[Musculocutaneoplasty by combined flap with tensor of the fascia lata- gluteus medius in trochanteric pressure sores. Apropos of a clinical case]. / Myocutanéoplastie par lambeau combiné tenseur du fascia lata-moyen fessier dans les escarres du grand trochanter. A propos d'un cas clinique.

The authors describe a musculocutaneous flap which can be used in trochanteric pressure sores in paraplegics. Described by Little and Lyons (1983), this reconstructive unit combines the proximal muscular segment of the tensor fasciae latae (TFL) and gluteus medius muscles in a round shaped flap pedicled on the lateral circumflex femoral artery. The anatomical basis of this muscle combination is found in the anastomotic network between the superior gluteal artery which supplies gluteus medius muscle and lateral circumflex femoral artery, the principal vascular pedicle of the TFL muscle. Cutaneous defects of the trochanter and associated osteitis are frequent complications in paraplegic patients which often require ostectomy and coverage of the bony prominence by well vascularised, padded skin. Musculocutaneous flaps are well suited for this purpose and we review various reconstructive units that may be brought into trochanteric defects. Among these, the gluteus medius-TFL flap appears to be an interesting option for, in case of recurrent ulcers, other donor areas are left intact, and the flap itself could give rise to a subsequent "traditional" TFL flap.

Pterygium colli: surgical treatment.

The authors report three cases of pterygium colli. Two of them presented as part of Turner's syndrome and were treated following a personal technique. The third, which was probably due to jugular lymphatic obstruction, was treated according to the butterfly excision technique of Shearin.

Congenital ring-constriction syndrome of the limbs; a report of 19 cases.

The authors report 19 cases of congenital ring-constriction syndrome of the limbs. Complications arose in eight of the pregnancies. The limb anomalies were always congenital ring-constrictions together with distal amputation. Moreover, 13 patients also had syndactyly and 15 associated anomalies were registered in 9 patients--8 of the limbs, 3 craniofacial and 4 visceral. One patient had a family history of hypospadias and cardiac malformation. Treatment usually required several operations, staged Z-plasty being the procedure of choice in surgical release of constriction bands. The acrosyndactylies were released early in life. More extensive fusions required division and skin grafting even if the webs did exist. The aetiology of the condition is still under discussion. The number of cases in the literature that cannot be explained by the exogenous theory of the congenital ring-constriction syndrome is increasing. Among them are four cases in our series.

The action of piracetam in ischaemic flaps.

The effects of piracetam on skin flap viability, capillary blood flow and temperature were studied in abdominal cutaneous flaps in rats. The drug significantly increased the viability of the distal (random) portion of the flap and this response was dose-related. Compared with controls, the area of skin necrosis was 12.4% less in the piracetam-treated animals and extended necrosis was not observed. Piracetam appeared to act by increasing the capillary blood flow, mainly in the distal portion of the flap. The improved perfusion was reflected as a smaller drop in the recorded temperature compared with controls. Blood levels of this drug in animals receiving the maximum effective dose corresponded to the active drug concentration in human rheology.

Study on the external fixator in the treatment of the fractures of the inferior end of the two bones of the adult's forearm. Report of fifty-five cases.

The authors report 55 cases of fracture with significant displacement of the distal end of the radius. In 30 cases, there were, moreover, lesions of adjacent bones and in 18 cases, lesions of the soft tissues. The fractures were treated by Hoffmann external fixator placed either immediately or later on, after the failure of conservative treatment. Thirty-four cases, reexamined within a period of at least six months, were used to show the results according to the criteria of Castaing. The overall results show 3 perfect results, 23 satisfactory ones and 8 quite satisfactory. The main complication of this series is frequent algodystrophy in the first cases. This has practically disappeared since much less traction is applied to the fracture site.

[Selective galactophorectomy: technic and indications]. / La galactophorectomie sélective: technique et indications.

The authors describe the way of operating the selective galactophorectomy and discuss the indications. Each pathological nipple discharge may reveal a carcinoma. The clinical characteristics of the discharge, the results of the cytology, of the mammography and the galactography help to come to a diagnosis. This can only be confirmed after a thorough histological examination of the involved duct. Selective galactophorectomy is a simple operation that hardly leaves any scars. According to the authors, this method has a real advantage to find the diagnosis and to treat pathological nipple discharge.