Variability in facial-muscle innervation: A comparative study based on electrostimulation and anatomical dissection.

Facial-nerve palsy is the most common complication during facial surgery. However, there are few detailed reports on the distribution of the terminal branches of the facial nerve to the mimetic muscles. This also applies to the communicating branches. The aim of our study was to assess the variability of communicant and terminal branches of the facial nerve in humans. This prospective study involved anatomical dissections and intraoperative electric stimulation of facial nerves. We first performed 30 dissections to define the branching patterns of the extracranial facial nerve, with particular focus on the penetrating points into the mimetic muscles. We then studied and compared these preliminary data with 14 operative facial stimulations conducted during parotidectomies. Each trunk and branch received systematic electrostimulation. The electrostimulation and facial-and-neck movements were analyzed by two independent reviewers. The peripheral branching and intercommunication of the facial branches were highly variable. Combining electrostimulation and dissections, the frontalis muscle, the depressor labii inferioris and the platysma showed little nerve recuperation whereas the sphincter muscles (orbicularis ori and oculi) were anatomically protected. Facial-muscle innervation differed among individuals. We found complex variations in the facial branching mode. Our study highlights the branches and corresponding areas that could be considered anatomically risky. Clin. Anat. 32:169-175, 2019. © 2018 Wiley Periodicals, Inc.

Non-surgical treatments for hidradenitis suppurativa: A systematic review.

INTRODUCTION: The management of hidradenitis suppurativa is multidisciplinary, involving general measures, medical treatment and surgery. Non-surgical treatments, often first-line procedures, mainly concern forms of low-to-moderate severity or, conversely, very severe forms in non-operable patients or those refusing surgery. While many treatments have been attempted, few randomized controlled trials have been conducted, so the choice of treatments is most often based on the personal experience of the clinicians. The objective of this systematic review is to propose a synthetic analysis of the currently available non-surgical procedures. METHODS: This systematic review of the literature was conducted in accordance with the PRISMA criteria. We searched for articles in the Medline®, PubMed Central, Embase and Cochrane databases published between January 2005 and September 2015. RESULTS: Sixty-four articles were included. They generally had a low level of evidence; indeed, the majority of them were retrospective observational studies. They involved biotherapy (44%), dynamic phototherapy (16%), antibiotics (11%), Laser (8%), retinoids (6%) and immunosuppressive therapies, anti-inflammatory drugs, zinc, metformin, gammaglobulins and fumarates. CONCLUSIONS: None of the non-surgical treatments can treat all stages of the disease and offer long-term remission. Antibiotics and biotherapy seem to have real effectiveness but their effect remains suspensive and the disease is almost certain to reappear once they are stopped. As regards antibiotics, no association has shown their superiority in a study with a high level of evidence. And while some biotherapies seem quite effective, due to their side effects they should be reserved for moderate-to-severe, resistant or inoperable forms of the disease. Randomized controlled studies are needed before valid conclusions can be drawn. In the resistant or disabling forms, it is consequently advisable to orientate to the greatest possible extent towards radical surgery, which is the only treatment allowing hope for cure.

Leech therapy in flap salvage: Systematic review and practical recommendations.

INTRODUCTION: Medicinal leeches have been part of the therapeutic armamenterium of plastic surgeons for more than 50 years. While their use in hand surgery is a matter of course, their use in salvage of flaps with venous congestion remains facultative depending on teams. MATERIALS AND METHODS: We conducted a systematic review of leech therapy for flap salvage between 1960 and 2015, analyzing 121 articles and subsequently taking into consideration 41 studies. In parallel, we collected data from 43 patients for whom leach therapy had recently been applied in treatment of venous insufficiency in pedicled or free flaps after revision surgery had failed to improve flap vascularization, or in cases where flap revision was not appropriate. The data collected pertained to relevant indications, treatment procedure, efficacy, adjuvant therapies, side effects and complications. RESULTS: For this indication, the success rate of leech therapy ranged from 65 to 85% (83.7% in our series) according to the situations encountered. Optimal frequency of application ranged from 2 to 8hours, while average overall duration ranged from 4 to 10 days. The number of leeches to be applied can be determined depending on volume of the flap. In 50% of the cases reported in the literature, the patients required transfusion. Antibiotic prophylaxis against Aeromonas is highly advisable. A ciprofloxacin and trimethoprim-sulfametoxazole combination currently appears as the most relevant prophylactic antibiotherapy. CONCLUSION: Hirudotherapy is a reliable treatment in cases of patent venous insufficiency of pedicled or free flaps (or when revision surgery is not recommended). Even though the relevant literature is highly heterogeneous, we have attempted to put forward a specific protocol bringing together dosage, delivery route, frequency of administration and appropriate prophylactic antibiotherapy. An algorithm for treatment and management of venous congestion and a practical information sheet have been placed at the disposal of plastic surgery teams.

