[Siliconosis with rheumatoid polyarthritis following a breast implant rupture: Case report and literature review]. / Siliconose avec polyarthrite rhumatoïde dans les suites d'une rupture d'implant mammaire : cas clinique et revue de la littérature.

Breast implant rupture is a common complication in plastic surgery, with various clinical presentations, due to silicone migration. In this article, we present the case of a patient with ruptured silicone implants, who developed siliconosis with rheumatoid polyarthritis, and evolved favourably after explantation surgery. The physiopathology of this disease, and the implication of silicone migration are still controversial, and yet to be confirmed.

[Therapeutic escalation in a case of nevoid hyperkeratosis of the areola and the nipple]. / Escalade thérapeutique devant un cas d'hyperkératose nævoïde de l'aréole et du mamelon.

Nevoid hyperkeratosis of the nipple areola complex (NAC) is a rare dermatological pathology of unknown etiology, first described in 1923. It is a benign condition characterized by verrucous thickening and brownish discoloration of the NAC. We described the case of a 26-year-old woman with bilateral nevoid hyperkeratosis of the NAC. Several lines of treatment have been used with varying efficacy: conservative (calcipotriol and local retinoids), semi-conservative (CO2 laser) and surgical (excision and total skin graft). The final result is very satisfactory and without recurrence at 1 year follow-up.

[Satisfaction after risk reducing mastectomy related to breast reconstruction surgery in patient with hereditary genetic mutation]. / Satisfaction après mastectomie de réduction de risque associée à une reconstruction chez les patientes porteuses d'une mutation génétique.

OBJECTIVES: Patients with very high risk of cancer mutation may decide to undergo prophylactic surgery in order to avoid heavy clinical and radiological monitoring. This is a promising and nonetheless risky surgery because it is a complicated procedure and highly mutilating. Our goal was to improve the practice of this prophylactic surgery, to do so we assessed a postoperative satisfaction survey to cancer-free patients who have undergone this procedure. MATERIAL: Single-center, cross-sectional descriptive study. Assessment of the primary efficacy endpoint using the BREAST-Q questionnaire. These results were compared to a control group representative of our sample of patients, those data came from the scientific literature using a single-sample Student's test. Several multivariate analyzes were also carried out in order to study the influence of certain factors on the patient's satisfaction. RESULTS: The averages obtained in the various questionnaires were 56.06/100 for "Satisfaction with breasts"; 66.94/100 for "Psychosocial well-being"; 50/100 for "Sexual well-being" and 59.22/100 for "Satisfaction with information". Postoperative satisfaction in our sample is comparable to the group control concerning the questionnaire "Satisfaction with breasts" (P=0.37) and "Psychosocial well-being" (P=0.18). Concerning the questionnaire "Sexual well-being" there is a significant statistical difference between our group and the control group (P=0.01). CONCLUSION: The post-operative satisfaction of our operated patients seems to be proportionally similar to the general population who have not undergone breast surgery except on the question of the quality of sexual life. The various analyzes of our study also allowed us to highlight the importance of preoperative information for postoperative well-being.

Clinical features associated with the invasive component in lentigo maligna of the head and neck: A retrospective study of 175 cases.

BACKGROUND: Lentigo maligna (LM) can develop into lentigo maligna melanoma (LMM) with risk of metastatic dissemination. LMM may be underestimated on the basis of the initial biopsy. The invasion may affect both the therapeutic options and the prognosis. OBJECTIVES: To identify the clinical features associated with invasive forms of LM and factors associated with its recurrence. METHODS: A retrospective, single-centre study of consecutive LM and LMM histologically confirmed and treated by surgery between 2009 and 2014. RESULTS: In total, 175 patients with LM/LMM were surgically treated in our establishment. In men, lesions were more likely to be in the "peripheral zone" (41.8%), while in women they were seen more often in the "central zone" (P=0.001). In multivariate analysis, only the peripheral zone was found to be associated with a risk of invasion (P=0.008). The rate of recurrence was 9% and lesions were more likely to be primary LMM (P=0.0006) excised with clear margins. CONCLUSION: The treatment of choice in LM with non-clear margins must be re-excision, especially for lesions situated in the peripheral zone. Close follow-up is recommended due to risk of recurrence, even in the case of clear margins.

Accuracy of mammography, sonography and magnetic resonance imaging for detecting silicone breast implant ruptures: A retrospective observational study of 367 cases.

