Frequency and socio-psychological impact of taunting in school-age patients with cleft lip-palate surgical repair.

OBJECTIVES: Cleft lip-palate (CLP) is a "social" pathology because of its impact on the child's facial appearance and speech. School is the first place where children are confronted to others and when they start socializing. Taunting and bullying are common and their psychological impact remains hard to assess. The aim of this study was to evaluate the importance of taunting in school and its impact in CLP patients who had surgical repair. METHODS: We conducted a multicenter prospective study where we consecutively included patients ≥ 12 years who had CLP repair. During a multidisciplinary consultation they were asked to complete a questionnaire (3 parts: surgical outcomes, taunting and its impact, socio-economic status) previously approved by our psychologists. RESULTS: 55 patients were included (37 B, 18 G) (mean age 15.5 years): 11 CL, 13 CP and 31 CLP. 69% of patients reported having suffered from taunting and peer victimization in school. In 84% of the cases, taunting was linked to the CLP defect itself. The teasing started in primary school to reach a peak of aggressiveness in middle school. 42% of patients reported that bullying occurred at least once a day (16/38). Regarding the psychological impact of taunting, 50% of patients reported sadness, 31% depression and 26.3% were marked for life. At one time or another 29% of patients did not want to attend school because of the teasing. The grade retention rate amounted to 37.7% (20/53), and 2 patients were in special education classes. As a matter of fact, 50% of these children repeated their 1st or 2nd year of primary school. Furthermore, 47% of patients wanted to change something to their face, but 63% of them never spoke to their surgeon about additional surgeries even though they were teased in school. CONCLUSIONS: Taunting is common in children with CLP. This study highlights the high frequency and impact of taunting on the daily lives and self-perception of patients with CLP or CLP repair. It is important for healthcare professionals to be aware of this issue in the context of a multidisciplinary approach.

Surgical and prosthetic treatment for microphthalmia syndromes.

Our aim was to evaluate the long-term outcomes of prosthetic treatment and orbital expansion in the management of microphthalmia syndromes. We did a retrospective single-centre study of all cases of microphthalmia treated between 1989 and 2010. The patients were divided into three groups: isolated microphthalmia, microphthalmia associated with micro-orbitism, and complex microphthalmia syndrome. To evaluate the results a score was computed for each patient by assessing the length of the palpebral fissure, the depth of the conjunctival fornix, and local complications together with an evaluation of the satisfaction of patients and their families. Forty-four children were included (27 boys and 17 girls). Twenty-seven had unilateral microphthalmia (61%) and 17 bilateral microphthalmia (39%). Twelve patients were lost to follow up. The mean duration of follow-up was 12 years (range 4-21). Management involved an ocular conformer in only 31 patients (71%). The treatment was deemed satisfactory in all except 10 children. Surgical treatment with orbital expansion permitted good symmetry of the orbital cavities with a final mean difference of 9% (range 3-17) compared with the initial 16.8% (range 13.6-20.3). The prosthetic treatment gives satisfactory results. Despite limited indications and difficult follow-up, our experience emphasises the value of surgical treatment for severe micro-orbitism.

[Treatment of sequelae of burns in children]. / Le traitement des séquelles de brûlure de l'enfant.

Burn sequelae in children are conveyed in the form of retraction, deformity and growth problems together with dyschromia and trophic disorders. All the plastic surgical procedures can be used to correct them: full thickness or split thickness skin grafts, Z plasty and its derivatives (trident plasty, IC flaps), expansion, flaps, artificial skin, and dermabrasion. In most cases, these procedures will be combined. The aim of surgical treatment coordinated with rehabilitation is to restore the function, correct the deformities induced, improve the morphological aspect and permit normal growth. Good knowledge of the paediatric environment is, however, required to cope with the specificities of the child: treat the severe local inflammation, get the family to participate in the projects of rehabilitation, sometimes with the help of social services, maintain normal schooling, accompany the disorders in body schema, and, finally, prolong follow-up until growth is complete, a challenge in these patients who are often very young at the time of the accident.

[History of skin graft]. / Une histoire de peau.

Skin graft is the most common and simple procedure to cover superficial defect. Skin of variable thickness and size is completely detached from its origin (donor site) to cover a defect (recipient site). This simple procedure is the result of a long and eventful technical and theoretical evolvement. The aim of this article is to re-trace the history of skin grafting, from its discovery until today.

