[Implantable doppler probe for microsurgical free flap monitoring in cervico-facial reconstructive surgery]. / Le micro-doppler implantable dans la surveillance des lambeaux microanastomosés en chirurgie reconstructrice cervico-faciale.

AIM OF THE STUDY: The use of free flaps in head and neck reconstructive surgery requires postoperative monitoring, usually by conventional clinical tests. Nevertheless, clinical testing is not applicable to buried free flaps that are more frequently used in the head and neck area. The purpose of this study was to describe the use and to evaluate the implantable doppler system in this setting. PATIENTS AND METHOD: Among 162 patients who underwent free flap reconstruction in our department, between June 2008 and October 2012, 23 patients had postoperative monitoring using implantable doppler system. Probe placement, monitoring parameters and postoperative course was analyzed. RESULTS: Our series included 15 forearm free flaps, seven fibular flaps and one scapular flap. Indications for reconstruction were following the removal of a malignant tumor in 18 cases, a benign tumor in two cases and an osteoradionecrosis in three cases. Free flap monitoring by conventional clinical tests was not possible in 19 patients. Doppler signal was detected continuously during seven days in 82% of cases. A loss of signal was observed in three cases. Surgical exploration was required in one patient. CONCLUSION: Implantable doppler for free flap monitoring is a safe, reliable and efficient technique and cost is reasonable. The use of implantable doppler system seems particularly useful in head and neck reconstruction for buried free flaps, which are not accessible to conventional clinical tests.

[Mandibular reconstruction with fibula free flap. Experience of virtual reconstruction using Osirix®, a free and open source software for medical imagery]. / Reconstruction mandibulaire par lambeau microanastomosé de fibula. Modélisation radiologique préopératoire par le logiciel Osirix(®).

The techniques of free tissue transfers are mainly used for mandibular reconstruction by specialized surgical teams. This type of reconstruction is mostly realized in matters of head and neck cancers affecting mandibular bone and requiring a wide surgical resection and interruption of the mandible. To decrease the duration of the operation, surgical procedure involves generally two teams, one devoted to cancer resection and the other one to raise the fibular flap and making the reconstruction. For a better preparation of this surgical procedure, we propose here the use of a medical imaging software enabling mandibular reconstructions in three dimensions using the CT-scan done during the initial disease-staging checkup. The software used is Osirix®, developed since 2004 by a team of radiologists from Geneva and UCLA, working on Apple® computers and downloadable free of charge in its basic version. We report here our experience of this software in 17 patients, with a preoperative modelling in three dimensions of the mandible, of the segment of mandible to be removed. It also forecasts the numbers of fragments of fibula needed and the location of osteotomies.

[Prenatal diagnosis of upper limb malformations]. / A props du diagnostic prénatal des malformations du membre superieur.

Three children with thrombopenia and radial aplasia were examined at the Centre de Génétique Médicale of Marsielles from 1974 to 1976. In each case the genetic basis of the anomaly was discussed with the family at genetic counseling underlining the high risk of recurrence related to the autosomal recessive transmission. Each proband was the only child of the couple. In the first case the father and mother, each having one child from a previous marriage, decided to have no more children. In the second case, the use of fetoscopy and its limitations were discussed as another pregnancy was desired. However, the parents finally refused the procedure during pregnancy which yielded a second child with phocomelia who did not survive. In the third and most recent case the proband died. Since the young couple strongly desired another child, ultrasonic monitoring of pregnancy was cautiously suggested and its limitations clearly exposed. Echography was regularly repeated from the third month of pregnancy. The forearms were never detected on echography, nor on fetal radiography. Pregnancy was thus interrupted with prostaglandins at 21 weeks gestational age. On examination the fetus presented bilateral aplasia of the forearm. Based on these observations, the authors discuss the problems raised by prenatal diagnosis of upper limb malformations.

[Prenatal diagnosis of congenital malformations using echotomography]. / Diagnostic anténatal des malformations congénitales par l'échotomographie.

From nine antenatal diagnosis, the authors discuss the opportunity of the ultra-sound echography, and the approach for complete diagnosis of the malformation and its surgical treatment.