[Lipoid proteinosis: importance of dermabrasion. Apropos of a case]. / Lipoïdo-protéinose: intérêt de la dermabrasion. A propos d'un cas.

The authors report case of lipoid proteinosis. This is an autosomal recessive genetic disease involving the skin and mucous membranes. Skin lesions have a granular appearance, with infiltration and wrinkling of the skin, especially on the face. The authors show the success of dermabrasion on skin lesions on the face of a 21-year-old girl displaying typical symptoms of lipoid proteinosis.

[Emergency cover of open fractures of the leg. Apropos of a series of 24 clinical cases]. / Couverture en urgence des fractures ouvertes de jambe. A propos d'une série de 24 cas cliniques.

The authors present 24 emergency covering procedures for 24 open leg fractures: 6 free flaps and 18 pedicled flaps. The procedure was selected according to the site dimensions and topography of the defect. Topographically, the division of the leg into 3 zones: middle, upper and lower seems to be some what artificial because in practice the junction between the middle and lower segments is still a source of error in the choice of the local flap which can be used. It is preferable to use pedicled flaps in the proximal half of the tibia and free flaps in the distal half. Many failures were observed with the use of fascio-cutaneous flaps. 18 of 24 fractures were internally fixed, which allowed emergency covering. In fact, although bony covering can wait 48 hours, the presence of osteosynthesis material means that covering must be performed at the same time. This makes the plastic and microsurgical procedures easier and ensures greater patient comfort during the consolidation period and rehabilitation. The authors present their results according to the method of soft tissue coverage, their reliability, the type of osteosynthesis, the complications, number of operations and time to bony consolidation. Encouraged by their results, the authors continue with this approach.

[Treatment of extensive traumatic loss of substance of the foot and ankle by free flaps. Apropos of 7 clinical cases]. / Traitement des pertes de substance traumatiques étendues du pied et de la cheville par transferts libres. A propos de sept cas cliniques.

The authors report 7 cases of extensive skin defects of the foot and/or the ankle treated by using a free flap. All cases presented with major trauma of the lower limb with obvious exposure of bone and joint tissues. The skin defect was covered: as an emergency in 4 cases; within the 48 hours following the trauma in 3 cases; on the 7th day after the injury in 1 case. The free flap used was: the latissimus dorsi muscle, 2 cases; the gracilis muscle, 1 case; the serratus anterior muscle, 1 case; the greater omentum, 2 cases. Arterial microanastomoses were performed onto the anterior tibial or pedal arteries, in 4 cases, and onto the posterior tibial artery in 4 cases. Except for 1 failure on the 8th day after the operation due to thrombosis of the venous anastomosis, requiring arthrodesis of the ankle, the outcome was favorable in all other cases, free of osteitis or arthritis. The authors emphasize the importance of covering defects the lower limb as quickly as possible, ideally as an emergency, when a free flap is required.

[Place of microvascularized tissue transplants in emergency treatment of multiple trauma of the limbs. Excluding reimplantation]. / Place des transferts tissulaires microvascularisés en urgence dans le traitement des traumatismes complexes des membres. En dehors des réimplantations.

When we evoked the indications of microsurgery in Traumatology, at first, we think reimplantations performed in emergency and also secondary management of soft tissues or complex defects. In fact, we resort to microsurgery in many other circumstances. Early microsurgical reconstruction of complex trauma of the extremities yield better results than delayed free flaps. In 7 cases, free flaps were performed on the lower extremities, in 2 cases on the upper extremities. Many advantages are credited with this offensive attitude which requires an appropriate organisation of the Departments of Traumatology, the intimate collaboration of surgeons called orthopedic or plastic surgeons, improperly divided by too administrative compartmentalization of the surgical specialties.

[Prospective study of the specific liability of the plastic surgeon]. / Etude prospective sur la responsabilité spécifique du chirurgien plasticien.

The authors of the article first pose this question: might plastic surgery not fit into the general principles that guide any medical procedure? The general principles, especially as regards the distinction between liabilities in terms of means and liabilities in terms of results, are discussed in the first part of the survey. The authors then demonstrate that the plastic surgeon does differ from other surgeons: he has to comply with the same restraints as any surgeon. However, the survey then presents certain aspects specific to this branch of surgery, and their implications in terms of responsibilities. The article successively discusses: the patient's freedom of choice, the need for particularly thorough information and its form, the limits to the practitioner's freedom in choosing the technique, and most importantly the so-called obligation to avoid (which the authors study in particular detail in the field of analysis and responsibilities) of obviously useless operations. The authors, after recalling important recent legal precedents, come to the conclusion that it is necessary to establish an institution: "the medical ombundsman" defined by a bill in the 1988 sitting of the French Parliament.

[Augmentation rhinoplasty using bone graft. Technical aspects and therapeutic deductions]. / Rhinoplastie d'addition par greffe osseuse. Aspects techniques et déductions thérapeutiques.

Reviewing 45 cases of augmentation rhinoplasties with bone grafting the authors discuss some technical points and the choices of their indications: donor site, incision, patterns of graft implantation depending on clinical examination which selected the cases where exogenous material from the nose is needed for reconstruction. A columellar support seem to them necessary to correct collapsed noses and in these cases a mortise and tenon joint has been employed. When a pure saddle nose deformity exists, a biomaterial can be used reducing morbidity of an iliac bone graft.