[History of breast cancer reconstruction treatment]. / Historique du traitement du cancer du sein.

The authors summarize in those six pages of drawings the history of breast cancer reconstruction treatment. The focus is on the variety of techniques available for breast reconstruction and on the debates around different indications.

A preoperative cotininury test for abdominoplasty reduces peri-operative complications.

BACKGROUND: Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. MATERIAL AND METHODS: This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. RESULTS: Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001). CONCLUSION: The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking.

[Principles of plastic pediatric surgery: Thirty years of surgical practice]. / Principes généraux de la chirurgie plastique pédiatrique. Expérience tirée de 30ans de pratique chirurgicale.

In this document, Pr Guy Magalon presents a reflection on the plastic pediatric surgery drawn from 30 years of surgical practice. His thinking is supported by several examples of plastic surgery results from children reviewed in adulthood. These cases highlight the evolution of surgical practices and the need for continuing education for surgeons to adapt to technical progress. Professor Magalon honors his masters and shares his personal vision of the principles of pediatric plastic surgery.

[Two anomalous muscles of a forearm revealed by ulnar nerve compressions, a Double Crush syndrome]. / Malformation musculaire associée à une variation anatomique de l'avant-bras révélées par des compressions étagées du nerf ulnaire (Double Crush syndrome).

This article describes the concomitant presence of two anomalous muscles on a left forearm in a 40-year-old man. The anconeus epitrochlearis muscle was responsible for a cubital tunnel syndrome and the unusual origin of the flexor digiti minimi brevis muscle was responsible for a compartment syndrome with ulnar nerve compression at the level of Guyon's canal during effort diagnosed by MRI. Resection of these muscles relieved the symptoms and allowed the patient to return to work.

[Autologous fat grafting and rhinoplasty]. / Rhinoplastie et injection de tissu adipeux autologue.

Revision rhinoplasty can be very challenging especially in cases of thin skin. Autologous fat graft is utilized in numerous applications in plastic surgery; however, its use relative to the nasal region remains uncommon. Adipose tissue, by virtue of its volumetric qualities and its action on skin trophicity, can be considered to be a gold standard implant. From 2006 until 2012, we have treated patients by lipofilling in order to correct sequelae of rhinoplasty. The mean quantity of adipose tissue injected was 2.1cm(3) depending on the importance of the deformity and the area of injection: irregularity of the nasal dorsum, visible lateral osteotomies, saddle nose. Following the course of our practice, we conceived micro-cannulas that allow a much greater accuracy in the placement of the graft and enable to perform interventions under local anesthesia. These non-traumatic micro-cannulas do not cause post-operative ecchymosis and swelling which shorten the recovery time for the patient. On patients who have undergone multiple operations, lipofilling can be a simple and reliable alternative to correct imperfections that may take place after a rhinoplasty.

[Establishment of a keloid model by transplanting human keloid onto the backs of nude mice]. / Mise au point d'un modèle animal original de cicatrice chéloïde.

Keloid scar is a proliferative healing dysfunction formed by an excessive build-up of collagen fibers on the dermis. It is responsible of aesthetic and functional disabilities. There is no ideal treatment and recurrence occurs very often. Keloid scars occur only to human, that's why animal model needs to be made to study this pathology and new treatments. Few models have been described using human keloid scars implanted into subcutaneous tissue of nude mice or rat. To allow study of topical and laser treatment we have developed a new animal model using human keloid scar fragment with epidermal and dermal tissue implanted into back of nude mice like a full thickness skin graft. Keloid fragments from five donors have been grafted onto 40 nudes mice. Macroscopic and microscopic studies have been made at day 28, 56, 84 and 112. We observed integration of the fragments in all cases. Hyalinized collagen bundles were observed in all implant biopsies confirming the stability of the keloid architecture within 112 days. This model is easily reproducible and allows the study of topical treatment and laser due to the accessibility of the keloid.

[Differential diagnosis between keloid and hypertrophic scars: a new approach by full-field optical coherence tomography]. / Diagnostic différentiel entre cicatrices chéloïdes et hypertrophiques : une nouvelle approche en tomographie par cohérence optique plein-champ.

OBJECTIVE: To evaluate the efficacy of full-field optical coherence tomography to differentiate hypertrophic and keloid scars on ex-vivo tissues. PATIENTS AND METHODS: All patients who underwent resection of pathological scar from November 2012 to September 2013 were analyzed. The scars were fixed in formalin and analyzed by conventional histology and full-field optical coherence tomography. The criteria for evaluation were: presence of dermal nodules, presence of cells and hyalinization of collagen. RESULTS: Nineteen pathological scars were analyzed. Histology found 7 keloid scars, 7 mixed and 3 hypertrophic scars. The sensitivity of optical coherence tomography for the detection of dermal nodules was 100%. This technology was not helpful for detection of cells and hyalinized collagen. CONCLUSION: In the present state of technology, optical coherence tomography did not identify the presence of cells, which makes the differential diagnosis difficult in the case of hypertrophic and keloid scars.

