[Our experiences with the frontal flap. Apropos of 105 cases]. / Notre expérience du lambeau frontal. A propos de 105 cas.

The plastic qualities and vascular reliability of the frontal flap have been widely used for reconstruction of facial tissue. We revised the files of 105 patients who had undergone surgical repair of facial tissue loss with frontal flaps. The epidemiology, etiology of the repaired tissue loss and indications for frontal flap as well as the various techniques were analyzed: 66.7% of the patients were over 60 years of age; 74% had ambulatory surgical repair; 54.4% of the repaired tissue losses were situated in the nasal region; 80% of the losses were due to tumoral formations. The median flap was the most widely used (23.2%).

[Decubitus ulcers of the buttocks: our therapeutic approach in the course of the last ten years. Report of 32 cases]. / Les escarres fessières. Notre attitude thérapeutique au cours des dix dernières années. A propos de 32 cas.

The authors conducted a retrospective study of 80 cases of pressure sores of the pelvic girdle. This study was designed to evaluate the therapeutic approach, surgical reconstruction techniques and their results at 1 year. Only 32 patients (40%) underwent surgical reconstruction, always using regional pedicled myocutaneous flaps. 15.6% of these patients developed a local recurrence (5/32). Analysis of the results of this series shows that failures of reconstruction cannot be attributed to surgical techniques, but to their indications. The reduction of recurrences depends on earlier medical and surgical management and more rigorous patient selection, especially concerning psychological aspects. The patient's cooperation is an essential condition to the success of treatment.

[Cover of the Achilles tendon by peroneus brevis and flexor hallucis longus flaps. Apropos of 5 clinical cases]. / Le recouvrement du tendon calcanéen par les lambeaux de muscles court péronier et long fléchisseur de l'hallux. A propos de cinq cas cliniques.

Exposure of the Achilles tendon may be secondary to injury, trophic ulceration or surgical management of Achilles tendon rupture. We used peroneus brevis (PB) and flexor hallucis longus (FHL) muscle flaps to cover the Achilles tendon. The muscular portion of these muscles extends very distally, allowing their transposition to the Achilles region. PB and FHL are narrow (about 4 centimeters); the use of both muscles increases their possibilities of coverage. We used PB alone in one case and both muscles in four cases. In every case we obtained a good functional and cosmetic result. Various fascio-cutaneous flaps have been described for the reconstruction of the Achilles region. When there is an infection, muscle flaps are preferable to fascio-cutaneous flaps because they provide well vascularized tissue. We consequently suggest the use of PB and FHL to cover the Achilles tendon when it has been exposed for a long time or when it is infected. It seems especially indicated when skin necrosis occurs after surgical management of Achilles tendon rupture.

[Prognostic factors of survival in medullary cancers of the thyroid. Apropos of 51 cases. Clinical, biochemical and immunocytochemical study]. / Facteurs pronostiques de survie des cancers médullaires de la thyroïde. A propos de 51 cas. Etude clinique, biochimique et immuno-cytochimique.

The aim of this study was to assess the main clinical biochemical and immunocytochemical factors influencing survival in 51 patients operated for medullary thyroid carcinoma (MTC). There were 55% of women and 37% of familial cases. Mean age was 43 +/- 3 years. The following survival variables were tested: sex, age, stage, familial disease, Serum Carcino Embryonic Antigen (CEA) and Calcitonin (CT) levels three months postoperatively, intensity of CEA and CT immunostaining, percentage of cells stained for CEA and CT. The actuarial survival rate, including postoperative mortality (N = 1), was studied by uni and multivariate analysis using a Cox model (N = 31). The 5-year survival was 69 +/- 7%. By univariate analysis, stages I or II (p < 0.0001), age of 45 years and less (p < 0.0001), normalized CEA levels (p < 0.006), percentage of CT stained cells greater than 80% (p < 0.04) and weak CT and CEA staining (p < 0.02) were significant predictors of increased survival rates. Age less than 45 and stages I or II were significant prognostic factors of goof survival on multivariate analysis (p < 0.001). We conclude that clinical criteria constitute good survival prognostic factors in patients operated for MTC. The better prognosis of familial cases was probably related to their earlier detection. The prognostic value of immunostaining remains controversial and requires further studies.