[Myocarditis or subendocardial myocardial infarction: role of MRI illustrated by a case report]. / Myopéricardite ou nécrose sous-endocardique: apport de l'imagerie par résonance magnétique illustré par un cas clinique.

A 50-year-old male patient treated with mesalazine for Crohn's disease was admitted in our unit for a chest pain, associated with nonspecific ST depression or ECG and troponin elevation. Coronarography showed minimal changes while SPECT imagery suggested a posterobasal subendocardial infarction, so that the diagnosis was unclear between ischemic disease and mesalazine-induced myocarditis. Eventually, MRI demonstrated clearly a subendocardial posterior infarction eliciting the diagnosis of mesalazine-induced myocarditis. This case report illustrates, in our opinion, that MRI is of invaluable interest in evaluating the characteristics of myocardium, and must be the cornerstone in the diagnosis of myocardial diseases.

[Intra-alveolar haemorrhage without renal damage as the initial presenting feature of Goodpasture's syndrome: case report and review of literature]. / Hémorragie intra-alvéolaire isolée révélant un syndrome de Goodpasture sans atteinte rénale : à propos d'une observation et revue de la littérature.

Isolated pulmonary involvement in Goodpasture's syndrome is exceptionally described. We report a 36-year-old woman with pulmonary haemorrhage and review 28 additional cases of the literature. In fact, these patients had often mild urine abnormalities and constant glomerular lesions. Antiglomerular basement membrane antibodies testing should be systematically ordered in patients presenting with alveolar haemorrhage. Goodpasture's syndrome without renal abnormality could be an early stage of the disease with a better prognosis.

[Reversed vascular full-thickness nasolabial flap]. / Le lambeau naso-génien de pleine épaisseur en îlot vasculaire à pédicule rétrograde.

The author describes a vascular island full-thickness nasolabial flap, which is superior pedicled and is nourished by the distal portion of axial vessels, the facial artery and vein, by means of a reverse blood flow. When the vein is not available, a muscular pedicle can provide the venous drainage. This composite musculo-mucocutaneous flap was used in a single stage procedure for external cover and internal lining repair in 32 cases of full-thickness defect of the alar lobule (18 cases) or of the lower half of the nasal sidewall (14 cases). Some cases needed a secondary defatting (37.5 per cent). The final result was good in all cases, with minimal sequelae on the donor site.

[Forum: reconstruction of the traumatic thumb. The thumb in hand mutilations. Indications for reconstructive surgery]. / Forum: la reconstruction du pouce traumatique. Le pouce dans les mutilations de la main. Indications de la chirurgie reconstructrice.

The indications for reconstruction of the thumb in traumatic mutilations of the hand are presented in relation to the various conventional and microsurgical techniques. Several clinical situations are distinguished according to the severity of the hand mutilation and the number of severed fingers. Paucidigital amputations (one or two fingers including the thumb) should be treated by pollicisation or other techniques (Matev, osteoplastic reconstruction, second toe or "custom-made" transfers) depending on whether or not the other fingers need to be preserved. Pluridigital amputations (the thumb and two or three long fingers) require transfer of the 2nd toe or "custom-made" transfers avoiding a further reduction of the digital capital of the hand. Amputations of the five fingers create oblique, transverse or convex sections which, when they are proximal, require elongation of one, two or three digits depending on whether surgery is designed to restore a bipod or tripod pinch grip. Lastly, complex mutilations require a combination of digital reconstruction and palmo-commissural skin repair by neurovascular free flaps from the foot. Nonsurgical management should also be discussed in every case.

[Forum: reconstruction of the traumatic thumb in practice...the surgeon passes!]. / Forum: la reconstruction du pouce traumatique en pratique.... Pouce, lechirurgien passe!

The aim of thumb reconstruction is to obtain, within a reasonable time, a thumb with an aesthetic appearance and function as close as possible to those of a normal thumb, leaving a minimum of sequelae at the donor site. The author reviews the various modalities of reconstruction, according to the severity of mutilation of the thumb. In pulp amputations, partial lesions are repaired by a homodigital island pulp flap (subcutaneous or unilateral or bilateral neurovascular pedicle advancement flap); total pulp defects should be treated by toe pulp transfer rather than the neurovascular pedicle conventional heterodigital pulp flap (with nerve anastomosis): hemipulp of the great toe or pulp of the 2nd toe. Several thumb reconstruction procedures can be proposed in digital amputations and the surgeon must be aware of their precise indications: up-to-date osteoplastic reconstruction by osteocutaneous forearm retrograde flaps (radial flap or anterior interosseous flap), progressive elongation of the 1st metacarpal, pollicisation (of the ring finger), microsurgical transfer of a toe (not the great toe because of the sequelae to the foot, but the 2nd toe), exceptionally microsurgical transfer of a (damaged) finger from the other hand. Lastly, with minimal sequelae to the foot, "custom-made" reconstructions allow repair of partial amputations (partial great toe transfers) and complete amputations of the thumb (great toe "wrap-around" flap, "twisted two toes" flap of great toe and 2nd toe) or even complex and multidigital mutilations of the hand (dorso-commissuro-bipulpar foot flap).

[Post-radiotherapy lesions of the brachial plexus. Classification and results of surgical treatment]. / Les lésions post-radiothérapiques du plexus brachial. Classification et résultats du traitement chirurgical.

A series of 60 cases with a follow-up of 3 to 13 years among 118 operations for post-radiation lesions of the brachial plexus performed between 1978 and 1990 was investigated as a function of three features: 1) anatomic classification according to 3 stages for per-operatory observations of extrinsic and intrinsic compression, 2) clinical classification according to 4 types of sensoro-motor neurological symptoms and 3) the different operative procedures used for decompression. It was concluded that post-radiation plexuses should be operated as early as possible as soon as paraesthesia appears and before the onset of pain since the aim of the operation is to stabilize the clinical course and not achieve cure. It was also found that the best operative procedure is a selective neurolysis of the plexus completed by a pedicled omentoplasty.

