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.

[Maxillofacial reconstruction with radial forearm osteofasciocutaneous free flap]. / Le lambeau ostéo-fascio-cutané antébrachial radial dans la reconstruction maxillo-faciale.

INTRODUCTION: Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. MATERIALS AND METHODS: We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. RESULTS: The mean age of the 10 patients was 60.2 years. The average length of bone defect was 8 cm. The average cutaneous defect area was 36.8 cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no reconstruction failure. Three patients had mild speech disorders, five had moderate speech disorders, and two major speech disorders. Four patients had a normal food intake, three patients needed mixed food, and three patients liquid food. DISCUSSION: The indications of radial forearm osteofasciocutaneous free flap for complex maxillofacial reconstructions should be extended. Its vascularization is less compromised by arteritis. Its pedicle may be long and adequate for a contralateral anastomosis. It is reliable and easy to harvest. But the bone quality is not as good as fibula.

[Complications associated with sentinel lymph node biopsy for cutaneous melanoma. A retrospective study of 127 patients]. / Les complications liées à la technique du ganglion sentinelle dans le mélanome cutané. Étude rétrospective à partir de 127 cas.

BACKGROUND: Sentinel lymph node (SLN) biopsy for patients with cutaneous melanoma has become a routine procedure. Its purpose is to confirm the potential presence of micrometastases in the first lymph node basin. Therefore, staging of the melanoma can be determined. Somehow, only few studies assess the morbidity of this procedure. Our study was performed in order to list and analyze SLN biopsy-related complications in melanoma-affected patients. PATIENTS AND METHODS: This mono-institutional, retrospective study enrolled patients, operated on from May 2001 until August 2008, who had undergone SLN biopsy that found no metastatic colonization. Patients with positive SLN biopsy underwent subsequent completion lymph node dissection (CLND) and, therefore, were not included in this study. Thus, CLND-related complications did not interfere with SLN biopsy-related ones. Median follow-up was 19 months. RESULTS: One hundred and twenty-seven patients, 58 men and 69 women were evaluated. Nine patients (7,1%) were diagnosed with one complication. We noticed seven early complications occurring during the first month (four seromas, one lymphocele, one infection with dehiscence of wound, one deep veinous thrombosis) and two late complications occurring beyond this period (one neuroma, one cicatricial bridle). Four (44%) among these complications arose in the groin. CONCLUSION: SLN biopsy is known as a simple and minimally invasive surgical technique. Somehow, some potentially severe complications may arise. These must be clearly explained to obtain the patient's informed consent prior to surgery.

[Multiple ossifying trichilemmal cysts of the scalp: a familial case]. / Kystes trichilemmaux ossifiants multiples du cuir chevelu : un cas familial.

INTRODUCTION: The trichilemmal cyst, also called pilar cyst, is a dermal epithelial cyst originating from the pilar follicle. It usually occurs in the scalp. Hereditary and ossifying cases are rare. CASE REPORT: We report the case of a 61-year-old woman presenting with familial multiple trichilemmal cysts, located in the scalp. The histological examination after surgical exeresis confirmed the diagnosis. The trichilemmal cysts featured intra-cystic ossification. The wide dimension of the lesions dimension imposed an extensive surgical scalp exeresis. Reconstruction was performed with a flap after skin expansion. DISCUSSION: The trichilemmal cyst is a benign tumor of skin appendages with a slow outcome. Multiple locations may require an extensive surgical scalp exeresis and lead to a problematic reconstruction. Hereditary cases require familial follow-up to prevent such problems.

[Postoperative necrotizing neutrophilic dermo-hypodermitis of the hand. A diagnosis not to miss]. / Dermo-hypodermites nécrosantes neutrophiliques postopératoires de la main. Un diagnostic à ne pas rater.

Pyoderma gangrenosum (PG) is an aseptic ulcerative dermatosis, belonging to the group of neutrophilic dermatoses, and could reveal a systemic blood disorders or inflammatory disease. This dermatosis could mimic rapidly extensive necrotizing dermo-hypodermitis in some clinical aspects. PG can be caused by tissue trauma as in surgical procedure. In this context, this pathology is easily confused with bacterial necrotizing dermo-hypodermitis, the treatment of which gives priority to survival rather than functional outcome, and causes rapid deterioration especially in the upper limb. This case report shows typical evolution of inappropriate treatment of postoperative PG. Faced with postoperative necrotizing dermo-hypodermitis, the diagnosis of PG must be considered, in order to favor good functional outcome.