[Place of 3D custom-made implants after failure of modeling steno-chondro-plasties]. / Place des implants sur mesure 3D après échec des sterno-chondro-plasties modelantes.

Most common congenital malformation of the thorax, Pectus Excavatum affects about one in 500 people. Several surgical or medical techniques have been proposed. Some are followed by complications or insufficient results even though their constant functional value is highly controversial. Secondary surgery with a deep customized 3D elastomer implant, may be an elegant effective and safe solution compared to others; it allows a good aesthetic result expected by patients in the absence of any respiratory or cardio-vascular functional context.

[Setting of a breast autologous microsurgical reconstructive surgery evolution in 20 years and review of 1138 cases]. / Mise en place d'une activité de reconstruction microchirurgicale du sein par tissus autologues. Évolution sur 20 ans et revue de 1138 cas.

UNLABELLED: The authors conducted a retrospective study of breast reconstruction with DIEP free flap between 1994 and 2014 by a single team. MATERIAL AND METHOD: A retrospective analysis of all operative charts and hospitalization was conducted for the period from 1994 to 2014. The number of cases per year, the complication rate of the donor site and recipient site, and surgery time were recorded. Sequence analysis was conducted to determine the elements that have enabled to implement this technique reliably and effects of the learning curve. The series was split into two periods (1994/2011 and 2012/2014) corresponding to two different hospitals with the same team. RESULTS: The total number of shreds of 1138 between November 1994 and December 2014 respectively with 477 and 661 the period 1994/2011 to 2012/2014 period. The failure rate increased from 8% to 2.2%. CONCLUSION: The establishment of units mainly dedicated to microsurgical reconstruction can offer the DIEP technique reliably and reproducibly.

Feasibility, reproducibility, risks and benefits of face transplantation: a prospective study of outcomes.

Composite tissue allotransplantations can be indicated when autologous transfers fail to restore human appearance. We report the reproducibility, difficulties, serious adverse events and outcomes of our patients. Five patients were included in a registered clinical research protocol after thorough screenings assessed by an independent expert committee systematically discussing the alternative options. One patient suffered from plexiform neurofibromas, two from third degree burns and two from gunshot injuries. They were included on a national waiting list with a dedicated face procurement procedure. Transplants were harvested from heart beating brain-dead donors before other tissues and organs. Induction immunosuppressive therapy included antithymocyte globulins, steroids, mycophenolate mophetil and tacrolimus. Maintenance therapy included the last three ones associated with extracorporeal-photopheresis. Four patients were transplanted with 7- to 38-month follow-up. One could not due to multiple panel reactive antibodies after 18 months on waiting list. Acute cellular rejections were controlled by conventional treatment. Opportunistic infections affected all patients and lead one patient to die two month after the transplantation. Voluntary facial activity appeared from 3 to 5 month. Face transplantation has been reproducible under conventional immunosuppression. Major improvements in facial aesthetic and function allowed patients to recover social relations and improved their quality of life.

[A cost analysis of DIEP flap in breast reconstruction]. / Analyse médico-économique du lambeau libre de DIEP en reconstruction mammaire.

BACKGROUND: We postulate that the absence of a CPT code for DIEP (deep inferior epigastric perforator) free flap in breast reconstruction is in part responsible for the delayed adoption of this modern technique in France. In order to provide data to our regulating health agency, we determined the cost of this technique compared to a gold standard. We performed a cost-identification study, comparing costs of DIEP free flap versus latissimus dorsi pedicled flap with implant (LD+I) in secondary breast reconstruction following irradiation. METHODS: Over a 12-month period, direct medical and non-medical costs as well as indirect costs were recorded in both groups (DIEP and LD+I). RESULTS: In an academic department funded by the national health system, total cost of a secondary breast reconstruction by DIEP free flap was 10,671 ± 3005€ (n=57) versus 8218 ± 2049€ (n=18) for the LD+I group (P<0.05). Mean OR occupation time was 390 ± 64minutes for DIEP versus 283 ± 44minutes for LD+I (P<0.05). Mean hospital stay was 6 ± 2 days for DIEP versus 5 ± 2 days for LD+I (P>0.05). CONCLUSION: DIEP free flap technique offers a long lasting breast reconstruction at an reasonable expense compared to the LD+I (+22%). Furthermore, in an academic department, collaboration of two microsurgeons during DIEP flaps allows OR times to drop significantly and become competitive with LD+I.

