Upper lateral lip flap for the coverage of large superficial labial defect.

BACKGROUND: Reconstruction of large superficial defects of the upper lip is challenging, as it requires the restoration of both function and morphology. To achieve optimal results, facial features and landmarks should be preserved and similar skin should be used. Moreover, in male patients, upper lip pilosity should be restored. Although myriad of local flaps have previously been described, few address these issues. Herein, we describe our results with an upper lateral lip rotation flap for large upper lip cutaneous defects coverage. PATIENTS AND METHOD: A retrospective study was performed including every patient who underwent an upper lateral lip flap between 2010 and 2017. Demographic data, defect dimensions, etiology, type of anesthesia, operative time, postoperative complications, functional and morphological outcomes were recorded. RESULTS: A total of 31 patients were included. All procedures were performed under local anesthesia as outpatient procedures. The length of the operative procedure was 48minutes in average. The mean size of the superficial defect was 19mm (ranging from 6 to 30mm). All patients were fully healed after 15 days, and no flap necrosis (partial or total) was reported. No nasal or lip distortion was observed and facial hair was successfully restored in all male patients. CONCLUSION: The upper lateral lip flap is a fast, safe, and reproducible procedure to cover defects of the lateral upper lip of up to 3cm. With scars hidden in natural folds and lip defects covered by lip tissues, this technique restores facial cosmetic features with very satisfying aesthetic outcome, especially in men as facial hair is restored.

Is brachioplasty acceptable as an outpatient procedure? A prospective study comparing ambulatory and traditional hospitalization procedures.

BACKGROUND: Ambulatory or outpatient surgery is defined as surgery that does not require an overnight hospital stay. It offers patients both convenience and reduced costs. With the increased use of bariatric surgery, Extended L-shaped Lipo-brachioplasty is now frequently requested as a follow-up procedure. Although numerous studies have focused on its technique and outcomes, none have evaluated its acceptability as an outpatient procedure. This was the aim of this prospective study. PATIENTS AND METHODS: This study was performed between January 2016 and September 2019. All patients undergoing extended L-shaped Lipo-brachioplasty during that period were included and divided into two groups, according to the type of hospitalization. For both groups, we recorded the demographics, medical and surgical data, as well as any postoperative complications. In the outpatient group, we also recorded discharge failures at day 0. RESULTS: 75 patients were included in the study (40 outpatients, 35 hospitalizations). There were no significant differences between the two groups in terms of demographics, surgical data, or the incidence of complications. In the outpatient group, three patients could not be discharged the evening of the procedure and had to stay overnight. No readmissions or major complications were reported in this group. CONCLUSION: Our prospective study shows that outpatient Extended L-shaped Lipo-brachioplasty safely provides the same outcomes as those performed during traditional hospitalization. We believe that for eligible patients, it should routinely be performed as an outpatient procedure.

Surgical approaches in neck dissection: Comparing functional, oncologic and aesthetic aspects of transverse cervicotomy to Paul André's approach.

BACKGROUND: Surgical approaches in neck dissection: comparing functional, oncologic and aesthetic aspects of transverse cervicotomy to Paul André's approach. METHODS: This single-center retrospective study compares a new transverse incision for cervicotomy to the classical approach described by Paul André in neck dissections. The evaluation criteria were: number of lymph nodes analyzed, operative time, complications, patient satisfaction and aesthetic aspects of the scar. RESULTS: A total of 34 patients were included in this study, from September 2009 until January 2015. The number of lymph nodes analyzed is not affected by this new approach compared to the classical one (P=0.9). The scar has a significantly more discreet appearance in the transverse cervicotomy group (P=0.023) likewise; patient satisfaction is higher in this group (P=0.006). CONCLUSIONS: Aesthetic and functional impairment can be reduced using this new transverse cervical approach hidden in the natural creases of the neck described by Langer.

Midface rejuvenation surgery combining preperiosteal midcheek lift, lower blepharoplasty with orbital fat preservation and autologous fat grafting.