INTRODUCTION: The purpose of this study was to assess the efficacy of magnetic resonance imaging, ultrasound and mammography in detecting breast implant rupture. METHODS: This retrospective study included all cases of breast implant revision. Implant integrity was determined preoperatively by magnetic resonance imaging, ultrasound and mammography. The primary study endpoint was the surgical finding. The sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio of the tests were evaluated. RESULTS: Two hundred and thirty-four (234) patients were included; 213 mammographies, 295 ultrasounds and 160 magnetic resonance imagings were carried out. While 114 clinical ruptures were confirmed, 253 implants remained intact. Magnetic resonance imaging was the most sensitive (99%); outperforming mammography (sensitivity: 70%). Mammography was the most accurate in diagnosis of intact implant (specificity: 93%), and magnetic resonance imaging was second (specificity: 78%). Ultrasound was rated intermediately. Positive mammography signifies a rupture in 84% of cases, whereas magnetic resonance imaging (positive predictive value: 78%) can be mistaken in 20% of cases. Negative ultrasound and magnetic resonance imaging rule out a rupture (negative predictive value of 93% and 99% respectively). Mammography and ultrasound are more accurate than magnetic resonance imaging in diagnosing implant rupture (positive likelihood ratios of 9.78, 8.24 and 4.44 respectively). Magnetic resonance imaging provides convincing affirmation of implant integrity (negative likelihood ratio: 0.02). CONCLUSION: Ultrasound seems to be the most reliable imaging method for patients younger than 50 years. In cases where doubt exists, mammography ensures supplementary assessment. In patients over 50 years of age, mammography and ultrasound should be carried out immediately. If necessary, magnetic resonance imaging rules out a hypothesized rupture.

[Unfavorable results of reduction mammoplasty: Causes, preventions and treatments]. / Résultats défavorables des plasties mammaires de réduction. Causes, préventions et traitements.

Reduction mammoplasty is known to be a highly satisfactory surgery but complications and unfavorable results can occur. The objective was to describe the main unfavorable results, to specify their causes, preventions and treatments. We have analyzed articles from the last ten years regarding reduction mammoplasty complications as well as their main unfavorable results. The most common complications were wound dehiscence, hypertrophic scars, infections, fat necrosis, hematomas, and partial or total nipple-areolar complex necrosis. The most frequently reported unfavorable results were unaesthetic and retracted scars, asymmetry in breast size, abnormalities in shape, and malposition of the nipple-areolar complex. For each type of unfavorable outcomes, the possible causes, preventions and treatments were detailed.

[Reduction mammaplasties on irradiated breasts: A litterature review]. / Réductions mammaires sur seins irradiés : revue de la littérature.

INTRODUCTION: Breast reduction is a very common intervention in plastic surgery. Its benefit on the quality of life of patients is certain. With the increasing number of conservative surgeries for breast cancer, the potential number of breast reduction on the irradiated breast has increased. The antecedent of irradiation is an absolute contraindication for the majority of breast reduction teams. The objective of this review of the literature is to evaluate the characteristics of the patients, the modalities, the complications and the overall satisfaction of the patients operated on breast reductions on irradiated ground. METHOD: A review of the literature according to the recommendations was carried out. A total of 207 articles were found with the appropriate keywords (Mammoplasty Reduction, Reduction Mammaplasty, Breast reduction crossed with the terms radiotherapy, irradiation). After selection, 11 articles were selected and analyzed. RESULTS: 126 patients were included. The average age was 50 years, the average BMI was 29kg/m2. The majority of patients were non-smokers and non-diabetics. The average resection weight was 507 grams. The average follow-up was 24.6 months. The delay between radiotherapy and surgery was 48 months. Five different surgical techniques were used. A complication rate of 50% is found. Overall satisfaction is good. CONCLUSION: This is the first review of the literature on breast reduction series on irradiated breasts. The results are inspiring and critical. Appropriate selection of patients seems essential. The publication of larger series and the description of a standardized technique would be interesting.

Multicenter evaluation of quality of life and patient satisfaction after breast reconstruction, a long-term retrospective study.

