Management of Large Sternal Wound Infections With the Superior Epigastric Artery Perforator Flap.

The management of sternal wound infections often requires pedicled flaps. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. For sternal wounds, the superior epigastric artery perforator (SEAP) flap can be used with the propeller procedure with minimal donor site morbidity. In our practice, this flap has replaced the traditional latissimus dorsi and pectoralis major flaps in the treatment of many sternal wounds. We report our experience with 4 patients with large sternal wound infection after cardiothoracic operations. The SEAP flap appears a safe alternative for low-morbidity coverage of sternal infections. Moreover, muscle flaps remain available in case the SEAP flap fails.

[Freon gas frostbite: an unusual burn evolving in two stages]. / Gelure au gaz fréon : une brulure atypique évoluant en deux temps.

Freon gas is a halogenated derivative widely used in refrigeration and air conditioning. It is maintained at a temperature below -41°C and its contact with skin may cause very serious burns. This is usually an accident at work and the burns affect the hands of patients first. Unfortunately, early clinical presentation is often reassuring and does not reflect the actual depth of the injury. Few cases of this injury are reported and no treatment protocol is established at this time. We present two cases of frostbite by freon gas, initially evaluated at a stage of superficial burns and evolved spontaneously in a few days to full thickness burns necessitating surgical treatment by excision and skin grafting. This evolution in two phases has never been described and could help to better understand the pathophysiology of this frostbite and the possibilities of management.

[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.

[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.