Vascularized lymph node transfer with submental free flap

Limb lymphoedema is common in patients who have undergone inguinal or axillary lymph node dissection. Lymphoedema seriously impacts the patient's quality of life by inducing adipogenesis, fibrosis and repeated episodes of lymphangitis and cellulitis. Following failure of compression therapies, several curative or symptomatic surgical options have been proposed over recent decades, such as liposuction or lymphovenous anastomosis. Vascularized lymph node transfer techniques have recently been described, with promising results. Vascularized lymph node transfer with submental free flap appears to be the most reliable of these technique, associated with the lowest morbidity. The flap harvesting technique presents several specific differences compared to conventional submental free flap. A good knowledge of neck anatomy is essential and multimodal and multidisciplinary management is often required. In the light of a case report, we describe the basic submental free flap technique for vascularized lymph node transfer for the treatment of lower limb lymphoedema. This technique may be used by head and neck surgeons performing flap harvest, as well as plastic surgeon surgeons or gynaecologists ensuring long-term management of these patients

Prise en charge des escarres chez les patients traumatisés médullaires (revue de la littérature et mise à jour du projet personnel de soin au CHU de Toulouse)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

La reconstruction pelvi-périnéale (techniques classiques, étude anatomique préalable à l'utilisation clinique d'une technique nouvelle)

La reconstruction pelvi-périneale recouvre un nombre conséquent de situations cliniques et sollicite un large panel d'options techniques. Le chirurgien plasticien en tant qu'expert de la restauration cutanée est partie prenante dans le cadre d'une prise en charge multidisciplinaire impliquant aussi chirurgiens gynécologues, urologues ou digestifs. Un avant-propos recense les situations cliniques conduisant à une reconstruction périnéale. La première partie fera le point sur les multiples options de reconstruction exploitables dans cette région en organisant l'exposé en deux grands chapitres : Les techniques de resurfaçage pelvi-périneale, faisant suite à une exérèse superficielle où seul l'apport de peau est impératif. Les techniques de comblement, le plus souvent faisant suite à une exentération pelvienne qui rend nécessaire l'apport d'un tissu bien vascularisé dans une cavité généralement irradiée. La deuxième partie présente une étude anatomique d'un lambeau moderne utile dans les indications de resurfaçage pelvi-périneal : le lambeau antérolatéral de cuisse.TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

River self-organisation inhibits discharge control on waterfall migration

International audienceThe action of rivers within valleys is fundamentally important in controlling landscape morphology, and how it responds to tectonic or climate change. The response of landscapes to external forcing usually results in sequential changes to river long profiles and the upstream migration of waterfalls. Currently, models of this response assume a relationship between waterfall retreat rate and drainage area at the location of the waterfall. Using an experimental study, we show that this assumption has limited application. Due to a self-regulatory response of channel geometry to higher discharge through increasing channel width, the bed shear stress at the lip of the experimental waterfall remains almost constant, so there was no observed change in the upstream retreat rate despite an order of magnitude increase in discharge. Crucially, however, the strength of the bedrock material exhibits a clear control on the magnitude of the mean retreat rate, highlighting the importance of lithology in setting the rate at which landscapes respond to external forcing. As a result existing numerical models of landscape evolution that simulate the retreat of waterfalls as a function of drainage area with a fixed erodibility constant should be re-evaluated to consider spatial heterogeneity in erodibility and channel self-organisation

Fertility sparing technique during pelvic exenteration for recurrent vaginal rhabdomyosarcoma

We present the first case and describe the surgical technique of anterior pelvic exenteration with uterine preservation in a 17-year-old patient with a recurrent vaginal rhabdomyosarcoma.Surgical technique included a skeletonization of uterine pedicles and ligation of superior vesical and vaginal arteries, adapting abdominal radical trachelectomy technique. Cervix was transected to avoid vaginal opening and tumor spillage. Uterus was reimplanted to a vaginal reconstruction, created with a DIEP, and a continent urinary diversion was performed. Pelvic filling was completed with an omental J-flap.Postoperative course was uneventful and the patient was discharged at day 17th. The last days of her stay were dedicated to self-catheterization education and learning the management of Miami pouch. Her menstrual cycle resumed two months after the surgery. Cervix exhibited a normal appearance during clinical examination eight weeks after surgery and postoperative MRI did not show signs of local recurrence. Unfortunately, distant metastatic relapse occurred three months after surgery and the patient died two months later.Fertility preservation at the time of anterior pelvic exenteration is technically feasible in selected young patients. Further cases are needed to assess the reproducibility of this surgical procedure, the reproductive function of the uterus and the rate of uterine recurrences. Keywords: Uterine conservation, Conservative surgery, Genital tract rhabdomyosarcom

Structure and dynamics of Toll immunoreceptor activation in the mosquito Aedes aegypti.

Aedes aegypti has evolved to become an efficient vector for arboviruses but the mechanisms of host-pathogen tolerance are unknown. Immunoreceptor Toll and its ligand Spaetzle have undergone duplication which may allow neofunctionalization and adaptation. Here we present cryo-EM structures and biophysical characterisation of low affinity Toll5A complexes that display transient but specific interactions with Spaetzle1C, forming asymmetric complexes, with only one ligand clearly resolved. Loop structures of Spaetzle1C and Toll5A intercalate, temporarily bridging the receptor C-termini to promote signalling. By contrast unbound receptors form head-to-head homodimers that keep the juxtamembrane regions far apart in an inactive conformation. Interestingly the transcriptional signature of Spaetzle1C differs from other Spaetzle cytokines and controls genes involved in innate immunity, metabolism and tissue regeneration. Taken together our results explain how upregulation of Spaetzle1C in the midgut and Toll5A in the salivary gland shape the concomitant immune response

Management of tumor volume changes during preoperative radiotherapy for extremity soft tissue sarcoma: a new strategy of adaptive radiotherapy

Using adaptive radiotherapy (ART), to determine objective clinical criteria that identify extremity soft tissue sarcoma (ESTS) patients requiring adaptation of their preoperative radiotherapy (RT) plan