[Correction of congenital malformations by custom-made silicone implants: Contribution of computer-aided design. Experience of 611 cases]. / Chirurgie des malformations congénitales par implants sur mesure en silicone. Apport de la conception assistée par ordinateur (CAO). À propos d'une expérience de 611 cas opérés.

INTRODUCTION: Modern techniques of computer-aided design and tridimensional prototyping for manufacturing silicone elastomer custom implants are growing. They have widely modified the surgical indications in our unit. MATERIALS AND METHODS: By presenting their experience of 611 cases managed between 1993 and 2016, the authors describe the method of conception from CT-scans, the virtual image of the body and the manufacture of the custom-made implant perfectly adapted to the anatomy of each one. The operative techniques are described for the three main indications: the funnel chest or pectus excavatum (474 cases) according to a modified CHIN classification is corrected simply and very satisfactorily. This approach may render thoracic surgery techniques obsolete. Indeed, these operations remain risky and of doubtful functional utility; Poland syndrome (116 cases), where the use of a custom-made implant for compensation of muscle volume is frequently used, but can be improved by a transfer of adipose tissue or a classic breast implant; the leg atrophies (21 cases) receive custom elastomer implants introduced in a sub-fascial plane. RESULTS: The results are excellent for pectus excavatum but more difficult to optimize for the other two indications, requiring sometimes complementary techniques. Complications are rare and often benign, implants endure for life. Quality of life, psychological comfort and self-esteem have been improved with low morbidity and without having undergone a painful surgical experience. CONCLUSION: Reconstructive procedures of congenital malformations by custom-made silicone implants open a new field of activity for our surgical specialty with vast opportunities.

[Interest and feasibility of local anesthesia in the management of massive extravasation of contrast medium]. / Intérêts et faisabilité de l'anesthésie locale dans la prise en charge de l'extravasation massive de produit de contraste.

Radiographic contrast medium extravasation in the upper extremity is not rare. It can be responsible for functional (compartment syndrome) and cosmetic sequelae. It is very difficult to predict the degree of final tissue injury in emergency. Currently, there is no consensus of emergency treatment. However, liposuction and saline washout as described by Gault is the usual treatment. We report the case of 42 year-old woman with radiographic contrast medium extravasation in the arm (120 cm(3)) with neurologic complications involving median nerve and medial cutaneous nerves of arm and forearm. Emergency conservative surgical washout with saline solution was performed under local anaesthesia. Drainage was realised by lipoaspiration cannula and arm massages. Clinical and radiological results were estimated. Ultimately, the patient has retained no sequela. Contrast medium extravasation in the arm with tissue complications is exceptional. We think that saline washout and lipoaspiration cannula drainage are an emergency useful treatment for radiographic contrast medium extravasation with tissue complications. Tolerance of the management was quite good. Postoperative X-rays are useful to assess treatment efficacy.

[Anterior medial cervicoplasty]. / Le lifting cervical antérieur médian.

Submental skin and fat excess are common with aging. Real cutaneous crop in pronounced forms, may be felt with difficulty by patients, which leads them to consult. The proposal of a conventional face-lift is not always suitable or accepted by a predominantly male population. Therefore, an anterior medial cervicoplasty with elliptical excision of excess skin and a medial platysmaplasty will be an interesting alternative. The authors offer a new description of this technique by simplifying, compared to the previously described techniques. Two clinical cases are reported, with both types of recommended incisions. This procedure is performed under local anesthesia. The results obtained by this technique were considered good to excellent by all operated patients in our unit. The final scar that may appear significant and sometimes unacceptable for some surgeons remains in fact very inconspicuous. The anterior medial cervicoplasty is an easy technique that allows responding gracefully to a frequent request, with good cosmetic results and few complications.

[Macrolane®: A severe case of calf cellulitis after modeling injection]. / Macrolane® : un cas grave de cellulite du mollet après injection modelante.

In recent years, the market for resorbable injectables has been steadily expanding. The European Community's seal of approval (CE) is a sufficient guaranty to get them distributed. These injectables do not require official approval because they are considered to be "implantable medical devices" and not medicines. Macrolane(®)is a hyaluronic acid in gel form (NASHA [non-animal stabilized hyaluronic acid]) and has been on the French market since 2007. It can be injected into all areas except the face. It is highly cross-linked which, while slowing its absorption into the body, can also leave long-lasting residues. We report the first case of cellulitis after injection into the calf by a practitioner in his office.