[Preoperative angiographic CT-scan for perforator flap transfer. Clinical applications in an emergency unit of reconstructive surgery: four clinical cases]. / Intérêt de l'angio-TDM dans la chirurgie des lambeaux perforants. Applications dans une unité de chirurgie plastique et reconstructrice. A propos de quatre cas cliniques.

Our experience of the deep inferior epigastric artery perforator flap has led us to perform systematically an abdominal CT-scan for the pretherapeutic checking. This exam gives us a precise vascular mapping of musculocutaneous and septocutaneous perforators artery of the flap, may enable a better orientation in the dissection and reduce the surgery time. We have enlarged the indication of this exam to the members flaps who needs the dissection of a musculocutaneous or a septocutaneous perforators vessels: Nakajima's et al. classification [1]. The mapping of perforating vessels on 3D reconstruction pictures helps us to planify the vascular cutaneous autologous grafts.

[Breast reconstruction with superior gluteal artery perforator (SGAP) flap without intraoperative setup change. About eight cases]. / Reconstruction mammaire par lambeau de superior gluteal artery perforator (SGAP) sans changement d'installation. À propos de huit cas.

INTRODUCTION: The superior gluteal artery perforator flap (SGAP) typically requires a peroperative change of the patient's position that increase the duration time of the procedure and the hospitalization. The aim of this study is to present our serie of eight consecutive SGAP flaps without setup change, and to precise the surgical technique we used. PATIENTS AND METHODS: This is a retrospective series of eight consecutive SGAP flaps performed between September 2001 and March 2010. All these flaps were performed without peroperative setup change. We studied the number of perforators used and their origins, the type of recipient vessels, the duration time of the procedure and the hospitalization. We also analyzed the morphological and functional outcomes for the donor site. RESULTS: All eight flaps were raised on a single septo-cutaneous perforator located between the gluteus maximus and gluteus medius muscles. The internal mammary vessels were chosen as recipients in all cases. The average duration time of the operation was 6 hours and 5 minutes. We report one flap loss. No functional or morphological complications were reported on the donor site. The morphological results on the reconstructed breast were satisfactory or very satisfactory in most cases. CONCLUSION: A satisfying breast reconstruction can be achieved with the SGAP flap without changing setup. The use of the septo-cutaneous branch between the gluteus maximus and gluteus medius muscles lengthens the pedicle and reduces the surgery time by facilitating the dissection. SGAP is therefore another autologous technique for breast reconstruction with low morbidity, when a DIEP flap cannot be harvested.

[Complications of injections of hypoosmotic solutes in an underage patient]. / Complications d'injections de solutés hypoosmotiques chez une patiente mineure.

Liposuction represents the standard surgical treatment of localized fat excess. Some non-plastic-surgery-board-certified practitioners are likely to offer non-invasive alternatives treatments. We report the clinical case of a 14-year-old female patient who followed a Lipectomy treatment. The Lipectomy technique consists in a hypodermic injection of hypotonic solutions in order to obtain an adipocytes lysis by osmotic shock. No PubMed referenced scientific publication is related to the efficacy or the tolerance of this technique. Postoperative evolution was marked by a polymicrobial subcutaneous abscess that needed two surgical evacuations and 10 days of overnight stay in our department. Through this clinical case, we evoke the possible dangers linked to the application of a non-evaluated medical technique and the necessity of establishing an official validation agency related to innovative techniques in aesthetic medicine and surgery.