5 fasciocutaneous and 1 excision/suture were realized. The mean follow-up was 8.6 years, and we observed 9 pressure ulcers recurrences (14.8%). We had a total result of 15 (24.6%) complicated pressure ulcers, with 8 early complications (13.1%) and 7 delay (11.5%). Antibiotic therapy was prescribed in 54 (88.5%) surgery cases and 7 were operated without any (11.5%). CONCLUSION: Pressure ulcers are major public health focus that need to be improved. A multidisciplinary care, mixed with education of patients are mandatory to achieve these goals: reduce complications and recurrences. Thanks to muscle sparring, perforators flap should become the gold standard of pressure ulcers surgery.

[Large surgical resection of a shoulder sarcoma's and secure one stage reconstruction with lattissimi dorsi and serratus anterior flap. Updating about a case]. / Exérèse large d'un sarcome de l'épaule et reconstruction en un temps par double lambeau de grand dorsal et de grand dentelé pédiculé. Discussion à propos d'un cas.

INTRODUCTION: The soft tissue sarcomas (STM) are tumors developed at the expense of connective tissue. They are rare and have severe prognosis. The principles of management are recalled through an extended case of shoulder sarcoma. CLINICAL CASE: A 48-year-old patient has a sarcoma of the right pectoralis major muscle confirmed by biopsy. After multidisciplinary meeting, a wide surgical excision exposing the subclavian vessels and brachial plexus is performed with double cover flap pedicled latissimus dorsi and serratus and thin skin graft. RESULT: Healing process is acquired at 3 months. Adjuvant chemotherapy is established (adriamycin, ifosfamide) along with radiotherapy (54Gy). CONCLUSION: Sarcomas treatment has to be realized after considering multidisciplinary meeting (RCP) in dedicated structures. Surgery is the main treatment, it should ideally be R0, that is to say, integral with healthy tissue margin around the tumor (or healthy anatomical barrier). Optimal surgery performs a resection "without seen tumor". The diagnosis has to be made with a biopsy before the surgical treatment. Healing is quickly obtained due to adjuvant treatments.

[Fat grafting in breast reconstruction. Retrospective study of satisfaction and quality of life about 68 patients]. / Lipofilling en reconstruction mammaire. Étude rétrospective de la satisfaction et de la qualité de vie à propos de 68 patientes.

BACKGROUND: Evaluate the aesthetic clinical results, satisfaction and quality of life related to health in patients who underwent breast reconstruction by exclusive lipofilling or in addition to other surgical techniques. MEANS AND METHODS: A retrospective observational study was carried between 2009 and 2014 in four groups of patients who underwent a lipofilling by the same operator either after a conservative treatment (group 1), or exclusively (group 2), or after a flap (group 3) or implants (group 4). The sociodemographic data related to lipofilling or tumor pathology were collected and reported in a software designed for this study. Satisfaction and quality of life after lipofilling was assessed using the questionnaire Q BREAST(©) postoperative reconstruction module. RESULTS: One hundred and seventy lipofilling procedures were performed in 68 patients. The average volume transferred was 1421.2cm(3) for the exclusive lipofilling group and the average number of sessions was 4.9 spread over a period of 15.6months on average. In adjuvant technique or conservative surgery, the average total volume transferred was 212.2cm(3) and the average number of sessions was 1.4. The abdomen was the site most used donor and the posterior thigh exclusively used in exclusive reconstruction. The cytosteatonecrosis rate was 8.8 % (n=6). A single case of infection was noted. The tumor recurrence at ten months after lipofilling concerned two patients. The response rate was 80.8 %. The lipofilling improves the final cosmetic result with a rate of 91.1 % of patients satisfied or very satisfied with their breast. In all, 95.4 % of patients in the exclusive lipofilling group found a secondary benefit after surgery. Quality of life after lipofilling is also improved socially and sexually in the four groups with better results in patients who underwent conservative treatment. CONCLUSION: The lipofilling is a simple, reliable technique, requiring a learning curve, improving the final aesthetic result and the quality of life it is used exclusively or to complement other techniques.

[Benefit of simultaneous contralateral breast symmetry procedure with unilateral breast reconstruction using DIEP flaps. About 33 cases]. / Intérêt de la symétrisation immédiate au cours de la reconstruction mammaire unilatérale différée par DIEP. À propos de 33 cas.

