[Aesthetic reconstructive surgery of the lip]. / Chirurgie réparatrice et esthétique labiale.

Lip reconstruction can be performed with numerous surgical techniques. The aim was here to present these usual techniques and to focus on the details that can be used to obtain the most favourable results. The goal of this surgery, that represents a compromise between function and aesthetic, has to be kept in mind to prevent mistakes that decrease the quality of the result.

[Reconstruction of nasal skin defect]. / Reconstruction des pertes de substance superficielles du nez.

There are many possibilities for nasal skin defect reconstruction. The purpose of this article is to highlight the important points to respect in order to achieve aesthetic results. The principles that must be observed in nasal reconstruction are recalled. The most interesting techniques are detailed and illustrated with clinical cases.

[Aesthetic aspects of eyelid reconstruction]. / Aspects esthétiques de la reconstruction des paupières.

In eyelid reconstruction, filling the defect is not sufficient. In young patients, the aim is to obtain a reconstructed eyelid, as normal as possible. In elderly patients, the large amount of available skin and the good quality of scars seem to be favorable. But weakening and stretching of the connective tissue and eyelid structures and deficient production of tears may compromise the functional result. In every case, restoring aspect and function are going together. The purpose of this chapter is to show how different techniques may be used in eyelid reconstruction with good cosmetic result. Different cases are carefully described and illustrated.

[Cheek reconstruction]. / Reconstruction jugale.

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.

[Full thickness reconstruction of the nasal pyramid]. / Reconstruction de pleine épaisseur de la pyramide nasale.

Nasal lesions, which are often carcinomas, require a histological control of the excision sometimes forcing to postpone the reconstruction source of nasal mutilation disfiguring. Reconstructive procedures have made steady progress and the notion of reconstruction in three planes advocated by Tiersch has been improved in a major way by Millard, Burget and Menick, who added an essential aesthetic dimension. We present our experience in this field by selecting procedures that seem most appropriate and describing the key points of the operating process, which remain the guarantee of both therapeutic and aesthetic success.

[Forehead and temple aesthetic reconstruction]. / La reconstruction fronto-temporale esthétique.

The purpose of this article is to address the techniques of reconstruction of the forehead and the temple trying to add an "aesthetic" dimension, as the fourth dimension introduced by Burget for the reconstructive surgery of the nose. Achieve "aesthetic" reconstruction is to have constant attention to details. This is how to choose the right indication depending on the age and the etiology of the defect. This is to place incisions to perfection. And it is to be humble and open oneself to criticism, always seeking to improve the quality of its results.

[Eyebrow reconstruction]. / Ophriopoïèse.

The eyebrow is an essential anatomical area, from a social point of view, so its reconstruction, in case of skin defect, must be as meticulous as possible, with the less residual sequela. Capillary density extremely varies from one person to another and the different methods of restoration of this area should absolutely take this into consideration. We are going to review the various techniques of reconstruction, according to the sex and the surface to cover.

[Eyelid, medial canthus and medial orbital wall reconstruction using a combination of Hübner and conchal grafts with two illustrative cases]. / Reconstruction par greffons de Hübner et conque après exérèse étendue palpébro-cantho-orbitaire médiale - Présentation de deux cas.

Post-ablative medial canthus and medial orbital wall reconstruction may involve various materials. Few articles present such reconstructions using cartilage homografts, and very few opt for conchal cartilage. In some cases of medial orbital wall excision, at least half of the eyelid must also be removed. We present two cases where we decided to use conchal cartilage to reconstruct the medial orbital wall and tarsomarginal Hübner grafts to reconstruct the eyelid. This combination offers several advantages: a very limited resorption, only one operative field and a reduced infection risk.

[Schmid-Meyer fronto-temporal flap for nasal reconstruction]. / Le lambeau fronto-temporal de Schmid-Meyer dans les reconstructions nasales.

INTRODUCTION: Many surgical techniques have already been described to repair full thickness defects of the inferior part of the nose. The Schmid-Meyer fronto-temporal flap procedure, a little known technique, is based on the old principle of autonomization of a cutaneous flap and uses a tailor-made composite cartilaginous graft placed in the temporal region. This graft is progressively detached and allows mucosal/cartilaginous/and cutaneous nasal repair. Can this technique still be used for nasal full-thickness reconstruction? PATIENTS AND METHOD: Nine cases of nasal reconstruction using this procedure were performed. The 4-steps of the operative technique were described and the results were analyzed retrospectively. RESULTS: This procedure allows, for some specific indications, excellent reconstruction of the ala, the columella or the nasal tip. In eight cases out of nine, the result was judged good or very good by both patients and physicians. In 78%, the reconstruction was performed under local anesthesia. DISCUSSION: The Schmid-Meyer flap procedure may still be used for full-thickness reconstruction of the lower third of the nose because it allows a high quality of nasal reconstruction and few scar sequels.

