In vitro effects of wound-dressings on key wound healing properties of dermal fibroblasts.

Healing of complex wounds requires dressings that must, at least, not hinder and should ideally promote the activity of key healing cells, in particular fibroblasts. This in vitro study assessed the effects of three wound-dressings (a pure Ca2+ alginate: Algostéril®, a Ca2+ alginate + carboxymethylcellulose: Biatain alginate® and a polyacrylate impregnated with lipido-colloid matrix: UrgoClean®) on dermal fibroblast activity. The results showed the pure calcium alginate to be non-cytotoxic, whereas the other wound-dressings showed moderate to strong cytotoxicity. The two alginates stimulated fibroblast migration and proliferation, whereas the polyacrylate altered migration and had no effect on proliferation. The pure Ca2+ alginate significantly increased the TGF-ß-induced fibroblast activation, which is essential to healing. This activation was confirmed by a significant increase in Vascular endothelial growth factor (VEGF) secretion and a higher collagen production. The other dressings reduced these fibroblast activities. The pure Ca2+ alginate was also able to counteract the inhibitory effect of NK cell supernatants on fibroblast migration. These in vitro results demonstrate that tested wound-dressings are not equivalent for fibroblast activation. Only Algostéril was found to promote all the fibroblast activities tested, which could contribute to its healing efficacy demonstrated in the clinic.

Reconstruction of caudal defects of the nose using the bilobe flap: A long-term follow-up retrospective review.

BACKGROUND: Reconstruction of nasal defects is a challenging task due to the complex nasal geometry and the need for aesthetic considerations. The bilobe flap has emerged as a reliable technique for nasal reconstruction, particularly for defects involving the nasal tip, alae, and inferior dorsum. OBJECTIVE: This study presents a review of 31 patients who underwent bilobe flap reconstruction for nasal defects after tumor resection. MATERIALS AND METHODS: The surgical technique, short- and long-term aesthetic outcomes, patient satisfaction, and complications were evaluated. Aesthetic outcomes were assessed using a qualitative ordinal scale, and long-term patient satisfaction was obtained through follow-up notes and phone interviews. RESULTS: Bilobe flap reconstruction yielded good aesthetic outcomes in the majority of cases, with high patient satisfaction. Complications were minimal, and revision surgeries were performed in a small number of cases to address aesthetic concerns. CONCLUSION: Overall, the bilobe flap technique proved to be an effective and reliable option for nasal reconstruction, providing stable and long-lasting results.

[Comparison of breastfeeding duration in women before and after breast reduction surgery]. / Comparaison de la durée d'allaitement maternel chez les femmes avant et après mammoplastie de réduction.

BACKGROUND: Breast reduction surgery often concern women of childbearing age. However, it can interfere with the ability to breastfeed, whereas the benefits of breastfeeding are well known. Current data in the literature do not provide precise information on the possibilities of breastfeeding after breast reduction surgery. OBJECTIVES: The aim of this study was to assess long-term breastfeeding ability of women after breast reduction performed in our centre. METHODS: This is a retrospective comparative study including patients treated with breast reduction at Saint-Louis Hospital between 2010 and 2017 and who have had children before or after surgery. Operative details were retrieved from medical records and ability to breastfeed was assessed during a phone interview. Breastfeeding before surgery was compared to breastfeeding after surgery. RESULTS: We analysed 21 births before and 35 births after breast reduction. Breastfeeding initiation was similar in the two groups (90% vs. 83%, P=0.7), but the median duration was significantly shorter after breast reduction compared with before (3 weeks vs. 10 weeks; P<0.01), the rate of breastfed child at 3 months was lower after surgery (11% vs. 43%; P<0.01), the use of infant formula was higher after surgery (100% vs. 74%, P<0.01), and we found a higher rate of discontinuation caused by hypogalactia (69% vs. 11%; P<0.001). CONCLUSION: Breastfeeding is possible but more difficult to sustain over time after breast reduction. Patients need to be made aware of that before surgery, and patients who still want to breastfeed should be encouraged at the maternity.

[Buried chipped skin grafts for patients in failure of treatment]. / Procédé de greffes enfouies en situation d'échecs d'autogreffes cutanées.

