[Differential diagnosis between keloid and hypertrophic scars: a new approach by full-field optical coherence tomography]. / Diagnostic différentiel entre cicatrices chéloïdes et hypertrophiques : une nouvelle approche en tomographie par cohérence optique plein-champ.

OBJECTIVE: To evaluate the efficacy of full-field optical coherence tomography to differentiate hypertrophic and keloid scars on ex-vivo tissues. PATIENTS AND METHODS: All patients who underwent resection of pathological scar from November 2012 to September 2013 were analyzed. The scars were fixed in formalin and analyzed by conventional histology and full-field optical coherence tomography. The criteria for evaluation were: presence of dermal nodules, presence of cells and hyalinization of collagen. RESULTS: Nineteen pathological scars were analyzed. Histology found 7 keloid scars, 7 mixed and 3 hypertrophic scars. The sensitivity of optical coherence tomography for the detection of dermal nodules was 100%. This technology was not helpful for detection of cells and hyalinized collagen. CONCLUSION: In the present state of technology, optical coherence tomography did not identify the presence of cells, which makes the differential diagnosis difficult in the case of hypertrophic and keloid scars.

[Hypogastric abdominal wall reconstruction with a pedicled anterolateral thigh flap]. / Reconstruction d'une perte de substance de pleine épaisseur de la paroi abdominale sous-ombilicale par un lambeau fasciocutané antérolatéral de cuisse pédiculé.

Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia.

[Two anomalous muscles of a forearm revealed by ulnar nerve compressions, a Double Crush syndrome]. / Malformation musculaire associée à une variation anatomique de l'avant-bras révélées par des compressions étagées du nerf ulnaire (Double Crush syndrome).

This article describes the concomitant presence of two anomalous muscles on a left forearm in a 40-year-old man. The anconeus epitrochlearis muscle was responsible for a cubital tunnel syndrome and the unusual origin of the flexor digiti minimi brevis muscle was responsible for a compartment syndrome with ulnar nerve compression at the level of Guyon's canal during effort diagnosed by MRI. Resection of these muscles relieved the symptoms and allowed the patient to return to work.

[Establishment of a keloid model by transplanting human keloid onto the backs of nude mice]. / Mise au point d'un modèle animal original de cicatrice chéloïde.

Keloid scar is a proliferative healing dysfunction formed by an excessive build-up of collagen fibers on the dermis. It is responsible of aesthetic and functional disabilities. There is no ideal treatment and recurrence occurs very often. Keloid scars occur only to human, that's why animal model needs to be made to study this pathology and new treatments. Few models have been described using human keloid scars implanted into subcutaneous tissue of nude mice or rat. To allow study of topical and laser treatment we have developed a new animal model using human keloid scar fragment with epidermal and dermal tissue implanted into back of nude mice like a full thickness skin graft. Keloid fragments from five donors have been grafted onto 40 nudes mice. Macroscopic and microscopic studies have been made at day 28, 56, 84 and 112. We observed integration of the fragments in all cases. Hyalinized collagen bundles were observed in all implant biopsies confirming the stability of the keloid architecture within 112 days. This model is easily reproducible and allows the study of topical treatment and laser due to the accessibility of the keloid.

[Role of the plastic surgeon in the management of ecthyma gangrenosum in children: clinical example]. / Rôle du chirurgien plasticien dans la prise en charge de l'ecthyma gangrenosum chez l'enfant : exemple clinique.

Ecthyma gangrenosum is a cutaneous infection, which result from a Pseudomonas aeruginosa septicemia, encountered in most of the case in immunocompromised people. Authors demonstrate the important role of the plastic surgeon in the diagnosis and therapeutic management of the disease in children. An eight-month-old infant has been hospitalized for acute leukaemia. She developed an extensive painful macule in the buttocks and perineal area in a septic context. A multidisciplinary management allowed to set up an adapted antibiotherapy, an early escharrotomy, a protection of the wound by digestive and urine derivation and a reconstruction with wound healing by second intention and split thickness skin graft, which lead to a good quality cure and wound healing at the end of 37 days of evolution. This case demonstrates the importance of the surgical management in the treatment of ecthyma gangrenosum. The wound healing associated with a split thickness skin graft seems to be the less invasive solution in a frail patient and the fastest to re-start the chemotherapy.

[Driving licence and hand surgery]. / Permis de conduire et chirurgie de la main.

OBJECTIVES: In hand surgery, the patient often asks his surgeon if he is authorized to drive his car after the intervention. It is very difficult to answer making the distinction between medicolegal reality and misconceptions. Authors try to offer relevant answers. METHODS: This paper is based on French laws governing the obtaining or the renewal of the driving license as published in traffic rules, penal code and official documents. RESULTS: The law defines the precise list of the "notifiable" medical conditions and disabilities incompatible with driving or requiring amendments. The patient must go through numerous stages to pass or renew a license (administrative procedures with the police, find a specialized driving school, medical examination, theoretical and practical examination). There are numerous developments adapted to vehicles. Possibilities of financing exist but are often difficult to obtain. The attitude towards insurance companies is not specified by the law but has to remain loyal and careful; the patient is nevertheless protected by the insurance code. CONCLUSION: The surgeon has to warn his patient of the new constraints imposed on him by his disability, whether temporary or definitive, but also to present him with the legal solutions. In conclusion, we propose an information sheet to assist the patients to regain their autonomy after surgery.

[Surgical managing of current cutaneous infections in children]. / Prise en charge chirurgicale des infections cutanées communes de l'enfant.

The cutaneous infectious pathology of the child is varied and frequent. Authors deal with surgical infections seen in current pediatrics, which often have to appeal to a plastic pediatric surgeon for their treatment. Superficial infections of skin and pilo-sebaceous follicles are common in big children. The folliculitis and the boil are the most frequent. Their treatment is medical and surgical and does not require an antibiotic treatment in most of the cases. The primitive abscesses or following an anterior lesion recover from a similar treatment. Some localizations or risky context need a particular follow-up. The whitlow is a particular example and needs to have a particular follow-up because of the risk of hand cellulitis. Nails embodied of the child require a specialized notice because of their numerous clinical forms, which must be distinguished according to the age. Finally the necrotizing cellulitis and fasciitis are surgical emergencies and have a well-codified treatment. These infections in children must benefit from an attentive care because when they are badly treated, they can involve the aesthetic, functional and vital forecast.