[Pelvic filling and perineal reconstruction using longissimus dorsalis myocutaneous flap after total pelvic exenteration]. / Comblement pelvien et reconstruction périnéale après exentération pelvienne totale par un lambeau libre myocutané de grand dorsal.

AIM: The study aim was to report an original technique for pelvic cavity filling and perineal floor reconstruction with longissimus dorsalis myocutaneous free flap after total pelvic exenteration and extensive perineumectomy. PATIENTS AND METHOD: This technique was used in three patients, two men and one women (mean age: 53.3 years) after total pelvic exenteration for recurrent carcinoma of the bladder and/or prostate (n = 1), recurrent rectal carcinoma (n = 1) and extended vulvar carcinoma (n = 1). In this female patient, who required an extended perineal resection, it was necessary to use a bilateral flap, but a unilateral flap is usually sufficient. The vessels of the flap were connected with the femoral vessels in the Scarpa's triangle by a manual microanastomosis. RESULTS: The postoperative course was uneventful except for one patient who had an hemorrhage unrelated to the technique. One patient died after 13 months of septic complications and the two other patients were alive after 6 and 7 months. CONCLUSION: The use of longissimus dorsalis myocutaneous free flap is a suitable procedure in order to fill the pelvic cavity and restore the perineal skin after a total pelvic exenteration with large perineal resection. Further experience is necessary to confirm these first attempts.

[Intraoperative abdominopelvic radiotherapy by single dose electrons]. / Radiothérapie abdomino-pelvienne per-opératoire par électrons à dose unique.

Thirty-four patients received, during laparotomy, a 15-20 Gy localized irradiation from a 10-13 MeV beam of electrons supplied by a linear accelerator and focalized by means of a localizer especially designed for this purpose. This technique is indicated for localized residual tumours of the pelvis and intra-operative irradiation of the lumbar aorta, as part of a chemo-radiotherapeutic programme in patients with advanced cancer of the cervix. It is too early to evaluate the medium-term results, but the technique is very well tolerated immediately.

[Operative mortality and morbidity in pelvic exenteration. Technical aspects]. / Mortalité et morbidité opératoires dans les exentérations pelviennes. Aspects techniques.

Postoperative complications in a continuous series of 23 pelvic exenterations for female genital tumor are analyzed, together with specific technical improvements capable of reducing morbidity and mortality of this major surgery. Emphasis is placed on the use of automatic suturing to improve hemostasis and to facilitate performance of digestive anastomoses. The preferred urinary bypass operation is ureterosigmoidostomy into an excluded loop, cutaneous ureterostomy being reserved for patients in a poor general condition. The only satisfactory procedure for filling of the pelviperineal cavity appears to be internal epiploplasty combined with perineal reconstruction by means of a musculus gracilis flap, which also allows the confection of a new vaginal cavity.

[Gracilis muscle flaps for covering losses of perineal substance in cancer surgery]. / Les lambeaux de droit interne dans la couverture des pertes de substance périnéale en chirurgie carcinologique.

Myocutaneous or purely muscular flaps were used in 14 patients after extended surgical excision in the perineal region. When taking out the flap, its one-pedicle and relatively weak blood supply must be taken into account. With this precaution, this technics can always be used for perineal resurfacing, particularly after total vulvectomy. In pelvic exenteration and amputation for anorectal cancer, it enables surgeons to fill the muscular gap, which seems to improve the post-operative course. It can also be used for vaginal, penile or sphincteric reconstruction.

[Role of the anesthetic consultation in an organization model of the anesthesia-resuscitation department]. / Place de la consultation d'anesthésie dans un modèle d'organisation de service d'anesthésie-réanimation.

The anaesthetic consultation is essential to give patients a sense of security. It should be organised taking into account the needs and resources of the department. In the light of the experience of the authors in an anti-cancer center, three main principles can be enumerated for this to be properly organised: the detachment of doctors from the surgical departments, a rotation in the department and a timetable for the consultations. The part played by the departments requesting help and the different secretarial offices is important. In this way one can anticipate and eliminate the improvisation which always occurs, to the detriment of the patient. Collaboration between the different departments involved is naturally indispensable. These general principles have beeen stated for at least a dozen or so years by a certain number of anaesthetists. It was quite easy to stranspose these principles and to adapt them to the organisation of the anti-cancer struggle. Such applications should be generalised.

[Valvular tube gastrostomy]. / Gastrostomie tubulée avec valve

Valvular tube gastrostomy was performed on 90 patients whose lesions necessitated permanent alimentary gastrostomy. 60 were cases of cancer of the oesophagus where the tumor could not be removed, and 30 were cancers of the oropharynx. 10 (11 p.cent) died within one month of surgery, but slackening of the sutures was an attributable cause in none of these cases. 4 succumbed to their cancer before the sixth month. The functional results of those surviving more than 6 months were examined: -- 75 p.cent had very good results; -- 17 p.cent had mediocre results, but feeding was still possible; -- 8 p.cent had bad results and a second operation was necessary.