Local conditions can lead to a failure of traditional skin grafts. We propose here our technique about the realization of autologous skin graft using it buried chipped grafts, for wounds in failure of treatments or at risk of failure. The protocol includes cutting the skin graft within little squared pieces of a few millimeters of length, that are then buried directly deep into the wound. We can then obtain little islands of epidermisation on the random places of the wound that will heal by confluence of those epidermal islands.

Utility of anaerobic bottles for the diagnosis of bloodstream infections.

BACKGROUND: Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS: We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS: A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS: Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.

[Quick screening for Body Dysmorphic Disorder in a plastic surgery population in France]. / Dépistage rapide du Body Dysmorphic Disorder en consultation de chirurgie plastique en France.

INTRODUCTION: All plastic surgeons are frequently faced with patients with Body Dysmorphic Disorder (BDD). However, no screening test exists in French to help the plastic surgeons to diagnose this disease. The Body Dysmorphic Disorder Questionnaire (BDDQ) is the Gold Standard to easily detect BDD in consultation with any non-psychiatric physician. The aim of this study was to translate and validate the BDDQ into French to help plastic surgeons to detect BDD before the surgery. This way, plastic surgeons will be able to provide an optimal medical care and to reduce the risk of psychiatric collapse. METHODS: We asked Katherine Philipps for her approval to use her BDDQ for our study, and thereafter we translated it respecting the criteria of the World Health Organization. We first evaluated the psychometric qualities of the BDDQ in French and then its reproducibility and its sensitivity to change. RESULTS: A French version of the BDDQ appeared to be reliable and comprehensible. The questionnaire has been tested on a sample of patients in plastic surgery consultation, at a T moment and a T plus one month to certify its reproducibility and its sensitivity to change. CONCLUSION: These results permit to claim that the French version of the BDDQ is now validated to detect patients with a BDD in a plastic surgery consultation.

Interleukin-32 promotes detachment and activation of human Langerhans cells in a human skin explant model.

BACKGROUND: Cross-talk between skin keratinocytes (KCs) and Langerhans cells (LCs) plays a fundamental role in the body's first line of immunological defences. However, the mechanism behind the interaction between these two major epidermal cells is unknown. Interleukin (IL)-32 is produced in inflammatory skin disorders. We questioned the role of IL-32 in the epidermis. OBJECTIVES: We aimed to determine the role of IL-32 produced by KCs on surrounding LCs. METHODS: We used an ex vivo human explant model from healthy donors and investigated the role of IL-32 on LC activation using imaging, flow cytometry, reverse transcriptase quantitative polymerase chain reaction and small interfering (si)RNA treatment. RESULTS: Modified vaccinia virus ankara (MVA) infection induced KC death alongside the early production of the proinflammatory cytokine IL-32. We demonstrated that IL-32 produced by MVA-infected KCs induced modest but significant morphological changes in LCs and downregulation of adhesion molecules, such as epithelial cell adhesion molecule and very late antigen-4, and CXCL10 production. The treatment of KCs with IL-32-specific siRNA, and anti-IL-32 blocking antibody significantly inhibited LC activation, demonstrating the role of IL-32 in LC activation. We also found that some Toll-like receptor ligands induced a very high level of IL-32 production by KCs, which initiated LC activation. CONCLUSIONS: We propose, for the first time, that IL-32 is a molecular link between KCs and LCs in healthy skin, provoking LC migration from the epidermis to the dermis prior to their migration to the draining lymph nodes.

[Reconstruction of abdo-perineal resection by Taylor flap: About 68 patients]. / Reconstruction par lambeau de Taylor après amputation abdomino-périnéale : à propos de 68 cas.

PURPOSES: Healing after abdomino-perineal resection is often difficult, especially in patients who have undergone radiation therapy. Vaginal reconstruction is also an important issue for the women who undergo this surgery. We describe and analyze here our series of perineal reconstructions with modified Taylor flaps. Between 2010 and 2016, 68 patients (52 women, 16 men) with cancer of the anal canal (53), adenocarcinoma of the lower rectum (9), or other malignant neoplasms of the perineum underwent reconstruction with a rectus abdominis myocutaneous (RAM) flap with an inferior pedicle and an oblique skin paddle. RESULTS: This review of records showed that all patients healed, with a median of 30 days. The reoperation rate was 11.7% including 1 for eventration. The principal causes for delayed healing were scar dehiscence, abscess, and partial necrosis. No flap required removal, however. The mean duration of hospitalization was 23.7 days. CONCLUSION: Modified Taylor flaps substantially improved the reconstruction of defects resulting from abdomino-perineal resection. They enabled complete and rapid healing with low comorbidity.

