Treatment of skin lesions related to pseudoxanthoma elasticum in plastic surgery.

BACKGROUND: Pseudoxanthoma elasticum (PXE) is a hereditary disorder of connective tissue characterized by progressive calcification and fragmentation of elastic fibers, which primarily affects the skin, retinal and arterial walls. Skin damage takes the form of yellow papules that can merge to create a cutaneous fold. This is accompanied by an excess of skin on the different sides of the neck and in the largest folds. These changes to the skin have a significant aesthetic, functional and psychological impact, especially among women. PATIENTS AND METHODS: We evaluated the treatment options in all patients with PXE of our University-Hospital. This group contains people who have been hospitalized for the assessment of their disease and applicants for surgical correction. The goal of the surgery was not the total removal of the lesions but instead a decrease in their size and a tightening of the skin. RESULTS: In total, 250 patients were seen between 2007 and 2022. Surgical treatment was advised for 29 women and 1 man. The main interventions were based on standard techniques such as cervico-facial facelifts, brachioplasties and cruroplasties. The results obtained during postoperative follow-up consultations were rated satisfactory to very good, both aesthetically and functionally. There were no postoperative complications recorded: neither bruising nor scarring issues. Patients with PXE heal as normal. CONCLUSION: Surgical treatment for excess skin observed during PXE is poorly described. Yet, these excesses can be removed when they become troublesome by making use of and adapting the traditional methods of plastic surgery for tightening of the skin.

[Nasal reconstruction: Decision tree based on 229 operated cases]. / Reconstruction des pertes de substances du nez : algorithme décisionnel à propos de 229 cas.

BACKGROUND: The Face is the most frequent localization for cutaneous carcinoma. The nose accounts for about 30% of these tumors. Nose tissue loss repair has to pursue 3 types of objectives: carcinologic, aesthetic and functional. The aim of this article is to identify a decision tree to guide the choice of surgical reconstruction technique based on localization and size of the defect. PATIENTS AND METHODS: We performed a retrospective analysis in Angers' CHU from 2013 to 2019 including 229 patients referred for cutaneous tumors excision in need of reconstruction. We analyzed the type of reconstruction, size of the tissue loss and localization of the defect in terms of nose aesthetic subunits. RESULTS: Among the 229 patients included, the most frequent localization was nose tip (32%). 44% of patients were reconstructed with skin grafts or composite graft, 56% with flaps (48% local flaps and 4% association of both methods). Limited central resections of nose tip were reconstructed with skingraft. The Rybka flap and bilobed flap were the preferred choice for lateral reconstruction of nose tip. Largest tip defects were reconstructed using Rieger flap or forehead flap. The dorsum was often reconstructed with local flap: glabellar on the upper part, Rieger on the lower part. Lateral side was perfectly reconstructed with island flap. Nose wings needed framework: composite graft was the judicious choice in case of limited tissue loss whereas forehead flap with framework or Schmid-Meyer flap were chosen for larger defects. CONCLUSION: Our past experience in nasal reconstruction has provided us with an original decision tree to guide surgeons in choosing the right reconstruction technique according to the size and localization of the defect.

Object kinetics perception in auto-stereoscopic vision.

In this paper, we study the conditions for the perception of object kinetics, produced by a multiview auto-stereoscopic system and a set of still images. We assess the capabilities and performances of such an optical system to encode complex trajectories and kinetics of objects moving in depth. In particular, we set up rules to create motions with nonuniform velocities, when obtained by motion parallax induced by the observer. We establish a link with plenoptic systems from where we derive applicable scaling rules to ensure stereoscopic vision and to provide fluid motion perception with satisfying visual comfort. Finally, we scale the optical system, thanks to obtained parameters, to emulate the perception of object motions in depth with fluid kinetics and to create impressive motion effects.

Does the repetition over a short time of a microsurgical suture improve its reliability?

Our hypothesis was that immediate repetition of a microsurgery-suturing task will improve its execution and outcome. This was an experimental animal study. Ten surgeons were divided into two groups of five surgeons. Each performed two end-to-end carotid anastomoses on the same rat, one after the other. The anastomosis was evaluated by the surgeon and an instructor. The primary endpoint was permeability. The outcome was evaluated using an objective and subjective assessment grid yielding 1 to 3 points per item. The total scores for each of the 10 surgeons were used to compare the anastomosis of carotid 1 versus 2, using the ratings given by the surgeon and the instructor. Twenty anastomoses were performed, but 1 rat died intraoperatively, leaving 18 anastomoses for evaluation. No significant differences were found on the main endpoint of permeability, with all anastomoses being permeable. The surgeon's self-assessment was significantly better for the second carotid artery (P=0.05), but this was not confirmed by the proxy assessment (instructor). The analysis by subgroups-morning versus afternoon-found the second carotid anastomosis was significant better in the self-assessment and proxy assessment for the morning group (P<0.001, P=0.024). There was no significant difference in clamping times. The immediate repetition of a microsurgical procedure seems to favor its execution, which leads us to propose that the more difficult or important anastomosis should be done after an easier or less important one during complex surgeries. LEVEL OF EVIDENCE: 2B.

[Deaf-mutism, lymphedema of the lower limbs and hematological abnormalities (acute leukemia, cytopenia) with autosomal dominant transmission]. / Surdi-mutite, lymphoedeme des membres inferieurs et anomalies hematologiques (leucose aigue, cytopenies) a transmission autosomique dominante.

Report of a syndrome constituted from sensorineural deaf mutism, lymphoedema of lower limbs with early onset and haematological anomalies (aucte myeloblastic leukaemia, cytopenia) in four individuals (three boys and two girls from two generations). This observation suggest autosomal dominant transmission, however recessive transmission cannot be formelly excluded.