Breast enlargement in an HIV-infected man on combined antiretroviral therapy: what if it was carcinoma?

We describe a case of an HIV-infected man on effective combined antiretroviral therapy, presenting with bilateral gynaecomastia revealing breast carcinoma. Gynaecomastia was first considered to be related to efavirenz and/or didanosine. Although breast carcinoma is rare among HIV-infected men, it should be considered as a potential cause of breast enlargement.

[Rejuvenation of the lower third of the face and the neck]. / Rajeunissement du tiers inférieur du visage et du cou.

One of the marks of the youth of a face is the absence of ptosis of the cheek and the perfect delimitation of the neck with an angle well defined. The objective of this work is to present our surgical technique for the treatment of the lower third of the face and the neck. After a degreasing of the neck and lower part of the cheek, we carry out an extensive cutaneous separation of these areas. The cervical face lift is performed in different layers. A suspension with posterior direction of the platysma is systematic. It is associated or not, according to the importance with the platysma bands, with an anterior approach or with counter side incisions. A reinforcement of the angles is obtained by a fat grafting. One fills the mandibular ligament and one underlines the relief of the chin.

[Surgical management of cutaneous necrosis in the purpura fulminans: report of 2 clinical cases]. / Prise en charge chirurgicale des nécroses cutanées dans le purpura fulminans : à propos de 2 cas cliniques.

The authors report their experience of the management of 2 patients with purpura fulminans. After a review of the epidemiology, diagnostic methods, natural course and prognosis of the disease, the various stages of the treatment are described. The urgency of the medical treatment is stressed and the specific technique of the surgical approach to the artificial dermis is detailed. The quality of initial management is of crucial importance and such extensive and deep cutaneous destruction is best dealt in burn centers.

[Rhinoplasty in the immediate assumption of responsibility of nasal burns. Technical note and report of two cases]. / Rhinoplastie dans la prise en charge immédiate des brûlures du nez. Note technique à propos de deux cas cliniques.

We report the use of a traditional technique of rhinoplasty in the immediate assumption of responsibility of deep burn of the nasal edge which cannot be grafted. The limit of the realization of this gesture lies in the fact that it must exist nasal morphological characteristics at the patient. The two cases presented had an hypertrophic nose with osseous and/or cartilaginous bump. The reduction height of the osseo-cartilaginous frame allows closing the defect without cutaneous tension. One carries out a true excision-joining of the burn of the nasal dorsum. We note at one year of retreat, the discretion of the scar located on the centre line of the nose, the absence of after-effects as well as the cosmetic satisfaction of the patients with respect to the modifications morphological their noses.

[Giant lymphedema of the upper extremity. A case report]. / Lymphoedème géant du membre supérieur droit. A propos d'un cas.

The giant lymphoedema of upper limb still a difficult therapeutic problem. The authors report a case treated as a Charle's operation derived. They underline the operation's value. As they are experienced with the third-degree burned patients, they insist on the respect of the pre-muscular aponevrosis during the excision and how as possible it's better to take the split-thickness skin graft on the excised skin. Excision and graft are made during the same operation. They come back to the initial medical treatment and to the different surgical treatments.

[Breast burn sequelae. Classification and therapeutic indications]. / Séquelles de brûlures de la région mammaire. Classification et indications thérapeutiques.

Reconstructive surgery of post-burns scars in female (either young children or adults) is a frequent need in our experience. The problems is to face the consequences by considering the growth of mammary gland either hormonal in case of children or breast reconstruction as if in case of malignancy in adult female. Classifications of post burn scars is helpful to adapt the method of initial treatment, is a real need. The authors have spent part of their experience to treat acute case of thoracic burns, proposing classification of three types and specific treatment for each.

[Reconstruction of facial burn sequelae]. / Réparation des séquelles de brûlures de la face.

The deep burns of the face can lead to horrible scars functionally and aesthetically. Treatment of these scars need several surgical interventions frequently and during many years. In our region we deal with this type of wounds as team work, multidisciplinary approach carrying out many process starting by emergency treatment of acute burns till the social rehabilitation. The expansion technique was great help in improving the shape of scars, by using the expanding skin as full thickness grafts. Reconstruction of the anatomical units and application of aesthetic techniques (like rhinoplasty, lifting, tattooing and autologous fat injections) participate equally in improving the quality of results. Many examples of treatments of burns scars are shown.