[Management of hypopigmented scars following burn injuries]. / Prise en charge des cicatrices hypopigmentées post-brûlure.

OBJECTIVE: Permanent hypopigmentation of burn scars is a common consequence after partial and full thickness burns that heal by secondary intent, and they can cause severe aesthetic issues. The surgical goals for effective treatment of postburn hypopigmentation are to remove scar tissues, and to produce healthy melanocytes, with minimal donor site morbidity. This article reviews the current literature about the different ways to treat hypopigmentation following burn injuries and discusses the indications. METHODS: The PubMed database was searched for articles published from 1985 and up to 2016. Papers with regards to the management of hypopigmented lesions were included only if scars were following burn injuries. The treatments were assessed according to body region treated, surface involved, skin color, effectiveness on restoring skin pigmentation. RESULTS: Sixteen studies were included in this review. Non-surgical treatments like makeup and tattooing, and surgical treatments including thin skin grafting, chip skin grafting, punch grafting, non-cultured keratinocyte-melanocyte cell suspension, and cultured epidermal cells were all compared. CONCLUSION: Thin skin grafting is a reliable treatment especially for patient who suffer from small hypopigmented lesions as this method requires a donor skin of the same size. The cell suspension procedure may be beneficial for larger scars. Moreover demarcation between skin graft and normal skin may exist and when a precise color match is required, particularly in the head, tattooing and chip skin grafting produce a good pigmentation outcome.

[Complications with surgical treatment of basal cell carcinomas in individuals over 75 years of age: A retrospective study of prognostic factors in 158 cases]. / Complications du traitement chirurgical des carcinomes basocellulaires après 75 ans. Étude rétrospective des facteurs pronostiques sur 158 cas.

INTRODUCTION: Basal cell carcinoma (BCC) is a pathology that evolves locally and it is common in elderly subjects whose frailty could restrict the indications for the reference treatment, which is based on surgery. The aim of this study was to investigate the morbidity and the mortality associated with surgical treatment of BCC in patients over 75 years of age, so as to identify possible prognostic factors for postoperative complications. MATERIALS AND METHODS: This was a retrospective study carried out with patients over 75 years of age who were treated surgically for one or several BCC between 2010 and 2015 in the reconstructive and cosmetic plastic surgery unit of the Saint-Louis Hospital in Paris (France). We collated the demographic characteristics, the characteristics of the treatment, as well as the rate of major postoperative complications. We performed a univariate and then a multivariate analysis of the various risk factors that were identified. RESULTS: A total of 158 patients were analyzed and they exhibited a rate of major complications of 12%. The statistical analysis identified five significant risk factors: being over 85 years of age (P=0.006), long-term use of anticoagulant treatment (P=0.02), the presence of at least one comorbidity (P=0.018), a conventional hospitalization (P=0.002), and the use of general anesthesia (P=1.2e-10). CONCLUSION: Five risk factors for major postoperative complications with the surgical treatment of BCC in patients over 75 years of age were identified. These factors may provide direction to medico-surgical teams in regard to the optimal treatment of BCC in elderly patients.

[Self-inflicted burns in our burns center between 2011 and 2016]. / Immolation dans notre centre de traitement des brûlés de 2011 à 2016.

The prevalence of immolation by fire in France is uncertain. We carried out a retrospective epidemiological study on immolations between 2011 and 2016 at the burn treatment centre at the hôpital Saint-Louis in Paris. We studied the prevalence and characteristics of patients entering hospital for this reason. Between 2011 and 2016, a total of 1098 patients were hospitalized in the centre, of which 50 were admitted for immolation, i.e. five percent of the hospitalized population. The average age at entry was 46 years, and they were mostly men (62%). All but one was a suicide attempt. The average total burn area was 34.5%, and the average length of stay in the centre was 53 days. The products used for the immolation were mostly white spirit, alcohol or gasoline. Nine (18%) out of the 50 patients died, burned at 62.5% on average. A psychiatric history was reported in 35 patients and 21 had previously attempted suicide; nine patients were chronic alcoholics and four were drug addicts. The most frequently reported reasons for the suicide attempt were sentimental breakdown, death of a relative or financial problem. The prevalence of immolation in our study is very low compared to that found in developing countries. The majority of our cohort is composed of patients with a history of psychiatric disorders. The history of attempted suicide is also a major risk factor for committing suicidal acts by immolation. Prevention measures should be implemented to reduce this risk.