[Management of upper obstetrical brachial plexus palsy. Long-term results of non-operative treatment in 22 children]. / Traitement conservateur des paralysies obstétricales hautes du plexus brachial. Résultats à long terme chez 22 enfants.

INTRODUCTION: Treatment of obstetrical brachial plexus palsy (OBPP) is always debated, especially for upper plexus palsy. Some authors perform early surgical treatment in case of absence of biceps contraction at the age of 3 months. Others prefer to wait until the age of 6 months before considering a surgical procedure when no suspicion of root avulsion is found. We think that a conservative approach with intensive rehabilitation program can obtain good functional outcome for patients who will recover biceps function spontaneously between 3 and 6 months, and that it is not necessary to perform surgery at 3 months. To argue our choice, we have compared the long-term outcome of two groups of children with upper OBPP conservatively treated regarding the age of biceps recovery (before or after 3 months). PATIENTS AND METHODS: Twenty-two patients with non operated upper roots birth palsy, followed in Timone's Hospital of Marseille by a multidisciplinary team, have recovered a biceps contraction between 1 and 8 months and were retrospectively included in this study. All children underwent an intensive rehabilitation program since birth, performed by a specialized physiotherapist. Patients were reviewed, and their shoulder function was assessed using Mallet score. The score was analysed regarding the age of biceps recovery. RESULTS: The mean follow up was 8.2 years. Nine children recovered a biceps contraction at 3 months of age or before; the mean global Mallet score was 4.11. Thirteen children recovered a biceps contraction after 3 months of age (between 3 and 8 months); the mean global Mallet score was 3.92. The difference was not statistically significant. CONCLUSION: This study shows that global shoulder function is comparable for two groups. The children who did not recover a biceps contraction at 3 months of age had a global shoulder function as good as the one who recovered biceps function earlier. We think our intensive rehabilitation program allowed us to avoid a useless early surgery. Surgical plexus treatment was indicated for children who did not have biceps contraction after 6 months of age.

[Flaps in lower limb reconstruction: a 10-year retrospective review of 157 pedicled flaps]. / Cent cinquante-sept lambeaux pédiculés utilisés dans la reconstruction des membres inférieurs : étude rétrospective sur dix ans.

BACKGROUND: The aim of this study was to review and present our experience with pedicled flap reconstruction of lower limb defects with particular reference to choice of flap, complications and pre-existing health disorders. METHODS: A retrospective review of lower limb reconstructions by pedicled flaps was carried out by the plastic and reconstructive surgery unit at Marseille's hospitals from January 1st, 1997 to December 31st, 2007. This study evaluated patients satisfaction and complications rate. RESULTS: During 10 years, 152 patients had 157 local flap reconstructions of lower limb defects. General patients satisfaction was 94% with 80% good or very good results and 20% of medium results. There were 16 immediate complications with three total necrosis, four partial necrosis, six hematoma, and three infections. There were nine late complications including wound dehiscence and graft instability. There were 11 functional sequels and 40 aesthetic sequels secondary to flaps. CONCLUSIONS: The current study presented our experience with locoregional flap reconstruction of lower limb defects. Lower limb reconstruction used a lot of locoregional flaps which had their own advantages and disadvantages. Their indication depended on the fiability and quality of the donor site.

[Correction of the deep nasolabial fold using a temporalis superficialis fascia graft]. / Le comblement du sillon nasogénien par greffon de fascia temporalis superficialis.

SUBJECT: The deep nasolabial fold (NLF) due to age is a frequent complaint from patients in plastic surgery. Various surgical and medical management solutions have been described in literature and are often based on different concepts to justify their interest. We present a new surgical treatment of this region using a temporalis superficialis fascia graft in order to fill the NLF. We also propose a review of the literature about the anatomy and the physiology of this major fold of the face. PATIENTS AND METHODS: From 1990 to 2010, we practiced the replenishing of the NLF using a temporalis superficialis fascia graft on 24 female patients. They all were presenting NLF of great or mild importance due to ageing. We also performed on patients with a great importance NLF a lipofilling of the cheek and the lips in order to recover the volumes lost with ageing. The evaluation items were the quality of the filling (importance and symmetry), quality of the scars and complications occurring on the donor and receiving sites. RESULTS: Objective and subjective results were good. Projection of the NLF was in most of cases strongly and durably restored. CONCLUSION: Filling of the deep nasolabial fold using a temporalis superficialis fascia graft is a simple and reliable technique. Depending on the patients this method can be associated with a lipostructure of the cheek and the lips in order to optimize the facial rejuvenation. According to us this tissular implant allows a long lasting and important correction of the NLF.