[Cervical congenital hemangioma: diagnosis and management difficulties]. / Hémangiome cervical congénital: difficultés de diagnostic et de prise en charge.

Rapidly involuting congenital haemangioma (RICH) is a rare vascular tumour whose antenatal diagnosis is difficult. During ultrasound examination at 32nd weeks' gestation, a voluminous heterogeneous cephalic lesion was discovered that could be a haemangioma or a teratoma. A caesarean delivery was performed. The tumour was removed directly after birth. The pathology examination concluded on a RICH. Antenatal, prepartum and postnatal management are not consensual and must consider the lesion size.

[Ophthalmologic characteristics of spheno-orbital meningiomas: a series of 23 surgical cases]. / Manifestations ophtalmologiques des méningiomes sphéno-orbitaires. A propos de 23 cas chirurgicaux.

PURPOSE: The authors report the ophthalmological characteristics and the postoperative results of patients presenting with spheno-orbital meningioma. DESIGN: A retrospective study of 23 charts of patients, presenting with spheno-orbital meningioma between 1994 and 2007, was performed. The data of preoperative and postoperative ophthalmologic examinations, perimetry and visual evoked potentials were collected. RESULTS: All the 23 patients were female. Diagnostic elements were proptosis (n=18), filling of the temporal pit (n=12) and visual impairment (n=11). Diagnosis was confirmed by orbital imaging. Perimetry and visual evoked potentials enabled to detect asymptomatic impairment of visual function, perimetry being the more sensitive method. Neurosurgery was the gold standard treatment, completed with radiotherapy in some cases of incomplete surgery or recurrence. CONCLUSION: Meningioma without optic nerve compression in the optic canal had better postoperative results with stabilization or improvement of the visual acuity compared with more unpredictable results obtained in cases with preoperative compression in the optical canal. Long term follow up of these patients is necessary because of the risk of relapse (n=3).

The morphology of cutaneous burn injuries and the type of heat application.

The morphology of burn injuries in 120 consecutive patients from the Department of Plastic and Reconstructive Surgery, CHR, Hospital B in Lille was correlated to the etiology and type of heat. Analysis identified five typical patterns of cutaneous burn injuries. Jet of flame-pattern from methylated spirits and gasoline detonations: superficial burn injuries; sparing of skin wrinkles and the submental region; absence or small amounts of soot; preference of exposed body regions, esp. the face and hands. Explosion-pattern from explosions and electrothermal injuries: superficial burn injuries; sparing of skin wrinkles but not of the submental region; soot; preference of exposed body regions. Alveolar soot arrangement and metallisation in electrothermal injuries. Considerable third-degree burns in dust explosions. Flame-pattern from direct flame effects due to burning gasoline or oil, open fires or ignited clothing: nonuniform depth including large third-degree burns; no sparing of the submental region; soot; preference of body regions covered by clothing. Immersion-pattern: superficial (bullous) injuries; blurred junction between scalded and unscalded areas; extremities, buttocks, and back are favourite sites; cave child abuse: waterlines and zebra-burns. Spilling-pattern: superficial injuries; sharp junction between scalded and unscalded areas; head, anterior trunk, and upper extremities are favourite sites; running off and splashing stains. Consideration of these patterns can assist the reconstruction in fire investigations or unclear scaldings. In cases of suspected arson, a typical burn injury pattern or a single finding not compatible with the rest of the pattern can disprove a suspect or raise the level of suspicion.

[Nipple-areola complex reconstruction with full-thickness skin graft and subcutaneous pedicled island flap]. / Reconstruction de la plaque aréolomamelonnaire par un lambeau à pédicule sous-cutané associé à une greffe de peau totale.

We are reporting on an easy, reliable and reproducible nipple-areola complex reconstruction. The main feature is to perform a full-thickness skin graft to rebuild the areola and a subcutaneous pedicled island flap for the reconstruction of the nipple in the middle of the graft. Each step is described. This technique remains easily practical and allows to keep an appropriate nipple projection. Moreover, it fits to all kind of breast reconstruction.

[Beyond the diagnosis of a genetic disease, the question of informing the relatives]. / Au-delà du diagnostic d'une maladie génétique, la question de l'information de la parentèle.

