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Composite tissue allotransplantation (CTA) is a new concept in reconstructive surgery to improve major physical defects with no current solution. Although not a life-saving procedure, tissue replacement by CTA offers great potential for improving quality of life but relies on lifelong immunotherapy. This new practice has become achievable with the refinement of microsurgical techniques, with experience gained from limb and scalp replantations, with the development of organ transplantation and the release of new immunosuppressive drugs. Experimental and clinical research made it possible. The first human cases of CTA proved the reality and the feasibility of the concept. While the early functional results of these allografts are encouraging, they will need to be assessed in the long-term, and development of less toxic - more efficient immonu-suppressive drugs will be a permanent requisite to the broadening of CTA. Although long-term outcome and potential adverse effects of chronic immunosuppression remain uncertain, as for organ transplantation, CTA is already a potential solution for some highly selected patients carrying physical disabilities such as large facial defects and bilateral hand amputation.

The author is neither anthropologist nor invested in social activities. He has learned some reviews of anthropology and some social and philosophical books since seven years. He describe not a general review but an analysis of these lectures according to the composite tissues allotransplantations (CTA). The discussion concerns anthropology and symbols, philosophical and social aspects. There is a natural umbilicus between the anthropological science and the surgical art according to CTA.

Resume La Societe francaise de chirurgie plastique reconstructrice et esthetique (SOF.CPRE) est nee le 3 decembre 1952. Initialement labellisee sans le mot esthetique, elle a accepte celui-ci en 1983 et les « logos » ont evolue au fil du temps : SFCPR, SFCPRE, SOF.CPRE. Son organe officiel d'expression a aussi evolue au cours du temps et des hommes : tributaire des Annales de chirurgie en 1954 et 1955, revue autonome Annales de chirurgie plastique en 1956, devenue Annales de chirurgie plastique et esthetique en 1983 puis Annales de chirurgie plastique esthetique (ACPE) en 1992. Depuis l'origine, cinq redacteurs en chef des « Annales » se sont succede : Claude Dufourmentel, Raymond Vilain, Jean-Pierre Lalardrie, Claude Le-Quang, Jean-Luc Cariou. Quatre d'entre eux sont encore vivants a ce jour. L'auteur, par connaissance et interviews, retrace ici l'histoire naturelle de ces cinq redacteurs en chef des ACPE qui ont tous eu un triple parcours : personnel, chirurgical et editorial.

One century, after Carrel in 1906, technics of vascular surgery are the same. After two world wars, peace surgery has been improved by war surgery. Microscopy surgery gave a new way for vascular surgery which became microsurgery with specific instrumentation. We have move from the developing period of microsurgery in the 1970s, to the fully matured period of microsurgery in the 1980s and the the development of clinical free flaps. The 1990s must be the turning point from autogenous tissue transplantation to allogenic transplantation. Ethic comity keeps keys of future! About microvascular anastomoses, many instrumental technics are explored but no-one is better than the classic manual suture. For us, the best instrumental technic is the anastomose with titanium clips VCS((R)) but we only use it in good situation without difficulties.

Resume Depuis 1975, le lambeau libre de perone n'a cesse d'evoluer et il represente actuellement pour nous le lambeau de choix en reconstruction mandibulaire, mais certaines circonstances postoperatoires rendent difficile ou impossible la surveillance de la vitalite osseuse. Par ailleurs, la vascularisation osseuse peut etre apprehendee par l'imagerie par resonance magnetique (IRM) dynamique, cela ayant ete valide experimentalement et chez l'homme dans le diagnostic precoce de l'osteonecrose. L'objet de cette etude etait de valider la surveillance postoperatoire des lambeaux libres osseux fibulaires en reconstruction mandibulaire chez l'homme par IRM dynamique. L'IRM dynamique, avec injection de gadolinium, consiste a etudier la variation de prise de contraste en fonction du temps au niveau du canal centromedullaire du transplant osseux fibulaire. Cette variation d'intensite de signal est materialisee sous la forme d'une courbe, veritable courbe de perfusion de la region centromedullaire. Cet examen a ete realise chez trois patients a des dates et dans des circonstances differentes. Il a permis dans un cas de confirmer le caractere vascularise du transplant de perone malgre la necrose de la palette fasciograisseuse adjointe. Sont exposees les difficultes de methodologie, notamment dans l'exploitation des donnees par l'outil informatique, et compares nos resultats avec ceux de la litterature. L'IRM dynamique est un examen simple, fiable, non invasif et son utilisation dans la surveillance postoperatoire des lambeaux libres osseux en chirurgie reconstructrice parait tres seduisante, permettant de confirmer le caractere vascularise ou non du transplant osseux.

A systematic and theoretic review is performed on the vascularised bone donor sites that may be useful in the case of hemifacial microsomia. A review of the literature reveals that the iliac crest and the scapula are the most commonly used vascularised bone grafts. A case study is included in the paper, showing an hemifacial microsomia reconstruction using a composite fibular vascularised bone graft. They highlight the criterias they think fundamental for choosing the vascularised bone graft donor site regarding the aims of the reconstruction of a Pruzansky grade II or III.

The author proves conclusions of that report on composite tissues allotransplantation (CTA). Cadaveric, functionnal and surgical anatomy has allowed the progress of reconstructive surgery since 30 years. It is an inventive, but always altruistic and emotional, reconstructive surgery which has allowed the progressiveness and expansion of CTA which is no more illusion but reality. The indications are and will remain exceptional. CTA's expansion remain dependent on progress of immunosuppressive drugs, and the actual research is turning towards immunologic allowance, induced chimerism and genetic mosaicism. In French, CTA is also Ethics and it is the only one case in the world, according to the lawful activity of the Ethics' advisory board.