[The distally based sural flap at the ankle and foot: complications analysis in a 27 cases study]. / Le lambeau sural à pédicule distal à la cheville et au pied : analyse des complications à propos d'une série de 27 lambeaux.

The distally based sural flap is widely used in foot and ankle skin and soft tissue repairs. It is described as an easy and reliable procedure. But in our experience, the flap necrosis was observed rather frequently. The analysis of this complication was the main goal of this retrospective study. The distally based sural flap has been used 27 times for skin repair at the foot and ankle. Twenty-six cases were post-traumatic. The success rate was 70%. Eight (mostly partial) necrosis occurred, one total necrosis lead to mid-leg amputation. In post-trauma reconstructions, this flap was not found so reliable. The rate of flap necrosis increases with age and comorbidities. No relationship could be established between the necrosis of the flap and its width. Heel and lateral localizations were found more risky. Technical modifications are discussed with a special focus on the two staged procedure.

[Coverage of chronic osteomyelitis of the ankle and the foot using a soleus muscle island flap, vascularized with retrograde flow on the posterior tibial artery. A seven cases report]. / Couverture des ostéites de cheville et du pied par un lambeau de muscle soléaire pédiculé en îlot rétrograde sur l'artère tibiale postérieure. A propos de sept cas.

AIM OF THE STUDY: The treatment of chronic osteomyelitis with large skin defects at the foot or the ankle is uneasy. In such cases, free muscular flaps are currently advised but they are less reliable in patients with medical diseases. In such difficult cases we have used the distally based soleus island flap, vascularized with retrograde flow on the posterior tibial artery. The technique and the indications of this flap are discussed. PATIENTS AND METHOD: This flap has been used for seven patients with bone infection and skin defects measuring an average of 10 x 7 cm. The preoperative arteriography had to find the whole three arteries at the leg, with a good distal anastomotic arcade. The soleus muscle was raised with the posterior tibial artery, after it was ligated proximally and dissected up to the tarsal tunnel. RESULTS: All of the seven flaps totally survived, except one that a marginal necrosis treated by excision and iterative dissection of the pedicle for a more distal repositioning. No clinical vascular deficiency was found on the legs. At the last review, all the osteomyelitis were cured. DISCUSSION: The soleus island flap, distally vascularized on the posterior tibial artery, is a reliable flap, useful for the coverage of the distal leg, from the ankle to the very distal foot. Harvesting a major artery at the leg should be weighed against the failure of a free flap in high risk patients.

[Traumatic dislocation of the pisiform bone: a case report and review of the literature]. / Luxation traumatique du pisiforme: à propos d'un cas et revue de la littérature.

Traumatic dislocation of the pisiform bone is uncommon. The authors report a case treated by primary excision with a good result. The literature is reviewed and treatment choices are discussed.

[Surgical treatment of chronic mallet finger by shortening--suture of the tendon scar. Sixty six cases]. / Traitement chirurgical du doigt en maillet invétéré par accourcissement--suture du cal tendineux. A propos de 66 cas.

Acute mallet fingers are commonly treated by splinting. Treatment of chronic injuries is more debated. Since 1989, a "shortening and suture" technique have been used for such chronic injuries on the elongated tendon scar. Sixty six of 77 patients treated on a 10 years period were reviewed with a mean follow-up of 21 months. The mean active extension lag at the distal interphalangeal (DIP) joint was 4.5 degrees (41 degrees of improvement) with 52% of fingers which recovered a full extension, representing 77% of good and excellent results according to Abouna's and Brown's modified criteria. There were two failures which lead to reoperation, and no complication (2 painful scars and 20% of cold intolerance). We propose this safe and simple technique for chronic mallet fingers if deformity exceeds 30 degrees, for patients untreated (after the second month), or when splinting has failed. "Swan-neck" deformities were improved by an associated Fowler procedure. In case of failure, a new "shortening and suture" or a DIP arthrodesis can be discussed.

External fixation of the thalamic portion of a fractured calcaneus: a new surgical technique.

The optimal treatment for intra-articular calcaneus fractures remains controversial, despite internal fixation techniques providing good results. The major point of contention is the need to reconstruct the overall morphology versus to restore the anatomy of the subtalar joint perfectly. We will describe a two-stage technique for treating intra-articular calcaneus fractures in which the primary fracture line goes through the thalamic fragment. The first procedure focuses on the overall morphology by restoring the height and length with osteotaxis being accomplished with a medial external fixator. The second procedure consists of internal fixation through a minimally invasive lateral approach to restore the anatomy of the articular facets. Any defects are filled with injectable bone substitute. This novel technique is compared to the complication rates and radiology and anatomy outcomes in published studies. This two-stage surgical technique reduces the length of hospital stays and the number of complications.