[Moldable titanium mesh for chest wall reconstruction, an elegant solution about a case report]. / Reconstruction d'une pariétectomie thoracique transfixiante par grille de titane malléable, une solution élégante à propos d'un cas.

INTRODUCTION: Several surgical techniques are available for full thickness chest wall reconstruction. The choice has to be adapted to the size of the loss of tissue, its location, and must finally be accepted by the patient's. We propose a new and unpublished solution. CASE REPORT: We have in our care a 54 years-old patient suffering from a previous loss of chest wall tissue measuring 7 cm(2) due to surgical treatment of mediastinal Hodgkin's disease with sternal and costal invasion. Because of the sequelae, the goal focused on aesthetic reconstruction. Heartbeat was visible under the skin due to a loss of secondary left breast tissue from an initial treatment with absorbable Vicryl(©) mesh followed by a local skin, and glandular flap. Our choice of reconstruction consisted of inserting a moldable titanium mesh followed by 200 g implants in each breast during the same operation. We did not experience any complications and the patient is satisfied with the results. DISCUSSION: No example of reconstruction using only a moldable titanium mesh was found in the literature on chest wall reconstruction. Our elegant choice is innovative in our discipline. However, this reconstruction materiel is already part of therapy procedures in other specialized surgeries. CONCLUSION: This case report illustrates the various facets of our speciality: bring a solution at once repair, aesthetic and unique according to the request of the patient. The use of a moldable titanium mesh allows the reconstruction of stable chest wall. The small size does not present any functional difficulties, but rather unsightly sequel.

[Conchal flap with a superior pedicle to reconstruct the middle or upper third of the auricle]. / Le lambeau de conque à pédicule supérieur pour les reconstructions hélicéennes supérieures ou moyennes.

The middle or upper third of the auricle can be reconstructed with a composite chondro-cutaneous peninsular flap of the conchal part of the auricle. This peninsular flap is based on the anastomotic network between the posterior auricular and the superficial temporal artery. The authors report their experience about 24 clinical cases. Most of the cases were partial auricular amputations for squamous cell carcinoma. The surgical procedure allows a hidden cartilaginous donor site, the concha, allowing in a single operation a color- and texture-matched reconstruction. This flap represents an alternative to more complex surgical procedures, and can easily be realised under local anaesthesia.

[The complete dorsum nasal island flap based on the superior alar artery]. / Lambeau total du dos du nez basé sur l'artère alaire supérieure.

The complete dorsal nasal aesthetic unit can be raised in a vascular island flap based on the superior alar artery, at the level of the nasalis muscle. This flap uses the vertical glabellar cutaneous laxity. It hides scars between the nasal aesthetics units and its distal rotation point allows a pure translation of the nasal skin without distortions encountered when using medial canthal rotation flaps. This local flap is reliable and had been successfully used for four patients without complications or secondary procedures. It allows large reconstructions for up to 25 mm defects leaving minimal scars. It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose, and has also been used for alar reconstructions.

[Primitive neuroendocrine cancer of the breast. Post-traumatic discovery of a man]. / Tumeur neuroendocrine primitive du sein. Découverte post-traumatique chez un homme.

We report a primitive neuroendocrine breast tumor (NET) in a male. This situation is uncommon by its mode of discovery. We have treated a 74-year-old man with a lesion in the left areola initially considered as an organized hematoma due to a severe trauma. The ablation was performed by direct access under local anesthesia. The analysis of the piece has showed a NET of the breast due to the positivity of the neuroendocrine, cytokeratin and hormone markers. No other NET lesion was found, excluding the secondary origin of the breast tumor. Complementary therapies associated mastectomy, lymphadenectomy, hormonotherapy. Male breast cancer is rare. NET are exceptional, only a dozen of male NET is reported. These tumors affect a specific population and have a better prognosis than infiltrating ductal carcinoma. In our case, no causal link can be demonstrated between trauma and tumor microenvironment necessary for the growth of quiescent cancer cells.

