[Free-flap head and neck reconstruction failures: predictive factors and management]. / Les échecs de la chirurgie reconstructrice cervicofaciale par lambeaux libres : facteurs favorisants et prise en charge.

BACKGROUND: Failure after head and neck reconstruction using free flap are rare but their management remains a challenging problem. The purpose of this study was to analyze the causes and the subsequent treatment of free-flap failure in head and neck reconstruction. PATIENTS AND METHODS: A retrospective review of patients who had undergone free flap transfer between 2000 and 2007 was performed in our center. Data were collected from computerized medical record to determine patient and tumor characteristics, as well as their treatment. Moreover, a univariate analysis was performed to determine factors associated with free flap failure. RESULTS: Three hundred and twelve patients had a free flap transfer after head and neck cancer resection. A total of 22 failures (7%) were encountered. Previous surgery for head and neck cancer (p=0.02), surgery after cancer recurrence (p=0.02) and reconstructions after circular pharyngolaryngectomy (p=0.008) were significantly associated with free-flap failure. A second free-flap was performed in 12 patients and the overall success rate of the repeated free flap was 92 percent (11 of 12 patients). CONCLUSION: After a free flap failure, surgeons should determine subsequent treatments after a reconsideration of the need of a second free flap, an analysis of the cause of the first flap failure and an evaluation of local and general conditions. In selected patients, second free flap has a high success rate.

[Primary essential cutis verticis gyrata: Case report and literature review]. / Cutis verticis gyrata primitif essentiel : cas clinique et revue de la littérature.

INTRODUCTION: Cutis verticis gyrata (CVG) is a rare and slowly progressive deformity of the scalp with thick gyrated skin folds and ridges which are similar to gyri of the brain cortex. Those folds can lead to local skin infections, to a social and cosmetic complain. CVG can be classified into two forms: primary (essential and non-essential) and secondary. To date, fifteen operated cases of primary essential CVG have been reported in the medical literature. CASE REPORT: We report the case of an 18 year-old male patient with a primary essential CVG. There were several large skin folds in the sagittal axis on the vertex region, and in the coronal axis on the occipital region. He did not present any cutaneous complication. His main complains was the unaesthetic aspect of his scalp with a psychological complex. The disease had occurred during puberty. We present the excision pattern and the results with a six months follow-up. CONCLUSION: CVG can be treated surgically with resection of the thickened excess skin in coronal and sagittal axis. Scalp lift must be effective all over the different areas of the scalp. The scalp flaps must have a reliable vascularisation. Combined incisions of the galea help to treat the residual folds. The excision pattern must be reproductible, as this disease is progressive.

[The use of the "spare-parts tissue bank" concept in emergency hand surgery]. / Utilisation des << tissus-banque >> en chirurgie de la main d'urgence.

INTRODUCTION: In the case of multidigital hand trauma, the tissue of the amputated parts can be used for the reconstruction of the defected tissue localized on the other fingers. PATIENTS AND METHODS: A series of seven patients has been reviewed in this paper; the authors illustrate the different possibilities of using the "spare-parts concept" in the emergency hand trauma surgery. RESULTS: The functional results are presented. DISCUSSION: The different techniques of reconstruction using the "spare-parts concept" are discussed. CONCLUSION: In the cases of multidigital lesions, the surgeon should choose the best opportunity to use the tissue of the amputated digits, or the non-conservable ones, to reconstruct the neighboring preserved segments.

[Constitutional asymmetries in aesthetic breast augmentation: incidence, postoperative satisfaction and surgical options]. / Les asymétries constitutionnelles en chirurgie d'augmentation mammaire esthétique: incidence, satisfaction et applications chirurgicales.

