[The gluteus maximus inferior split-muscle flap for the cover of ischiatic pressure ulcers: Study of 61 cases]. / Le lambeau de faisceau inférieur de muscle gluteus maximus dans la couverture des escarres ischiatiques : étude d'une série de 61 cas.

AIM OF THE STUDY: The coverage of ischiatic pressure ulcers is characterized by a significant recurrence rate (8-64% depending on the series). It therefore seems necessary to introduce the concept of saving in the use of muscle flaps available to avoid being in a situation of therapeutic impasse. The gluteus maximus inferior split-muscle flap allows a tailored coverage to the ischiatic pressure ulcers grade IV with skin defect less than 8cm after surgical debridement. It is associated with an advancement-rotation skin flap removed above the sub-gluteal fold. PATIENTS AND METHODS: The surgical treatment is performed in a single-stage (care+coverage), undercovered by probabilistic antibiotic per- and postoperative then secondarily adapted. After excision of the cavity, a gluteus maximus inferior split-muscle flap was realized. The inferior gluteal artery ensures the muscular flap vascularization. Afterwards, patients follow a rehabilitation program in a specialized center. RESULTS: Sixty-one flaps were performed in 55 patients between September 2000 and January 2015. Fifty-nine (97%) were conducted in first-line and 2 (3%) for covering recurrent pressure ulcers. After a mean duration of 4 years and 8 months follow-up, 13 pressure ulcers (21.3%) relapsed. If reoperation, a simple remobilization of the muscle flap was achieved in 54% of cases, a myocutaneous flap of biceps femoris in 23% and surgical abstention in a patient with non-compliant perioperative care. CONCLUSIONS: The gluteus maximus inferior split-muscle flap, simple to implement, provides coverage of ischial pressure sores while sparing muscle flaps usually used for this indication. The recurrence rate associated with the gluteus maximus inferior split-muscle flap is comparable to biceps femoris and gluteus maximus muscle flaps (totally harvested). It does not sacrifice function gluteus maximus muscle and can be performed in the valid patient. This flap keeps the Superior split-muscle, mobilized in case of sacral pressure ulcer. The gluteus maximus inferior split-muscle flap is the first intention flap indicated for the cover of cover of ischiatic pressure ulcers of less than 8cm in diameter.

[Anatomical study of muscular latissimus dorsi surface vascularized by the transverse branch of thoraco-dorsal artery]. / Étude anatomique du territoire musculaire du latissimus dorsi vascularisé par la branche transverse de l'artère thoraco-dorsale.

INTRODUCTION: The latissimus dorsi muscle flap is a type V according to Mathes and Nahai. It is vascularized by a proximal main pedicle represented by the thoraco-dorsal pedicle and pedicle distal accessory represented by the dorsal branches of the posterior intercostal arteries. The main thoraco-dorsal pedicle has a descending branch and a transverse branch. This anatomical study clarifies the muscular territory vascularized by the transverse branch of thoraco-dorsal artery for a secondary use after harvesting a thoraco-dorsal artery perforator flap or a muscle-sparing latissimus dorsi flap. MATERIAL AND METHODS: Our study focused on ten dissections latissimus dorsi muscle taken from five fresh cadavers chest, carried out within the University Department of Anatomy. The descending branch of thoraco-dorsal artery was ligated, the transverse branch was cannulated and injected with a mixture of barium sulfate/gelatin. After freezing, a static angiotomodensitometry (3D) of each flap was performed. RESULTS: The average muscular surface vascularized by the transverse branch is measured at 80% (77% minimum value, maximum value 83%) of the complete latissimus dorsi muscle. Intermuscular connections between the two branches of thoraco-dorsal pedicle were shown. CONCLUSION: The use of a ipsilateral latissimus dorsi muscle is a therapeutic option after harvesting a thoraco-dorsal artery perforator flap (TAP) or a muscle-sparing latissimus dorsi flap (MSLD-flap).

[Transtibial amputation salvage with a cutaneous flap based on posterior tibial perforators]. / Sauvetage d'un moignon d'amputation transtibiale grâce à un lambeau cutané basé sur les perforantes de l'artère tibiale postérieure.

When performing an amputation of the lower limb, the preservation of the knee joint is important to obtain an optimal functional outcome. Many reconstruction procedures are available to cover the amputation defect in order to preserve a sufficient length of the stump, so a prosthesis could be put in place with the best functional results. Local musculocutaneous flaps or free flaps are conventionally described with their advantages and disadvantages. In this report, we describe our experience with a transtibial amputation and stump covering using a fasciocutaneous flap based on tibial posterior perforators. An extensive tibial bone exposure with only posterior skin was viable. It is an efficient and reliable solution for covering tibial stump without microvascular anastomosis.

[Diagnosis and treatment management of basal cell skin carcinoma - guidelines analysis]. / Prise en charge diagnostique et thérapeutique du carcinome cutané basocellulaire - Analyse des recommandations.

Basal cell carcinoma (BCC) is the most frequent skin cancer in France. BCC has above all a local evolution with an important locoregional morbidity. BCC are found in 80% in the cervicofacial region. Surgery is currently recognized to be the most reliable treatment. The surgeon needs to achieve an in sano excision and must recover the defect with the less aesthetic consequences. The aim of this work is to combine and to get-at-able the recommandations of the "Haute Autorité de santé" of 2004, and also to supply some details for the clinical practice of the plastic surgeon.