[Greater omentum flap: Treatment of chronic wounds and seroma: About a case]. / Le lambeau de grand épiploon : traitement des plaies et lymphorrhees chroniques : à propos d'un cas.

INTRODUCTION: Cicatricial complications after abdominal or pelvic surgery are more frequent in obese patients. In this case, infection, seroma and delays in scarring can be extremely difficult to treat. The objective of this technical note is to present an original case of an obese patient operated nine years ago of a hysterectomy by laparotomy and chronically presenting a non-resolving septic seroma despite multiple surgical procedures whose healing could be obtained by a flap of greater omentum. SURGICAL TECHNIQUE: The ideal is to carry out this intervention in a double team with a digestive surgeon in case of intra-abdominal visceral or vascular wound during dissection. The greater omentum flap was raised in a conventional manner over the gastroepiploic artery. A sufficiently wide orifice should be left at the level of the abdominal aponeurosis in order to avoid any compression of the pedicle. Finally, the flap must be spread over the whole surface of the detachment and fixed to the anterior aponeurosis. CONCLUSION: Reliability and vascular and lymphatic richness make the greater omentum flap a very effective method in chronic wound cases associated with important seroma. The scarring obtained in the clinical case presented thus highlights the specific qualities of this flap.

[Study of satisfaction concerning the navel after abdominal dermolipectomy with transposition: A report of 96 cases]. / Ombilicoplastie en aile de mouette : technique et satisfaction ; à propos de 96 cas.

GOAL OF THE STUDY: The umbilicus has a major role in the aesthetics of the anterior abdominal wall. Many publications deal with abdominal dermolipectomies but few focus on umbilicoplasty. However, these are essential in assessing the aesthetic result. Umbilicoplasty in "aile de mouette" used in our service is reliable and easily reproducible. In this article, we evaluate the satisfaction of patients with abdominal dermolipectomy with this technique of transposition. MATERIALS AND METHOD: In the plastic surgery department of the Saint-Louis Hospital in Paris, we carried out a retrospective study of patients undergoing abdominal dermolipectomy with transposition of the umbilicus, between 1 January 2012 and 31 December 2012. All patients were operated according to our technique of umbilicoplasty: disinsertion of the umbilicus in V, reinsertion of the umbilic in "aile de mouette", a degreasing periumbilical associated with a plication of the umbilical stem. The complications identified in patients medical records and satisfaction were assessed by a telephone questionnaire. RESULTS: Ninety-six patients were included. No patient presented umbilical necrosis. The overall result of umbilical transposition was considered good to excellent for 92.7% of patients. CONCLUSION: Umbilicoplasty in gull wing has many advantages: it is a simple, easily reproducible, reliable technique, the patients of which are for the most part very satisfied.

Intraoperative instillation of ropivacaine during the placement of sub-muscular cosmetic breast implants: Is there a clinical benefit?

INTRODUCTION: The sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery. MATERIAL AND METHODS: We conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time. RESULTS: Pain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05). CONCLUSION: Local instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5. LEVEL OF EVIDENCE: Level II.

Our 35 years' experience on postburn heterotopic ossification: A three-step treatment.

Our retrospective study of burn patients presents a three-step treatment of heterotopic ossification: excision surgery, early rehabilitation, and analgesia. We included patients admitted to the department for treatment of postburn heterotopic ossification between January 1, 1979, and September 30, 2015. The mean age at the time of the burn was 43.3 years. Men accounted for the majority of burn patients who developed an osteoma (70.8%). The mean total skin area burned was 38.4%. No osteoma justifying surgery was found for any patient with a total burned skin area less than 19%. The burned zones were related to the osteoma development in 94.3% of cases. On average, the surgery took place 10.8 months after the burn. The osteotomy was accompanied by surgical treatment of a contracture in 37.1% of patients. Most of the osteomata were found at the elbows (30), followed by the shoulders (3), and finally the knees (2). Rehabilitation began on D0 after the surgery, except if a flap or a thin-skin graft was used. Regarding analgesia, opiates were prescribed systematically during the immediate postoperative period. Elbow range of motion on flexion improved by a mean of 84.1°. During the postoperative period, we found 2 recurrences of osteoma and 1 elbow hematoma in two separate patients. There were no postoperative infections or neurological sequelae. Our retrospective French study confirmed results found in the international literature. The three-step treatment - excision surgery, early rehabilitation, and antalgia - seems to be the best means of treating osteoma with satisfactory results. Surgery is indicated only in the case of functional impairment and not simply based on imaging.

