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Les chordomes sacrés sont des tumeurs osseuses primitives rares, dont l'exérèse chirurgicale est le seul traitement permettant près de 50 % de rémissions à 10 ans, avec ou sans radiothérapie. À un stade évolué, la résection tumorale peut être importante et morbide, allant de la sacrectomie totale à l'amputation abdomino-périnéale. La reconstruction de ces défects fait alors appel le plus souvent aux lambeaux musculo-cutanés de grand fessier ou de grand droit de l'abdomen. Nous décrivons le cas d'une patiente ayant bénéficié d'une sacrectomie étendue avec amputation abdomino-périnéale pour un volumineux chordome avec la réalisation d'un lambeau perforant glutéal supérieur désépidermisé. Il s'agissait d'une patiente de 57 ans ayant eu une sacrectomie partielle avec amputation abdomino-périnéale. Le premier temps laparoscopique avait permis de disséquer un lambeau d'épiploon, de réaliser une colostomie terminale et de préparer l'exérèse finale lors du temps postérieur. Un lambeau perforant glutéal supérieur gauche désépidermisé fut prélevé dans le but de combler le défect, et d'apporter un soutien aux organes pelviens en recréant le mur abdominal postérieur. L'apport récent de la cœlioscopie dans l'exérèse chirurgicale a permis de diminuer considérablement la morbidité de l'intervention. Cependant, la plupart des reconstructions utilisent des lambeaux musculo-cutanés, notamment de grand droit et de grand fessier, à l'importance fonctionnelle notable, et dont les prélèvements vont à l'encontre de la démarche diminution de morbidité entreprise par les chirurgiens oncologues. Sacral chordomas are rare primary bone tumors and represent more than half of all primary malignant sacral tumors. Surgical resection is the only treatment with close to 50% of remission at 10 years, with or without radiotherapy. This tissue removal can be very extensive and morbid, particularly for evolved tumors. The reconstruction mostly uses myocutaneous flaps, notably the gluteus maximus flap and the latissimus dorsi flap, increasing morbidity of the surgical procedure. To avoid a muscular sacrifice and reduce the post-surgical morbidity, we describe the case of a patient who underwent a giant sacral chordoma resection and a reconstruction with a superior gluteal artery perforator flap. A 57-y.o. patient with a voluminous sacral chordoma had undergone a partial sacrectomy and abdomino-perineal resection. Firstly, a laparoscopy was realized to create a colostomy, to dissect an omental flap and to prepare the monobloc resection. In a prone position, the resection of the tumor was achieved and a de-epithelialized superior gluteal artery perforator flap was performed to fill the space and to support pelvic organs. For resections of sacral chordomas, coelioscopy has considerably reduced the surgical morbidity. However, the majority of reconstructions use myocutaneous flaps, specifically gluteus maximus and latissimus dorsi, which their postural function is considerable. Muscular sacrifice can lead to functional impotence with difficulty walking and standing up and run contrary to the diminution morbidity initiated by oncologic surgeons. [ABSTRACT FROM AUTHOR]

Résumé La reconstruction en carcinologie cervicofaciale est un challenge pour le chirurgien confronté au volume et à la diversité des tissus à reconstruire. Les larges defects oromandibulaires nécessitent non seulement un apport osseux, mais aussi de tissus mous pour la reconstruction pelvilinguale, ce qui impose le plus souvent, le prélèvement de deux lambeaux distincts dont un lambeau de fibula. L’option d’un lambeau unique chimérique prélevé sur l’artère fibulaire et ses branches est moins connue alors qu’il offre l’avantage de ne prélever qu’un seul lambeau tout en permettant de disposer de différentes palettes cutanées, musculaire et osseuse, indépendantes les unes des autres, et autorisant la reconstruction des différentes composantes de la perte de substance, parfois distantes les unes des autres. L’objectif de cet article est de décrire en détail la technique que nous employons pour prélever ce type de lambeau et partager cette méthode qui permet d’éviter un second lambeau libre. Summary Carcinological head and neck reconstruction still remains a challenge due to the volume and varied tissues needed. Large and wide oromandibular defects require, not just the bone but also soft tissues for the pelvilingual reconstruction and therefore, a second free flap may become necessary in addition to a fibular flap. The option of an unique chimeric flap based on the fibular artery and its branches is less known whereas it offers the advantage of a unique flap with bone, muscle and multiple skin paddles, independent of each other. The aim of this technical note is to present step by step the surgical procedure of this chimeric flap and share this method that avoids a second free flap. [ABSTRACT FROM AUTHOR]

