[Composite tissues allotransplantation (CTA). Conclusions]. / Allotransplantation de tissus composites (ATC). Conclusions.

The author proves conclusions of that report on composite tissues allotransplantation (CTA). Cadaveric, functionnal and surgical anatomy has allowed the progress of reconstructive surgery since 30 years. It is an inventive, but always altruistic and emotional, reconstructive surgery which has allowed the progressiveness and expansion of CTA which is no more illusion but reality. The indications are and will remain exceptional. CTA's expansion remain dependent on progress of immunosuppressive drugs, and the actual research is turning towards immunologic allowance, induced chimerism and genetic mosaicism. In French, CTA is also Ethics and it is the only one case in the world, according to the lawful activity of the Ethics' advisory board.

[Social and anthropology considerations on the composite tissues allotransplantations (CTA). Excerpts from reading and analysis of a surgeon]. / Considérations socioanthropologiques sur les allotransplantations de tissus composites (ATC). Extraits de lecture et analyse d'un chirurgien.

The author is neither anthropologist nor invested in social activities. He has learned some reviews of anthropology and some social and philosophical books since seven years. He describe not a general review but an analysis of these lectures according to the composite tissues allotransplantations (CTA). The discussion concerns anthropology and symbols, philosophical and social aspects. There is a natural umbilicus between the anthropological science and the surgical art according to CTA.

[52th Commemoration of French Journal of Plastic Aesthetic Surgery (1956-2007). Fifty-four years of editorial; five Editors-in-chief]. / 52(e) Anniversaire des Annales de chirurgie plastique esthétique (1956-2007). Cinquante-quatre ans de rédaction; cinq rédacteurs en chef.

The french Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) is born December 3th 1952. Initially without "aesthetic", this "key-word" is agreed in 1983 and the symbols are advanced since: SFCPR, SFCPRE, SOF.CPRE. Its official organ, formerly included in Annales de chirurgie (1954-1955), become Annales de chirurgie plastique in 1956, Annales de chirurgie plastique et esthétique in 1983 and finally Annales de chirurgie plastique esthétique (ACPE) in 1992. Since the origin, five Editors-in-chief succeded: Claude Dufourmentel, Raymond Vilain, Jean-Pierre Lalardrie, Claude Lê-Quang, Jean-Luc Cariou. Four of them are alive, Raymond Vilain is dead. The author relate here the natural story of these five editors who had all a triple route: personnal, surgical and editorial.

[Experimental and clinical experience of composite tissues allotransplantation in reconstructive surgery]. / L'histoire expérimentale et clinique des allotransplantations de tissus composites en chirurgie reconstructrice.

Composite tissue allotransplantation (CTA) is a new concept in reconstructive surgery to improve major physical defects with no current solution. Although not a life-saving procedure, tissue replacement by CTA offers great potential for improving quality of life but relies on lifelong immunotherapy. This new practice has become achievable with the refinement of microsurgical techniques, with experience gained from limb and scalp replantations, with the development of organ transplantation and the release of new immunosuppressive drugs. Experimental and clinical research made it possible. The first human cases of CTA proved the reality and the feasibility of the concept. While the early functional results of these allografts are encouraging, they will need to be assessed in the long-term, and development of less toxic - more efficient immonu-suppressive drugs will be a permanent requisite to the broadening of CTA. Although long-term outcome and potential adverse effects of chronic immunosuppression remain uncertain, as for organ transplantation, CTA is already a potential solution for some highly selected patients carrying physical disabilities such as large facial defects and bilateral hand amputation.

[Microsurgery: History of instrumental vascular anastomoses, our experience with eversion-stapling using VCS forceps]. / Microchirurgie: passé, présent, futur... Histoire des anastomoses vasculaires instrumentales, expérience personnelle par éversion et agrafage par pince VCS.

One century, after Carrel in 1906, technics of vascular surgery are the same. After two world wars, peace surgery has been improved by war surgery. Microscopy surgery gave a new way for vascular surgery which became microsurgery with specific instrumentation. We have move from the developing period of microsurgery in the 1970s, to the fully matured period of microsurgery in the 1980s and the the development of clinical free flaps. The 1990s must be the turning point from autogenous tissue transplantation to allogenic transplantation. Ethic comity keeps keys of future! About microvascular anastomoses, many instrumental technics are explored but no-one is better than the classic manual suture. For us, the best instrumental technic is the anastomose with titanium clips VCS((R)) but we only use it in good situation without difficulties.

[Postoperative monitoring of free fibular grafts by dynamic magnetic resonance imaging. Preliminary results in three cases of mandibular reconstruction]. / Surveillance postopératoire des lambeaux libres osseux de péroné ou fibula par IRM dynamique. Résultats préliminaires à propos de trois cas en reconstruction mandibulaire.

