Background: Primary anaplastic large-cell lymphoma (ALCL) occurring in women with breast implants is very rare. It is usually described as tumor cells infiltrating the periprosthetic capsule. These are most often revealed by a periprosthetic recurrent isolated effusion (seroma cavity), occurring late after implantation of the prosthesis. ALCL is more rarely a tumor or periprosthetic capsular contracture. Case: We report a 66-year-old woman, initially diagnosed by cytological examination of breast effusion, in whom ALCL appeared two and a half months after the removal of a ruptured implant. Repeated biopsies of the periprosthetic capsule performed in parallel showed fibrous tissue, without tumor proliferation. Only meticulous histological examination of the total capsulectomy identified tumor cells as a thin and discontinuous layer along the inner surface of the capsule without capsular invasion. Conclusion: Awareness of the histological pattern of this new clinical entity is important. A total capsulectomy with a good sampling for microscopic examination should be conducted for any suspicion of breast implant-associated ALCL. Cytology-histology correlation is essential.
An original method for thumb reconstruction by the anterior interosseous osteocutaneous island flap is presented. This flap, based on the superior perforating branch of the anterior interosseous artery, is located on the posterior aspect of the forearm, over the distal third of the radius. The dorsal vascular network of the wrist allows the flap to be raised as a retrograde island flap to reach all the parts of the first ray for reconstruction of osteocutaneous loss of the thumb. Two cases have been operated upon successfully with a satisfactory result.The choice of technique in thumb reconstruction represents a delicate balance between potential gains of the envisaged procedure and the price paid at any given donor site. A simple and economical one-stage thumb reconstruction technique is described. The anterior interosseous island flap is used, this is based on the superior perforating branch of the anterior interosseous artery. AnatomyThe anterior interosseous retrograde island flap has been previously described in 1991 [5][6][7]. This anatomical study was performed on 44 upper limbs of fresh cadavers with various injection materials. The findings are summarized as follows:1. The anterior interosseous artery originates from the common interosseous artery which branches from the ulnar artery in 95.5% of cases. It arises between the insertions of the flexor pollicis longus and the flexor Correspondence to. Dr. W. Hu, Department of Plastic and Reconstructive Surgery, Surgery of the Hand and Microsurgery, PellegrinTondu Hospital, Place Am6lie-Raba-L~on, F-33076 Bordeaux Cedex, France digitorum profundus muscles and has an average caliber of 1.5 mm at its origin. The vessel lies close to the interosseous membrane of the forearm accompanied by the anterior interosseous nerve, and it gives off 3-4 small branches to the supinator and 5-7 to the flexor pollicis longus and the flexor digitorum profundus. Most of these muscle branches are located in the proximal half of the forearm.In the distal half of the forearm, the anterior interosseous artery gives several perforating branches (on average 6) which perforate the interosseous membrane to supply the dorsal aspect of the distal two-third of the forearm. The two principal ones are named "the superior and the inferior perforating branches". At the level of the pronator quadratus the anterior interosseous artery divides into two terminal branches: the inferior perforating branch and the anterior terminal branch (Fig. 1). The latter supplies the pronator quadratus and in 73% of cases it joins the volar vascular network of the wrist which is dominated by the radial and the ulnar arteries.2. The superior perforating branch of the anterior interosseous artery perforates the interosseous membrane 10+2 cm above the radio-carpal joint line and runs in the septum between the extensor pollicis longus and brevis muscles accompanied by two venae comitantes. The calibre of the artery at its origin varies from 0.9 to 1.5 mm. During its course, the artery gives off 5-7 cutaneous branche...
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