Summary: By offering a new concept in tissue defect management, perforator flaps reduce morbidity of the donor site. The thoracodorsal perforator flap allows the harvesting of a cutaneous flap that can reach 15×25cm, by sparing the underlying muscle. Moreover, the postoperative strength of the latissimus dorsi does not seem to be affected and seroma is less frequent. We review the anatomical basis and the operative technique of this flap. For us, this flap is more suitable than its muscular homologous in several indications. [Copyright &y& Elsevier]

Summary: Flap surgery is the art of transposing an autonomous vascularised tissue, from a donor site to a distant recipient site. It was born 2000 years ago in India, evolving from random flaps to microsurgical flaps with a skeletonised vascular pedicle. This evolution was possible through the knowledge of cutaneous vascularisation and allows today the spreading field of perforator flaps. Writing the story of any particular flap is, in fact, looking back to understand the global concept and evolution of flaps surgery. Therefore the authors detail every step of the development and technical improvement of the thoracodorsal flap from the classical musculocutaneous latissimus dorsi flap to one of its latest achievement, the thoracodorsal perforator flap. This story helps us to appreciate the armamentarium of thin and low donor site morbidity flap that perforator flaps offer to us. [Copyright &y& Elsevier]

Summary: The perforator flaps are increasingly used in reconstructive surgery. Among their many applications, propeller perforator flap technique is one of the most recent. It allows any part of the body to become a potential donor site for a perforator flap based on the Doppler tracing. The shape of the flap is adapted bespoke then it is turned like a propeller up to 180° to fill the wound. The donor site is most often self-closing or grafted. We describe the principles, the operative technique and advantages of this method. [Copyright &y& Elsevier]

Summary Background Hidradenitis suppurativa is a very debilitating disease, treated by antibiotics and excision. The reconstruction is usually done by secondary wound healing and/or split-thichness skin graft. The aim of this study was to evaluate the reconstruction of the axilla with local perforator flaps as a single stage surgical treatment. Methods This was a monocentric retrospective study conducted between November 2013 and June 2015. We included the patients with a severe axillary localization of the disease. Between 6 months and 1 year postoperatively, we noted length of complete healing, complications, patients satisfaction score about the surgery, DASH functional score, maximum abduction angle of the arm, and recurrence of the disease. Results Thirteen patients were included, for a total of seventeen affected axillae. We performed seven thoracodorsal artery perforator flaps, seven lateral intercostal artery perforator flaps and three serratus anterior artery perforator flaps. The mean duration of follow-up was 279.1 ± 84.1 days (180–365). The average complete healing time was 20.5 ± 13.5 days (10–60). Six axillae were compounded (35%). The average recurrence rate of HS was 0%. The average score in the DASH questionnaire was 68.6 ± 35.3 points (39–152) and the average maximum abduction angle of the arm was 160.6 ± 18.5 degrees. The average score on the satisfaction questionnaire was 36.5 ± 5.6 points (25–43). Conclusion This is a single stage, reliable and effective surgical procedure. The results are very encouraging, with a good quality of life, a low functional disability and a shorter healing time. [ABSTRACT FROM AUTHOR]

