[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.

[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.