BACKGROUND: After unilateral breast reconstruction, a procedure on the contralateral breast is often needed to achieve symmetry. Here, we present a single surgeon's experience with performing contralateral symmetry procedures simultaneously with DIEP flap. METHODS: We evaluated 33 consecutive patients (mean age, 52.1 years) who underwent DIEP flap unilateral breast reconstruction and a simultaneous contralateral breast procedure performed and 2 patients with delayed controlateral symmetry procedures. A single-stage breast cancer reconstruction is successful if after the original reconstruction no correction for revision of breast mound, or contralateral breast procedures are performed, under general anesthetic, to complete the reconstruction. RESULTS: In 24 patients (73%), breast reconstruction was completed after a single stage with one general anesthetic, and in 8 patients (24%), revisions were performed with two general anesthetic (7 patients) and three general anesthetic in one case. Reconstructions requiring more than one general anesthetic were due to 4 of 39 (10%) postoperative complications. Mean operating time was 485 minutes. CONCLUSIONS: For patients who need contralateral reduction mammoplasty or mastopexy for symmetry, performing these procedures and breast reconstruction simultaneously facilitates single-stage breast reconstruction in most patients.

Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations.

OBJECTIVES: Smoking patients undergoing a plastic surgery intervention are exposed to increased risk of perioperative and postoperative complications. It seemed useful to us to establish an update about the negative impact of smoking, especially on wound healing, and also about the indisputable benefits of quitting. We wish to propose a minimum time lapse of withdrawal in the preoperative and postoperative period in order to reduce the risks and maximize the results of the intervention. METHODS: A literature review of documents from 1972 to 2014 was carried out by searching five different databases (Medline, PubMed Central, Cochrane library, Pascal and Web of Science). RESULTS: Cigarette smoke has a diffuse and multifactorial impact in the body. Hypoxia, tissue ischemia and immune disorders induced by tobacco consumption cause alterations of the healing process. Some of these effects are reversible by quitting. Data from the literature recommend a preoperative smoking cessation period lasting between 3 and 8 weeks and up until 4 weeks postoperatively. Use of nicotine replacement therapies doubles the abstinence rate in the short term. When a patient is heavily dependent, the surgeon should be helped by a tobacco specialist. CONCLUSIONS: Total smoking cessation of 4 weeks preoperatively and lasting until primary healing of the operative site (2 weeks) appears to optimize surgical conditions without heightening anesthetic risk. Tobacco withdrawal assistance, both human and drug-based, is highly recommended.

Smoking and plastic surgery, part II. Clinical implications: a systematic review with meta-analysis.

OBJECTIVES: Tobacco addiction is a risk factor for complication in plastic surgery. The authors have assembled concrete arguments detailing the risks of perioperative and postoperative complication that are incurred by a patient with continued tobacco intoxication who wishes to undergo a surgical intervention. RESEARCH STRATEGY: Through application of the PRISMA criteria, we have carried out a systematic review of the literature, in which we explored five databases while using predefined keywords. We selected randomized, controlled observational studies on the perioperative and postoperative complications related to tobacco use in actively smoking, abstinent and non-smoking patients. DATA COLLECTION AND ANALYSIS: The levels of evidence for each article were evaluated. Risk of bias was assessed using the Newcastle-Ottawa Scale. Incidence parameters including the Odds Ratio and relative risk were calculated for each complication of which the number of occurrences had been indicated. Meta-analysis of the results was carried out. RESULTS: We included 60 observational studies. In the cosmetic surgery group, we calculated a combined Odds Ratio of 2.3 [1.51-3.54] P<0.001 for surgical site infections and 2.5 [1.49-4.08] P<0.001 for delayed wound healing. In the bariatric surgery sequelae group, we found a combined Odds Ratio of 3.3 [1.90-5.64] P<0.001 with regard to delayed wound healing and 3.1 [1.39-7.13] P=0.006 for cutaneous necrosis. No proof was provided as to the possible influence of tobacco on the success rate of free flap microsurgery, but it is difficult to extrapolate results on the latter to digital reimplantation. CONCLUSIONS: The review underlines the fact that patients with smoking habits run a significantly heightened risk of cutaneous necrosis, particularly in the event of major detachment (cervico-facial lift, skin-sparing mastectomy, abdominoplasty), of additionally delayed wound healing and of addition surgical site infections. Rigorous preoperative evaluation of smokers could help to diminish these risks.

[Emergency free flap in reconstruction of the lower limb. Thirty-five years of experience]. / Reconstruction des pertes de substance de membres inférieurs par lambeau libre en urgence. À propos de 35ans d'expérience.

Authors analyzed 89 cases (86 patients) of lower limb extensive soft tissue defects reconstruction during 1978 to 2013. The mean age is 37 years and 2 months old (range: 5-84 years old). A total of 71 males and 15 female were included. Free flaps were used in emergency in 23 cases for principally covering Gustilo 3B open lower limb fracture and in a later stage for 66 cases all referred from their center for coverage of exposed bone, with frequently osteomyelitis. About the selection of free flaps, in 47 cases we used a latissimus dorsi flaps, 12 cases of epiploon free transfer (in septic area), 10 cases of gracilis transfer and 10 serratus anterior flaps. There are one medial gastrocnemius flap, 2 composite soleus and fibular free flap, 2 antebrachial flap, one inguinal myoosteocutaneous flap, 1 transferred from the other lower limb and one inguinal cutaneous flap. There are 18 free flap losses: one in emergency and 17 after delayed reconstruction. Authors retrospectively analyzed the results (complications, osteomyelitis) according to the timing for lower extremity reconstruction. They found a low infection and flap failure rates (4%) when the coverage is made in the same operating time than initial fracture fixation, they increase to 60% for osteomyelitis and to 23% for flap failure when the reconstruction is delayed.

