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Purpose: The aim of this study was to report our experience in embolization of high flow peripheral arteriovenous malformations (AVMs) with Onyx., Material and Methods: Nineteen patients (10 men, 9 women) with peripheral high-flow AVMs who were treated with arteruial embolization using Onyx were retrospectively included. AVMs were located in the head and neck (6), extremities (5), chest (2), kidney (2), uterus (2), pelvis (1) and parietal (1). In 13 patients, embolization was done using Onyx only. One patient underwent embolization by direct puncture, the others by transarterial approach. Embolization was performed in one or multiple sessions (up to 5). A total of 28 sessions were performed. Follow-up was performed with a delay between 10 and 34 months., Results: Technical success was achieved in all patients. Complete devascularization was obtained in 12 patients. Surgical excision was performed in 9 patients. Non-target Onyx embolization was not observed. One patient developed stroke. In 1 patient microcatheter fracture occured. One patient presented severe pain and bradycardia during the procedure that disappeared shortly after. One patient had persistent but less frequent epistaxis after embolization. Another patient had persistent pain without improvement. One patient was lost to follow-up. Other patients were free of symptoms on follow-up., Conclusions: Embolization with Onyx ® is an interesting option for management of peripheral high-flow AVMs either preoperatively or as a single treatment., (Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Advancing the posterior pharyngeal wall is a classic technique to treat velopharyngeal insufficiency. Injection of autologous fat behind the posterior pharyngeal mucosa according to the Coleman Lipostructure technique is a recent development. The authors report their experience in six cases using this modification. The preoperative work-up was performed by a speech therapist with a physical examination and measurement of the nasal air loss was performed using an aerophonometer. Fat was harvested either on the abdominal wall or on a buttock and then centrifuged. Fat injection was performed using a curved blunt cannula under the mucosa of the lateral and posterior pharyngeal walls. Injecting fat is an autologous graft of fat tissue: after a postoperative period of three months, the volume of fat becomes permanently stable. In five out of the six patients who presented moderate velopharyngeal insufficiency, speech improvement was significant. The single failure was a patient with bilateral cleft lip and palate sequels after previous pharyngoplasty using the Orticochea procedure. Treatment of moderate velopharyngeal insufficiency using fat injection is an efficient method. The advantages are its innocuousness and that scaring of the pharynx is avoided.

We report our experience of tissue expansion for removal of skin tumors in 62 patients treated between 1985 and 1991. Thirty-nine complete and 23 partial excisions were performed. Major complications with complete failure occurred in 3 percent of the cases, and minor complications in 10 percent. Skin expansion constitutes a considerable advance in the treatment of benign skin tumors as it reduces the risk of permanent scars and provides a skin that is normal in both quality and colour. In cases where the tumor cannot be entirely removed in one step (e.g. giant hairy naevus, haemolymphangioma) expansion brings quality skin within the most visible areas, enabling complete excisions by re-expansion or skin graft to be contemplated.

The authors describe 10 cases of mandibular reconstruction following transmandibular buccopharyngectomy, using scapular osteocutaneous flaps. Repair of mandibular substance loss due to neoplastic surgery becomes a problem. Composite bone resections are associated with mucous and muscular defect formation. There is dual advantage in using this type of flap: on the one hand, reliability is great, independently of the case (revisions or other types of surgery) because of the presence of constant elements in the vascular pedicle; on the other hand, the cutaneous flap and the bone transplant are independent from each other, such plasticity affording equally successful symphyseal and lateral repair.

Mandibular reconstruction in 6 patients was by free flap from iliac crest in pelvi-mandibulectomies. The different technics proposed for mandibular reconstruction are described with emphasis on the specificity of repair surgery in cervicofacial oncology. In this precise indication stress is placed on the limitations of conventional graft and endoprosthesis procedures and the need to transfer a vascularized bone fragment. Among the technics for transfer of vascularized bone, preference is accorded to the composite flap from iliac crest as against the osteo-musculo-cutaneous flap, and details for removal of the former are given. The osteo-musculo-cutaneous flap from iliac crest appears to be the procedure of choice for reconstruction of bone in all cases where mandibular reconstruction is necessary after loss of continuity.