OBJECTIVE: The aim of this study was to describe a technique for midface rejuvenation combining lower blepharoplasty, midcheek lift and autologous fat transfer. METHODS: All patients who underwent a midface rejuvenation procedure performed by the same surgeon and using a classic subciliary blepharoplasty surgical approach were identified. The technique combined three distinct procedures: lower blepharoplasty with use of a transposition flap of orbital adipose tissue in the medial and central compartment to reduce the subpalpebral bags and attenuate the palpebrojugual sulcus; midcheek lift in the preperiosteal plane with trans-osseous fixation exerting traction on the soft tissues of the cheek along several vectors; autologous fat transfer to offset the loss of volume in the target area. RESULTS: Between January 2011 and December 2015, 14 patients were operated with the described technique. Long-term results were good and stable over time. Two complications in the form of ectropion were observed in the series but resolved with daily massages. CONCLUSIONS: The combination of lower blepharoplasty, midcheek lift and autologous fat transfer appear to enable treatment of midface ageing. The results were satisfactory and durable, and the procedure was well tolerated. The procedures could be combined with others for the treatment of the upper and lower face during the same surgical procedure.

[Delay of professional activity recovery after implant based breast augmentation surgery: Influence of healthcare coverage]. / Délai de reprise de l'activité professionnelle après chirurgie d'augmentation mammaire par prothèse: impact de la prise en charge par la sécurité sociale.

AIM OF THE STUDY: The main goal is to determine if the delay before going back to work after implant-based breast augmentation surgery is influenced by the healthcare coverage criteria. MEANS AND METHODS: In this retrospective, single center based study, patients who underwent implant-based breast augmentation surgery (excluding reconstructive surgery) in the past 3 years with a minimum follow-up of 1 month were questioned by telephone. Patients who had early postoperative complications, or no professional activity, were excluded. The demographic and perioperative data were collected and two groups were compared: those who were covered by the healthcare system and those who were not. RESULTS: Sixty patients were included. The two groups were comparable concerning the demographic (age, BMI, children, work intensity, smoking status, comorbidity) and surgical data (surgical approach, type, volume and position of the implant, operative time and drainage). There was a significant difference between the groups concerning the delay of return to work (P=0.0001): 18.4 days for reimbursed patients versus 9.45 days for patients without healthcare coverage. CONCLUSION: For the same implant-based breast augmentation surgery, and for the same population, the duration of postoperative recovery period doubles for the patients for whom surgery is reimbursed by the healthcare system.

[The "two positions" lipoabdominoplasty]. / Plastie abdominale en deux positions.

BACKGROUNDS: Lipoabdominoplasty is a way to improve morphological outcomes by treating the areas not accessible to resection during classical abdominoplasty, especially hips. However, patients can present a lateral and posterior fat extension, not accessible to an anterior liposuction. This situation is managed by a first step with liposuction in the prone position. The aim of this study was to determine whether lipoabdominoplasty performed in two positions increases morbidity compared with lipoabdominoplasty in supine position only. METHODS: This was a retrospective study of 137 patients who underwent lipoabdominoplasty between 2009 to 2013. Eighty-five patients underwent a one position lipoabdomynoplasty and 52 a two positions lipoabdomynoplasty. Medical records were reviewed to collect data regarding patient demographics, operative technique, volume of liposuction and complications. RESULTS: The posterior liposuction has significantly increased the length of procedure (mean: 43.3 minutes). The volume of liposuction was significantly higher when the procedure was performed with prone and supine position (2789.6 mL versus 1373.8 mL, P<0.001). There was no significant difference between the two groups regarding complications and blood loss. CONCLUSION: Lipoabdominoplasty in two positions is an effective technique with the same morbidity as a lipoabdominoplasty in supine position only. The procedure finds its indication, between classic abdominoplasty and bodylift, for patients with lateral and posterior fat extension without posterior skin excess.

Characterization of hybrid biphenyl dioxygenases obtained by recombining Burkholderia sp. strain LB400 bphA with the homologous gene of Comamonas testosteroni B-356.

