[Use of a submental flap for reconstruction of both lips in a complex case of mutilation]. / Utilisation du lambeau sous mental dans la reconstruction simultanée des lèvres supérieure et inférieure dans un cas de mutilation complexe.

Authors present a new technique allowing simultaneous reconstruction of both lips. In a severe mutilation, a submental flap pedicled on both submental axes was used. Three weeks after the operation, an horizontal incision was done into the flap combined with full thickness skin grafts to achieve the reconstruction of both labial esthetic units. The other available techniques are discussed, among them, microsurgery. This technique seemed very relevant in this reconstruction and a good example of Gillies' principle: "replace like with like".

[Interventional angioradiology as a solution for microsurgical flap failure]. / La radioangiologie interventionnelle comme solution de sauvetage en microchirurgie.

The microsurgical failure rate is almost constant for several decades. We present two case reports describing a novel method of free flap salvage using angioradiological techniques. Our first case shows the potential utility of in situ thrombolysis, our second case describes the first use of stents within a microsurgical anastomosis. In boths cases, the flap would have been lost immediately, because flap revisions failed. Thus, before abandoning on a flap, one could perform a simple angiography to evaluate further angioradiological salvage possibilities and hereby contribute to improve long term microsurgical failure rate.

[History of skin graft]. / Une histoire de peau.

Skin graft is the most common and simple procedure to cover superficial defect. Skin of variable thickness and size is completely detached from its origin (donor site) to cover a defect (recipient site). This simple procedure is the result of a long and eventful technical and theoretical evolvement. The aim of this article is to re-trace the history of skin grafting, from its discovery until today.

[Is muscle the best coverage for leg Gustilo IIIb fractures? A retrospective comparative study]. / Le muscle est-il la meilleure couverture pour les fractures ouvertes de jambe Gustillo IIIb ? Etude rétrospective comparative.

UNLABELLED: Well-vascularized muscle flaps have been the traditional gold standard for coverage of open fracture of the lower extremity. The last 15 years have brought the fasciocutaneous and perforator flaps and raised the issue of the type of coverage required for open fracture of the lower extremity. In recent years, in selected compromised patient, we have been using nonmuscular flaps for reconstruction. The goal of this study is to compare the results of fasciocutaneous reconstruction to those of classical muscular flaps. PATIENTS AND METHODS: A comparative retrospective study, including all patients from 2002 to 2006 requiring a coverage of a Gustillo III b fracture of the lower extremity, is done. The type of flaps, the fracture localization, the infection rate, the time required for consolidation of the fracture and the complication rate are reviewed. An independent university laboratory verified the statistical analysis. RESULTS: Twenty patients have experienced coverage by muscular flaps and 18 by fasciocutaneous flaps. We found a skin fistula and a chronic infection in the muscular-flap group, and two skin fistulae in the fasciocutaneous flaps group. The overall surgical results were comparable, except the bony union delay shorter in the fasciocutaneous flaps group. CONCLUSION: Muscle coverage is not mandatory to cover bone in the lower leg. The fasciocutaneous flaps can provide a good alternative for muscle-flap coverage. There is no significant difference as far as consolidation and infection are concerned, between the coverage by muscular or fasciocutaneous flaps.

[Launois-Bensaude's disease: report of 17 cases]. / Maladie de Launois-Bensaude : à propos de 17 cas.

