[Proposal of guidelines for antibiotic prophylaxis in plastic, reconstructive, and aesthetic surgery]. / Proposition de recommandations sur l'antibioprophylaxie en chirurgie plastique, reconstructrice et esthétique.

BACKGROUND: In plastic surgery, guidelines about antibiotic prophylaxis are inaccurate and incomplete, due to result the absence of high-level studies on this subject. The main aim is to establish national common recommendations for plastic surgery antibiotic prophylaxis. MATERIALS AND METHODS: A working group will discuss and validate a multi-center analysis of practices in three University Hospital Centers compared to an interdisciplinary analysis of recommendations to the French Society of Anaesthesia and Intensive Care Medicine and scientific literature. This working group is composed of plastic surgeon members of the French Society of Aesthetic Reconstructive Plastic Surgery, infectious disease physicians, and anaesthesiologists to define clear and precise antibiotic prophylaxis recommendations. RESULTS: Antibiotic prophylaxis with cefazoline (or clindamycine±gentamicine in case of allergy), has been recommended for general surgery with flap or implants, for breast surgery, lipofilling, and rhinoplasty. In other plastic surgery, no antibiotic prophylaxis has been recommended. CONCLUSION: We established common recommendations for plastic surgery antibiotic prophylaxis that is the first step to update these recommendations. Now, they can be evaluated in clinical situation to validate them.

[Past, present and...future of breast implants]. / Passé, présent et...avenir des prothèses mammaires.

The past of breast implants is well known, the techniques seem to be up to date and the future definitely optimistic. Breast implants have been at the top of the polemic due to their complications. Technical innovations allow plastic surgeons to choose adequate types of breast implants and also improve the innocuity of this surgery. Due to the last juridic reglementation and behaviour's evolution, breast augmentation will probably keep its place at the top.

[A variant of island flaps for the covering of pressure sores: the hatchet flap. Apropos of 31 cases]. / Variante des lambeaux en îlot pour couverture d'escarres: le lambeau en hachette. A propos de 31 cas.

The authors propose a modification of the classical design of island flaps for cover of pressure sores, applied to gluteus maximus and tensor fascia lata muscles: the hatchet flap. 31 flaps have been used including 13 gluteus maximus superior flaps for sacral pressure sores, 9 gluteal inferior flaps for ischial pressure sores and 9 tensor fascia lata flaps for trochanteric pressure sores. A small partial necrosis and two cases of sepsis were observed in this series, but did not require surgical revision. The authors emphasize the value of this modification of the classical flap design, which preserves an even better musculocutaneous capital in these patients, who are often already multi-operated. The very rapid recovery of patients supports the authors' application of hatchet flaps to the surgery of pressure sores, and suggests the extension to other musculocutaneous flaps in the future.

[Ultrasonographic data of the solid organs of the abdomen in stage IV human immunodeficiency virus infection. A prospective study of 101 cases in central Africa]. / Données de l'échographie des organes pleins de l'abdomen au stade IV de l'infection par le virus de l'immunodéficience humaine. Etude prospective de 101 cas en Afrique centrale.

A systematic abdominal study of the solid organs of the abdomen (liver, spleen, pancreas, kidneys) carried out in one hundred patients from Central Africa suffering from full blown AIDS revealed disseminated hyperechoic liver in 37 cases and hypoechoic nodules of the spleen in 10 cases. The combination with abdominal adenopathy and/or serous exudates (peritoin, pleura, pericardium) suggested disseminated tuberculosis. Twenty of the 37 patients with diffusely hyperechoic liver presented within tuberculosis which was confirmed by bacteriological data (AARB present in the sputum) in 13 cases. Of the 10 patients presenting with hypoechoic nodules of the spleen, 5 presented with confirmed tuberculosis. These 10 patients were all considered to have disseminated tuberculosis. In view of the current high incidence of extrapulmonary or disseminated tuberculosis occurring in a context of AIDS and the relative infrequency of positive tests for Mycobacterium, abdominal ultrasound must be coupled with chest X-rays in screening and prompt follow-up for TB instigated in HIV-positive adult Africans.

