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Anterolateral thigh flap is a perforator flap, which is vascularised by the descending branch of the lateral circonflex femoral artery. It has been described first by Song in 1984 and is essentially developed in Asia. This flap can be pedicled but it is widely used as a free flap for reconstruction of head and neck defects. Knowing that its vascular anatomy and the variation's origins of the perforators are well documented, our study's objective is to locate the main points of the dissection and its traps, starting from an anatomic study including 15 inferior members. The first constraint is the localisation and the individualisation of intermuscular septum between rectus femoris and vastus lateralis. The perforators of the flap can be septo-cutaneous (14.4%) and then the dissection of the flap is easy but can usually be musculo-cutaneous (86.6%) and the intramuscular dissection in the vastus lateralis represents then the second most difficult period of the intervention. This flap would be frequently used in France thanks to its intrinsic qualities, but due to the difficulty of the dissection of perforators vessels, teams who are intending this operation must make a previous work of anatomic dissection.

Objective: To compare various techniques for the treatment of pilonidal sinus., Design: Retrospective study, Setting: University Hospital of Toulouse, France., Subjects: 246 consecutive patients who presented between 1979 and 1996. The male:female ratio was 2:1, and the mean age 26 years (range 18-69)., Interventions: 218 one or two stage excision and rotation skin flaps, and 28 simple incisions., Results: 16 sinuses recurred, and no flaps necrosed., Conclusion: Excision and rotation skin flaps offers an effective and elegant alternative to the more classic operations for pilonidal sinus as it causes less postoperative pain and shortens convalescence.

Five patients with high energy trauma of the lower limb with tissue defect located in the knee or the proximal third of the leg underwent reconstruction with a free latissimus dorsi flap. This flap was connected to a vascular saphenous loop which initially creates an arterioveous shunt between proximal femoral vessels. This was performed in a single operation with two teams of surgeons. This technique was chosen because a healthy recipient pedicle was not available in the vicinity of the defect. Application of vein grafts is not the usual procedure but there are situations in which it becomes necessary. Our aim in this paper is to discuss these situations, to describe the technique used in our Hospital and to analyze the advantages and disadvantages of a one or two-stage operation.

The authors describe a reconstruction technique for defects of the superior third of the face using a fascio-cutaneous flap with a forehead paddle supplied by an occipital pedicle. This flap has been successfully used in three cases to cover defects of the temporo-zygomatic area indeed, the superior part of the cheek. Our three patients presented recurrent cutaneous carcinoma, a local and general poor condition. This process suits reliability and easiness to a good carcinologic, functional and aesthetic result.

Reconstruction of the chest wall after balistic or other trauma requires good and muscle cover and creation of a new, stable and airtight wall. The authors present a case of balistic trauma of the right anterolateral chest wall which was urgently debrided and subsequently reconstructed by sandwich combination of a latissimus dorsi muscle flap and synthetic material composed of a sheet of PTFE and creation of two methylmethylacrylate ribs. The advantage of this technique is that it avoids the use of autologous tissue from an already weakened chest wall and confers a new chest stability in several sites corresponding to the wall defect with easily available and easy-to-use materials.

The use of an inferiorly based rectus abdominis myocutaneous flap to cover a pelvic pressure sore offers a solution when the possibilities of other local flaps have been exhausted. For sacral pressure sores, the iliac bone is an obstacle for the transposition of this flap. In this case report, we describe how this obstacle can be overcome by creating a trans-osseous tunnel in the ala of the iliac bone through which the flap takes the most direct route to the recepient site.

Eleven cases are reported of island flaps containing only venous pedicles. All but two survived completely without arterial input and all the successful cases were on the extremities. The possible reasons for this are discussed.

Trochanteric bedsores are a serious condition because of the danger of osteoarthritis of the coxofemoral joint, which is a source of septicemia, and also because of the difficulty of covering them with skin owing to the mobility of the bone and the absence of skin laxity in the area. The authors suggest a new technique of closure after local preparation providing a clean "surgical" defect. They use a groin island flap raised in the Japanese "retrograde" manner (i.e. laterally to medially). This technique is of course the fruit of the authors' experience of the microsurgery. The distal portion of the flap is drawn, corresponding to the size of the defect (round shape). The proximal portion contains the vessels surrounded by subcutaneous and protected by a de-epithelialized triangle of skin with a distal base. The flap is passed through a subcutaneous tunnel between the femoral trigone and the trochanteric area to be covered. The donor site is closed by approximation of the edges after they have been undermined. The authors discuss the others possible surgical managements: 1) local flaps (transposition flap, Z plasties, are unsuitable; 2) the double S-rotation flap had the drawback of creating a large undermined area and leaving a scar on the trochanteric region; 3) simple GER-type muscle flaps are not advisable because the transposed muscle always indergoes a fibrous involution so that the graft provides insufficient protection; 4) myocutaneous flaps, and especially fascia lata myocutaneous flap, offer better indication, because of muscle only acts as a vascular pedicle for the skin flap. The only drawback is the relative defect resulting from raising the flap. The authors conclude that the groin island flap offers the following advantages; a skin material which is more than efficient; ideal vascularization; perfect corverage without undue tension of the trochanteric surface; an interesting training for the plastic surgeon performing microsurgical reconstruction.

Abstract: Anterolateral thigh flap is a perforator flap, which is vascularised by the descending branch of the lateral circonflex femoral artery. It has been described first by Song in 1984 and is essentially developed in Asia. This flap can be pedicled but it is widely used as a free flap for reconstruction of head and neck defects. Knowing that its vascular anatomy and the variation’s origins of the perforators are well documented, our study’s objective is to locate the main points of the dissection and its traps, starting from an anatomic study including 15 inferior members. The first constraint is the localisation and the individualisation of intermuscular septum between rectus femoris and vastus lateralis. The perforators of the flap can be septo-cutaneous (14.4%) and then the dissection of the flap is easy but can usually be musculo-cutaneous (86.6%) and the intramuscular dissection in the vastus lateralis represents then the second most difficult period of the intervention. This flap would be frequently used in France thanks to its intrinsic qualities, but due to the difficulty of the dissection of perforators vessels, teams who are intending this operation must make a previous work of anatomic dissection. [Copyright &y& Elsevier]