A new option for autologous anterior chest wall reconstruction: the composite thoracodorsal artery perforator flap.

Dast S, Berna P, Qassemyar Q, Sinna R.

Sternal chondrosarcoma is rare and often requires total or subtotal sternectomy. The authors describe the case of a 70-year-old man with sternoclavicular joint chondrosarcoma who underwent subtotal sternectomy with partial resection of the two clavicles and anterior arches of first to third right ribs. Anterior chest wall reconstruction was performed with a composite thoracodorsal artery perforator free flap with sixth and seventh ribs vascularized on serratus muscle. The postoperative course was uneventful. Seven months after surgery, the patient was doing well. This surgical procedure is a new option for autologous reconstruction without prosthetic material after extensive sternectomy see more...

Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories

Qassemyar Q, Havet E, Sinna R

BACKGROUND: The facial artery perforator flap was developed to perform more accurate reconstruction of perioral and nasal alar defects. This technique allows tailor-made reconstruction and shifting from the traditional two-stage procedure to a one-stage technique. Cadaveric studies have described the number, location, and size of facial artery perforators. Understanding of the facial artery blood supply can be complete, however, only if the cutaneous supply of each perforator is known.METHODS: The authors performed 20 dissections of facial arteries on fresh cadavers. All facial artery perforators greater than 0.5 mm were dissected and the diameters measured. All perforators were selectively injected with 1 ml of diluted ink solution. All these results were statistically analyzed.RESULTS: Twenty facial arteries were dissected, with a mean length of 12.06 cm. The average number of perforators greater than 0.5 mm per facial artery was 5.05. The mean diameter of the perforators was 0.96 mm. A total of 101 perforators were selectively injected, and the mean size of all injected skin areas was 8.05 cm. Seven main, reliable types of perforator territory were identified.CONCLUSIONS: Facial artery perforators seem to be predominantly between 1 and 2 cm lateral to the level of the oral commissure. Seven main types of perforasomes have been identified and appear to be the basis for local flap design. This study improves our understanding of facial vascularization and will allow the face to give up the era of random flaps to take advantage of more accurate reconstructions from the rest of the body.

Use of Macrolane to treat Pectus excavatum

Sinna R, Perignon D, Assaf N, Berna P.

The use of subcutaneous hyaluronic acid injection in cosmetic surgery is a popular and well-accepted technique. A new highly reticulated, nonanimal, stabilized hyaluronic acid has been recently developed for high-volume enhancement, especially breast augmentation. We describe this technique for funnel chest treatment.e. see more...

Prothèse mammaire et lymphome T anaplasique à grandes cellules : que savons-nous ?

Mychaluk J, Perignon D, Qassemyar Q, Gianfermi M, Sinna R.

Une nouvelle controverse est récemment apparue sur le lien qui existerait entre les prothèses mammaires et l’apparition de lymphome T anaplasique à grandes cellules (LAGC). Afin d’en préciser la nature, nous avons réalisé une analyse de la littérature reprenant l’ensemble des articles publiés entre 1991 et 2011. Nous avons pu identifier 41 cas de LAGC publiés. L’âge moyen d’apparition était de 51 ans avec un intervalle de 108 mois en moyenne entre la pose de l’implant et le diagnostic. Dans plus de 60 % des cas, il s’agissait d’une augmentation mammaire esthétique. Cependant, au terme de l’analyse, aucune des cohortes ou des méta-analyses étudiées n’a pu établir un lien entre les prothèses mammaires et le risque de LAGC. Au terme de cette revue, il semble que le chirurgien peut rassurer la patiente sur la faible incidence des cas rapportés et son caractère indolent, cependant, il doit rester vigilant devant un épanchement périprothétique tardif ou une tuméfaction mammaire. La prise en charge chirurgicale apparaît indispensable tant dans la démarche diagnostique que thérapeutique, en particulier par la caractérisation ALK négatif et CD30 positif de ce lymphome see more...