[Submental flap for auricule reconstruction]. / Lambeau sous mental suite à l'exérèse de l'oreille externe.

OBJECTIVE: We present our experience in the use of submental flap in reconstruction of post-auricular excision defects. MATERIAL AND METHODS: Three patients underwent reconstruction with submental flap. RESULTS: The submental flap has been used in 3 patients for auricular defect reconstruction. All patients had a carcinoma involving the auricle. All the donor site defects were closed primarily. Outcomes were simple. In one case, we noticed a partial necrosis of the flap extremity. CONCLUSION: The submental flap produces excellent skin color and contour. It leaves a very well-hidden donor site. The operative technique makes it easy to use. So, the submental flap has definite advantages over distant flaps and it is a useful addition to the reconstruction in head and neck surgery.

[Optimized negative pressure therapy. Case report]. / Thérapie par pression négative optimisée. A propos d'un cas.

Our patient showed major abdominal cutaneous necrosis. Detersion removed the entire thickness of half of the right-hand wall of the abdomen. We are going to explain how, by combining well known procedures, we conducted this closure. This deals with a patient aged 53, with a long case history of dermatomyositis and highly debilitating sub-cutaneous calcinosis. This patient has been treated with Imurel and high doses of corticoids since 1997. In the face of the much debilitated terrain of the patient, it was not certain that a local flap or even a pediculated flap could be made to cover this loss of substance with a minimum of risk. A cutaneous extension was then envisaged using a system of Wisebands fillets. To protect the parietal plate, accelerate its growth and reduce the skin tension, we used in combination a system of foam dressing with negative pressure therapy (NPT). The optimized NPT was used for 2 weeks. The Wisebands were installed for 1 month. The treatment lasted for 50 days and required five short sessions of general anaesthesia. The histopathological interpretation revealed an EBV lymphoma. The assessment of the extension and the therapeutic treatment of the lymphoma contributed to the duration of hospitalisation and the number of general anaesthesia sessions. The synergy effect of these two associated procedures have allowed a faster skin closure; 18 months later, no complications have occurred. The wound has closed totally and the abdominal wall is solid in spite of not having resorted to a flap or separation.

[Abbé-Mustardé's flap with lower lid transposition: three clinical cases]. / Intérêt du lambeau de transposition palpébrale d'Abbé-Mustardé : à propos de trois cas cliniques.

The ideal solution first recommended is the use of Abbé-Mustardé's flap with lower lid transposition to rebuild the total loss of the upper eyelid. Every step of the surgical technique has been detailed to improve the result and keep the drawbacks under control. After having read articles on this subject, we describe three clinical cases, which enable us to compare with others surgical techniques that cannot rebuild all the levels of the eyelids and the edge of the eyelashes.

[The orbitonasolabial flap. Anatomical and clinical study]. / Le lambeau orbitonasogénien. Etude anatomique et clinique.

How to use the orbitonasolabial flap in vascular island thanks to his pedicle based an angular vessel. An anatomic study based on 11 cadavers allows to check the existence of a constant pedicle. This flap was used on 6 patients aged 62 to 90 years old on an average period of 16 months to fill up jugular, orbital, nasolabial and inner canthal defects. Two complications have occurred, a superficial necrosis of the lower part of the flap having spontaneously healed and an ectropion on a senile part. It has been necessary to degrease a second time in 50% of the cases. Nevertheless, the flap can be considered reliable and able to cover tissue defect in the central facial region with minor aesthetic and functional sequel on the donor site.

Post-ablative reconstruction of the medial canthus and medial orbital wall using conchal cartilage graft with three illustrative cases.

When the medial third of the upper or lower eyelid has to be reconstructed after full-thickness tumour excision, we usually use Hübner tarsomarginal grafts, but when medial canthal lesions spread to the medial orbital wall without invading the orbital margin, conchal graft becomes our first surgical option. Previously reported solutions to this difficult problem are few and concern more directly medial orbital wall fractures. We found no article dealing specifically with the use of conchal graft in post-ablative reconstruction of the medial orbital wall. Nevertheless the concha presents great advantages over bone grafting or rib cartilage, because it is more flexible and malleable. And it is less prone to extrusion or infection as may be allografts implants. It is a very effective way to repair medial orbital defects, but graft reorientation must be perfect to match exactly the medial orbital wall concavity.