[Coverage an irradiated wound of the lower lumbar area with a latissimus dorsi musculocutaneous free flap by lengthening the vascular pedicle with interpositional vein grafts]. / Couverture d'une radionécrose lombaire par lambeau libre musculocutané de grand dorsal avec allongement pédiculaire par greffons veineux.

Reconstruction of radionecrosis of the lower lumbar area is a challenging problem because of the difficulty of mobilization of the irradiated local tissues, absence of a reliable locoregional procedures and prolongation of the receiving vessels of the free flaps. The ideal treatment is a wide excision of the irradiated tissues and an immediate reconstruction in one step, which is better to be done by using a musculocutaneous flap. The latissimus dorsi musculocutaneous flap is ideal for this indication. The authors prefer to do the revascularization of the latissimus dorsi flap by its'thoracodorsal pedicle because of the possibility to have a high pressure blood flow which allow to use long venous bypass, the exposure of the recipient vessels at the same time of dissecting the flap and to have the anastamosis site away from the irradiated tissue. The authors are presenting their experience in treating a case of radionecrosis in the lower lumbar region with exposed vertebrae by a latissimus dorsi musculocutaneous free flap with exposed vertebrae by a latissimus dorsi musculocutaneous free flap with the lengthening of its'pedicle by two 30 cm interposition saphenous vein grafts.

Microsurgical lip replantation: evaluation of functional and aesthetic results of three cases.

Lip amputations are rare, and microsurgical replantation must be systematically tried to restore form and function in one step. The authors present a series of three cases. Revascularization of the amputated segment was obtained by arterial anastomosis with the corresponding labial coronary artery. No venous anastomosis was carried out, because no vein could be identified. Venous drainage was obtained by inducing bleeding and by postoperative application of leeches for 6 days. Anticoagulant therapy and antibiotherapy were used for 10 days. With this approach, two lip amputations were completely saved, and a third amputation only suffered partial necrosis. Aesthetic and functional results were evaluated as being good, with reestablishment of labial continence and recovery of protective sensitivity.

[Value of pulsed color Doppler before transverse rectus abdominis musculocutaneous flap breast reconstruction. 45 cases]. / Apport du Doppler pulsé couleur avant reconstruction mammaire par lambeau myocutané de grand droit de l'abdomen. A propos de 45 cas.

The transverse rectus abdominis musculocutaneous TRAM flap is an interesting alternative for breast reconstruction after mastectomy for cancer disease in patients who refuse mammary prosthesis and when the clinical situation allows it. There is however a risk of unpredictable partial necrosis even after rigorous surgical procedure. Some authors have proposed a Doppler evaluation before reconstruction surgery to better identify the vascular network and optimize patient selection. We performed a preliminary study in 45 patients between January 1996 and December 1999. An echo-Doppler Ultramark 9 HDI (Advanced Technology Laboratories) equipped with a high frequency (10 MHz) linear probe was used to compare blood flow and vessel caliber in the superior epigastric artery and the perforating vessels (number, localization, peak flow). The results obtained in this series could be used to determine indications for TRAM flap with or without delay procedure.