The role of endothelin production and sensitivity in the no-reflow phenomenon of vascularized bone grafts

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

The role of endothelin production and sensitivity in the no-reflow phenomenon of vascularized bone grafts

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Evolution of surgical techniques for skin releases in the treatment of simple congenital syndactyly: A review

Since the first publications in the early nineteenth century on surgical techniques for releasing congenital syndactyly, this pathology has received constant interest in the medical literature. Current techniques for separating syndactylized digits include three major steps that are discussed separately: commissure reconstruction, digital incision and ways to overcome the lack of skin. The use of the recently described commissural flaps - usually larger and more proximally-raised than conventional flaps - that allow for closure without a skin graft is discussed, based on the personal experience of the authors.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Congenital syndactyly: Defatting facilitates closure without skin graft

We attempted to correct 24 syndactylies without skin grafts in 16 consecutive patients. Digital volume was decreased by defatting the full length of the fingers and the interdigital space. Closure of the zigzag incisions on both fingers could then be achieved with minimal tension and did not seem to be related to the type of flap used for commissure resurfacing. We used 2 different types of flap closure. We noted that defatting was a more important determinant of whether the wound could be closed without graft than flap configuration. The new type of flap may represent an improvement for web appearance but is not a determination for finger closure. Only a complex syndactyly involving 3 adjacent atrophied fingers required a skin graft for separation. The results were evaluated after a mean follow-up period of 22 months. Three patients had a complication: an intraoperative digital nerve laceration, a scar contracture, and a recurrence of the treated commissure due to local infection. Two patients needed another surgical procedure. Supple and good quality scars were observed in the other patients. No conspicuous change in finger contour compared with the nonsyndactylized fingers was observed. Copyright © 2001 by the American Society for Surgery of the Hand.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Evaluation of the donor site morbidity after lateral arm flap with skin paddle extending over the elbow joint

The free lateral arm flap may be extended to include the skin over the lateral aspect of the elbow and the forearm. However, extending the flap beyond the lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the lateral aspect of the elbow joint. Seventeen consecutive lateral arm flaps with a skin paddle designed over the elbow joint were performed for different indications. Eleven patients were followed up postoperatively for a minimum of 6 months. The range of motion, torque, power and endurance of the elbow joint were recorded using a Cybex 340 isometric dynamometer. The values of the operated elbow were compared to those of the unoperated elbow and the deficits were expressed in percentages. The touch sensation in the territory of the posterior cutaneous nerve of the forearm was assessed using Semmes-Weinstein monofilaments. Patient satisfaction was evaluated with a self-assessment scale. The donor site scar was stretched in one patient. No patient complained of elbow pain or cold intolerance. Elbow mobility was not significantly affected by flap harvesting (P = 0.06). An extension deficit of 4% was found in four patients. The mean torque, power and endurance deficits were 7.3%, 7.5% and 4.4% respectively as compared to the contralateral side. Complete loss of sensation was not present in any of the donor sites. However, an area of hypoaesthesia with a mean size of 45 cm2 (range 20-75 cm2) was found on the posterolateral surface of the forearm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the lateral arm flap over the lateral condyle. (C) 2000 The British Association of Plastic Surgeons.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Distally planned lateral arm flap

The lateral arm flap presents some drawbacks: the vascular pedicle is short (2-6 cm), and the flap is rather thick. An anastomotic network between the posterior radial collateral artery and the recurrent radial artery, demonstrated by our previous anatomical dissections, enables one to locate the skin paddle solely over the epicondylar region and the proximal forearm. Furthermore, since no skin is harvested over the lateral aspect of the arm, a random-type vascularisation for the distal skin can be excluded. This modification increases pedicle length up to 100% and limits the amount of subcutaneous fat. A series of 13 consecutive distally based lateral arm flaps was performed, and eight patients were followed up for a minimum of 12 months postoperatively. Flap size ranged from 8 x 5.5 cm to 23 x 7 cm (average, 14 x 6 cm), and pedicle length ranged from 9 to 14 cm (average, 10.5 cm). No venous grafts were needed. The mean flap harvesting time was 60 minutes. All the donor sites were closed primarily. One flap suffered from an arterial thrombosis and only partially survived, and another healed uneventfully after successful re-exploration of a venous thrombosis. Only one flap had to be partially debulked. The donor site scar was enlarged in one patient. Elbow mobility was unaffected by surgery. Patient self-assessment on the appearance of both the reconstruction and the donor site showed a high satiSfaction rate. The distally planned lateral arm flap presents decreased bulk and a longer pedicle when compared with the classical lateral arm flap with no added technical difficulties or morbidity.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