The examination of a person's genetic characteristics is not a classic diagnostic. It concerns the gene pool of an entire family. It is valid in the present and may affect some part of the future. The diseases that it reveals, sometime very serious ones, may or may not be treated. But genetic advice allows sometimes to preventing some of these diseases. The 2004 Bioethics Law makes the provision that in case a serious genetic anomaly is diagnosed during the examination of a person's genetic characteristics, the medical doctor informs the person or its legal representative of the risks that his silence could cause to the potentially concerned family members as long as prevention measures or care can be offered to them. For these reasons, besides the specificity of the diagnostic for the person directly concerned, there is also the question of the right of other people, like family members, to be informed of the diagnostic. As such, there is an ethical conflict between medical confidentiality owed to each patient and the duty of information. The pharmacist must know the medical confidentiality rules that frame this information. He must also know the different patient attitudes and must be able to encourage him to inform his family because the future if not the life of others may depend on this information.

[Long-term morphologic results of a 32 successive patients series presenting unilateral complete cleft lip and palate with surgery at early age]. / Résultats morphologiques à long terme d'une série de 32 patients successifs porteurs de fentes labiopalatines unilatérales totales opérées en conditions précoces.

STUDY OBJECTIVE: The aim of this retrospective study is to describe and evaluate the long term morphologic results of patients who present unilateral complete cleft lip and palate. PATIENTS AND METHODS: Thirty-two patients with non syndromic unilateral complete cleft lip and palate were operated early by the same surgeon, at the mean age of 70,4 days old, with two operating procedures. The first group was operated of cheiloplasty with the Millard method during the neonatal period, associated to the closure of the palate in the same time. The second group was operated with a modified Millard method during the neonatal period associated to a closing of the palate by the Wardill method at the age of ten months old. The criteria of evaluation were the anatomic remaining abnormalities after surgery of nose, lips, primary and secondary palate (back of 17 years). RESULTS: Our results show that Millard method and derived are taken as a whole effective, even if the number of secondary surgery and supplementary adjustments was sizeable (87%). The postoperative abnormalities concerning red lip (discontinuity, mucous excess) were frequent (53%), but easily correctable. The secondary surgeries were mainly for minor touch up of lip (46%), second time palate surgeries (53%), and rhinoplasties (40%). CONCLUSION: Progress in anesthesia and reanimation allowed us to assure an early management of clefts. The absence of incorrigible after-effects by a secondary surgery of the first-operated patients encouraged the team to continue in this way.

[Deleated breast reconstruction, witch strategy?]. / Reconstructions mammaires différées, quelles stratégies?

Breast reconstruction is part of the treatment of breast cancer needing mastectomy. To deal with the numbering technics in breast reconstruction surgery and with the number of patients seeking reconstruction, the authors proposed a strategy taking care of the patients wishes, of the patients morphology and of the surgicals limits of the different technics. On this aim, the authors reviewed a 30 patients series of secondary breast reconstruction composed of 23 inferior gluteal free flaps, 4 transverse rectus abdominus myocutaneous flaps and 3 latissimus dorsi musculocutaneous flaps.

[The osteomuscular latissimus dorsi scapula flap: anatomical study and 3 cases]. / Le lambeau ostéomusculaire de muscle latissimus dorsi avec bord latéral de scapula: étude anatomique et application clinique.

The goal of the reconstruction of complex defects of the leg is to restore morphology, trophicity and function. The purpose of our study was to analyse the reliability of the latissimus dorsi scapula flap in this indication. We realized an anatomical study on 12 cadaver dissections. The presence of the angular artery was found to be constant with four types of origins described in this article. The same technique was applied on three patients presenting a complex tissue loss of the middle third of the tibia. This clinical application confirmed the validity of the technique.

[Early preventive pressure therapy in extensive skin grafts on children's face, a comeback of classic methods? A retrospective study on 8 cases]. / Pressothérapie préventive précoce pour les greffes extensives au niveau facial chez l'enfant, retour aux méthodes classiques? Une étude rétrospective sur huit cas.

INTRODUCTION: One of the common techniques in the treatment of giant facial naevi is the excision covered by a skin graft. It's functional and esthetic results are not always excellent. Physiotherapy including immediate postsurgical preventive pressure therapy could ameliorate these results and shorten the period of scarring. PURPOSE: Evaluation of scarring results with early pressure therapy in skin grafts of congenital facial naevi. PATIENTS AND METHODS: Retrospective study on 8 children being 1 to 9 years old and presenting congenital facial naevi. All of them were treated by excision followed by full thickness skin grafting. The associated physiotherapy was realized by a transparent rigid or elastic mask. The pressure was started after skin graft uncovering between 7 and 20 days. The period for this treatment was depending on the maturing of the scar. Evaluation was established by 3 examinators on: time till scar maturing, trame quality and esthetic quality. RESULTS: The period till definitive scar maturing was showed to be between 8 and 14 month; trame quality was mostly evaluated as excellent, the esthetic result oscillated between good and medium. CONCLUSION: Physiotherapy seems to be an essential association for the treatment of facial full thickness skin grafts in children. Early pressure therapy could better the functional and esthetic result and accelerate scar maturing. Simple skin grafting could become the first treating option in this indication. Future prospective studies are expected to confirm these results.