INTRODUCTION: Breast reconstruction techniques are multiple and they should be chosen in order to improve women's satisfaction and well-being, thus obtaining a personalized treatment. This report's major purpose was to study, through the Breast-Q questionnaire, how the functional and aesthetic outcomes, as well as the complications, of the main autologous breast reconstruction techniques, can affect patients quality of life and well-being at long-term. The secondary purpose was to analyse, thus to identify, the independent factors characterizing the different reconstructive techniques, which may affect patients' satisfaction. METHODS: Women who underwent autologous breast reconstruction through deep inferior epigastric artery perforator or Latissimus dorsi muscle flap from May 2006 to May 2013 were included. The assessment was based on the Breast-Q reconstruction questionnaire. All times of post-mastectomy reconstruction were concerned: immediate, delayed, after previous procedure failure or conversion to another reconstructive technique due to the patient's dissatisfaction. RESULTS: A total of 98 patients were included. Concerning patients satisfaction, the breast-Q score is highest in patients who underwent immediate breast reconstruction, while scores after delayed breast reconstruction, previous surgery failure or conversion to another technique are generally equivalent. Higher scores have been observed in patients who underwent reconstruction through autologous Latissimus dorsi compared to Latissimus dorsi with prosthetic implant reconstruction. CONCLUSION: The authors identified factors of higher patients' satisfaction, like absence of major complication and advanced patient's age, in order to personalize the surgical planning according to the patient's priorities.

Percutaneous cryoablation of symptomatic venous malformations as a second-line therapeutic option: a five-year single institution experience.

PURPOSE: To report the mid-term outcomes of percutaneous cryoablation (PCA) performed as second-line therapeutic option of venous malformations (VM). MATERIAL AND METHODS: From 2011 to 2015, PCA was offered in 24 patients (mean age: 31 years, range: 12-64) as second-line treatment for recurrence of symptoms after sclerotherapy and when resection was not possible (due to lesion location or previous failure) or refused by the patient. Adverse effects were recorded, disease-free survival (DFS) and local tissue control (LTC) rates were calculated based on symptoms and volume evolution. RESULTS: Mean follow-up was 18.7 months (6-48). Nine (37.5%, 9/24) adverse effects occurred and three (12.5%, 3/24) were severe. Mean pain assessed by visual analog scale (VAS) was 41.7 mm (0-80) before treatment and 20.3 mm (0-80) (p=0.01) after. Mean volume decreased significantly after treatment from 22.4 cm3 (0.9-146) to 8.35 cm3 (0-81.3) (p<0.001). Pain recurred in nine patients and size of one lesion increased. The DFS and LTC rates were 54% [95%CI: 22.94-77.27] and 93.33% [61.26-99.03] at 24 months, respectively. Only VM volume >10 cm3 was associated with a higher risk of local recurrence (p=0.05). CONCLUSION: PCA as second-line treatment appears to be safe and effective for local control of VM according to mid-term results. KEY POINTS: • Percutaneous cryoablation of venous malformations appeared well tolerated. • Size of venous malformations decreased significantly after percutaneous cryoablation (p<0.001). • Pain decreased significantly after percutaneous cryoablation of venous malformations (p=0.01).

Percutaneous Image-Guided Cryoablation as Second-Line Therapy of Soft-Tissue Venous Vascular Malformations of Extremities: A Prospective Study of Safety and 6-Month Efficacy.

PURPOSE: To report the safety and short-term efficacy of percutaneous image-guided cryoablation performed as second-line therapy of venous vascular malformations (VVM) of extremities. MATERIALS AND METHODS: In this non-blinded, no-randomized trial, cryoablation was proposed in 14 patients presenting with symptomatic VVM for recurrences after treatment. Eligibility criteria were: cryoablation feasible, localization at least 5 mm from skin and nerves, absence of contra-indication for anesthesia. Safety was evaluated by the common terminology criteria for adverse events (AE). Clinical response was assessed by evaluating pain at day 7, month 2 and 6 using visual analog scale; quality of life before cryoablation and at 2 and 6 months after using questionnaire. Evolution of volume was evaluated by MRI at 6 months. Comparison was performed using the Wilcoxon test. RESULTS: A technical success was observed in all cases. While 11 patients (78.6%) presented AE (13 grade 1-2 and 3 grade 3), only two severe AE (grade 3) related to cryoablation occurred in two patients (14.3%) during the 6-month follow-up: one immediate sciatic paralysis and one delayed paresthesia. A clinical response was observed in 12 patients (85.7%) at 6 months. Pain decreased significantly from 42.5 ± 14.2 mm before the intervention to 11.8 ± 17.9 mm at 6 months (P = 0.002). A significant decrease in the mean volume from 12.8 ± 14.3 to 3 ± 2.7 cm3 was observed at 6 months (P = 0.002). CONCLUSION: Percutaneous cryoablation is a promising alternative treatment for sclerotherapy-resistant venous malformations. However, to improve safety, careful patient selection and treatment planning will be mandatory.

[Reconstruction of an abdominal wall defect with a superior epigastric perforator propeller flap: case report]. / Reconstruction de la paroi abdominale par un lambeau propeller issu de l'artère épigastrique supérieure: cas clinique.

