Annales de chirurgie plastique et esthétique
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Ann Chir Plast Esthet · Jun 1995
Historical Article[Reconstruction of the nose in deep extensive facial burns].
The nose is in the medial portion of the face and is frequently injured in trauma of this area. Due to its situation its structure and shape, and its essential function, this organ is particularly exposed in the case of facial burns. ⋯ They then recall the fascinating story of rhinopoiesis through the ages. The third part is devoted to their personal approach to reconstruction of the nose in severe panfacial burns, using a forehead flap with one or several tissue expanders.
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The face is one of the areas of the body most frequently affected by burns. Pressure therapy maintains facial scars until maturation is achieved to present hypertrophic scars or contractures. Elastic pressure garments are usually used, but they do not provide adequate pressure on areas such as naso-labial folds or labio-chin folds. ⋯ Follow up is necessary to prevent complications and to revise the mask as the scars change. Nostril and oral commissures are treated with inserts which maintain adequate size or corrected contractures. Satisfactory results can be obtained with cooperative patients.
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Ann Chir Plast Esthet · Aug 1994
[Mandibular reconstruction using an iliac crest free flap vascularized by the deep circumflex iliac vessels. A clinical study apropos of 30 cases].
Thirty cases of mandibular defects were reconstructed with a free iliac flap vascularised by the deep circumflex iliac vessels. Twenty five of these cases involved soft tissue damage with a defect of the mandible. The surgical procedure described by I. ⋯ The natural shape of the iliac bone does not require complex osteotomies and its healing capacity allows simple osteosynthesis. The thickness of the muscular pedicle, and thus the flap, is determined by the position of the lower edge of the skin components with respect to the iliac crest. This type of flap currently remains very useful in reconstruction of major mandibular and adjacent soft tissue destruction because of the very low incidence of failure (2 cases) and complications.
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An anatomical study which was carried out on 44 upper limbs of fresh cadavers has enabled us to describe a new flap based on the superior perforating branch of the anterior interosseous artery: "the anterior interosseous flap". The anterior interosseous artery participates in the vascularization of the dorsal aspect of the distal two-third of the forearm by providing two perforating branches, "the superior and the inferior perforating branches". The superior perforating branch of the anterior interosseous artery, pedicle of the flap, perforates the interosseous membrane 10 +/- 2 cm above the radio-carpal joint and runs in the septum between the extensor pollicis longus and brevis muscles accompanied by two venae comitantes. ⋯ The surgical procedure of the retrograde island flap consists in raising the cutaneous or compound flap based on the superior perforating branch, division of the interosseous membrane and ligature of the anterior interosseous trunk proximally. The flap is vascularized by a retrograde blood flow through the dorsal (or volar or both) vascular network of the wrist. Theoretically, the most distal point of rotation of the flap is located at the level of the luno-capitate joint and the pedicle is long enough to allow the most distal point of the flap to reach the DIP joint of the finger.(ABSTRACT TRUNCATED AT 400 WORDS)