The bacterial degradation of polychlorinated biphenyls depends on the ability of the enzyme biphenyl 2,3-dioxygenase (BPDO) to catalyze their oxygenation. Analysis of hybrid BPDOs obtained using common restriction sites to exchange large DNA fragments between LB400 bphA and B-356 bphA showed that the C-terminal portion of LB400 alpha subunit can withstand extensive structural modifications, and that these modifications can change the catalytic properties of the enzyme. On the other hand, exchanging the C-terminal portion of B-356 BPDO alpha subunit with that of LB400 alpha subunit generated inactive chimeras. Data encourage an enzyme engineering approach, consisting of introducing extensive modifications of the C-terminal portion of LB400 bphA to extend BPDO catalytic properties toward polychlorinated biphenyls.

Interaction of the viral protein genome linked of turnip mosaic potyvirus with the translational eukaryotic initiation factor (iso) 4E of Arabidopsis thaliana using the yeast two-hybrid system.

The yeast LexA interaction trap was used to screen a cDNA library from Arabidopsis thaliana in order to identify proteins that interact with the viral protein genome linked (VPg)-proteinase of turnip mosaic potyvirus. The screen allowed the isolation of four candidate cDNA clones. Clones pHC4, pHC21, and pHC40 were partially sequenced but no homologies to known proteins were found. However, the amino acid sequence deduced from the complete nucleotide sequence of pSW56 revealed that it was the eukaryotic initiation factor (iso) 4E [eIF(iso)4E]. Deletion analysis indicated that the VPg domain was involved in the interaction with the plant protein. Interaction between the viral protein and the cellular protein was confirmed by ELISA-based binding experiments. eIF(iso)4E plays an essential role in the initiation of the translation of capped mRNAs and its association with VPg would point to a role of the viral protein in the translation of the virus.

Purification of turnip mosaic potyvirus viral protein genome-linked proteinase expressed in Escherichia coli and development of a quantitative assay for proteolytic activity.

The 49-kDa, nuclear inclusion a-like, viral protein genome-linked proteinase (VPg-Pro) of turnip mosaic potyvirus (TuMV) was expressed in Escherichia coli. The protein was produced in a soluble form at high levels and was active, as demonstrated by intermolecular cleavage of the polymerase capsid protein (Pol-CP) substrate. The VPg-Pro was purified by metal-chelation and ion-exchange chromatographies. Two forms of VPg-Pro, which differed in molecular masses, were obtained during isolation; their identities were confirmed by immunoblot analysis and N-terminal amino acid sequencing. Data indicated that cleavage took place at a site near the C-terminus of VPg-Pro and was the result of the proteolytic activity of the viral protein. The purified proteinase retained enzymic activity on its natural substrate (Pol-CP) and was also capable of hydrolysing the synthetic peptide acyl-Ala-Ala-Val-Tyr-His-Gln-Ala-Ala-NH2, derived from the consensus cleavage site for the TuMV polyprotein. Analysis by mass spectrometry of the two fragments resulting from this reaction indicated that cleavage took place between the Gln and Ala residues, as expected. A fluorogenic derivative of this peptide was hydrolysed by VPg-Pro, affording a convenient quantitative assay for intermolecular proteolytic activity, and was used to determine the pH-activity profile. The availability of large quantities of pure proteinase and of a rapid and sensitive assay will permit detailed kinetic and structural studies which are essential to obtain a better understanding of the mode of action of this and related viral proteinases, such as the 3C proteinase of picornaviruses.

Release of a 22-kDa protein derived from the amino-terminal domain of the 49-kDa NIa of turnip mosaic potyvirus in Escherichia coli.

The coding region for the precursor 6K-small nuclear inclusion a (NIa) protein and for the NIa protein of turnip mosaic potyvirus (TuMV) were introduced into the plasmid pET-11d for high-level expression in Escherichia coli. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblot analyses of E. coli proteins showed that the NIa protein underwent endoproteolysis and released a 22-kDa polypeptide. NH2-terminal amino acid sequencing of the recombinant 22-kDa protein was performed and was identical to the predicted amino end of the NIa protein. Site-directed mutagenesis confirmed that the hydrolysis was associated with the NIa proteolytic activity and that the proteinase recognized a Glu residue within an amino acid sequence found in the NIa protein which fitted the TuMV consensus cleavage site sequence. Fusion of the 6K protein with the NIa protein partially inhibited the hydrolytic reaction. The recombinant 22-kDa protein is likely the VPg of TuMV.