[Treatment of pseudogynecomastia in massive weight loss patients: Liposuction assisted and made-to-measure desepidermization technique]. / Prise en charge chirurgicale de la pseudogynécomastie après perte de poids massive : technique de désépidermisation sur mesure assistée par lipoaspiration.

BACKGROUND: After massive weight loss (MWL), the chest in men may show significant deformities. The surgical treatment of gynecomastia after MWL remains a difficult and partially misunderstood surgery due to 4 main factors: a complex excess of skin in height and width that sometimes continues in the axilla or dorsal region, a predominantly fatty rather than glandular component, the malposition of the nipple-areola complex (NAC) that is often enlarged and an inframammary fold (IMF) that is often marked. The techniques currently described are either insufficient or lead to frequent and/or significant complications. The authors describe a new approach that dissociates the treatment of the volume and the skin with a customized resection that is simple, reproducible and safe. Our goal is to improve patient satisfaction while reducing complication rates. METHODS: Seventeen patients with adipomastia with excess skin after massive weight loss were operated on using liposuction and skin redraping technique. The authors describe the technique, indications and contraindications of the procedure and analyze the results. RESULTS: The average age of the patients was 39 years. The average body mass index (BMI) before weight loss is 42,7kg/m2, the average weight loss before body correction is 49kg, with an average delta of BMI loss of 15,34kg/m2. The average stay in hospital is 1,3 nights. No patient had major complications (hematoma, hemorrhage, necrosis, thrombophlebitis, immediate surgical revision to treat complications). Minor complications including scar dehiscence, infection, steatonecrosis, and distant scar correction were reported in 2 patients, i.e. 11%. CONCLUSION: Liposuction assisted and desepidermization torsoplasty is a new technique for correction of pseudogynecomastia in MWL patients. The results are reproductible and the complication rates are low. There is no dead space and therefore no drains are needed. There is little pain and a short hospital stay. This technique is simple, quick and easy to learn. However, it is only applicable in adipomastia. A different technique should be used in the presence of firm glandular tissue.

[Profunda artery perforator flap: Reliable secondary option for breast reconstruction?] / Profunda artery perforator flap : quelle place dans la reconstruction mammaire par lambeau autologue ?

BACKGROUND: In recent years, the DIEP-flap has become the standard for autologous breast reconstruction. However, when abdominal donor site is unavailable, secondary options are numerous. This report documents our experience with PAP-flap breast reconstruction. METHOD: We carried out a retrospective study of patients who underwent reconstructive breast surgery by PAP-flaps in our institution since 2014. RESULTS: Seventeen PAP-flaps were carried out in 15 patients, two of which received consecutive reconstruction of each breast at distinct intervals. Indication was lack of abdominal excess in 8 patients and history of abdominoplasty in 6 patients. These six patients and one more had bad or absence of perforator for DIEP flap. There were 2 flap losses (11.8%). Other complications included minor dehiscences from seroma at donor site in 6 cases (35.3%), flap dehiscence in one case (5.8%), and receiver site hematoma in 1 patient (5.8%). DISCUSSION: The authors analyze their series when the high rate of complications and the results obtained compared to the second alternative choices of other teams. CONCLUSION: The author is of the opinion that the PAP-Flap is a reliable option as a second choice for breast reconstruction in patients whose DIEP can not be retained. It is limited in terms of volume and a third choice should be considered when the indication is to reconstruct a breast of large volume.

An ultrasonic time-of-flight system for hand movement measurement.

We have designed and built an ultrasonic time-of-flight system to measure the three-dimensional coordinates of up to three moving emitters. These emitters are fixed on the hand and arm of a human subject or on a hand-held stylus, to provide information concerning motor control. Three stationary receivers are suspended above the experimental space and provide three diagonal distances which are converted to x, y and z coordinates. The sampling rate for one emitter is 200-400 Hz, depending on the nature of the experiment. Multiple emitters are time-multiplexed. The piezoelectric resonator emitter is pulsed with 200 V for 12 microseconds of each cycle and rings at 40 kHz with a Q factor of four. The piezoelectric resonator receiver drives circuitry with a gain of 500 and a bandwidth of 60 kHz. The system provided highly linear results with a repeatability of +/- 1.64 mm and a resolution of 0.7 mm.