[Mediatisation and "facial graft" or "to whom belongs the facial graft"?]. / Médiatisation et "greffe de visage" ou "à qui appartient la greffe de visage"?

Mediatisation of a scientific event could be neither controlled, nor verifiable. The experience which has been lived through the first worldwide allotransplantation of composite tissues of the face confirms that the actors of a surgical innovation are not the owners. Because there is neither confidentiality nor possible patent. Curiously the scientific world, providing with a sharing ethic, which rightly privileges the free spreading of knowledge in the way that most people could benefit of it. Obviously it is made without denied controversy, for truth as purpose. This scientific word that way joins the media one, with a specific ethic of the duty of information, but also interested in mercantile preoccupations quick to cultivate controversy not to enlighten this truth but to better sell pictures or papers. Than the author should only sustain this instrumentation which could certainly flatter him, and from which he could used, but in reality that paralysed him a little to go on in serenity with his shadow worker way.

["Facial graft": about the first facial allotransplantation of composite tissues]. / Greffe de visage: regards portés sur la première allotransplantation composite partielle de la face.

The first facial allograft was realised in Amiens 2005 November 27th. Breaking the technical limits of the so called possible and in appearance transgressing some cultural forbidden in organ transplantation, this resolutely innovative intervention open more than new perspective in the surgery of the reconstruction after disfigurement, but also a wide field of scientific investigations about dynamic and meaning of the facial function. Obviously, it also deals with numerous ethical and medical problems. The authors here shortly described the technical points of the surgery firstly done to restore oral function and facial expressively, the principles of the immunosuppressive treatment built to control any rejection time episode and the anatomical, neurological and functional results obtained after more than 18 months follow-up. Those perfectly demonstrate the perfect morphological, dynamic and cortical integration of the graft in the recomposed face. They also allow to confirm the legitimacy of the surgical indication and to oppose the factual objective arguments to the ethical reticences dealing with the facial and psychological identity of the receptor.

Total lower lip functional reconstruction with a prefabricated gracilis muscle free flap.

Total lower lip reconstruction was performed in an 18-month-old boy following a dog bite. In order to obtain an optimal functional result and to avoid any additional facial scarring, a prefabricated gracilis muscle free flap was used in a two-stage procedure. Firstly, the muscle was delayed on its main pedicle, a 'tendinous' strip was inserted along its free border and a silicone sheet was slid under its predicted intraoral side. At the time of reconstruction, the neomucosal lining obtained in this way reconstituted the labial vestibule. Furthermore, the muscle, reinnervated by the mandibular branch of the facial nerve, was also put under minimal tension and suspended between the two modioli using the 'tendon' graft. This allowed both lip occlusion and normal speech development to be restored without any impairment of mandibular growth during a 4-year follow-up.

Extensive lymph node clearance for cancer of the esophagus or cardia: merits and limits in reference to 5-year absolute survival.

BACKGROUND/AIMS: The present study evaluates both merits and limits of extensive lymph node clearance in the mediastinum and upper abdomen on patients operated on more than 5 years ago. MATERIALS AND METHODS: One hundred forty-four esophageal cancer patients underwent subtotal (n = 97) or distal (n = 47) esophageal resection more than 5 years ago. Twenty-six patients operated on in a curative attempt were given radiotherapy (n = 14) or radiochemotherapy (n = 12). RESULTS: Esophagectomy with extensive lymph node clearance was feasible in 102 of the 144 patients (70.8%). In-hospital mortality was 1.4%. Thirty-six patients lived more than 5 years, ie. 25% of all the esophagectomized patients and 35.3% (36/102) of those who were operated on in a curative attempt. Five-year absolute survival was 38.4% after combined therapy v.s. 34.2% after surgery alone (p > 0.05). In the latter instance, it was 57.1% for those patients with normal lymph nodes v.s. 14.6% for those with metastatic lymph nodes, and it was 64% for those with non-transmural tumors v.s. 19.6% for those with transmural tumors. One half of those patients who were not given adjuvant therapy following esophagectomy with extensive lymph node clearance died of neoplastic spread, namely distant metastases (27.6%), cervical spread (3.9%), and local recurrence (10.5%). CONCLUSIONS: Esophagectomy with extensive lymph node clearance is not feasible in 30% of the patients in whom it is attempted, and it does not prevent further neoplastic spread in one half of those in whom it is feasible. It is capable of curing 15 to 20% of those patients with locally advanced neoplasms and shelters 90% of the patients from local recurrence.

Retroperitoneal laparostomy: a surgical treatment of pancreatic abscesses after an acute necrotizing pancreatitis.

BACKGROUND: From 1982 to 1988, 20 patients with pancreatic abscesses after an acute necrotizing pancreatitis underwent a retroperitoneal laparostomy (RPL). METHODS: The severity of the disease was assessed by Ranson's bioclinical and Hill's computed tomographic scoring systems. The RPL, guided by the results of repeated computed tomographic scans (high frequency of peripancreatic necrotic extension through the anterior pararenal space) consists of a left or right lateral incision under the twelfth rib, allowing direct access to the pancreas and peripancreatic spaces. RESULTS: Four patients (20%) had local complications: colonic fistula (one patient), gastric and colonic fistula (one patient), jejunal fistula (one patient), and local hemorrhage (one patient). Only one complication was lethal (gastric and colonic fistula). Four patients died (mortality rate 20%). In two of the cases death was related directly to a persistent sepsis after the RPL, whereas the two other patients died despite a complete surgical drainage. CONCLUSIONS: RPL (left or right, sometimes bilateral) allows a total exploration of the pancreas and peripancreatic spaces in most cases, as well as a complete manual removal of the necrotic infected masses. Furthermore, several second-look removals of newly formed necrotic masses can be performed without the risk of peritoneal contamination and with a low rate of digestive fistula.

Length of the styloid process of the temporal bone.

The length of 404 styloid processes of the temporal bone was measured on 246 macerated skulls from men and women aged between 26 and 93 years. The statistical distribution of the styloid processes in function of their length obviously shows the existence of two different groups. In the first one, the length is inferior or equal to 20 mm, while it is superior to this value in the second one. A length more than 30 mm that cannot be related with age is common (29%) despite its low clinical occurrence. To explain the existence of short and long styloid processes, a variable involvement of the different segments of the Reichert's cartilage during the morphogenesis is suggested.