[Tracheotomy scars. "Cross-over" platysma muscle flaps in the treatment of subcutaneous adhesions and depressions]. / Les cicatrices de trachéotomie: lambeaux musculaires de platysma "croisés" dans le traitement des adhérences et dépressions sous-cutanées.

The authors analyse the principal complications of healing of tracheotomy orifices and their causes. Apart from the poor quality of the skin scar, often large and irregular, several other anomalies of the deep layers under the scar may be responsible for various deformities: adherent, depressed scars or scars which move with deglutition. Surgical reconstruction of the various planes and filling of the dead spaces limit the inaesthetic and uncomfortable aspects of these scars. The use of platysma muscle flaps which are mobilised to reconstruct correct subcutaneous planes appears to be an optimal solution combined with other specific procedures of the cutaneous and visceral planes.

[Findings of bile duct ultrasonography in 100 patients with AIDS in black Africa]. / Données de l'échographie des voies biliaires chez cent patients atteints de SIDA en Afrique noire.

A systematic study of bile ducts by abdominal echotomography on 100 African patients affected by AIDS disease has showed 11 bile ducts abnormalities (7 alithiasic cholecystitis and 6 inflammatory cholangitis, associated in 2 cases). The patients studies showed several associated infections, particularly a pulmonary tuberculosis and/or extra-pulmonary. The etiology of bile ducts attack has not been formally specified: lack of Cryptosporidium at the stools parasitologic exam, but presence of several opportunistic germs, or no, in the several samples (blood, cerebrospinal fluid, stools, expectoration).

[Current techniques and indications of pedicled groin flap for hand surgery. Apropos of 100 cases]. / Technique et indications actuelles du lambeau inguinal pédiculé en chirurgie de la main. A propos de cent observations.

Based on an analysis of the anatomical and physical data reported in the literature, the authors describe their personal technique based on an experience of 100 pedicled inguinal flaps. The authors define the current indications for this flap in reconstructive hand surgery. The quality of pedicled inguinal flaps makes this procedure a technique of choice in the emergency treatment of wounds of the hand.

[Cutaneous dehiscences during tissue expansion: use of surgical adhesive plastic film]. / Déhiscences cutanées en cours d'expansion: utilisation d'un film plastique chirurgical adhésif.

Cutaneous expansion, especially in the lower limb, is sometimes complicated by the development of partial dehiscence of the surgical scar or a small area of necrosis over an angle of the prosthesis. The expander implant can be salvaged by closing the dehiscence with surgical adhesive film which allows continuation of expansion while preventing herniation of the prosthesis.

Stereochemistry of carbon monoxide binding to normal human adult and Cowtown haemoglobins.

The structures of carbonmonoxyhaemoglobins A and Cowtown (His146 beta----Leu) have been refined at 2.2 A (1 A = 0.1 nm) and 2.3 A resolution, respectively. The least squares fit to the Fe-C-O line makes an angle to the haem normal of about 6 degrees. The Fe-C-O group is bent from linearity by about 7 degrees. The porphyrins in the CO liganded haemoglobins are ruffled. This deformation of the haem and the distortion of the Fe-C-O group may explain the low CO affinity of haemoglobin. The electron density for the C-terminal residues is low but sufficient to distinguish the histidyl and leucyl residues clearly. The similarity between these two structures, apart from 146 beta, means that the reduced alkaline Bohr effect is due solely to the replacement of histidine by a leucine.

[Tuberous breast: clinical and therapeutic considerations. Report of 20 cases]. / Les séins tubéreúx: réflexions cliniques et thérapeutiques. A propos de vingt cas.

Tuberous breast is a so-called mammary deformity which associates: deficient and contracted base, enlarged nipple-areolar complex, glandular herniation through the areola. The parenchyma is reduced, cylindrical, asymmetric, and frequently posted. Surgery reveals a basic glandular ring. The gland passes through this ring like a "glove's finger", revealing the herniation. All the cases are very different, but the surgical correction is common: concentric skin excision for areolar reduction. "V" vertical excision, allowing gland dissection. Via the skin wedge of the "V", extended dissection is carried out and half of the breast is denuded. The inferior mammary sulcus is released. The basal ring is cut and the posterior breast tissue is radially incised to expanding base, the parenchyma is stretched out. Correction of volume abnormalities: augmentation (implant), posterior reduction of symmetry. Correction of ptosis by skin redraping over the new mammary shape.

