Risk, IV.

Thoracoacromial venous supercharging using the ipsilateral superficial inferior epigastric vein is a valuable method which considerably secures the DIEP free flap in breast reconstruction although it lengthens the operative procedure. EBM level: Level III.

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Gluteal artery perforator flaps are a good option to reconstruct perineal and posterior vaginal wall defects after abdominoperineal resection. The bulkiness of the folded flap may compromise the results by obliterating the introitus and vaginal cavity. In this report, we present a case of the use of a superior gluteal artery dual perforator-pedicled propeller flap to reconstruct the posterior vaginal wall and perineum in a 60-year-old female who had an abdominoperineal resection of a locally progressive anal squamous cell carcinoma. Two perforators were completely skeletonized through gluteus maximus muscle fibers. The vascularization of the skin flap was based on the first perforator, whereas the aponeurotic flap was vascularized by the second perforator. The vaginal defect was reconstructed with a gluteus maximus aponeurotic flap, and the perineal reconstruction was based on a superior gluteal artery perforator skin flap. No postoperative infection or necrosis occurred. Skin healing was completed in 3 weeks. Vaginal opening was controlled using lubricant and graduated vaginal dilators during 6 weeks. The patient began sexual intercourse 2 months postoperatively. No revision was needed. Perineal and posterior vaginal wall defects may be reconstructed with a gluteal artery perforator flap. The thickness of the flap allows a complete filling of the full perineal cavity. The gluteus maximus aponeurosis may be suitable for the reconstruction of the posterior vaginal wall.

Galactorrhea is a rare event after breast augmentation. The physiopathologic bases of galactorrhea depend on the central secretion of prolactin. These physiopathologic bases must be clearly understood for the prevention and treatment of postoperative galactorrhea. This report describes two cases of a postoperative galactorrhea after aesthetic breast augmentation with silicone implants. The clinical appearance closely resembles a postoperative sepsis without hyperthermia. Bacteriologic samples are negative. Endocrinologic examination finds a characteristic hyperprolactinemia. The evolution is favorable under dopaminergic agonists.

π-Shaped lymphaticovenular anastomosis is a supermicrosurgical method with a low morbidity to treat peripheral lymphedema. The procedure can easily be performed under local anesthesia, and the postoperative recovery is short. The results of this series demonstrate a clinical efficiency of the technique to reduce chronic lymphedema of the limbs.EBM level IV.

Dorsiflexor tendons are particularly exposed in crush injury of the foot. Anterior tibialis tendon defects may be responsible for a steppage gait and a drop foot deformity. Drop foot reconstruction is challenging because of the high risk of postoperative adhesions and functional sequelae. In this report, we present the results of the reconstruction of post-injury anterior tibialis tendon defects with chimeric deep inferior epigatric artery perforator (DIEP) free flap associated with a quadriceps osteotendinous graft in two patients. Two men (32-year-old and 19-year-old) presented drop foot deformity with defect of the anterior tibialis tendon secondary to a crush injury. The sizes of the soft tissues defects at the foot dorsum were 24 cm × 8 cm and 20 cm × 8 cm, respectively. The quadriceps osteotendinous grafts were used to reconstruct the anterior tibialis tendon in both patients. The chimeric DIEP free flaps with skin paddles (24 cm × 8 cm and 20 cm × 8 cm) and rectus abdominis fascia (24 cm × 4 cm and 20 cm × 4 cm) were used for reconstruction. The skin component based on a musculocutaneous perforator was used for soft tissue reconstruction of the foot dorsum. The fascial component based on a second perforator was used to create a sliding surface around the osteotendinous graft. Postoperative course was uneventful. Rehabilitation lasted 3 months. The range of ankle movement was measured during 12 months. The first patient recovered 10 degree of dorsiflexion. The second patient recovered 25 degree of dorsiflexion. Walk recovery was satisfying in both patients. The single-stage procedure using the chimeric DIEP free flap may be an option for post-injury drop foot reanimation. Creating a sliding surface around a composite osteotendinous quadriceps graft with a vascularized fascial component avoid postoperative peritendinous adhesions. This technique may improve foot dorsiflexion and walk recovery. © 2015 Wiley Periodicals, Inc. Microsurgery 36:334-338, 2016.