Annales De Chirurgie Plastique Esthetique最新文献

Introduction: Fournier's gangrene is a severe infection of the perineum and genital regions, with high mortality rate. Treatment is medico-surgical and multidisciplinary, usually requiring extensive debridement of scrotal tissue and distant surgical reconstruction. Regarding scrotal reconstruction, numerous techniques have been described, however, to our knowledge, none has focused on testicular repositioning.

Case: We present the case of a 47-year-old patient treated for secondary Fournier's gangrene on post-traumatic colic fistula following a road traffic accident. We performed scrotal reconstruction using an ALT flap, with simultaneous positioning of testicular implants to create new lodges. In a second time, the testicular implants were removed and the previously buried testicles were repositioned in their new lodges, with bilateral orchidopexy.

Discussion: The anterolateral thigh flap has already been described for scrotal reconstruction. Its main advantages over a thin skin graft are partial innervation and more convincing aesthetic results, with notably less skin retraction. In addition, it allows a sufficiently large skin palette to be harvested, enabling satisfactory scrotal coverage.

Conclusion: Placement of 2 testicular implants during scrotal flap reconstruction after Fournier's gangrene enables the creation of testicular lodges, facilitating subsequent repositioning of previously buried testicles. This technique also ensures a satisfactory aesthetic and functional result.

Total nasal reconstruction represents a complex challenge, requiring restoration of all three anatomical planes while preserving respiratory function. This procedure has significant therapeutic, aesthetic, social and professional implications for patients. We share our academic experience of reconstruction using a folded microanastomosed radial forearm flap (FRFF) combined with a paramedian forehead flap, using the technique of F.J. Menick. We detail the technical aspects of this surgical approach, as well as the aesthetic results observed at the donor sites. In our single-center retrospective study, we analyzed 6 cases of total nasal reconstruction performed between January 2017 and January 2024. We assessed the typology of substance loss, types of reconstruction, and aesthetic results via the NAFEQ score at 6 months postoperatively. Among the cases, necrosis was observed (16%), occurring on the fourth day following thrombosis. Mean loss of substance was 5.5cm, with a mean NAFEQ functional score of 82% and aesthetic score of 88%. The FRFF reconstruction technique combined with LFP is optimal for total nose reconstructions, offering adequate cartilage projection and good nostril conformation.

Background: Unicortical plate fixation offers several theoretical advantages in the treatment of metacarpal shaft fractures compared to bicortical fixation. This approach avoids the potential hazard of excessive drilling into the volar cortex, thus minimizing damage to surrounding soft tissues and helping prevent complications related to improperly sized screws. These benefits prompted our team to conduct a preliminary clinical study to investigate the effectiveness and safety of this approach. In this study, we present our initial experience assessing the efficacy of utilizing unicortical plate fixation for treating metacarpal shaft fractures.

Methods: A retrospective study was conducted on patients who presented with transverse or short oblique displaced metacarpal shaft fractures and who underwent surgical intervention using unicortical plate fixation. The primary outcome measures assessed the union rate and total active motion (TAM), and the secondary outcomes included evaluations using the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), as well as complication rates.

Results: Thirteen patients with a median age of 35.2 years were included in this study. All patients in the study were followed for six months. All fractures achieved successful union (100%) in all patients, and the average TAM of the respective digit was 257.7° during the final follow-up period. The mean quick DASH score was 16.83±18.1 at the 6-month follow-up. There were no cases of implant failure in our series; however, one patient (7.69%) had a rotational deformity that necessitated corrective surgery.

Conclusion: Unicortical plating fixation is a safe and reliable alternative to the standard bicortical plating method for metacarpal shaft fractures. It offers comparable union rates and satisfactory outcomes.

Level of evidence: IV/therapeutic.

Phalloplasty is one of the most complex procedures in plastic surgery. The criteria for an ideal neophallus include an aesthetic and erogenous phallus that allows for sexual intercourse, with a functional neo-urethra enabling standing urination. The free forearm flap has become the gold standard for phallic reconstruction. Various modifications have been made to improve vascularization and reduce urinary complications, such as fistulas and urethral stenosis. Each design has its advantages and disadvantages, with the goal of minimizing functional and aesthetic sequelae in the donor area while achieving the most satisfactory result in the recipient area. Over the years, several prominent surgeons have proposed different forearm flap designs, always with the aim of improving outcomes and patient satisfaction.