INTRODUCTION: The clinically observable, constitutional breast asymmetries are frequent and physiological in the general population. Although there has been a preponderance of literature concerning breast augmentation, a conspicuous lack of data exists regarding the preoperative breast and chest wall asymmetries seen in the patient seeking consultation for aesthetic breast augmentation. These asymmetries can lead to postoperative dissatisfaction in patients. MATERIALS AND METHODS: An independent plastic surgeon analysed the data of 200 patients who had a primary aesthetic breast augmentation. The mean follow-up was 36 months. All patients had pre- and postoperative standardized pictures of the anterior chest wall. The clinical examination was achieved using an original evaluation form. Patients were also asked to fill an exhaustive satisfaction form. Breasts and chest wall asymmetries were diagnosed by clinical examination and photographic analysis. Mastopexy-augmentations, breast reconstructions, breast malformations (tuberous breasts and Poland syndrome) and patients with incomplete data were excluded from the study. Stastical analysis was done using SPSS software version 15. RESULTS: There were 77% of chest wall and breast asymmetries and 69,5% of breasts asymmetries (26,5% of breast mound volume asymmetry and 62,5% of shape asymmetry). An isolated chest wall asymmetry was found in 17% of patients. Scoliosis was the main cause of asymmetry (52,9% of chest wall asymmetries) as it is often associated with chest wall rotation, chest wall depression, submammary depression or rib asymmetry. Patients often noticed an asymmetry postoperatively (28%). Among the patients complaining from a postoperative asymmetry, 83,3% had a constitutional breast or chest wall asymmetry. Asymmetry was the third cause of dissatisfaction and the third argument for revision surgery (after volume dissatisfaction and ptosis). Thirty per cent of patients asking for a surgical revision and 35.3% of unsatisfied patients complained about asymmetry, which was preoperative in 83.3% of cases. CONCLUSION: The asymmetry rate of our study is compared with the others studies found in the literature. In the daily practice, asymmetry can be diagnosed by a complete clinical examination and standardized chest wall pictures. Patients with constitutional asymmetry should be educated, helping to increase postoperative satisfaction. The authors propose and discuss a surgical pattern for the handling of the different types of asymmetries in breast augmentation.

[Surgical management of traumatic ear amputations: literature review]. / Prise en charge des amputations traumatiques de l'oreille : revue de la littérature.

Traumatic ear amputation (TEA) is a complete avulsion of a part or of the total auricular tissue. TEA are rare (only 74 cases have been described in the literature) and their handling is complex. The surgeon's objective is to obtain the best cosmetic result without demolishing the auricular area in order to allow future ear reconstruction in case of replantation failure. Many techniques of ear replantation have been described in the literature during the last 30 years: microsurgical replantation, pocket techniques and reattachment techniques. Microsurgical replantation should be achieved every time it is possible. When it is not possible, the surgeon can choose between ear reattachment and a pocket technique according to two clinical features: the size of the amputated part and the involvement of the ear lobe. Ear reattachment can be achieved when the amputated part is smaller than 15 mm or when amputation involves the earlobe. Pocket techniques, which are appropriate for the replantation of the auricular cartilage, can be used when the amputated part is bigger than 15 mm and does not comprise the earlobe.

[Necrotizing fasciitis: complication of patient positioning?]. / Dermohypodermite bactérienne nécrosante avec fasciite nécrosante : complication d'une installation opératoire ?

Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. It disseminates along fascias with a mortality sometimes within 18 hours. The average mortality, reported in the literature, is about 30%. A 65-year-old man, with a history of Vaquez disease (under hydroxurea) and a smoke addiction, had an epidermoid carcinoma of the left vocal cord (T2 N0 M0). The cancer treatment consisted of a functional lymph node excision, followed by tracheotomy then by partial laryngectomy. At the end of the intervention, after removal of operative fields, it was noticed that the Montandon cannula had slid and was between the medial side of the left upper limb and the lateral side of the chest. There was a cutaneous imprint with ecchymosis on the route of the cannula. At the second postoperative day, a necrotizing fasciitis quickly developed on the left side of the chest, the medial side of the left upper limb, and the left hip without infection of the operating site. An Escherichia coli was identified in tracheal secretions and operative samples. The presumed hypothesis of this necrotizing infection is the cutaneous contamination of the thoracic wall by tracheal secretions colonized by E. coli, whose penetration was induced by the cutaneous traumatism due to the cannula. We remind, by analyzing this unusual case, the caring principles one of which diagnosis and the surgical excision must be as premature as possible. We insist on the elementary measures of protection of the support points and the good binding of cannulas.