[Skin diversity: histological study of 140 skin residues, adapted to plastic surgery]. / La diversité de la peau : étude histologique de 140 résidus cutanés, adaptée à la chirurgie plastique.

UNLABELLED: We present in this original article a histological study of surgical skin residues. AIM OF THE STUDY: This study was realized in order to show, in objective way, skin diversity according to sex, age and area, and to illustrate some current surgical practices of our speciality. PATIENTS AND METHOD: Two years along, 141 patients was selected, 69 Men and 72 women. Fifty-four biopsies were realized on the upper extremity, 34 on the trunk and 53 on legs and arms. The histological study was based on two steps; the first one was a classic quantitative study, with measurement of each cutaneous layer, and objective evaluation of elastic density in superficial dermis. The second one was a descriptive histological analysis of each cutaneous area. RESULTS: The results coming from the quantitative analysis, allowed us to establish a classification of all the areas, according to each parameter. These results are globally compliant to the literature. The results of the descriptive analysis, lead us to conclude that it exists a lot of different skins with regional specificities. Then the crossover of the two analyses allowed us to define good practices tricks, in order to choose the best reconstruction technique for each area. CONCLUSION: This study is just a rough draft of a dynamic skin cartography adapted to our surgery. But it allowed us to confirm our basic premise: it doesn't exist only one skin but many skins.

[Breast morphology in Turner's syndrome. A prospective multicentre clinical study about 21 cases]. / Morphologie mammaire dans le syndrome de Turner. Étude clinique prospective multicentrique de 21 cas.

INTRODUCTION: The Turner's syndrome encompassed several conditions, of which monosomy X (absence of the entire sex chromosome X) is most common. It is a chromosomal abnormality in which all or part of the sex chromosomes X is absent. Typical females have two X chromosomes, but in Turner's syndrome, one of those sex chromosomes is missing or presents abnormalities. Patients show a shield shaped thorax with thick and bulging chest, breast hypotrophy and widely spaced nipples. The objective of this study was to characterize the breast abnormalities observed in Turnerian. PATIENTS AND METHODS: We describe a prospective multicentric study (August 2007-March 2008) on 21 nullipar patients, ranging from 16 to 35 years old. Six were monosomic and 14 were Turner mosaic (in this case the chromosome is missing in some cells but not others), 19 were treated with estrogens and progestatives. This study was achieved through the use of clinical examinations including body, waist, hips (BWH) measurements and photography. The statistical method involved a descriptive analysis, linear correlation calculations and student test. RESULTS: The breast morphology appears to be quite closed to that of the general woman population, but with average thorax volume more bulky mainly in the anteroposterior zone, and with more reduced breast volumes. No specific abnormalities in the chest development were observed. No differences in the hypotrophy, hypertrophy, and normal breast volume repartition were observed between monosomic and mosaic patients. The self-satisfaction index on the breast look is quite low, patients mainly complain about breast hypotrophy. Nevertheless, these results are not representative of the whole turnerians, since this study address only to volunteer patients and we cannot exclude possible distortions. CONCLUSIONS: In contrast to common beliefs, we don't have observed any increase of the average of the internipple space; this observation is in good agreement with the most recent published literature works, which report only an apparent increase of this intermamelonary distance versus the thoracic width (in front view), probably caused to an optical distortion effect.

[Role of the plastic surgeon in the management of ecthyma gangrenosum in children: clinical example]. / Rôle du chirurgien plasticien dans la prise en charge de l'ecthyma gangrenosum chez l'enfant : exemple clinique.

Ecthyma gangrenosum is a cutaneous infection, which result from a Pseudomonas aeruginosa septicemia, encountered in most of the case in immunocompromised people. Authors demonstrate the important role of the plastic surgeon in the diagnosis and therapeutic management of the disease in children. An eight-month-old infant has been hospitalized for acute leukaemia. She developed an extensive painful macule in the buttocks and perineal area in a septic context. A multidisciplinary management allowed to set up an adapted antibiotherapy, an early escharrotomy, a protection of the wound by digestive and urine derivation and a reconstruction with wound healing by second intention and split thickness skin graft, which lead to a good quality cure and wound healing at the end of 37 days of evolution. This case demonstrates the importance of the surgical management in the treatment of ecthyma gangrenosum. The wound healing associated with a split thickness skin graft seems to be the less invasive solution in a frail patient and the fastest to re-start the chemotherapy.