Résumé Introduction Le lambeau médial sural perforant (medial sural artery perforator [MSAP] flap) est un lambeau cutanéo-graisseux, fin et malléable, prélevé aux dépens de la face médiale de la jambe. Ce lambeau est encore peu utilisé en France. L’objectif de ce travail, effectué à partir de dissections sur sujets anatomiques, est de rappeler les bases anatomiques et la technique chirurgicale de ce lambeau, et de proposer des indications en reconstruction cervicofaciale. Matériel et méthodes Nous avons disséqué 10 lambeaux MSAP sur 5 sujets anatomiques différents. Dans chaque cas, le nombre et la localisation des perforantes issues de l’artère surale médiale étaient enregistrés. Pour chaque lambeau, nous avons rapporté la longueur du pédicule, le calibre des vaisseaux à l’origine du pédicule ainsi que l’épaisseur du lambeau. Enfin, nous avons réalisé un cas clinique pour un trismus post-thérapeutique. Résultats Un total de 23 perforantes de calibre supérieur à 1 mm a été identifié sur les 10 jambes disséquées. L’artère surale médiale donnait 1 à 4 perforantes musculocutanées. Les perforantes étaient localisées en moyenne à 10,3 cm ± 2 cm du creux poplité et à 3,6 cm ± 1 cm de la ligne médiane du mollet. La longueur moyenne du pédicule était de 12,1 cm ± 2,5 cm. À l’origine du pédicule, l’artère mesurait en moyenne 1,8 mm ± 0,25 mm et les veines mesuraient en moyenne 2,45 mm ± 0,9 mm. Le cas clinique s’est déroulé sans complication avec le prélèvement d’un lambeau perforant sural médial droit. Discussion Cette étude confirme la constance de l’anatomie du lambeau médial sural perforant. Le lambeau MSAP est fin, malléable et particulièrement adaptée à la reconstruction des pertes de substance muqueuses de la cavité orale ou pour le « resurfaçage » de la face ou des extrémités. Les séquelles au niveau du site donneur sont moindres qu’avec le lambeau antébrachial radial pour des résultats fonctionnels équivalents en reconstruction cervicofaciale. Summary Introduction The medial sural artery perforator (MSAP) flap is defined as a thin cutaneo-adipose perforator flap harvested on the medial aspect of the leg. The aims of this study were to describe the anatomical basis as well as the surgical technique and discuss the indications in head and neck reconstructive surgery. Material and methods We harvested 10 MSAP flap on 5 fresh cadavers. For each case, the number and the location of the perforators were recorded. For each flap, the length of pedicle, the diameter of source vessels and the thickness of the flap were studied. Finally, we performed a clinical application of a MSAP flap. Results A total of 23 perforators with a diameter superior than 1 mm were dissected on 10 legs. The medial sural artery provided between 1 and 4 musculocutaneous perforators. Perforators were located in average at 10.3 cm ± 2 cm from the popliteal fossa and at 3.6 cm ± 1 cm from the median line of the calf. The mean pedicle length was 12.1 cm ± 2.5 cm. At its origin, the source artery diameter was 1.8 mm ± 0.25 mm and source veins diameters were 2.45 mm ± 0.9 mm in average. There was no complication in our clinical application. Discussion This study confirms the reliability of previous anatomical descriptions of the medial sural artery perforator flap. This flap was reported as thin and particularly adapted for oral cavity reconstruction and for facial or limb resurfacing. Sequelae might be reduced as compared to those of the radial forearm flap with comparable results. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: La couverture du talon impose au chirurgien la prise en compte de multiples paramètres concernant le type de perte de substance, les tissus exposés, la contrainte en charge du tissu reconstruit, la rançon du site donneur et enfin la forme du talon reconstruit permettant au mieux un chaussage et une vie normale. Bien que de nombreuses méthodes de couverture existent, elles sont souvent choisies au prix d’un compromis entre l’ensemble des paramètres décrits. Depuis quelques années, les lambeaux perforants libres freestyle offrent aux chirurgiens plasticiens une liberté inégalée pouvant s’adapter à la fois aux contraintes de la reconstruction et aux désirs de minimiser la rançon fonctionnelle et cicatricielle au site donneur. Patients et méthode: Nous présentons quatre cas de perte de substance du talon d’étiologies différentes traitées par trois types de lambeaux libres ű freestyle Ƈ sur mesure (ALT, TAP et SCIP). Trois des lambeaux ont été anastomosés sur l’axe tibial postérieur et un sur l’artère plantaire interne. Résultats: Nous n’avons noté aucune complication postopératoire. Cette approche a permis, chez tous les patients, une reconstruction d’excellente qualité au prix d’une rançon cicatricielle minime. La reprise complète de la marche a été effective à 21jours pour l’ensemble des patients. Conclusion: Les lambeaux libres perforant de type ű freestyle Ƈ offrent une solution de premier choix dans la couverture du talon. Sans perte de chance pour le patient et au prix d’une cicatrice linéaire masquée, ils offrent une couverture fonctionnelle, esthétique et durable. [ABSTRACT FROM AUTHOR]

Abstract: Reconstruction of hand dorsum soft tissue defect usually requires a flap. The dorsal skin is thin and the underlying structures require coverage by vascularised tissue. We have been using perforator flaps in these cases, especially the anterolateral thigh perforator flap. After a description of the technique, we present a case report in which this flap, in a free version, was used to reconstruct a dorsal hand defect after failure of a posterior interosseous flap. The fascia underlying the flap was used to create a sliding interface for extensor tendons. Postoperative care was without complications. The indications of this flap are numerous but after a review of international literature, we found that its use was seldom reported in France compared to other countries. However, we think that its trophic qualities and minor donor site morbidity make it ideal for coverage of hand dorsum soft tissue defects. [Copyright &y& Elsevier]