Perforators flaps take a special place in reconstructive surgery. These flaps can be dissected and turned as a propeller blade on its pedicule axis. We report the case of a 54-year-old man presenting a recurrence of a dermatofibrosarcoma in the right hypochondrium. Tumor resection caused a large abdominal wall defect taking the anterior aponeurosis of the rectus abdominis. An angioscanner was realized in preoperative to locate the perforators of the deep superior epigastric artery. We realized a propeller flap based on a perforator of the left superior epigastric artery who allowed to cover the wall defect. We set up a patch of Vicryl® to reconstruct the aponeurosis plan at the same operative time. We didn't note any necrosis and complete healing occurred in 2 weeks. The margins were healthy. The cosmetic result and the low morbidity make this flap a good therapeutic option. This flap seems reliable, arteries perforators are constant with good diameter.

[Complications of breast reduction about 715 breasts]. / Complications des réductions mammaires à propos de 715 seins.

BACKGROUND: Breast reduction is one of the most frequent operations in elective plastic surgery. The main objective of this study was to describe complications due to breast reduction, and to determine the risk factors. METHODS: Our comparative retrospective study reviewed the medical files of 715 operated breasts between 2004 and 2009. Statistical analyses were performed with bivariate analyses and multivariable analysis. RESULTS: Smoking, resected mammary gland mass and stretch marks were the three risk factors associated with complications after breast reduction. Smoking was also associated with a high risk of hypertrophics carring. Body-mass index was not associated with a risk of general complications but with a risk of wound dehiscence. The superior pedicle and free nipple graft surgical techniques presented a higher complication rate than the postero-superior and postero-inferior pedicle techniques. CONCLUSIONS: These results incite us to postpone and even contraindicate breast reduction surgery in obese and smoking patients. These results also incite us to prefer surgical techniques with optimum security in terms of vascular supply. Complications of breast reduction about 715 breasts.

[Management of patients with squamous cell carcinoma of the skin]. / Prise en charge chirurgicale des carcinomes spinocellulaires.

Recurrence, metastasis and mortality due to squamous cell carcinoma are all most often linked to late or inappropriate management and/or aggressive histological types. In consequence, clear guidelines for management are necessary. The aim of this article is to detail clinical management of squamous cell carcinomas based on the official guidelines.

[Inferior gluteal artery perforator flap: anatomical study for its application in breast reconstruction]. / Lambeau perforant glutéal inférieur : étude anatomique en vue de son application en reconstruction mammaire.

PURPOSE: The inferior gluteal artery perforator flap, which is vascularised by perforator branches of the inferior gluteal artery (formerly ischiatic artery) is harvested in the gluteal crease. The purpose of this anatomical study was to clarify the anatomical features of this flap and locate the perforators of the inferior gluteal artery destined to the flap, in view to facilitate its surgical removal, as free flap for breast reconstruction. MATERIALS AND METHOD: We performed 12 dissections on fresh cadavers, after selective injection of the inferior gluteal artery with a gelified solution. During harvesting, we located the perforators which arise from the inferior gluteal artery and perfuse the flap. RESULTS: We distinguished four zones, defined relatively to anatomical landmarks of the region, according to the frequency of perforators. CONCLUSION: This anatomical study makes possible an improvement of the technique to raise this flap in its free shape with view to use it for breast autologus reconstruction especially given its numerous advantages: a constant volume of fat even in thin patients and minimal donor site morbidity.

Reliability of a classification of fractures of the hand based on the AO comprehensive classification system.

The AO/ASIF Comprehensive Classification of Fractures is a logical system to describe and compare long-bone fractures. We adapted this classification to the hand to classify fractures of the metacarpals and phalanges. The alphanumeric sequence codes the bone involved, the bone segment, and the fracture type. To assess the reliability of this classification, one hundred radiographs of hand fractures were classified by nine observers in four sessions. Using Cohen's kappa coefficient, overall inter-observer agreement was 0.93 for bone identification, 0.80 for bone segment, and 0.44 for fracture type. Corresponding intra-observer agreement was 0.94, 0.92 and 0.62 respectively.

Anatomical study of the palmar intermetacarpal perforator flap.

The authors present an anatomical study of a small flap that may be harvested from any of the palmar intermetacarpal spaces while performing fasciectomy in Dupuytren's contracture. The flap is diamond-shaped, vascularised by two perforating branches originating from the underlying true digital arteries and may be rotated through 90 degrees to 180 degrees in either direction to provide skin cover and subcutaneous padding over the distal palm and/or the base of the finger.

