[Superficial ulnar artery while harvesting a radial forearm flap]. / Artère ulnaire superficielle, découverte fortuite lors du prélèvement d'un lambeau antébrachial radial.

Forearm vascular anatomical variations are common and may have complications during flaps harvesting. This article describes the presence of an ulnar superficial artery, revealed while harvesting a radial forearm flap. The prevalence of this anatomical variation is between 0.7 and 9.4%. It may have important consequences while covering loss of substance with a radial forearm flap. Unknown, there is a risk of vascular injury which may lead to distal ischemia of the upper limb. Preoperative diagnosis can anticipate this risk and harvest a fascio-cutaneous flap centered on a perforator of this artery.

[Reconstruction of an extensive endonasal chondromucosal defect with a composite graft]. / Reconstruction d'une perte de substance chondromuqueuse endonasale étendue par greffe composite.

INTRODUCTION: Reconstruction of an endonasal chondromucosal defect without skin defect is a rare event, which involves functional and esthetic outcomes. We report the original use of a composite graft, for the repair of an endonasal chondromucosal defect. OBSERVATION: A 57-year-old woman presented with extensive tissue loss after the complete resection of an arteriovenous malformation. The excision procedure removed a cartilaginous part of the dome, the lateral crus of the alar cartilage, and the adjacent mucosa. An auricular composite graft allowed for an effective reconstruction, with a very satisfactory result, in a single surgical step. DISCUSSION: Using an endonasal composite graft has rarely been reported even though there are few alternatives for the reconstruction of an endonasal chondromucosal defect.

[Hypertrophic adipose tissue transplantation secondary to a lipopenisculpture]. / Hypertrophie de greffon adipocytaire et lipopénosculpture: gestion d'une complication rare.

Reconstruction of the penile skin requires a functional and esthetically perfect result, combining a high degree of skin elasticity to allow regular erections and a satisfactory cosmetic appearance. Demand for cosmetic surgery penile augmentation continues to increase for several years. The surgical technique most commonly used is now widening and lengthening lipopenisculpture (LPS), combining an adipocyte graft to a section of the suspensory ligament of the penis. A patient who underwent LPS presented several years after a major hypertrophy of the adipocyte graft, making it impossible to have sexual activities, imposing to perform liposuction. This liposuction was being complicated by necrosis of the penile skin. Reconstruction was required and consisted of an unexpanded thin skin graft associated with artificial dermis. Through technical adaptation of the skin graft on the erect penis, the use of artificial dermis and external stabilization by negative pressure therapy, reconstruction of the penile skin provides excellent aesthetic and functional results. Finally, it is rarely reported in the literature complications of lipofilling like alteration of the aesthetic result after weight gain.

[Hypogastric abdominal wall reconstruction with a pedicled anterolateral thigh flap]. / Reconstruction d'une perte de substance de pleine épaisseur de la paroi abdominale sous-ombilicale par un lambeau fasciocutané antérolatéral de cuisse pédiculé.

Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia.

[Resurfacing of an ischial and trochanteric recurrent pressure sore by a pedicled fasciocutaneous anterolateral thigh flap]. / Couverture d'une escarre ischiatique et trochantérienne récidivante par un lambeau fasciocutané antérolatéral de cuisse pédiculée.

Ischial pressure sores, common in paraplegic patient, are the most difficult to treat, and poor prognosis associated with a high rate of postoperative recurrence. Many surgical techniques by muscular or myocutaneous flap coverage have been described. We report an original use of a fasciocutaneous pedicled anterolateral thigh (ALTp) flap for coverage of an ischial pressure sore combined with a trochanteric pressure sore, exceeded beyond any conventional therapeutic solution. A 45-year-old paraplegic patient suffered from a trochanteric and ischial pressure sore, which had already received coverage by a muscular flap of biceps femoris and gluteus maximus. At 1 year, the result is satisfactory, with good coverage without recurrence. The fasciocutaneous ALTp flap can be a solution to cover recurrent ischial pressure sores beyond conventional methods.

[Probable side effects caused by plethoryl. Common acute hepatitis, anicteric hepatitis, cirrhosis due to hypervitaminosis A, inflammatory arthralgias]. / Effets secondaires probablement dus au Pléthoryl. Hépatite aiguë habituelle, hépatite anictérique, cirrhose par hypervitaminose A, arthralgies inflammatoires.

Plethoryl is a combination of triatricol, cyclovalone and vitamin A normally prescribed in the treatment of hypercholesterolaemia. Four cases of side-effects most probably caused by this product are reported. They include: 1) a case of common acute hepatitis, 23 cases of which have already been published, with aggravation and reduced time-lapse after reintroduction; 2) a case of clinically silent but biochemically classical hepatitis; 3) a case of cirrhosis due to vitamin A toxicity; 4) a case of inflammatory arthralgias recurring after the same time-lag when the drug was reintroduced despite double doses and without clinical evidence of hepatitis. The last three side-effects have never been previously reported. The adverse reactions to Plethoryl almost always occur in the unofficial indications of the product, notably in the "treatment" of obesity.

[Apparently superficial epidermoid cancer of the esophagus: value of radiotherapy and electrocoagulation]. / Cancer épidermoïde apparemment superficiel de l'oesophage: intérêt de la radiothérapie et de l'électrocoagulation.

A 77 years old man has been treated by roentgenotherapy for an epidermoid carcinoma of the esophagus. The lesion extended from 24 to 37 cm of the arcades and did not modify roentgenographically the contraction of the muscular layer. This cancer has been heralded by inhalations when swallowing. An error of focusing of radiotherapy resulted in an under irradiation of the upper segment of the esophagus. At the same level a recurrency of the lesions has been treated by electrocoagulation under fibroscopy. The palliation was good but it did not prevent multiple recurrences. The remainder of the esophagus which received 60 Grays has been cured during the three years of follow-up. A second patient has a asymptomatic microcarcinoma at 32 cm. seemingly superficial and was cured by 60 Grays after a follow-up of seven years. External roentgenotherapy is compared to surgery and the use of local treatments as electrocoagulation, laser therapy and intraluminal roentgentherapy are discussed.

[Acute pancreatitis complicating biliary distomatosis caused by Fasciola hepatica in a patient with a choledochal diverticulum]. / Pancréatite aiguë compliquant une distomatose biliaire à Fasciola hepatica chez un patient porteur d'un diverticule cholédocien.

A 43 years old man presented with acute pancreatitis following 13 years of mild grade hepatic colitis and angiocholitis. The absence of visible gall stone evocated the possibility of millithiasis. The operation discovered a big and hard head of the pancreas and an hypertrophied choledocal mucous membrane and the microscopic analysis of bladder's bile, ova of Fasciola hepatica. A control opacification on the 7th day revealed an adult fluke and a small diverticulum which were not visible on the roentgenogram at the time of the operation. Seven infusions of 60 mg de dehydroemetin permitted to eliminate the fluke with only a peak of fever. The diagnostic, pathophysiologic and therapeutic implications are discussed.