The distally planned lateral arm flap in hand reconstruction

The lateral arm flap is a versatile free flap with straightforward dissection and low donor site morbidity. However, it presents some drawbacks: the vascular pedicle is relatively short (2-6 cm), and the flap is rather thick. Further surgery is often needed to decrease flap volume. An anastomotic network between the posterior collateral radial artery and the recurrent radial artery allows the skin paddle to be safety located over the epicondylar region and proximal forearm. This modification increases pedicle length up to 100% and limits the amount of subcutaneous fat. A series of eight consecutive distally planned lateral arm flaps used for hand reconstruction is presented. The medical records and operative notes were reviewed. Six patients were reviewed. The minimum follow-up was six months. Flap size ranged from 11 x 5.5 cm to 23 x 7 cm (average 15 x 6 cm), pedicle length ranged from 8 to 10 cm (average 9 cm), no venous grafts were needed for the microanastomosis. The mean flap harvesting time was 50 minutes. All donor sites were closed primarily. All flaps survived totally despite postoperative arterial thrombosis in one case that was salvaged by a skin graft over the surviving fascia. To date, no further surgery was needed to debulk the flaps. The donor site scar was enlarged in one patient. Elbow mobility was unaffected by surgery. Patient self- assessment of appearance of both reconstruction and donor site showed a high satisfaction rate. The distally planned lateral arm flap presents decreased bulk and a longer pedicle than the classical lateral arm flap with no added technical difficulties.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

The distally based lateral arm flap for intraoral soft tissue reconstruction

Background: The radial forearm flap is probably the most frequently used among free flaps for intraoral soft tissue reconstruction. However, this flap is not always available. The other fasciocutaneous flaps may be too bulky or less pliable or may have a short vascular pedicle; their use is therefore less than ideal. We present a variant of the lateral arm flap located distally to the lateral epicondyle and having the same advantages as the radial forearm flap. Methods: Vascular study (dissection and radiography) was previously undertaken to determine the vascular anastomotic network in the epicondylar area, between the posterior radial collateral artery and recurrent arteries running in front of the lateral epicondyle. This demonstrated the possibility of taking a skin paddle on and below the lateral epicondyle, based on the proximal pedicle. Results: We used this flap on three patients for intraoral soft tissue reconstruction (tonsil, floor of the mouth, and piriform sinus). No complication with the flap itself was encountered. In all cases, direct closure of the donor site was possible, with no local complication. Conclusion: The distal lateral arm flap (LAF) represents an interesting and reliable alternative to the fasciocutaneous radial forearm flap. The positioning of the skin paddle over the lateral epicondyle and the proximal third of the lateral aspect of the forearm increases pedicle length, thus avoiding the use of vein grafts. Dissection is straightforward with a reliable vascular anatomy. Moreover, in this area, the limited amount of subcutaneous fatty tissue ensures easier placement and more pliability when compared with the standard LAF.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Le lambeau libre de grand droit abdominal dans la couverture des pertes de substance du membre inférieur.

The rectus abdominis is one of the free flaps available to reconstruct soft tissue defects of the lower limb. After a short description of anatomy and surgical technique we report 7 recent cases showing the versatility and reliability of this flap. It may be used to cover large soft tissue defects without functional or esthetic sequelae at the donor site.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Simultaneous bilateral facial reconstruction of a Barraquer-Simons lipodystrophy with free TRAM flaps

Barraquer-Simons lipodystrophy is a rare disorder of unknown origin characterized by a progressive atrophy of the subcutaneous fat of the upper part of the body. Renal disease with abnormalities of complement factors is the most frequent accompanying feature. A case is presented in which bilateral facial contour has been restored simultaneously with two deepithelialized TRAM flaps.SCOPUS: ar.jinfo:eu-repo/semantics/publishe