[Necrotizing fasciitis of the upper limb: a case]. / Fasciite nécrosante du membre supérieur: un cas.

Necrotizing fasciitis is a rare form of anaerobic infection, quite different from gas forming gangrene: it affects the skin, the cellular tissue, the fascia; it doesn't diffuse in depth to the muscles and doesn't produce gas. Its microbic agents vary from haemolytic streptococcus to anaerobic bacteria in synergy. It rapidly spreads into a massive necrosis and can in a week's time lead to death by toxic shock. It spreads locally to large cutaneous areas eventually leading to the necessity of amputations. A joint treatment must be started with extreme urgency: extensive surgical excisions of all necrotic teguments, and medical treatment consisting of correcting metabolic troubles and antibiotherapy. This difficult treatment can save the patient, but it involves great loss of cutaneous and subcutaneous substance leading to local problems which are similar to serious burns, then to problems of reconstruction. An open fracture of the elbow led to an observation. A review of the literature sets out the different forms and complications.

[Müllerian cyst. Apropos of a case of the prostatic region]. / Kyste müllérien. A propos d'un cas de la région prostatique.

One case of the unusual entity, prostatic müllerian duct cyst, is reported. Depending on their volume, they may, like in our case-report, or may not be symptomatic. Ultrasonography, C.T. scan and vasoseminal vesiculogram precised its midline location and its relationships with other adjacent anatomic structures. The endo-uretral approach to drainage was used successfully.

[Extensive coxo-femoral resection with preservation of the thumb for prosthesis. An alternative to disarticulation at the hip]. / Technique de résection coxo-fémorale élargie avec conservation d'un moignon appareillable. Une alternative à la désarticulation de la hanche.

To avoid the severe mutilation of a hip disarticulation and to improve limb-fitting, a method of partial limb preservation is proposed. Two cases of septic arthritis of the hip with neurological and atrophic lesions sufficient to justify disarticulation are described. Disarticulation was avoided by partial conservation of the thigh with an extensive resection of the upper end of the femur, a through-knee amputation and a large posterior musculo-cutaneous flap including the triceps surae whose muscle provided a good cover for an end-bearing myoplasty. The stump obtained was of good quality which, though a little unstable, was firm and well provided with muscle which allowed early mobilization with a temporary prosthesis and later limb-fitting with much more satisfactory function than that in a hip disarticulation.

[Dangers of ischiectomy in ulcers in the paraplegic patient. Review of 236 records]. / Les dangers de l'ischiectomie pour escarre chez le paraplégique. Revue de 236 dossiers.

Two hundred and thirty-six paraplegics were operated on for unilateral or bilateral ischial ulceration between 1956 and 1981. A study was made of the long-term results, of the development of recurrences or bilateral involvement in unilateral lesions, of secondary complications and of their treatment and consequences. A distinction was made between procedures involving removal of the ischium and those with preservation of bone. The results, with a follow-up of one to 28 years were less satisfactory after extensive bony resection. Recurrence reached 50 per cent and a contralateral ulcer developed in up to 50 per cent. In contrast, when the ischium was preserved, these figures were respectively 20 per cent and 10 per cent. Complications such as the appearance of other pressure sores, or of perineal or urethral lesions occurred in 50 per cent of cases in which both ischia were resected but did not reach 15 per cent if the ischia were preserved. The analysis of these complications, their etiology and their outcome, with eleven deaths and two disarticulated hips implies the need to treat these ulcerations without removing the ischium. Infection and osteomyelitis can be healed without sacrifice of bone with at most one or two procedures preceding a plastic procedure. Myocutaneous flaps can be used to fill the lesions and to cover the bone with the help of proximal mobilisation of the hamstring muscles.

[Amputation below the fracture site in pseudarthrosis complicated by infection or vascular lesion]. / L'amputation au-dessous du foyer dans les pseudarthroses compliquées d'infection ou de lésion vasculaire.

In cases of fractures of the shaft of a bone complicated by non-union, infection and vascular and/or neurological lesions, amputation may be the ultimate possible treatment. In some cases, an amputation at the level of the fracture site would produce too short a stump for a normal prosthesis. The authors consider that, in this type of lesion, it may be wise to preserve some of the distal portion of the bone below the site of the fracture, even in cases of infected non-union. They performed this technique in seven cases, the distal fragment of the bone being covered by an osteomyoplasty, infection being treated by antibiotics. Early rehabilitation was started with immediate weight-bearing in the prosthesis. In all cases, union was obtained secondarily and in five cases infection healed as well. Two still had an intermittent sinus. The authors consider that the infected non-unions healed because of suppression of the weight of the limb. The technique allowed better rehabilitation because of the presence of a sufficiently long stump.

[Extensive resection of the hip for suppurative arthritis in the paraplegic. Evaluation of 170 cases]. / La résection large de hanche pour arthrite ouverte chez le paraplégique. Bilan de 170 cas.

Trochanteric or ischial sores in paraplegia may lead to suppurative arthritis of the hip, followed by anaerobic infection, septicaemia, gangrene and amyloidosis. In 121 patients this complication was bilateral in 49. Extensive resection of the hip and the upper quarter of the femur avoided surgical disarticulation of the limb. This type of correction makes it possible to treat hip infection and to perform muscle and skin plastic procedures. The operation was performed 170 times in the course of twenty years. Post-operative care must be very precise to allow organisation of the new arthrosis and to prevent ossification. Seven patients died. Five disarticulations had to be performed secondarily despite the resection. The results were satisfactory in the remaining patients from the point of view of suppuration and the procedure provided satisfactory adaptation to a wheelchair. Only five cases developed a disabling hip ankylosis.