New technologies have over the past forty years become widespread across all domains of basic and applied research particularly in health-related fields.Telemedicine is a form of remote medical practice using information and communication technologies. It connects one or more health professionals with other health professionals or with patients. Within the framework of emergencies in maxillofacial surgery, requests received for specialist advice often pertain to procedures to be followed for facial wounds, bites, burns, maxillofacial bone trauma or facial cellulitis. These requests for specialist advice were previously made by phone between emergency physicians and maxillofacial specialists, with exchange of patient photos by text messaging, which raised security issues. We collaborated with the Telehealth Normandy Health Cooperation Group (GCS TSBN) for the implementation of a mobile application using the "Therap-e" telemedicine platform. This platform links together websites and remote health professionals via the Internet. Physicians communicate over a mobile network or from a health institution, in online or offline mode, synchronously or asynchronously, using any medium (tablet, PC, Mac, smartphone). This scheme both ensures secure transmission of personal and clinical data (especially facial photographs) and records specialist advice in patient medical records. The purpose of tele-expertise applications in an emergency context is to provide a solution to the demographic problems facing
Summary:
Aesthetic lower-extremity reconstruction is a secondary field in lower limb reconstructive surgery. Nevertheless, it plays an important role in the final stages of patient rehabilitation after traumatic events, treatment of deformations, and oncoplastic surgery, and in unique cases of purely aesthetic reconstruction. We present a clinical case of lower limb reconstruction with a prefabricated bipedicled deep inferior epigastric artery (DIEP) flap in a young patient who underwent a massive congenital circular pigmented nevus excision surgery. Due to the lack of sufficient donor site tissues anywhere on the body, a bilateral DIEP flap was prefabricated using tissue expansion. Two expanders were used to prepare the donor site. Six months after expansion, lower limb reconstruction was performed. A large (50 × 25cm2) surgical defect was covered by a prefabricated DIEP flap. Flap positioning was regarded with extra care due to importance of proper venous outflow in accordance with lower limb venous anatomy. Treatment results were above the satisfactory level both aesthetically and therapeutically. Aesthetic and therapeutic incentives were assessed before surgical treatment decision. Large defects of the lower limbs require significant amount of excess tissue in the donor site and may require prefabrication. In young patients with low BMI, flap transfer is nearly impossible without prior expansion. In this case, we successfully performed giant pigmented nevus excision, with immediate reconstruction with a prefabricated bilateral DIEP flap. Venous outflow was problematic due to the anatomical structure of lower limb veins. This required extra venous drainage and special regard to positioning of the flap.
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