[Abdominal perforator flap (DIEP) and autologous latissimus dorsi in breast reconstruction. A retrospective comparative study about the first 60 cases of a same surgeon]. / Le lambeau perforant abdominal (DIEP) et grand dorsal autologue en reconstruction mammaire. Étude rétrospective comparative à propos des 60 premières patientes d'un même opérateur.

INTRODUCTION: Autologous techniques for breast reconstruction get the best cosmetic results. Aesthetic satisfaction with breast reconstruction is an important evaluation criterion. The indication is based on technical criteria (morphological, medical history) and the wishes of the patient. A rigorous evaluation of the results is necessary to assist the patients in their choice of reconstruction. METHODS: Thirty-three DIEP and 27 latissimus dorsi were involved. A satisfaction questionnaire was sent to patients to collect the aesthetic evaluation of their reconstructed breast, sequelae at the donor site of the flap as well as their overall satisfaction. Post-operative photographs of the patients were subject to aesthetical evaluation by two groups of observers. Complications were analyzed. RESULTS: The DIEP tends to get higher aesthetic satisfaction regarding the symmetry of the breasts and the volume of the reconstructed breast (P=0.05), and a better overall satisfaction (P=0.02). The uniformity of the colour of the reconstructed breast was considered superior by observers in the latissimus dorsi group (P=0.005). Donor site scar of DIEP was considered more unsightly while the latissimus dorsi was considered more painful (P=0.04) and uncomfortable, with more frequently contour abnormalities (P=0.03). We noted two total flap necrosis and three partial necrosis in the group DIEP, and two partial flap necrosis in the group latissimus dorsi. CONCLUSION: This study provides evidence that can guide the patient and the surgeon in the complex process of therapeutic decision, without exempting the latter from a careful selection of indications.

Capillary measurement of lactate and glucose for free flap monitoring.

BACKGROUND: It is reported that the salvage rate of free flaps is inversely related to the time interval between the onset of pedicle impairments and their clinical recognition. Monitoring of free flaps is therefore of major importance and clinical monitoring remains the most used technique because of lack of low-cost and non-invasive techniques. The authors suggested an efficient, simple and cheap technique to detect early thrombotic events in monitoring free flaps with skin paddle. METHODS: In this multicentre prospective study, measurements of capillary glucose and lactate in the flaps were done. These parameters were compared to standardized clinical monitoring during the first five days. Two sets of data (eventful versus uneventful postoperative period) were analyzed to define the thresholds of lactate and glucose values for diagnosis of pedicle complications, and to establish parameters for this screening test. RESULTS: Over a period of 19 months, 37 patients were included. With 5 pedicle impairments, complication thresholds were defined as lactate ≥ 6.4 mmol L(-1) and glucose ≤ 3.85 mmol L(-1), in order to obtain a sensitivity of 98.5% and a specificity of 99.5% for the test. Modifications of capillary glucose and lactate measurements appeared in average 5.7 hours earlier than clinical symptoms in pedicle impairments. The mean cost of a five-day monitoring was about 90 USD. CONCLUSION: This simple and cheap technique could be used as a routine technique in monitoring free flaps to improve safety of this reconstructive technique.

[Characteristics of Dupuytren's disease in women. A study of 67 cases]. / Particularités de la maladie de Dupuytren chez la femme. À propos de 67 cas.

OBJECTIVES: The aim of this study was to identify the clinical differences of the Dupuytren's disease in gender. Testosterone induces an increase of the Dupuytren's fibroblast proliferation via androgen's receptors. Testosterone rate increases during pregnancy and menopausis. We also reached a link between this factors and the clinical aspects of Dupuytren' disease in the women of our study. METHODS: This retrospective, comparative study was about all women and a randomized number of men, who underwent surgery for Dupuytren' disease between 1980 and 2010. We analysed all the epidemiologic and clinical data, the surgery procedures and the complications. Pre- and postoperative measurements of the extension lack of all the joints were performed with a manual goniometer. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate the patients function. This specific data of women were reached. RESULTS: Sixty-seven women and 69 men were compared. The complex regional pain syndrome was significantly more common in women and the correction of the proximal interphalangeal joint was significantly lower in women. Recurrence rate and mean follow up were not statistically different. Mean DASH score was higher in women. We have not found any association between menopausis, pregnancy and the average age at presentation of the disease, the recurrence rate or the extension rate. CONCLUSIONS: The prognosis of the Dupuytren's disease is worse in women than in men. Other studies are necessary to reach the link between the testosterone and the clinical history of the disease in women.