INTRODUCTION: Launois-Bensaude's disease (LBD) is a rare condition affecting patients aged between 30 and 60, and being considered as more frequent in males. It is characterized by symmetric fat deposits mainly on the neck and upper trunk that can lead to major functional and aesthetic damage. The cause of LBD is unknown but alcoholism is often associated. PATIENTS AND METHODS: The objectives were to study the epidemiological, clinical, and biological particularities, the therapeutic modalities and the evolution of 17 patients (nine males, eight females) seen between 2003 and 2005 at a medical and surgical consultation, and to compare them to the literature data. Seven patients were seen again in our out-patient department and the nine others (one was lost for follow-up) agreed to answer our questionnaire on the phone. RESULTS AND COMMENTS: The high proportion of female in our study is due to the high prevalence of female alcoholism in Northern France. Indeed, all patients were alcoholic but eight were deprived at the time of the first consultation. Mean age for the beginning of the disease was 48. Mean delay between the first signs and our medical and surgical consultation was eight years. Tumoral masses mainly involved the neck, the trunk, and the deltoid areas. Surgical treatment was performed in nine deprived patients for at least 12 months with a satisfactory functional and aesthetic result and a mean decrease of 50% was noted for the dermatology life quality index (DLQI). We observed no immediate complications but two cases with hypertrophic scar and one case with persistent dysesthesia. Four out of them presented recurrence corresponding with resumption of alcohol abuse, confessed in two cases and suspected in the two others. In the absence of surgical management, the disease was stable in three cases but evolved in four cases. No spontaneous regression was observed.

[The osteomuscular latissimus dorsi scapula flap: anatomical study and 3 cases]. / Le lambeau ostéomusculaire de muscle latissimus dorsi avec bord latéral de scapula: étude anatomique et application clinique.

The goal of the reconstruction of complex defects of the leg is to restore morphology, trophicity and function. The purpose of our study was to analyse the reliability of the latissimus dorsi scapula flap in this indication. We realized an anatomical study on 12 cadaver dissections. The presence of the angular artery was found to be constant with four types of origins described in this article. The same technique was applied on three patients presenting a complex tissue loss of the middle third of the tibia. This clinical application confirmed the validity of the technique.

[Early preventive pressure therapy in extensive skin grafts on children's face, a comeback of classic methods? A retrospective study on 8 cases]. / Pressothérapie préventive précoce pour les greffes extensives au niveau facial chez l'enfant, retour aux méthodes classiques? Une étude rétrospective sur huit cas.

INTRODUCTION: One of the common techniques in the treatment of giant facial naevi is the excision covered by a skin graft. It's functional and esthetic results are not always excellent. Physiotherapy including immediate postsurgical preventive pressure therapy could ameliorate these results and shorten the period of scarring. PURPOSE: Evaluation of scarring results with early pressure therapy in skin grafts of congenital facial naevi. PATIENTS AND METHODS: Retrospective study on 8 children being 1 to 9 years old and presenting congenital facial naevi. All of them were treated by excision followed by full thickness skin grafting. The associated physiotherapy was realized by a transparent rigid or elastic mask. The pressure was started after skin graft uncovering between 7 and 20 days. The period for this treatment was depending on the maturing of the scar. Evaluation was established by 3 examinators on: time till scar maturing, trame quality and esthetic quality. RESULTS: The period till definitive scar maturing was showed to be between 8 and 14 month; trame quality was mostly evaluated as excellent, the esthetic result oscillated between good and medium. CONCLUSION: Physiotherapy seems to be an essential association for the treatment of facial full thickness skin grafts in children. Early pressure therapy could better the functional and esthetic result and accelerate scar maturing. Simple skin grafting could become the first treating option in this indication. Future prospective studies are expected to confirm these results.

[Reconstruction strategy in chest wall defect relating to the localization of the lost substances: retrospective study of 18 patients]. / Strategia reconstructiei defectelor toracice în functie de localizarea pierderii de substanta: un studiu retrospectiv a 18 cazuri.

