[Breast reconstruction by latissimus dorsi flap: Towards an evolution of ideas]. / Reconstruction mammaire par lambeau de grand dorsal: vers une évolution des idées.

AIM OF THE STUDY: Breast reconstruction with latissimus dorsi flap and fat grafting is a technique widely used in current practice. Some operators still complain at the lack of final results at the first intervention and the need for repeated lipofilling sessions. The objective of this study was to compare the number of reoperations in patients who underwent reconstruction with latissimus dorsi with prosthesis versus without prosthesis. PATIENTS AND METHODS: We included all patients operated for breast reconstruction with latissimus dorsi flap, with or without prosthesis between 2008 and 2012 in our center. We noted the number of new surgical interventions in these patients on the reconstructed breast. We also noted the average weight of mastectomy in two groups each year. RESULTS: One hundred and eighty-six patients were included in this study. Ninety-one patients underwent reconstruction with latissimus dorsi and prosthesis, and 95 patients reconstruction by latissimus dorsi and fat graft. It has not been demonstrated significant differences in the number of new surgical procedures between the two groups. The average weight of mastectomies in the autologous group has steadily increased over the five years. There was no significant difference in the average weight of mastectomies between the two groups over the last two years. CONCLUSION: For breast reconstruction with latissimus dorsi flap, surgical indications changed in our center to the absence of prosthetic implant, whatever the volume of the breast.

[Increasing the reliability of SIEA flap using peroperative fluorescent angiography with indocyanine green in breast reconstruction]. / Fiabilisation du lambeau de SIEA par angiographie fluorescente peropératoire au vert d'indocyanine en reconstruction mammaire.

UNLABELLED: The lower abdominal skin and fat have become a standard for breast reconstruction. For 30 years, techniques have evolved, seeking to reduce the morbidity while increasing the reliability of the flap. The Superficial Inferior Epigastric flap Artery (SIEA) spares the abdominal fascia and provides a very satisfying autologous breast reconstruction. However, the pedicle of this flap and its angiosome exhibit a considerable variability, making its use less reliable than other abdominal flaps. MATERIAL: The Indocyanine green (ICG) is soluble dye. When illuminated by an near-infrared light, the ICG emits fluorescence that is not trapped by the skin. A single device (Photo Dynamic Eye(®)) provides the emission of the near-infrared light and the reception of the fluorescence. It provides therefore a simple and efficient intraoperative real-time surface angiographic imaging. SURGICAL PROTOCOL: After dissecting the superficial inferior epigastric vessels, the abdominal flap was harvested from the abdominal wall preserving one perforator arising from the deep inferior epigastric vessels. The perforator was then clamped, and the vascular territory of the SEIA artery was visualized using laser-induced fluorescence of the indocyanine green. The surgical technique was modified depending on the indication for surgery and the result of perfusion measurements. RESULTS: The authors present four clinical cases of breast reconstruction with SIEA to illustrate this procedure. CONCLUSION: The SIEA flap is another surgical technique to achieve autologous breast reconstruction without abdominal morbidity or muscular dissection. Intraoperative angiographic imaging with ICG makes this flap more reliable.

[Salvage of infected prosthesis in breast reconstruction: About seven consecutive cases]. / Sauvetage de prothèses en reconstruction mammaire : à propos de sept cas consécutifs.

UNLABELLED: In breast reconstruction, periprosthetic infection is one of the most feared complications. Treatment is not clearly defined. The classical recommendation mandates implant removal and antibiotic treatment before a 3- to 6-month delayed reimplantation. This approach may compromise the final result. PATIENTS AND METHOD: The authors present a series of seven consecutive infected implants early "salvages" in six patients over 304 implants during a period ranging from February 2008 to October 2009, All patients were operated using the same protocol: implant removal, irrigation with 6l of saline, implant replacement, antibiotic treatment for staphylococcus during 3 weeks. RESULTS: The seven infections were treated successfully. No recurrent infection was found with a mean follow-up of 16 months. One case of Baker III capsular contracture is noticed. Cosmetic results were moderate in one case, and satisfying or very satisfying in six cases. CONCLUSIONS: In case of periprosthetic infection without sign of severity or skin necrosis, abundant irrigation and implant salvage is an effective alternative to implant removal.

[The skin overlying the sentinel lymph node: a full thickness skin graft donor site after local excision for cutaneous melanoma]. / Prélèvement de greffe de peau totale en regard du ganglion sentinelle : un site donneur préférentiel après exérèse de mélanomes cutanés. A propos de 16 cas.

Wound defects resulting from wide local excision for cutaneous melanoma, can require the use of skin graft for closure. Harvesting the skin graft can result in an additional morbidity. The increasing use of sentinel lymph node biopsy in cutaneous melanoma allows us the development of an alternative technique for obtaining donor skin. This method utilizes the skin overlying the sentinel lymph node as the skin graft donor site. Sixteen patients with cutaneous melanoma over than 1 mm of Breslow index, underwent wide local excision with sentinel lymph node biopsy and full thickness skin graft harvested from the node biopsy site. After a median follow-up of 18 months, there were no graft failure, one case of lymph swelling was relieved in the donor site. There were no melanoma recurrence and no metastasis. One case of in transit metastasis was treated by local excision and suture. In cases were primary closure is not feasible or cosmetically unfavourable, the use of the sentinel lymph node site as a skin graft donor, provides an alternative technique sparing the patient an additional skin graft donor site defect.