Challenges in lower face soft tissue reconstruction: The value of the historical bipedicled scalp flap procedure

[Lessons from a master in tissue transfer: A study of the surgical notebooks of General Gustave Ginestet during the Foch years]

The surgical notebooks (1945-1959) of General Gustave Ginestet are the last direct testimony of the quintessential period in which autoplastic techniques were used, before their twilight, favored by the advent of axial pedicle flaps, musculocutaneous flaps and later free flaps. They summarize all the refinements of the experience accumulated at the National Center for Reconstructive Surgery (Centre Médico-Chirurgical Foch-Suresnes). They appear to be more informative than the various books of the time, which were intended for an experienced public or for those benefiting from a companionship, thus eluding a certain number of precautionary advice, which are undoubtedly tacit but essential to obtain a successful operation in the hypothesis of their current use. This paper aims to establish the principles of historical surgical techniques and to integrate them into the management of patients in therapeutic impasse. One hundred and seven clinical situations requiring tissue displacement were analyzed by reconstructed region and by type of flap used. This technical view of the past, as close as possible to the daily practice of a famous reconstructive surgery center, does not offer absolute methodological or technical precepts. From the surgical notebooks studied, the only thing that emerges is a rigorous approach that allows us to contain a permanent doubt and an experimental process. This notion of constant evolution of the autoplastic practice, guided by its errors, intuitions and beliefs, highlights the importance of a surgical culture, which, with a humanistic approach, must be nourished by the paths of the past.

A twostep supraclavicular flap method in head and neck reconstruction for refractory osteoradionecrosis

Techniques of reconstructive surgery of the head and neck region have existed since Antiquity, with the pedicled forehead flap of Susruta as a reference. These methods are constantly evolving, with the introduction of free flaps in the 1980s, and more recently new technologies such as CAD-CAM. However, the surgical management of patients treated by radiotherapy for upper airway cancers remains a challenge in terms of functional and aesthetic results. Indeed, cervical irradiation, which alters the quality of skin and vascular tissue, jeopardizes good healing after head and neck reconstructive surgery. In this article, the authors proposed to revisit the standard technique of the pedicled supraclavicular flap. Flap design inspired from the known and described technique of the two-stage forehead flap, for the management of a fragile patient with refractory mandibular osteoradionecrosis.