Use of osteomuscular free flaps after extended maxillectomy and craniofacial resection. About two cases.

A composite free flap with the lower part of the scapula and the serratus muscle has been used in two clinical cases for reconstruction after extensive maxillectomy and craniofacial resection. The palatal defect was reconstructed with the lower part of the scapular bone and the bone and the serratus muscle was used to restore facial contour. This type of osteomuscular free flap based on the thoracodorsal artery and veins provides a one-stage reconstruction of complex facial defects, including bone and soft tissue. The main advantages of this flap are the configuration of its bony component that closely matches the hard palate and its versatility that allows other regional flaps such as the latissimus dorsi and/or the serratus to be raised on the same vascular pedicle.

[Polydactyly]. / La polydactylie.

Polydactyly is one of the hand's most frequent congenital deformities. Classification of this deformity distinguishes radial or thumb duplication, central duplication that is almost constantly associated with syndactyly (called polysyndactyly) and ulnar duplication. The latter is important especially in caucasian people because it can be part of a syndrome. Surgical techniques are briefly mentioned for the different forms.

Indications and results of skin flaps in painful digital neuroma.

Of the many procedures for treating painful neuromas, resection and proximal translocation are the most usual techniques, but these can decrease distal sensibility increasing deafferentation pain. In cases of intricate pain (nociception plus deafferentation), certain types of flaps allow the treatment of both components of the pain. We have used 30 such flaps in 28 patients: local flaps (exchange, advancement or lasso island flaps) and distant flaps (free "custom-made" toe flaps). The results of the different techniques provides 86.6% excellent or good results.

[Neuritis and neuroma of the sensory branches of the radial nerve. Apropos of 44 cases]. / Névrites et névromes des branches sensitives du nerf radial. A propos de quarante-quatre cas.

The authors present a series of 44 cases of sensory disorders in the radial nerve territory. Eighteen cases of pure painful neuromata gave, excellent results according to Herndon criteria in 11 cases with various techniques. Wartenberg neuritis (22 cases) was found to respond favorably to conservative treatment in the majority of cases (19 cases). A legal problem can arise from association with De Quervain disease if the condition has not been recognized before surgical release of the first compartment. Finally 9 cases are presented with intricate pathology of neuroma plus neuritis. Treatment addressing both conditions provided good results.

Amputation in elderly and high-risk vascular patients.

Fifty-eight patients underwent lower limb amputation for arterial disease over a 30-month period. Mean age of the patients was 72 years. Cardiopulmonary and metabolic risk factors were present in the majority of the patients. Postoperative one-year and three-year mortality rates were 24, 40, and 76%, respectively. Contralateral amputation was required in one-third of the patients after a mean period of eight months. Only younger and healthier patients returned to a meaningful social life after appropriate prosthetic fitting. In view of the high mortality and morbidity rates, above-knee amputation seems a better choice than below-knee amputation in these elderly and high-risk patients.

Vertical hemipharyngolaryngectomy: reconstruction with the radial forearm free flap.

A considerable body of literature defines techniques to restore glottic function after partial laryngectomy. The authors of this paper describe a new original technique for glottic and hypopharyngeal reconstruction after vertical hemipharyngolaryngectomy. Using a radial forearm free flap including the tendon of the palmaris longus and a sensitive branch of the radial nerve, they were able to reconstruct the missing vocal cord and a pyriform fossa. This procedure permits an extended resection without the usual phonatory or swallowing inconveniences. There is no contraindication for postoperative radiotherapy. The technique and preliminary functional results are reported.

Free and pedicled flaps for head and neck reconstruction in radically irradiated fields: 6 years' experience at the Jules Bordet Institute.

From 1982 to 1988, 127 flaps were performed after ablative surgery for head and neck squamous cell carcinoma: 86 pedicled pectoralis major island and 41 free flaps of different types. One hundred and four were evaluable for this retrospective study: 66 after definitive radiotherapy (6000-8000 cGy) and surgery for recurrent or persistent disease and 38 after elective surgery for Stage III and IV tumors without previous irradiation. Wound healing, hospital stay, survival rate and complications are compared between irradiated and nonirradiated areas. The indications, advantages and disadvantages of each type of flap are reviewed according to the main goals of our treatment: i.e. local disease control, restoration of function, cosmetic appearance and short hospital stay.

[Role of orthosis in the treatment of stiffness of the hand]. / Le rôle de l'orthèse dans le traitement des raideurs de la main.

The statistical analysis of results obtained with splinting treatment of finger and hand stiffness, and derived from a series of 635 motion range measurements taken on 249 hand joints, provided us with sufficient data to identify the various factors likely to have an impact on the therapeutic outcome. A mean increase of 25.8% in the range of movements is enough to justify the use of orthosis, although this figure actually varies substantially with the patient's age, the duration of the stiffness, the latter's degree and origin, the joint involved, and the duration of the orthotic treatment. An analysis of the time factor enabled us to establish the date beyond which changes for recovery are quite limited, whereby allowing to schedule surgical mobilization.

Influence of stress on epithelial cell proliferation in the gut mucosa of rats.

Wistar rats were stressed by immobilization in a cold environment during either 2 or 12 h. The animals were killed 1 h after intraperitoneal injection of 3H-thymidine and autoradiography was used. The proliferative parameters were estimated in the mucosa of the stomach after the 2-hour stress period. After the 12-hour stress period, labeling and mitotic indices were measured in the gastric mucosa as well as in the antrum, duodenum, ileum, colon and epidermis. The stress period of 2 h did not induce significant changes of the proliferative parameters in the mucosa of the stomach whereas cell proliferation was significantly inhibited in all examined tissues, including the skin, after the 12-hour stress period. Gastric hemorrhagic lesions were observed only in the oxyntic part of the stomach and occurred as early as 2 h after stress despite there was no change in the proliferative parameters at this time. The lesions became more obvious after the 12-hour stress period. Our observations indicate that inhibition of cell renewal by stress is not the mechanism by which stress erosions develop in the digestive mucosa.