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Abstract: Dupuytren''s contracture is a retractile fibrosis of the superficial palmar aponeurosis of the hand, resulting in a progressive and fixed flexion of the fingers that may result in severe limitation of hand function. It affects several millions of people in Europe and North America. Risk factors are genetic and sometimes related to mellitus diabetes. There is no spontaneous remission. Until recently, surgery was the only treatment, but now needle aponeurotomy emerges as a therapeutic alternative. It should be performed as first line treatment by a trained practitioner. Short and long-term results of needle aponeurotomy appear identical to those of surgery, with milder complications. It is indicated in palmar, palmo-digital, as well as in strictly digital forms of the disorder. The “table-test” is used to assess the loss of extension of the digit and to select the indication to needle aponeurotomy. A medico-surgical consensus should define the optimum treatment strategy in this affection. [Copyright &y& Elsevier]

Summary: Introduction: The aim of this study was to assess the efficacy of dissection of radial forearm flap in a superficial plan above the deep fascia to prevent donor site problems. Patients and methods: Eighteen radial forearm flaps were used for orofacial reconstruction: 11 suprafascial flaps and seven infrafascial flaps. We compared in the two groups: flap failure, graft success, tendon adhesions, sensory nerve damage at donor site. Results: We observed one case of flap failure in the infrafascial group and one case in the suprafascial group. With suprafascial elevation flap technique, we noted 100% of grafts integration without tendon adhesion. In infrafascial elevation flap technique, four out of seven patients had delayed healing. Discussion: The suprafascial dissection of free radial forearm flap creates a superior graft recipient bed ensuring early and complete successful graft. [Copyright &y& Elsevier]

Summary: The necrotizing fasciitis (NF) is a soft tissue infection affecting the superficial fascia, the subcutaneous tissue and the skin, the latter being affected tardively. This diagnosis is confirmed only after surgery, which consists of debridement of the necrotized tissue. The discordance between the symptomatology and physical exam made that the diagnosis is mistaken in 35% of cases. However, it seems important to remember that the prompt recognition and surgical treatment depend on the morbidity and mortality. We report the case of a patient with NF of the upper limb after a right elbow blunt trauma. [Copyright &y& Elsevier]

Summary: Hands defect coverage needs thin and pliable flaps. Few free flaps such as free temporoparietal flap are adequate. It provides moderate donor scar and unique range of motion for tendinous coverage. We expose three cases of hand reconstruction: two dorsal coverage with tendinous exposition and reconstruction and one thumb coverage. The postoperative results were satisfactory concerning hands. One patient developed alopecia and dysesthesis on scalp. We think that this flap is a good alternative for serratus free fascial flap. [Copyright &y& Elsevier]

Summary: It is well known that percutaneous fasciotomy must not be realized at the digital level because of the risks of iatrogenic nervous injury. The purpose of this study is to verify if the percutaneous fasciotomy in the digital level is responsible or not for sensory complication by injury of the collateral nerves, thanks to the precise sensory analysis of a series of twenty five palmodigital or digital fasciotomies. Our series included 20 patients operated on between September 2006 and June 2008, as a total of 25 fingers. Only one patient presented preoperative sensory disorders. It was a multi-operated finger. The patients were operated on in one-day surgery by two senior surgeons using percutaneous fasciotomy in the palm and the digit. The analysis of the results consisted in studying at follow-up pain, DASH score, and discriminative sensibility by the static test of Weber, and the test of mono strands of Semmes Weinstein. The postoperative average follow-up was of 10 months. The pain was on average 1.8/10 and the DASH score of 19.77/100. The statistical analysis of the discriminative sensibility showed that there was no significant difference in the average of the results between the hemi-pulp of the operated finger and that of the not operated finger (test of Weber 0.1< p <0.5; test of Semmes Weinstein 0.5< p <1). A single patient had a bad result at the same time in the Weber and in the Semmes Weinstein. It was a patient operated on several times. Our study shows that the digital percutaneous fasciotomy provokes no sensory disorder. Consequently, it is possible to spread the indications of percutaneous fasciotomy to Dupuytren''s contracture in the digital region. [Copyright &y& Elsevier]