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Berkane Y, Tawa P, Guinier C, Bertheuil N, El Batti S, Lellouch AG. Reconstruction of a septic femoral triangle fistula with a pedicled DIEP flap: A case report and mini-review. ANN CHIR PLAST ESTH 2024; 69:233-238. [PMID: 37932173 DOI: 10.1016/j.anplas.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
Flap-based reconstruction techniques have shown promise in preventing scar contractures and enhancing healing in fold areas by providing vascularized and thick tissue. We report a septic rupture of the superficial femoral artery treated with an arterial allograft and covered with a contralateral pedicled Deep Inferior Epigastric Artery Perforator (DIEP) flap. The patient presented favorable outcomes, including optimal healing at 8 months, with no functional limitation. A literature review also discusses alternative pedicled perforator flaps. These modern techniques present several advantages, including reliability, and can be of great interest in complex vascular surgery cases.
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Affiliation(s)
- Y Berkane
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States; Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes, France.
| | - P Tawa
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States
| | - C Guinier
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes, France
| | - S El Batti
- Department of Vascular Surgery, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm UMRS 1140 Innovation thérapeutique en hémostase, université de Paris, Paris, France
| | - A G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, United States; Shriners Children's Boston, Harvard Medical School, Boston, MA, United States
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Gandolfi S, Chaput B, Berkane Y, Lupon E, Karra A. The accessory vascularization of the tensor fasciae latae muscle: towards a new classification? Surg Radiol Anat 2024:10.1007/s00276-024-03343-8. [PMID: 38530383 DOI: 10.1007/s00276-024-03343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The tensor fasciae latae (TFL) muscle is supplied by the lateral femoral circumflex artery (LCFA), arising from the deep femoral artery. However, it has been noted that there is also a consistent vascular anastomotic network. The aim of this study was to describe the accessory vascularization of the TFL muscle through a descriptive anatomical study, in order to hypothesize the feasibility of harvesting a TFL flap in the event of an injury to the main pedicle. In addition, we illustrate this hypothesis with a successful clinical case of Scarpa freconstruction following ligature of the deep femoral artery. METHODS The description of the accessory vascularization was obtained by injecting dye into seven lateral femoral circumflex arteries (LCFA), six superficial circumflex iliac arteries (SCIA), and three inferior gluteal arteries (IGA). RESULTS The TFL muscle was vascularized primarily by the LCFA. A vascular anastomotic network with the SCIA and the IGA was observed. After selective injection to the SCIAs and IGAs, the subsequent injection to the LCFA showed a diffusion of the TFL skin paddle with a perforasome overlapping between the different vascular territories. CONCLUSION The ascending branch of the lateral femoral circumflex plays a dominant role in the vascularization of the TFL muscle. As a result of a periarticular anastomotic network of the hip, this artery establishes several connections with the proximal arteries. Consequently, in cases where blood flow through the LCFA is interrupted, it should be equally possible to harvest the TFL flap through its accessory vascularization.
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Affiliation(s)
- Silvia Gandolfi
- Plastic and Reconstructive Surgery Department, Rangueil University Hospital Center of Toulouse, 1 Avenue du Professeur Jean Poulhès, Toulouse, 31400, France.
| | - B Chaput
- Plastic and Reconstructive Surgery Department, Rangueil University Hospital Center of Toulouse, 1 Avenue du Professeur Jean Poulhès, Toulouse, 31400, France
| | - Y Berkane
- Plastic and Reconstructive Surgery Department, Pontchaillou University Hospital Center of Rennes, 2 Rue Henri le Guilloux, Rennes, 35000, France
| | - E Lupon
- Plastic and Reconstructive Surgery Department, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - A Karra
- Plastic Surgery Department, Habib Bourguiba University Hospital Sfax, Sfax, Tunisia
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Gherle B, Pozner VL, Berkane Y, Watier E, Bertheuil N, Qassemyar Q. Pre-expanded thin DIEP free flap in pediatric upper extremity reconstruction for burn sequelae: A case report. ANN CHIR PLAST ESTH 2024; 69:173-177. [PMID: 38216362 DOI: 10.1016/j.anplas.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 01/14/2024]
Abstract
Deep burns sequelae involving the upper limb are challenging even for experienced surgeons, mainly because local reconstructive options and donor sites are often compromised. The use of free flaps for this type of reconstruction remains difficult due to the small recipient vessel diameter and tendency to vasospasm. Moreover, pediatric cases bring the challenge to another level. We present the case of a 13-year-old girl presenting major retractile sequelae of the upper left limb, including complete wrist immobilization combining wrist hyper-extension, ulnar deviation deformity, and a ulno-carpal dislocation. She was referred to our department where a two-stage reconstruction was performed using a pre-expanded free deep inferior epigastric artery perforator (DIEP) flap. The first surgery consisted of placing two kidney-shaped expanders in a subfascial plane in the hypogastric region. Four months later, after a bi-weekly expansion, an excision of the scar tissue, and the DIEP flap transfer were completed. At the 12-month follow-up evaluation, both aesthetic and functional results were satisfactory, with a good contour and regained mobility of the wrist.
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Affiliation(s)
- B Gherle
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Doctoral School of Biological and Biomedical Sciences, University of Oradea, Oradea, Romania.
| | - V L Pozner
- Private Practice, 66, rue de Lisbone, 75008 Paris, France
| | - Y Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston MA
| | - E Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; MOBIDIC, UMR INSERM 1236, Rennes University Hospital, Rennes, France.
| | - Q Qassemyar
- Private Practice, 66, rue de Lisbone, 75008 Paris, France
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Berkane Y, Herlin C, Bertheuil N. Comment on "Surgical management of slightly or non-displaced corporal scaphoid fractures by retrograde percutaneous screw fixation through the anterior trapezium horn: A single-center retrospective French study of 33 patients between January 2015 and January 2019". ANN CHIR PLAST ESTH 2023; 68:385-386. [PMID: 37121848 DOI: 10.1016/j.anplas.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Y Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud (CHU de Rennes), University of Rennes 1, Rennes, France; Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - C Herlin
- Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud (CHU de Rennes), University of Rennes 1, Rennes, France; SITI Laboratory, Rennes University Hospital, Rennes, France; Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rouen, Rouen, France
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Meresse T, Lupon E, Berkane Y, Classe JM, Camuzard O, Gangloff D. [Oncologic plastic surgery: An essential activity to develop in France]. ANN CHIR PLAST ESTH 2023; 68:286-287. [PMID: 36967308 DOI: 10.1016/j.anplas.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 06/14/2023]
Affiliation(s)
- T Meresse
- Department of Onco-Plastic Surgery, IUCT-Oncopole University Hospital and Department of Plastic surgery, University Toulouse III Paul Sabatier, Toulouse, France
| | - E Lupon
- Department of Plastic and Reconstructive Surgery, institut universitaire locomoteur et du sport, Pasteur 2 Hospital, University Côte d'Azur, 30, voie Romaine, 06001 Nice, France.
| | - Y Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - J M Classe
- Department of Surgical Oncology, institut de cancerologie de l'ouest, Saint-Herblain, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, institut universitaire locomoteur et du sport, Pasteur 2 Hospital, University Côte d'Azur, 30, voie Romaine, 06001 Nice, France
| | - D Gangloff
- Department of Onco-Plastic Surgery, IUCT-Oncopole University Hospital and Department of Plastic surgery, University Toulouse III Paul Sabatier, Toulouse, France
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