[Secondary microsurgical reconstruction of the breast and free inferior gluteal flap]. / Les reconstructions microchirurgicales secondaires du sein et le lambeau libre fessier inférieur.

A technique of secondary breast reconstruction by microsurgical transfer of an inferior gluteal flap is presented. The principal characteristics of the inferior gluteal myocutaneous flap, described for the first time by the author in 1978, are presented: anatomical bases, harvesting technique. Breast reconstruction with this flap is performed in three operative steps. Step 1: application of a skin expander in the breast region in order to re-create the mammary space. Step 2: microsurgical transfer of the de-epithelialized flap, rolled up to create a pseudo-mammary gland, then insertion into the expanded mammary space. Step 3: reconstruction of the areola-nipple complex from the contralateral side and restoration of breast symmetry. The results of breast reconstruction according to this technique were evaluated in a series of 14 cases operated between 1987 and 1991, while the sequelae of the gluteal donor site were evaluated on a series of 65 free inferior gluteal flaps performed between 1977 and 1991. The advantages of this procedure are the natural curvature and softness of the reconstructed breast, the moderate sequelae at the donor site, leaving a scar dissimulated in the gluteal fold. This technique was compared with other reconstruction techniques: microsurgical procedures (non de-epithelialized inferior gluteal flap, superior gluteal flap, lateral mammary flap, etc.) and conventional procedures (breast expansion+prosthesis, latissimus dorsi flap, rectus abdominis flap). In conclusion, another technique is described, which appears to offer the advantages of the de-epithelialized inferior gluteal flap without the disadvantage of microsurgical transfer: reconstruction with a de-epithelialized rectus abdominis pedicle flap after expansion of the mammary space.

[Forum: dermopigmentation or medical tattooing. In practice ... how to perform medical tattooing?]. / Forum: dermopigmentation ou tatouage médical. En pratique ... comment faire un tatouage médical?

Dermopigmentation is now part of the therapeutic armamentarium of plastic surgeons. In good indications and when applied according to a few simple rules, every surgeon can obtained reliable and reproducible results with medical dermography. This therapeutic procedure is performed on an outpatient basis, usually in several sessions; subsequent revisions are always possible provided certain basic errors are avoided. The authors describe each step of this technique.

[Improvement in the prognosis of severe mediastinitis by the use of muscle flaps]. / Amélioration du pronostic des médiastinites graves par les musculoplasties pédiculées.

Between 1984 and 1988, 12 mediastinitis were observed in a series of 1.724 cases of cardiac surgical procedures by sternotomy (0.7%). These 12 patients were retrospectively separated in 2 groups in terms of surgical management. In group I (5 patients in 1984 and 1985) the treatment was mediastinal irrigation and in case of failure, an omental transposition. In group II (7 patients in 1986, 86 and 88) the treatment was mediastinal irrigation and in case of failure, a mobilization of muscle flaps. Four patients died in group I of poly-visceral failure with a persistent severe sepsis. In group II, there was no death and the cicatrization was quickly obtained with an average length of stay in intensive care unit of 62 days. The mediastinal irrigation is the treatment of choice for benign mediastinitis, but the prognosis of severe mediastinitis was in our series greatly improved by muscle flap procedures realized with plastic and reconstructive surgical techniques.

[Anatomical study of the vascularization of the flag flap. Apropos of its use in loss of substance from the palmar face of the proximal phalanx]. / Etude anatomique de la vascularisation du lambeau en drapeau. A propos de son utilisation dans les pertes de substance de la face palmaire de la première phalange.

The flag flap, elevated from the dorsal aspect of the proximal phalanx, may be employed as a one-stage procedure to cover a loss of soft tissue on the volar aspect of the adjacent finger, the staff of the flap running over an oblique web-space incision.

Two new free flaps developed from aesthetic surgery I. The lateral mammary flap.

A new donor site for free skin flap transfer from the breast is described. The vascular anatomy and the operative technique for raising the flap is detailed. The clinical application is illustrated by 3 case reports including 4 flap transfers. The use of the lateral mammary flap is indicated in largebreasted women when a reduction mammaplasty is required at the level of the donor site and can be combined with the microsurgical flap transfer.

Two new free flaps developed from aesthetic surgery II. The inferior gluteal flap.

A new vascular musculocutaneous flap from the lower buttock is described that is based on the inferior gluteal vessels and includes skin from the gluteal fold and a part of the gluteus maximus muscle. The inferior gluteal flap has been clinically used either as an island flap for sacral repair or as a free flap. The results of 6 clinical cases are presented and the features of the flap are exposed. The minimum residual deformity of the buttock contour and, even in some cases of trochanteric lipodystrophy, the cosmetic improvement of the donor site appearance are emphasized.

[The surgical treatment of large incisional hernias by lacing of autogenous full thickness skin. 36 cases (author's transl)]. / Traitement chirurgical des éventrations par laçage avec de la peau totale autogène. 36 observations.

Strips of skin taken from the excess skin adjoining the scar, prepared carefully and used as a loose continuous suture, represent an elastic material which is easy to use and of great strength. Results studied in a group of 36 patients with a follow-up varying from 12 month to 16 years were excellent in 70% of cases and moderate in 25%. The quality of the results obtained, from both a mechanical standpoint as well as in terms of tolerance, together with the simplicity of the technique, have led us to consider it as a method of choice in the repair of large incisional hernias, in particular recurrent.