[Burn contractures of the extremities]. / Séquelles de brûlures des membres.

Burn contractures are common after deep burns of the limbs. When rehabilitation fails to restore joint function and normal range of motion, surgical contracture release should be performed. Different plastic surgery techniques can be used, from Z-plasty to skin grafts, artificial dermis and flaps. Surgery can also be used in case of esthetic concerns. Available surgical techniques and indications are presented.

[Vascular anomalies: information documents]. / Les anomalies vasculaires : fiches d'information.

Vascular anomalies are a complex pathological group. They are composed of hemangiomas and other vascular tumors and congenital vascular malformations: venous, lymphatic, arteriovenous and capillary malformations. The management of these anomalies is difficult and must involve an interdisciplinary approach. To help patients to understand their pathology, we have made some information documents.

[Diagnosis and management of vascular anomalies]. / Diagnostic et prise en charge des anomalies vasculaires.

Vascular anomalies are a complex pathological group. They are especially difficult to study because of confusion in the terminology used. The classification developed by the International Society for the Study of Vascular Anomalies (ISSVA) in 1996 allows using a common scientific language. There are two groups of lesions: vascular tumor and vascular malformation. The management of these anomalies is difficult and must involve an interdisciplinary approach including specialists in plastic surgery, radiology, pediatry and dermatology. We propose a simplified approach for the management of these pathologies. This approach is coming from the experience of Marseille (France) multidisciplinary team.

[The surgical innovation: From the legal framework through the veritable ethics innovation - Technical aspects and practical applications]. / L'innovation chirurgicale : du cadre légal à une véritable éthique de l'innovation. Aspects théoriques et applications pratiques.

Grace to the creativity of surgeons and the introduction of new technologies, second half of the XXth century opened the era of innovations and decisive progress. At the same time, however, is born the feeling of distrust and claiming which has come with the graving and threatening juridiciarisation. The evolution of complex structures of our society joined the ingenuity researchers unlimited makes formal law and the legal framework constantly to adapt oneself to circumstances. In the field of surgery, it's necessary to make work in integrity the innovation and protection at the patient's and their dignity. The legal framework that governs today innovation in surgery must still to go further and will precise. Dignity, compelling paradigm for all those who seek to better understand and better protect human starred as impassable limit any search and any experimentation. To make this chapter more alive, we have supplemented it and illustrated by the testimony some of the most fruitful French last years innovative in order to enrich our thinking of the fruit of their large and brilliant experience.

[Amniotic band syndrome]. / Syndrome des brides amniotiques.

Amniotic band syndrome is a well-described clinical entity, which includes several congenital deformities. Hand malformations and limb defects represent the most frequent clinical characteristics, gathering, with variable localization, constriction rings, acrosyndactylies and amniotic amputations. Other anomalies of skull, face, body wall and internal organs, sometimes complex and lethal, are significantly associated with this syndrome. The syndrome is then included in the larger entity of limb body wall complex (LBWC). Congenital ring constriction, amniotic band disruption complex, or congenital transverse defect are some of the numerous synonyms defining this malformative syndrome, showing either its clinical variability, or the uncertainties surrounding its etiology. Indeed, several pathogenic theories have been successively opposed, bringing about a certain degree of confusion. Recent experimental genetic studies could unify the different fetal malformations. The surgical treatment actually applies only to the aftereffects of the intrauterine phenomenon, until antenatal diagnosis followed by in utero surgery will be perfected.

[Vascular anomalies of the children's hand]. / Les anomalies vasculaires de la main de l'enfant.

Vascular anomalies are common on the hand of children. There are two types of vascular anomalies: the vascular tumours and the vascular malformations. The most frequent vascular tumour is infantile haemangioma. The vascular malformations could be predominantly venous, lymphatic, capillary or arteriovenous. Combined vascular malformations, often syndromic, must be searched for. Diagnosis is sometimes difficult. It is based on clinical history, aspect, evolution and radiological examinations (color-Doppler ultrasound and MRI). Treatment is often a combination of medical and surgical approaches performed by a multidisciplinary team.

[Clinodactylies: delta phalanx and Kirner deformity]. / Les clinodactylies: phalange delta et déformation de Kirner.

Clinodactyly is a symptom defined as an excessive angulation of a finger in the radio ulnar plane. The authors present the various etiologic patterns of clinodactyly, including delta phalanx and Kirner's deformity. Surgical techniques, indications and ideal timing for surgery are detailed.