Long-term sequelae treatment of peripheral facial paralysis with botulinum toxin type A: Repartition and kinetics of doses used.

STUDY OBJECTIVES: Botulinum toxin is a key therapeutic tool in the comprehensive treatment of peripheral facial paralysis. It fights spasms, synkinesis and overactivity of the different skin muscles responsible of facial expressions. Even though injection techniques as well as target muscles have been well identified, doses used remain quite imprecise and often not detailed muscle by muscle, further more dosage progression has not been monitored over time. Our retrospective study is the first one to refine the repartition of botulinum toxin doses on each of the relevant skin muscles and assess dosage kinetics. PATIENTS AND METHODS: Thirty patients were included since 2008 with a mean follow-up of 2.3years. Each patient had at least 3 injections, with a delay of 4 to 6months between each injection. RESULTS: Mean doses are indicated for each muscle injected on the paralyzed and healthy sides. Dose kinetics suggests an initial dosage increase after the first injection followed by a decrease over time. No treatment resistance was observed. CONCLUSION: Our study represents a didactic help in using botulinum toxin for sequelae of peripheral facial paralysis by providing more details on the effective mean doses for each muscle and their progression over time.

[Emergency management of extravasation in children]. / L'extravasation chez l'enfant, prise en charge en urgence.

The subcutaneous diffusion of intravenous drips, or extravasation, is a frequent iatrogenic complication in children, mainly in the neonatal period. This potentially severe pathology can lead to local ischemia that sometimes mimics compartment syndrome. It can also evolve towards vast soft-tissue necrosis. Nursing staff often underestimate the risk of functional, aesthetic, and psychological consequences. The speed and quality of the initial medical and surgical management can greatly decrease morbidity associated with extravasation. Prevention is fundamental, such as raising awareness in and training medical and paramedical staffs and creating efficient protocols. Surgical management involving aspiration and washing the site as early as possible improves the prognosis. Aspiration and washing can be done on a larger area if one criteria of severity is met, particularly in cases of extravasation using a vesicant or hyperosmolar agent. If necrotic lesions appear, it is wise to wait until they become delimited. Debridement and coverage can be performed using classical methods.

[Is cosmetic surgery proposal to children and adolescents well-founded?] / Est-il légitime de proposer de la chirurgie esthétique aux enfants et aux adolescents ?

Cosmetic surgery for children and adolescents experiencing an international increase. Their physical and psychological development is incomplete; establishment of an indication for cosmetic surgery requires several essential prerequisites. The motivations of surgery, often multiple and intricate, must be understood. There is a difference in motivation between adult, trying to be more "competitive" and the young patient, wishing to comply with a social group to integrate. We must identify who made the request to respond to requests from the child himself. The role of parents is crucial. Their presence, legal obligation, gives variable contribution: asset to a non-participating children, role of information relay delivered, organizational aspects of care but sometimes leads to difficulties if parent-child relationship is confrontational. According to the American Society of Plastic Surgery, 63,623 cosmetic surgery procedures occurred in 2013 in adolescents from 13 to 19 years old. Mainly rhinoplasties, otoplasties, breast surgery (breast augmentations, breast reductions, gynecomasties). From a purely technical viewpoint, cosmetic surgery is not riskier in young patients. However, surgery only targets "surgical problems"; we must make a distinction between "complex" and "depression", be able to identify a psychiatric underlying disease or understand that surgery is a hidden demand. If surgical art requires a real expertise, only a well-indication establishment will process to a successful result.

[Tattooing of the nipple-areola complex in breast reconstruction: Technical note]. / Tatouage de la plaque aréolo-mammelonnaire en reconstruction mammaire : note technique.

The reconstruction of the nipple-areola complex is an essential step in breast reconstruction. It announces the end of the reconstruction process, which is often long and sometimes difficult to live for the patient and will significantly improve the perception of body image. Concerning the reconstruction of the areola, tattooing is one of the preferred techniques. It's a simple, quick and safe procedure with a high satisfaction rate. This technique is still perfectible in our opinion, because the random lifetime of pigmentation is a recognized disadvantage of this procedure. We propose a modification of the conventional technique for improving the quality of dermopigmentation while reducing its completion time. Our method is to perform a dermabrasion before starting the tattoo. Indeed, dermabrasion allows better penetration of the pigments inside the dermis and thus offers two advantages: a more durable result over time and reduced operation time by reducing the number of passing of the machine tattoo. Finally, our tattooing technique seems relevant and totally appropriate: its realization is simple, reproducible, does not increase the overall cost of reconstruction, provides timesavings and gives a better long-term result.

[Massive panniculectomy and bilateral subtotal mastectomy in a case of calciphylaxis: A case report and up date]. / Dermolipectomie abdominale et mastectomie bilatérale subtotale dans le cadre d'une calciphylaxie: à propos d'un cas et mise au point.

Calciphylaxis or calcific arteriolopathy is a rare, life-threatening obstructive pathology of the small cutaneous and subcutaneous vessels. It mainly affects patients with chronic renal failure but it also has been described in patients with normal renal function. The principal risks factors apart from renal failure and phosphocalcic metabolism imbalance are: the female sex, obesity, peripheral vascular disease, diabetes and oral anti-coagulation. We present a very rare case of abdominal, mammarian and upper thighs calciphylaxis in a patient with normal renal function. She presented a severe obesity with a recent important loss of weight and had been treated by oral anticoagulants for a long time. She benefited of a multidisciplinary approach with dermatologists, plastic surgeons and anesthesists permitting a recovery in fourteen weeks. Multidisciplinary approach is necessary but the place of the surgery is not well defined. We report a case in which early and wide surgical approach permitted to obtain a favourable evolution of the pathology. Then, we propose a therapeutic strategy after review of the literature.