[Use of a free antero-lateral thigh flap for two-stage reconstruction of a large thoracic defect]. / Utilisation du lambeau antéro-latéral de cuisse selon la technique du chausson aux pommes pour la couverture d'une large perte de substance thoracique.

In case of extremely large thoracic full-thickness defects where no pedicled flap is available, very large free flaps are sometimes the only options. Dealing with such full-thickness defects where failure of the flap could be lethal, Servant and al described the concept of "two stage free flap" using Latissimus Dorsi muscular or myocutaneous flap. We present a reconstruction of a wide right posterior trunk radionecrosis with exposure of an underlying infected prosthesis using this two-stage free flap strategy with a fasciocutaneous antero-lateral thigh flap.

[« Double flag ¼ flap nipple reconstruction. Clinical evaluation on 70 cases]. / Reconstruction mamelonnaire par lambeau en « double drapeau ¼. Évaluation clinique à propos de 70 cas.

BACKGROUND: Since 2004, we have chosen a nipple reconstruction with a "double flag" local flap. We have retrospectively assessed its results in the long term and identified the factors likely to influence them. METHODS: Seventy reconstructions have been analyzed through a subjective study and objective one through measures of size and the projection of the nipple. RESULTS: They were examined in an average of 15months. The result was found satisfying for 74% of the patients and 66% of the clinician. The diameter of new nipple was 12.6mm (less 1mm than controlateral). The average height was 4.9mm and an average projection ratio was 0.8 (between reconstructed and controlateral). The limit of satisfaction of the patients and of the surgeon corresponded to a 0.7 projection ratio. We observed 4% of complete necroses. CONCLUSIONS: These results, compared to those of the literature, are very encouraging. The tegument quality of the reconstructed breast has a great influence on that of the nipple.