OBJECTIVE: To evaluate an original algorithm in function of the chest wall defect localization after large surgery for cancer including more than 3 ribs. PATIENTS AND METHODS: Our retrospective study on 18 patients (10 women, 8 men), operated by the senior author, showed 8 pathological tumor localization in the central chest region, 7 in the lateral region and 3 borderline localizations. For central localizations, when the sternum was resected, the reconstruction was realized with a Gore-tex mesh in depth, metal hooks (staples) and Marlex mesh under the musculocutaneous superficial coverage flap. Lateral localizations was done by a Gore-tex mesh covered by the musculocutaneous flap; the borderline localizations were covered by a Marlex mesh and superficial musculocutaneous flap. The superficial coverage flaps were performed by latissimus dorsi flaps in 16 cases and transversus rectus abdominis flap in 2 cases. RESULTS: All the patients were extubated and breathed spontaneously in the postoperative period. Two deaths and one infection were to regret at distance. No flap was lost. CONCLUSION: The algorithm of reconstruction according to the location of the defect allows a simplification of the indications.

[Prospective study of early predictive factors of permanent hypocalcemia after bilateral thyroidectomy]. / Etude prospective des facteurs prédictifs précoces de la survenue d'hypocalcémie définitive après thyroïdectomie bilatérale.

AIM OF THE STUDY: The aim of this prospective cohort study was to identify the early criteria potentially predictive for outcome of permanent hypocalcemia after thyroidectomy. PATIENTS AND METHODS: Serum calcium (Ca) et phosphorus (Ph) were measured daily until discharge in 2035 consecutive patients undergoing bilateral thyroidectomy. In all patients experiencing postoperative hypocalcemia, defined as a Ca < 8.0 mg/dl on two consecutive days, parathyroid hormone was measured prior initiation of calcium therapy et discharge (early PTH), et blood sample was also obtained 7 to 14 days after discharge for Ca et Ph measurements (delayed Ca et Ph). These patients were then followed up until complete resolution of hypocalcemia or at least one year. Those still needing substitutive therapy to maintain normocalcemia one year after surgery were considered to have permanent hypocalcemia. Correlation of outcome with clinical characteristics, postoperative Ca et Ph levels, early PTH, et delayed Ca et Ph were examined with univariate analysis et multivariate logistic regression. RESULTS: Postoperative hypocalcemia occurred in 153 patients (7.5%) and spontaneously recovered in all but 7 patients (0.3%). Delayed Ca, and delayed Ph were found to be predictive for outcome of hypocalcemia by univariate analysis (p < 0.01). Relative risk to develop permanent hypocalcemia was 15 for patients with early PTH < 12 pg/ml, 52 when delayed Ph was > 4.0 mg/dl, and 121 when delayed Ca was < 8.0 mg/dl. None of the 113 patients with delayed Ca > or = 8.0 mg/dl and delayed Ph < or = 4.0 mg/dl developed permanent hypocalcemia, in contrast to 1 out of 31 patients (3%) with delayed Ca > 8.0 mg/dl or delayed Ph > 4.0 mg/dl, and 6 out of 9 patients (66%) with delayed Ca < 8.0 mg/dl and delayed Ph > 4.0 mg/dl. Both delayed Ca and delayed Ph appeared as independent factors predicting outcome of hypocalcemia at one year with multivariate logistic regression analysis. CONCLUSION: Delayed serum calcium and phosphorus levels, when measured one week after starting calcium therapy but prior to administration of any vitamin D analogs, accurately predict outcome of hypocalcemia after thyroidectomy. Patients with delayed Ca under 8.0 mg/dl and/or delayed Ph above 4.0 mg/dl are at high risk to develop permanent hypocalcemia.

[Recurrent herpes labialis infections: cellular immunity and immunomodulation]. / Rezidivierende Herpes-labialis-Infektionen: Zellvermittelte Immunität und Immunomodulation.