The vascularized free fibular graft has been used in mandibular reconstructive surgery since 1975. This technique has been progressively developed, and it is now the procedure of choice for mandibular reconstruction although in certain postoperative circumstances it can be difficult if not impossible to monitor bone vitality. However, bone vascularization can be detected by dynamic magnetic resonance imaging (MRI), as this technique has been experimentally and clinically validated in the early diagnosis of osteonecrosis. The aim of this study was to evaluate the efficacy of MRI for the postoperative monitoring of vascularized free fibular grafts in human mandibular reconstruction. Dynamic contrast-enhanced MRI was used to study the variation in contrast over time following injection of gadolinium contrast medium, and to evaluate the degree of bone marrow perfusion of the fibular graft. This variation in signal intensity was visualized in the form of a curve, i.e., a perfusion curve for the bone marrow region. An examination was performed in three patients at different postoperative times and under different conditions. In one case, MRI confirmed the presence of fibula blood supply in spite of the necrosis of the adjacent fascio-adipose layer. In this article, the methodological difficulties have been discussed, particularly as regards data processing, and the present results have been compared with the findings in the literature. Dynamic MRI is a simple, reliable, non-invasive technique and its use in the postoperative monitoring of bone marrow perfusion and vascularized free fibular grafts permits a determination of the status of the latter following surgery, i.e., whether there is an adequate blood supply or not.

[Vascularized bone grafts in the treatment of hemifacial microsomia]. / Apports osseux microchirurgicaux et microsomie hémifaciale.

A systematic and theoretic review is performed on the vascularised bone donor sites that may be useful in the case of hemifacial microsomia. A review of the literature reveals that the iliac crest and the scapula are the most commonly used vascularised bone grafts. A case study is included in the paper, showing an hemifacial microsomia reconstruction using a composite fibular vascularised bone graft. They highlight the criterias they think fundamental for choosing the vascularised bone graft donor site regarding the aims of the reconstruction of a Pruzansky grade II or III.

[Facial artery. Embryological review, descriptive and functional anatomy based on a review of the literature]. / L'artère faciale. Rappel embryologique, anatomie descriptive et fonctionnelle d'après une revue de la littérature.

After a summary of the embryology and anatomy of the arterial blood supply of the face, the authors present the descriptive anatomy of the facial artery and its eight most frequent branches. Variations of the origin, course and division of the artery are then described. The literature contains 3 to 5 different descriptions of the course of the artery. The authors considered 4 of these descriptions to be relevant: I (angular), II (nasal), III (superior labial), IV (hypoplastic). Seventeen different branches have been described, many of which are inconstant. The superficial and deep anastomotic network is described, with emphasis on the subdermal network and that of the transverse facial artery. The various vascular regions of the face, first described by Mitz and Whetzel, are described. Based on these observations, and on Lasjaunias'theory of the triple hemodynamic balance, the authors propose a functional analysis of the arterial blood supply of the face. According to this analysis, the anatomic variations observed are determined by regional hemodynamic balances. These observations influence the design and creation of certain local facial flaps, such as the submental, nasolabial and buccinator flap. They may also influence present concepts concerning the hemodynamics of arteriovenous malformations of the face.

[Bone vascularization. Anatomic and physiological considerations, surgical deductions concerning osteosynthesis procedures and vascularized bone graft]. / La vascularisation osseuse. Considérations anatomiques et physiologiques, déductions chirurgicales quant aux ostéosynthèses et lambeaux libres osseux revascularisés.

The authors report some general considerations concerning the bony anatomy and the bone blood flow. They describe the vascularization of the long bones involving arteries, veins, capillaries and lymphatic vessels. The double systemic and local control of the bone blood flow is evaluated. The local factors are numerous: autoregulation, nervous regulation as well as humoral, metabolic and cellular factors. Some surgical deductions are then discussed concerning osteosynthesis procedures and biomechanical properties of vascularized bone grafts.

[The peroneal or fibular free flaps. Surgical anatomy, operative procedures and indications]. / Les transferts ou lambeaux libres de et avec péroné ou fibula. Anatomie chirurgicale, techniques de prélèvement et de préparation, indications.

The microsurgical story of the fibula began 25 years ago. The author reports on the vascular anatomy of the fibular free flaps, particularly the osseous, cutaneous and muscular branches of the fibular artery and their variations. This surgical anatomy explains the various osseous and composite flaps that can be harvested on the fibular vessels. The fibular flaps harvested on the anterior tibial vessels are used less often. The surgical procedure is explained about the typical osteocutaneous peroneal flap and the many other variations. The indications and results are discussed according to the international literature and the author's experience: 42 mandibular, 12 tibial, ten femoral, three radial, two humeral and one nasomaxillary reconstructions. The aetiological and topographical particularities, various abilities of the fibular donor site, preoperative strategy, bone implantation and contention, vascular anastomosis and delays of consolidation are analysed for each recipient site. The advantages and disadvantages of these fibular flaps are then discussed. Finally, the present and future associated procedures are evoked.

[Reconstruction of post-traumatic diaphyseal bone loss by segmental bone transfer]. / Comblement des pertes de substance osseuse post-traumatiques diaphysaires par transport osseux segmentaire.

Until the beginning of the 1980s, reconstruction of major post-traumatic diaphyseal bone loss as an alternative to amputation was possible only by massive autologous bone grafts. Such a technique was limited by the amount of available bone required for grafting. Ilizarov explained the distraction osteogenesis principle and designed a circular external fixation material that was suitable for compression-extension. He described the concept of segmental bone transfer, which allows bone regeneration to take place within the actual injured limb. Our present experience is based on the literature and the study of 12 cases. All patients presented with significant post-traumatic tibial bone loss ranging from 45 to 145 mm. In this article, we discuss the indications, benefits and risks of such a technique compared to classic methods. Mainly indicated in patients who have sustained significant bone loss, bone transfer is the method of choice for preserving bone stock and correcting limb discrepancy, although it does not reduce consolidation time. Moreover, circular external fixations are often poorly tolerated and may be replaced by unilateral devices that are easier to install.