Introduction: Vertical rectus abdominis myocutaneous (VRAM) flap is the most common option for large sacral defect reconstruction but is known to have donor-site abdominal morbidity compared to deep inferior epigastric perforator (DIEP) flaps.

Report: Fifty-seven and 63 year-old men were admitted for large sacral soft tissue defects after tumour excisions. They both underwent an inferiorly based pedicled vertical DIEP flap passed transabdominally with successful postoperative outcomes and not any abdominal wall complication.

Discussion: Since the introduction of perforator flaps, using DIEP flap allows reducing donor-site complication rate. These two cases are the first DIEP flaps in sacral defects coverage suggesting DIEP flap may be a reliable option with superiority due to low donor-site morbidity compared to the gold standard VRAM flap.

Introduction: Esophagus reconstruction could be complicated by leakage, stenosis or graft loss. Salvage surgery may be needed in case of failure of endoscopic treatment or large esophagus defect. Although free jejunal flap is admitted for salvage head and neck reconstruction, few reports assess the results of free jejunal interposition in salvage esophagus reconstruction. We undertook a systematic review whose primary aim is to investigate outcomes of secondary esophageal reconstruction with free jejunal flap in terms of mortality, complications and functional results.

Material and method: We conducted a systematic review of the literature according to the PRISMA 2020 statements searching PubMed and Scopus databases for articles assessing free jejunal flap for secondary reconstruction after failed esophagus reconstruction. References of included studies were also screened. Studies quality was assessed using the JBI Critical Appraisal tools.

Results: 562 studies were yielded through databases search and 328 studies were yielded through citations search. 18 articles were included in the systematic review corresponding to a total of 62 patients from 3 to 76 years old. All studies were level of evidence IV case reports or case series. We found that overall mortality was 3.2%, anastomotic fistula rate was 21%, anastomotic stricture rate was 4.8% and graft loss rate was 9.7% with survival of all jejunal regrafts. Solid oral intake was achieved in 93.0% of cases.

Conclusion: Jejunal free flap is a pertinent option for secondary esophageal reconstruction but remains a challenging surgery with high risk of complications that requires multidisciplinary team in large volume/tertiary care hospitals.

This clinical case report describes the reconstructive management of a child who developed a rare aggressive soft tissue infection - necrotizing fasciitis - complicating varicella skin lesions, with a synthetic dermal regenerative template - NovoSorb Biodegradable Temporizing Matrix - in conjunction with a split thickness meshed skin graft. The scarcity of this clinical case, the need to cover large skin defect promptly while facing infectious and pediatric challenges make it interesting to describe NovoSorb Biodegradable Temporizing Matrix in addition to split thickness meshed skin graft a novel treatment in necrotizing fasciitis of the child. A rapid surgical treatment followed by this reconstructive strategy achieved an acceptable functional and aesthetic result, with timely healing despite the severity and extensive surface area of the infection.

Background: Superficial leiomyosarcoma is a rare malignant soft tissue tumor arising from smooth muscle cells, accounting for 2-3% of superficial sarcomas, with limited literature available on the subject. It is typically observed in patients aged 50-60 years and affects both men and women equally in the subcutaneous subtype, whereas the cutaneous subtype predominantly affects men.

Objective: This study aims to examine the clinicopathological features and therapeutic outcomes of patients with leiomyosarcoma.

Method: This is a descriptive retrospective study of 26 cases of cutaneous and subcutaneous leiomyosarcomas, with histological confirmation.

Results: We identified 10 (38.5%) subcutaneous leiomyosarcomas and 16 (61.5%) cutaneous leiomyosarcomas. The majority of tumors were located in the lower limbs, accounting for 13 (50%) cases. During follow-up, 6 patients experienced recurrence, and 7 developed metastases, including 2 of the 7 patients who had R0 resection margins. Among these, 3 out of the 6 recurrent cases and 3 out of the 7 metastatic cases were subcutaneous leiomyosarcomas. The average time to recurrence was 6.2 years.

Conclusion: The observed risk of metastases and recurrences, despite clear surgical margins, in both cutaneous and subcutaneous leiomyosarcomas, along with the delayed onset of these events, justifies prolonged patient follow-up. The lungs, bones and liver have been identified as the most common site of metastasis.