[Heat-moulded plastic splint for the nose]. / Attelle plastique thermoformable de contention nasale.

The authors present a very simple and very comfortable splinting device for use after rhinoplasty. It consists of a splint made from malleable plastic which can be moulded by soaking in water at 60 degrees C, allowing perfect modelling to the shape of the nose. This splint is held in place by means of Velcro bands which offer remarkable flexibility of use.

[Specificity of hatchet flaps in the laterofacial region]. / Spécificité des lambeaux en hachette dans la région latérofaciale.

The hatchet flap, well known for the repair after skin resection of the nasal pyramid, is adapted, in a cutaneo-aponeurotic form, to the laterofacial region. The authors describe the principle of the technique which they illustrate by several clinical cases. Its simplicity, its harmonious adaptation and its reliability led them to consider that it has a place in the therapeutic arsenal for skin repair after resection of jugal and temporo-jugal lesions.

[Low transcartilage incision: an advantage for submucosal dissection in rhinoplasty]. / L'incision trans-cartilagineuse basse: un "plus" pour la dissection sous-muqueuse dans la rhinoplastie.

The authors recall the advantages of low transcartilage incision in rhinoplasty and, by means of several technical details, illustrate the value of this approach in submucosal dissection. They emphasise the anatomical clarity, safety and rapidity of the technique.

[Reflections on ankylosing spondylitis in Black Africa. Apropos of a juvenile-onset case]. / Réflexions sur la spondylarthrite ankylosante en Afrique noire. A propos d'un cas à début juvénile.

From the starting point of two cases of ankylosing spondylitis, one of which began in youth, observed in Abidjan, Ivory Coast, a review of the literature concerning the major cases amongst africans is carried out. This disease is unusual in tropical Africa: about thirty published cases, of varied origin. This low incidence of ankylosing spondylitis is correlated to the rarity of the HLA B27 group and of seronegative spondylitic joint diseases in general amongst the black population of Africa. Whereas the high incidence of forms with juvenile onset in North Africa suggests some connection with undetected Reiter's disease, the infrequency of this form of onset of the disease in sub-Saharan Africa and the lack of bacteriologic evidence make it impossible to reach any such conclusions.

[Gallbladder pathology in the Ivory Coast. Contribution of ultrasonics]. / Etude de la pathologie vésiculaire en Côte-d'Ivoire. Apport de l'échographie.

Ultrasound imaging was first used in the two hospital and university centers of Abidjan in 1983, and findings since then have demonstrated the previously unrecognized frequency and variability of gallbladder affections. Particular conditions of functioning of an ultrasonography department in tropical surroundings are analyzed and ultrasound features of bile stones, cholecystitis and gallbladder cancer described.

[Incidence of biliary lithiasis in African urban areas (Abidjan): a little known pathology?]. / Incidence de la lithiase biliaire en milieu urbain africain (Abidjan): une pathologie méconnue?

The rarity of cholelithiasis in black Africa is a very classical concept that must be called in question again. With the exception of pigmentary lithiasis frequently found in patients with an homozygous haemoglobinopathy, genetic as well as environmental (particularly food related) factors explain in part the low frequency of cholelithiasis with cholesterol gallstones in Africa. Yet the true incidence of cholelithiasis is too often unappreciated. Before the use of ultrasonography, only symptomatic cholelithiasis were detected, usually by the surgeon (19 cases admitted during a 6 years period in the Internal Medicine Department at Treichville University Hospital, Abidjan). The practice of ultrasonography will ease the detection of asymptomatic cholelithiasis. Since ultrasonography has been set up at Treichville University Hospital, 30 cholelithiasis of which 21 were asymptomatic have been detected during an 8 months period, a high detection level of course for a so-called rare disease.