Neurocutaneous flap of the anteromedial aspect of the thigh with a distal pedicle. Anatomical study and clinical application

The authors report an anatomic study of the vascularization of the medial aspect of the thigh on 21 cadaveric dissections with injection. They describe a neuro-cutaneous medial thigh flap, with a distal pedicle, vascularised by proximal branches of the saphenous artery (branch from the descending genicular artery). This flap includes the medial femoral cutaneous nerve, which runs with a supra-aponeurotic vascular network. The anatomic variants and harvesting technique of this flap are described. Our clinical experience is based on 3 patients operated between 1996 and 1998, for coverage of an amputation stump. The results were excellent in all cases with a follow-up of 6 months to 3 years. The good quality of this skin coverage allows satisfactory adaptation of the leg prosthesis in our cases.     

A Feasibility Study of High-Entropy Alloy Coating Deposition by Detonation Spraying Combined with Laser Melting

In this work, a new two-stage approach to the deposition of high-entropy alloy coatings is proposed. At the first stage, a composite precursor coating is formed by detonation spraying of the metal powder mixtures. At the second stage, the precursor coating is re-melted by a laser, and the formation of multi-component solid solution phases can be expected upon solidification. The feasibility of the proposed approach was validated using three different mixtures of Fe, Ni, Cu, Co and Al powders. It was shown that detonation spraying allows forming composite coatings with a uniform distribution of the lamellae of different metals. The results of the structural analysis of the laser-treated coatings suggest that complete alloying occurred in the melt and face-centered cubic solid solutions formed in the coatings upon cooling.     

Les lésions traumatiques de l’aorte descendante en dehors de l’isthme : particularités diagnostiques et thérapeutiques

Lesions involving the descending thoracic aorta apart from isthmus are rare and less known by anesthetists. We report the clinical course of two severely injured patients who sustained a thoracic aortic rupture in whom favorable outcome was achieved with endovascular treatment. Mechanisms, diagnosis and therapeutics aspects of these rare lesions are discussed according to literature.     

Subscapular artery Y-shaped flow-through muscle flap: a novel one-stage limb salvage procedure

OBJECTIVES: Major tissue loss caused by the critical limb ischemia requires improvement of distal perfusion and cover of large tissue defects. We propose a new method, the y-shaped subscapular artery flow-through (Y-SCAFT) muscle flap using the subscapular artery that yields an arterial graft and a free muscle flap sustained by a collateral branch of this artery. This prospective study evaluated the feasibility of this technique and analyzed wound healing, graft patency, and limb salvage. METHODS: Between 2002 and 2007, 20 patients, mean age 64 years (range, 55-79 years), were treated with this technique. All presented with critical ischemia and major tissue loss, with exposure of the tendons, bones, or joint, and were candidates for major amputation. Revascularization and cover of tissue loss with the same Y-SCAFT anatomic unit was used for all patients. The distal anastomosis was performed between the distal branch of the Y-SCAFT and the pedal artery in 9, posterior tibial artery in 4, peroneal artery in 1, lateral tarsal artery in 3, and the plantar artery in 3. In four patients, the distal part of the arterial graft, including the anastomosis, was covered with the muscle flap because the tissue loss was nearby. The proximal anastomosis was performed between a leg artery and the arterial graft in 10 patients. A venous graft was necessary in 10 patients to extend the bypass proximally. RESULTS: One patient died during the postoperative period. Duplex control evidenced patency all the Y-SCAFT muscle flaps. Healing was achieved in all patients. Mean follow-up was 31 months (range, 6-58 months). No patients died during follow-up. One patient presented occlusion of the Y-SCAFT muscle flap and underwent amputated. One patient had major amputation despite a patent graft. At 2 years, leg salvage was 85%, patency was 94%, and survival was 94%. At the end of the follow-up, 17 patients (1 death, 2 amputations) had a patent graft, a viable muscle flap, wound healing, and a functional leg. CONCLUSION: We showed the clinical feasibility of the technique of Y-SCAFT muscle flap, which allows for revascularization and cover of major tissue loss with one anatomic unit. This method is particularly useful in selected cases with poor run-off and large ischemic lesions.     

Clinical and social factors of resuming work by patients with ischemic heart disease after aortocoronary bypass

In spite of the fact that clinical condition in 85.6% of coronary patients subjected to aortocoronary shunting has improved against their preoperative status, only 43.3% of them resume work. Invalidity in these patients increases two-fold mounting to 94.4%. The causes of the discrepancy between the expected and real performance are scrutinized with due consideration of clinical and social factors essential for the patients' decision to resume or give up work.