[Complex breast reconstruction after severe chest trauma by firearm]. / Reconstruction complexe de la région mammaire après traumatisme thoracique grave par arme à feu.

This case report is of a 47-year-old woman who suffered a ballistic chest trauma with severe left hemothorax and heart wound. She was treated in emergency for the collapse by heart surgery. Then the coverage for her soft thorax tissue loss was done by an ipsilateral musculocutaneous latissimus dorsi pedicled flap. The patient was subsequently addressed to our team for a repair, especially for reconstruction of the left breast. Initially, rehabilitation of aesthetics units breast was achieved through the realization of an abdominal advancement flap, and breast volume was restored by several sessions of lipomodeling. The surgical alternatives were very limited for this post-traumatic complex breast reconstruction. Due to ballistic trauma, no reliable recipient vessels allowed a microsurgical solution, and the ipsilateral latissimus dorsi was used for the coverage. In conclusion, the restoration of the aesthetics units with lipomodeling has achieved a very good result in this extreme thoracomammary region repair.

[Giant abdomino-pubic melanoma. A case report]. / Mélanome géant abdomino-pubien. À propos d'une observation clinique.

Cutaneous melanoma patients are usually young adults. The evolution into a nodular form darkens the prognosis because it increases the risk of metastasis occurrence. The only curative treatment is wide surgical excision when extension check is negative. We report a case of abdomino-pubic melanoma original by its amazing size, its spreading, both superficial and nodular, without metastasis, and its late occurrence to a senior patient. Curative management was performed with a plastic surgery technique: the abdominal plasty. The melanoma was removed with free margins and the patient was free of disease at six month. This report illustrates the interest of plastic surgery techniques in oncology. It also confirms that plastic surgeon forms an integral part of a multidisciplinary team managing patients with cutaneous melanoma.

[Baropodometric analysis of the functional donor-site morbidity after gastrocnemius or soleus muscle-flap procedure]. / Analyse baropodométrique des séquelles fonctionnelles liées au prélèvement des lambeaux gastrocnémiens et soléaire.

The triceps surae muscle is a major donor-site for muscle-flap to cover soft-tissue defects of the leg. There are very limited datas on the functional donor-site morbidity in the literature. From a retrospective study on 14 patients, we realized a baropodometric analysis comparing the operated lower limb with the healthy non operated side and a functional evaluation by a questionary. The modified functional score of Kitatoka was good (87/100). Ninety percent of the patients were able to resume a professional activity and 2/3 to resume the sport. The baropodometric analysis did not show statistically significant difference of propulsion and absorption between the healthy side and the operated side, but a modification of the programming of the step. The absence of important functional donor-site morbidity is probably bound to a compensation of the remaining triceps surae muscles and/or to mechanisms of adaptation. Our study confirms the little functional donor-site morbidity of the partial triceps surae muscle-flap procedure. These flaps remain a good solution for the coverage of the soft-tissue defects of the leg.

[Retrospective study of complications and imperfections in superior pedicle breast reduction: 100 cases]. / Etude rétrospective des complications et imperfections : à propos de 100 cas de mammoplastie de réduction à pédicule supérieur.

A retrospective study was made to assess complications of superior pedicle breast reduction, in the Besançon hospital plastic surgery ward. One hundred patients operated between 2003 and 2007 were reexamined. In every case, the intervention was performed by the same operator (Pr Tropet) using the same technique. The average postoperation time range was 2 years (from 8 months to 5 years). The interview's minutes were formalized via a revisions sheet, including medical files, photos, and pre- and postoperative measures. Complications (hematoma, infection, necrosis, suture disunion, thromboembolic disease) were reported in 16 % of the cases. These lead to three emergency reoperations for drainage, and six delayed reoperations. Result imperfections were related to areola and nipple, and to scars. Two patients requested a scar revision. The results match reported data. Technical modifications are suggested to reduce complications or imperfections.

[Bilateral latissimus dorsi V-Y musculocutaneous rotation flap for closure of a large dorsal radionecrosis. Geometric analysis and interest. About one case]. / Couverture d'une perte de substance dorsale médiane par deux lambeaux musculocutanés de rotation de latissimus dorsi avec palette cutanée en V-Y. Bases géométriques et intérêt. A propos d'un cas.

Reconstruction of a large dorsal radionecrosis with bilateral latissimus dorsi V-Y musculocutaneous flaps is reported. This procedure provides a reliable, well-vascularized soft-tissue coverage. Geometric analysis and differences between V-Y advancement flap and V-Y rotation flap are discussed.