[From plastic surgery to space conquest. First microsurgical procedure and first surgical procedure in man during weightlessness]. / De la chirurgie plastique à la conquête spatiale. Première microchirurgie et première opération chez l'homme faites en apesanteur.

The authors present their experience of surgery in weightlessness conditions. Russians and Americans already focused on that subject but two questions were still unsolved: what was the limit of human skill in these extreme conditions and was it possible to operate a human under total safety? Between 2003 and 2007, using a 0G plane for our experiment, we focused on two goals: firstly, the conception of a microsurgical module to test complex microsurgical procedures in rats and secondly, the construction of a surgical workstation with specific air filtration device and define surgical and anaesthetic protocols to carry on a surgery in man. In September 2003, we succeeded to perform the microscopic report of a 0,5mm artery (which is the smallest we can suture in terrestrial conditions) by using seven stitches of 10 x 0 monofilament suture. The 27th of September 2007, we removed a lipoma from the forearm of a 47-year-old man. These experiments take place in a wide program of development of telesurgery controlled through satellite transmission with all forthcoming civil, military and humanitarian applications.

Autologous fat injection in Poland's syndrome.

Poland's syndrome is a deformity of the breast and sometimes of the chest wall. Several techniques, which may be combined if necessary, are generally used to treat the forms involving both the breast and chest wall (breast implants, customised chest wall implants, latissimus dorsi pedicled flap). For some years, we have also grafted autologous fat cells according to Coleman's method to treat this rare disorder. We report the preliminary results of this technique and demonstrate its value in the treatment of Poland's syndrome. We studied patients treated for Poland's syndrome by autologous fat injection between 1 January 2003 and 31 December 2005. We recorded their age, gender, the other surgical techniques used, and grade of Poland's syndrome according to the classification of Foucras. Concerning fat injections, we recorded the number of sessions, volumes injected and complications. The series was composed of seven women and one man, mean age 25 years (range 13 to 40 years). Four patients were grade I, three were grade II and one grade III. The mean number of fat injection sessions was 2.1 (range 1-5) and mean volume injected 96 cc (range 25-200 cc). Lipofilling was used alone in one case and associated with other reconstruction techniques in seven. We had one complication, fat necrosis which progressed favourably after surgical drainage. Autologous fat injection appears to us to be a treatment which can be used alone, or more often associated with traditional reconstruction techniques in all grades of Poland's syndrome. This technique is useful to add volume and especially to correct the contour defects of this syndrome such as the subclavicular hollow and absence of anterior axillary fold.

The pedicled vascularised scapular bone flap for proximal humerus reconstruction and short humeral stump lengthening.

The vascularised scapular bone free flap is popular in mandible reconstruction, but it is less commonly used as a pedicled flap to reconstruct the upper humerus. We analysed our experience with pedicled scapular crest flaps in humerus reconstruction and compared our results with cases reported in the literature. We considered the age at surgery, the time elapsed before reconstruction, the time required to obtain solid bony union, the operative indication, the osteosynthesis procedure used and whether circumflex scapular vessels or angular vessels were used. There were eight patients (seven men and one woman, mean age=33): four humerus stump lengthenings, two upper-third humerus bone and soft tissue defects and two multioperated established humerus non-unions. Flaps were pedicled either on circumflex scapular vessels (three) or angular vessels (five). The mean size of the scapular bone used was 9.4 cm (range 7-11 cm). We associated a covering flap for seven patients. All the flaps survived and bone healed in a 3.75 month mean delay (range three to six months), and there was one accidental secondary fracture one year after reconstruction. For a vascularised reconstruction of the upper humerus, the pedicled scapular bone flap is a valuable option especially if a composite reconstruction is needed. For short humerus stump lengthening, this flap seems to provide a very satisfactory solution.

Reliability of the pulp nail bone (PNB) classification for fingertip injuries.

Evans and Bernardis proposed the 'PNB classification', by which a fingertip injury is classified according to each structure: pulp P, nail N, bone B. The objective of this study was to assess the inter-observer reliability, repeatability and accuracy of PNB. One hundred patients presenting with a fingertip injury were included prospectively, photographed, then classified in randomly chosen orders by nine independent observers. A third were drawn randomly and classified a second time to measure repeatability. A reference classification was also provided by one of the authors of the PNB system. Classifications agreed with the reference in 59% of injuries for P, 55% for N and 54% for B. The Kappa values for inter-observer agreement were 0.520 for P, 0.512 for N, and 0.504 for B; for intra-observer agreement, they were 0.616 for P, 0.658 for N, and 0.577 for B. Although levels of agreement are comparable with results found for other classifications, they are insufficient for use of the PNB classification without improvement.