One-stage procedure for total knee arthroplasty in post-traumatic osteoarthritis of the knee with wound defect. Usefulness of navigation and flap surgery.

Total knee arthroplasty in post-traumatic arthritis of the knee joint is a challenging situation. Difficulties are linked to malalignment, joint stiffness, or wound complications. The authors report on a case of post-traumatic intra-articular knee arthritis with tibial malalignment and a skin defect. Using computer-assisted surgery for implant positioning, and simultaneous pedicled flap surgery for wound coverage, IKS score at 2 years follow-up was 85 and 75 for clinical and function respectively. The results of total knee replacement in post-traumatic knee arthritis are not as satisfactory as in degenerative situations. In severe malalignment due to bone landmark changes following malunions, computer-assisted surgery gives immediate correct references for final positioning of implants and restoration of limb alignment. Implant selection must allow use of normal and revision components to fit the local anatomy. Commonly-used pedicle flaps such as the gastrocnemius flap are valuable to cover wound defects after prosthesis implantation. All these procedures can be used successfully in a one-stage surgical procedure.

Prepubic and thigh abscess after successive placement of two suburethral slings.

We present a case of prepubic and thigh abscess after the placement of two types of suburethral slings in a 65-year-old woman suffering from stress urinary incontinence (SUI). The first surgical procedure (prepubic tension-free vaginal tape) was unsuccessful. Thus, 2 months later, we placed an ObTape sling by transobturator approach. This second procedure was successful. Seven months later, the patient presented with vaginal erosion of the sling with no inflammatory signs. The suburethral portion of the sling was immediately removed and the vagina was sutured. Nine months later, a prepubic abscess occurred and required removal of the prepubic sling, drain placement, and antibiotic therapy. Unfortunately, 9 months later, a thigh abscess occurred. Magnetic resonance imaging (MRI) allowed precise diagnosis and anatomic localization of the thigh abscess. Surgery consisted of opening and draining the abscess and removing the transobturator sling. At 6 months follow-up, no persistent inflammatory sign was observed on MRI, and SUI did not recur.

In vitro and in vivo cytotoxicity of gossypol against central nervous system tumor cell lines.

Gossypol is a lipid soluble polyphenolic compound isolated from cotton seed oil which has been previously shown to have antiproliferative activity in vitro against a variety of human solid tumor cell lines. It has been extensively tested in clinical trials as a male contraceptive agent and found to be well tolerated. Its mechanism of action is thought to be inhibition of cellular energy metabolism. It inhibits glycolysis through inhibition of LDH isoenzyme type 5, and it inhibits mitochondrial oxidative phosphorylation and electron transport. We tested the in vitro antiproliferative effect of gossypol against four well characterized human glioma cell lines, HS 683, U373, U87 and U138, and one rat glioma cell line, C6, using the colorimetric Microculture Tetrazolium Assay (MTT). Cytotoxicity was found to be concentration and time dependent and increased with incubation times up to 8 days. The relative sensitivity of the glioma cell lines to gossypol at 48 hour incubation correlated with their respective LDH isoenzyme profiles, with the more sensitive cell lines expressing increased cathodal LDH isoenzymes (LDH5). The in vitro cytotoxicity of gossypol to these CNS tumor lines was compared to the other non central nervous system solid tumor cell lines which had been previously reported as being sensitive to gossypol, including SW-13 (adrenal), MCF-7 (breast), T47-D (breast), and HeLa (cervical). Additional lines tested included SK-MEL-3 (melanoma), Colo 201 (colon) and BRW, a line established in our laboratory from a patient with a Primitive Neuroectodermal tumor. C6, HS 683, and BRW had similar IC50s as the sensitive solid tumor cell lines. U373, U87 and U138 had significantly less sensitivity at 48 hours. There was greater cytotoxicity and no significant differences in the IC50s between any of cell lines at 8 day incubations. Additionally, we tested the cytotoxicity of gossypol against BRW in vivo, using the nude mouse xenograft model. Gossypol, given at a dose of 30 mg/kg per day five days a week for four weeks orally via gavage, was found to decrease the mean tumor weight of treated xenografts by more than 50% as compared to untreated xenografts. These findings suggest that gossypol has potential for further study as an agent for the treatment of primary CNS malignancies.