Dealing with tattoos in plastic surgery. Complications and medical use.

Not only has tattooing been socially performed for thousands of years, but it has also been part and parcel of medical practice since antiquity. In our day and age, plastic surgeons are ever more frequently compelled to deal with tattooing, whether in terms of its medical application or its complications. While the process itself may appear harmless, it is not without risk and necessitates use of suitable tools and management by expert hands.

Outcome of 122 delayed breast reconstruction following post-mastectomy radiotherapy: The scarless latissimus dorsi flap with tissue expansion technique.

BACKGROUND: Delayed breast reconstruction with tissue expansion may be risky after radiotherapy, due to the poor skin quality. To permit the use of the tissue expansion procedure, we propose a scarless latissimus dorsi flap to bring tissue trophicity, by a healthy vascularized muscular interface with no donor scar and no patch effect. The objective of this study is to assess the outcome of the tissue expansion technique with scarless latissimus dorsi flap after post-mastectomy radiotherapy. METHODS: All the patients who had benefited of a delayed breast reconstruction after radiotherapy using tissue expansion technique with scarless latissimus dorsi flap, between January 2000 and January 2013, were reviewed. The exclusion criteria were: prior breast reconstruction, or interruption of breast reconstruction procedure due to active metastatic disease requiring ongoing oncological treatment. The complications were identified: failures of reconstruction, implant exposure, wound dehiscence, capsular contracture, deflation of implant, hematoma, infection, and skin necrosis. RESULTS: One hundred and twenty-two breasts were reviewed. The average time between the flap and the expander intervention was: 194±114 SD (28-1051) days. The mean volume of inserted expander was 633±111 SD (350-1100) mL and the mean inflation volume was 578±190 SD (170-1160) mL. The average time between insertion of the expander and insertion of the permanent implant was 132±76 SD (49-683) days. The mean inflation of the implant volume was 368±105 SD (130-620) mL. Forty patients developed at least one complication. The most common complication was the appearance of a capsular contracture requiring a capsulectomy: 11 (9.2%) with permanent implants and 6 (4.9%) with expander. Deflation of implants occurred with six permanent implants and with one expander. There were 3 breast reconstructions failures (two infections and one exposure of implants). CONCLUSION: This procedure offers the advantages that there is no unattractive scar, and that there are low rates of exposure or failed reconstruction.

Dealing with tattoos in plastic surgery. Tattoo removal.

Not only has tattooing been socially performed for thousands of years, but it has also been part and parcel of medical practice since antiquity. In our day and age, plastic surgeons are ever more frequently compelled to deal with tattooing - and with tattoo removal procedures, as well. While the process itself may appear harmless, it is not without risk and necessitates use of suitable tools and management by expert hands.

[T plasty for the treatment of skin forehead defects]. / La plastie en T pour la reconstruction des pertes de substances cutanées du front.

INTRODUCTION: The closure of the skin defect of the forehead area with local flap must prevent the distortions of the eyebrow and hairlines and must limit the visibility of the scars. The H plasty is the most common procedure to treat this kind of defect but the scars are extensive and numerous. The H cutaneous flap presents necrosis risks if the skin is thin and the defect important. The H musculocutaneous flap presents sensitive and motors lesions risks. The T cutaneous flap is a good choice because of its excellent cosmetic result and minimized risks. MATERIALS AND METHODS: Twenty-six patients have been treated by the same surgeon between 2006 and 2012 with T cutaneous flap in order to treat forehead and temples' skin defects (the surface goes from 1.5 to 15cm). RESULTS: Excisions were completed in the every 26 cases. We had excellent cosmetic result and no complications such as necrosis, infection, sensitive and motor troubles after the surgery. DISCUSSION: The T plasty is easy for treating skin forehead defects. The scars are 25% less extensive than with a H plasty. The T flap permits to treat important defects without distortion or risks. CONCLUSION: The T cutaneous flap can easily substitute the H plasty for the forehead and temples reconstruction with no risks but good cosmetics results.