The therapy with thymus extracts, oral and parenteral, reduced the frequency and the intensity of recurrences of herpes labialis infections. The duration of the effect was at least 6 month after interruption of the therapy. Indomethacin was effective and developed and intensive effect only during the therapy. The skin test with recall-antigens and the neopterin-elimination were altered at the first day of the menstruation during the recurrence. The normalisation succeeded during therapy. In patients with recurrences in the perimenstrual time we observed a reduced T-helper/T-suppressor index during the first day of menstruation. Normal data were registered out of the recurrence time and/or under therapy. Inhibitors of the lymphokine: leucocyte/migration inhibitory factor (LIF) with a molecular weight of 6-12 KD were obtained with the specific stimulation of mononuclear cells of patients with recurrent infections with herpes labialis using the herpes-virus-1 antigen. The inhibition of fibrinolysis/proteolysis with aprotinin, tranexamic acid, phenyl-methyl-sulphonyl-fluoride and di-isopropyl-fluorophosphate could prevent the appearance of inhibitors. Inhibitors could be produced by splitting the LIF-molecule with urokinase and plasminogen but not with trypsin. The production, but not the activity, of present LIF-inhibitors are blocked in vivo and in vitro by indomethacin and thymus peptides.

Assay of the cell-mediated immunity in patients with malignant and non-malignant diseases.

The depression of cell-mediated immunity (CMI) was determined in patients with ovarian and breast carcinomas by lymphokine production under Con-A-stimulation (migration inhibitory factor), T-lymphocyte-transformation test under PHA-stimulation and with a skin reactivity test with a viscum album extract (Plenosol, Dr. Madaus, Cologne, FRG). The results show a good correlation between the different types of CMI function tests. The cytostatics have a depressive effect on CMI more through a cumulative effect than through the actual concentration. Some of the patients with chronic rheumatism who were not treated were anergic, and that also had an influence on the therapy.

Immunomodulation with Viscum album and Echinacea purpurea extracts.

Extracts of Viscum album (Plenosol) and Echinacea purpurea (Echinacin) are used clinically for their non-specific action on cell-mediated immunity. In vitro we could prove that these two extracts have a stimulating effect on the production of lymphokines by lymphocytes and in the transformation test. A toxic effect on cells was produced only with very high, clinically irrelevant concentrations. Clinical application of these extracts can produce a stimulation of cell-mediated immunity (one therapeutic administration followed by a free interval of one week) or can have a depressive action (daily administrations of higher doses). These observations were confirmed by lymphokine production and assay, 3H-thymidine incorporation and a skin test with recall antigens (Multitest Merieux).

Human leucocyte response to migration inhibitory activity from lymphocytes. Modification by aprotinin, Tranexamic acid and phenylmethyl sulfonylfluoride.

Human lymphokines can elicit several effects associated with inflammation, e.g. leucocyte migration inhibition and fibrinolysis. These effects can be assessed in vitro by the leucocyte migration agarose technique (LMAT) and the leucocyte migration fibrinolysis technique (LMFT). The present study shows that preincubation of normal leucocytes with aprotinin, tranexamic acid and phenyl-methyl-sulfonylfluoride (PMSF) reduces or abolishes their migration inhibition response to leucocyte migration inhibition factor. The compounds exert this effect at non-toxic concentrations, which do not otherwise interfere with migration or fibrinolysis, and are non-toxic as estimated by PHA stimulation of lymphocytes. The LMFT is more sensitive to the modifying effect than the LMAT. The effect of aprotinin and tranexamic acid is reversible, the effect of PMSF is irreversible.

Leucocyte migration inhibitory activity of concanavalin-A-stimulated lymphocytes. In vivo and in vitro modifications with dipyridamole and acetylsalicylic acid.

Lymphocytes from 14 patients treated with a combination of acetylsalicylic acid (ASA) and dipyridamole (DIPY) showed a decreased ability to produce leucocyte migration inhibitory activity (LMIA) when stimulated with concanavalin-A (ConA). The combined treatment also produced a decrease of leucocyte response to a standard LMIA-containing culture supernatant. Treatment with only one of the two drugs did not cause detectable alteration of the lymphocyte response to Con-A or the leucocyte response to LMIA. In vitro, both DIPY and ASA were independently effective in decreasing the LMIA production of Con-A-stimulated lymphocytes and the leucocyte response to a standard LMIA-containing culture supernatant.