La reconstruction de la face dorsale du pied nécessite l'apport d'un tissu fin qui permet de recouvrir les structures nobles du pied (tendons, nerfs, vaisseaux) tout en résistant à la contrainte appliquée sur ces tissus lors de la marche ou du port de chaussures. Nous rapportons le cas d'un enfant de 13 ans qui présentait une séquelle de brûlure de troisième degré du pied droit avec une rétraction cutanée et une ulcération chronique douloureuse en regard du 5e métatarsien malgré de multiples greffes de peau. Il était trop douloureux pour se chausser et la marche était difficile. Nous avons réalisé un lambeau perforant libre type « Superficial Circumflex Iliac Artery Perforator flap » (SCIP) mesurant 12 × 7 cm et prélevé à la région inguinale droite afin d'être anastomosé au pédicule vasculaire du premier espace inter-métacarpien droit. À trois mois postopératoire, l'enfant peut à nouveau marcher et se chausser sans douleur. La cicatrice induite au site donneur est discrète au niveau du creux inguinal, cachée dans le sous-vêtement. Le SCIP est un lambeau souple et fin avec une faible morbidité induite au site donneur. Il convient aux reconstructions des extrémités distales des membres, tant chez l'adulte que chez l'enfant. The dorsalis pedis reconstruction requires to bring a thin tissue to recover every noble structure of the foot including tendons, nerves and vessels while resisting the stress induced on these structures when walking or wearing shoes. We report the case of a thirteen year-old child who presented a third-degree burn sequelae on the dorsalis pedis with scar retraction and chronic ulceration on the fifth metatarsal despite multiple skin grafts. He couldn't put on his shoes because of the pain and walking was difficult. We performed a SCIP flap (Superficial Circumflex Iliac Artery Perforator) to reconstruct this defect. The flap measuring 12 × 7 cm has been harvested on the right groin and anastomosed with the pedicle of the first intermetatarsal space. At 3 months postoperatively, the child can put on his shoes again and walk without pain. The donor site is discrete in the inguinal crease, hidden in the underwear. The SCIP flap is a thin and pliable flap with a discrete donor site. It is suitable for reconstructions of distal extremities of limbs, both in adults and children. [ABSTRACT FROM AUTHOR]

Le lambeau perforant thoracodorsal est plus en plus utilisé dans les reconstructions tête et cou. Il présente de nombreux avantages notamment la discrétion de son site donneur par rapport aux autres lambeaux libres classiquement utilisés dans ces indications, tels que l'antébrachial radial ou l'antérolatéral de cuisse. Toutefois son mode de prélèvement actuel en vue d'un transfert libre nécessite une incision remontant dans le creux axillaire pour disséquer l'ensemble du pédicule. Cette incision proximale empêche une discrétion optimale de la cicatrice résultante, en particulier chez les femmes. Nous exposons une technique originale de prélèvement du lambeau thoracodorsal à palette cutanée transversale pure prélevée sur la perforante seule, laissant ainsi une cicatrice totalement dissimulée dans le soutien-gorge et épargnant le pédicule thoracodorsal. Nous détaillons les impératifs propres à ce nouveau type de prélèvement. The thoracodorsal artery perforator flap is increasingly used in head and neck reconstructions. One of its multiple advantages is the low donor site morbidity compared to the other free flaps usually used for this type of surgery, such as the radial forearm free flap and the anterolateral flap of the thigh. However, the current harvesting technique of the thoracodorsal artery free perforator flap needs a vertical incision rising high in the axillary hollow for the dissection of the pedicle, thus impeding optimal discretion of the donor site, especially for women. We describe an original technique to harvest a pure transversal skin paddle on its own perforator, leaving a horizontal scar thoroughly hidden in the bra and preserving the thoracodorsal pedicle. We detail the requirements for this new type of harvesting. [ABSTRACT FROM AUTHOR]

Summary Today's customary techniques for pharyngo-esophageal reconstruction are jejunum and radial forearm free flaps. In this type of reconstruction, the jejunum flap is considered as the reference, but when its harvesting is not possible, the radial forearm flap is used. Since perforator flaps have begun to be developed, the anterolateral thigh flap (ATF) has become increasingly prominent in pharyngo-esophageal reconstruction. The aim of our study was to describe the use of the anterolateral perforator flap in pharyngo-esophageal reconstruction (indications, harvesting method, flap design) and to discuss its advantages and drawbacks as regards oral feeding and esophageal speech. [ABSTRACT FROM AUTHOR]

Summary: Axillary hidradenitis suppurativa is a chronic and debilitating disease that primarily affects the axillae, perineum, and inframammary areas. Surgical removal of all the diseased skin constitutes the only efficient treatment. Covering an axillary fossa defect is challenging, due to the range of shoulder movement required. Indeed, shoulder movement may be compromised by scar contraction after inadequate surgery. The present study is the first to apply an inner arm perforator flap to the treatment of twelve axillary skin defects in 10 patients. The defect originated from extensive excision of recurrent hidradenitis suppurativa in the axilla. The technique used to cover the defect is a V-Y advancement flap or a propeller flap from the inner arm based on one to three perforators arising from the brachial artery or the superior ulnar collateral artery. The flap provides a tensionless wound closure and a generally unremarkable postoperative course in a short hospital stay. No major complications occurred. Two patients had minor delayed wound healing. Outcomes (including donor site morbidity, function and the cosmetic outcome) were very satisfactory in all cases. We consider that the inner arm perforator flap is a valuable new option for the reconstruction of axillary defects. [Copyright &y& Elsevier]