[Early surgical treatment of cutaneous hemangiomas]. / Le traitement chirurgical précoce des hémangiomes cutanés.

Infantile hemangioma appears after the birth as a vascular tumor, which is known for its characteristic evolution in 3 phases: rapid augmentation then stabilization and involution on several years with in the best cases, classical "restitutio ad integrum". Usual surgical attitude is abstention and surgery is proposed only in order to treat sequel. But some particular situations require early surgery for life-threatening lesions or in case of functional impairment. Surgery consists in these cases in a simple volumetric diminution of the tumor with no aim for esthetic improvement. Other kinds of hemangiomas require an early surgical treatment before their complete involution. In some particular locations, deformation or growth delay can occur due to the lesion's development. In some cases, hemangiomas present a delayed involution with minor regression capacity; these are mainly located on the median part of the face and have principally a subcutaneous development. Early surgery can be proposed in order to avoid definitive deformation or growth impairment of adjacent structures. It should be performed before school age and before occurrence of psychological difficulties. Surgery is indicated in a perspective of esthetic improvement. Surgical procedure consists first in modeling excision followed by simple repair technique as linear suture or purse string closure; complex surgical procedures inducing their own sequels are usually inappropriate.

[Role of lipo-filling in the treatment of sequelae in craniosynostosis surgery]. / Intérêt du lipofilling dans le traitement des séquelles de chirurgie des craniosténoses.

AIM: This study presents an innovative technique of correction of cranioplasty sequelae by lipo-filling in 9 patients treated for cranioplasty in childhood with a long-term follow-up. PATIENTS AND METHODS: A prospective study was conducted from January 2001 to February 2005, including all patients treated with lipo-filling technique in the Plastic Surgery department of Lille. For a period of 4 years and 5 months, 144 patients were operated on with 206 lipo-filling procedures: 30 patients for cosmetic purposes and 114 patients for reconstructive surgery. In the current investigation, we examined the 9 cases of lipo-filling which were performed in complement to craniofacial surgery. All patients presented with a sub-cutaneous fronto-temporal deformation which in 3 of the cases was associated to a frontal medial defect. The assessment of results was performed in the context of post-operative follow-up visits by an observer. RESULTS: Nine patients, with a mean age of 16,7 years and a ratio of 1 female for 2 males underwent a total of 17 lipo-filling procedures. The mean time lapse was 15,06 months. 9 patients judged the result to be good. No complication was observed. CONCLUSION: The S.R. Coleman technique of fat grafting seems to offer several advantages, namely the simplicity of the procedure itself, its apparent innocuity, its reproducibility, as well as patients and surgeons satisfaction. It appears to be an alternative of choice in the corrective surgery of craniosynostosis.

[To a margin reduction in the dermatofibrosarcoma protuberans? Retrospective study of 34 cases]. / Vers une réduction des marges latérales dans les dermatofibrosarcomes de Darier et Ferrand ? Etude rétrospective de 34 cas.

INTRODUCTION: The dermatofibrosarcoma protuberans (DFSP) is a rare but not exceptional tumour. Surgical treatment should contain a wide excision to avoid local recurrence. MATERIAL AND METHOD: We report a retrospective study of 34 cases treated by the same team from 1994 to 1999. In this series, only 4 cases (12%) presented recurrences after previous treatment by the other teams. In all cases, surgical resection was performed with 3 cm lateral margin and a disease free anatomic layer removed with the tumour. RESULTS: The mean of follow up was 60 months. There was no recurrence case in our 34 patients during this period. We compare our results with those, from others teams described in international literature since 1951. Margins and results are similar with some teams who practice the Mohs surgery. CONCLUSION: These data are in favour of a reduction of the lateral margins in classical surgical procedure of DFSP. They should be consolidated by a follow-up in longer term with a prospective study.