[Labial recurrent swelling revealing median congenital upper-lip fistula]. / Tuméfaction labiale récidivante révélatrice d'une fistule congénitale médiane de la lèvre supérieure.

Midline upper-lip fistulas are an extremely rare variant of congenital facial malformations. Less than 30 cases have been reported in the literature since 1970. We report the case of a 2 and a half-year-old girl presenting with a median congenital blind fistula of the upper lip, without any relation with the oral cavity. A recurrent swelling of the upper lip was the main symptom. Complete surgical excision of the cyst or of the fistulous tract must be obtained to avoid recurrence.

[Buccal mucosal graft for the treatment of urethral stricture]. / Greffe de muqueuse jugale pour le traitement d'une sténose urétrale.

INTRODUCTION: The indication of the buccal mucosal graft for urethroplasty has evolved over recent years. The ease of its harvesting, availability, and immunohistological properties, as well as its satisfactory results, has made the buccal mucosal graft the current procedure of choice. We report a case of use of a buccal mucosal graft to treat an urethral stricture correction. CASE REPORT: A 48-year-old man underwent a buccal mucosal graft for post-infectious urethral stricture correction. An inner right cheek graft of 50 × 30 mm was harvested and inserted into place after complete excision of the stricture. Postoperative evolution was satisfactory with no pain at the 5th day, resumption of normal diet at the 12th day, a significant improvement of peak flow rate at the 21st day. Follow-up examination at the 7th week revealed a mouth opening to 40 mm with complete healing. DISCUSSION: Buccal mucosal graft has currently the highest success rate compared to other surgical techniques as full thickness skin graft from hair or graft of bladder mucosa. Its harvesting can be single or multiple, however care must be taken as regards Stenon's duct and to the labial commissure. The complications of the donor site are infrequent and can be characterized by numbness and limited mouth opening. Tissues that contain immunohistological properties, which are similar to those of the urothelium, buccal mucosal graft, have become the gold standard for this type of correction.

["Classical" abdominoplasty]. / Les plasties abdominales dites "classiques".

The term "classical" abdominoplasty includes those procedures designed and performed before the introduction of liposuction techniques. All of these operations leave a considerable scar: the importance of this residual scar makes abdominoplasty the poor cousin of cosmetic plastic surgery. In practice, it should be generally considered to be a functional comfort surgery, which sometimes resembles cosmetic surgery. All wall lesions must be treated during abdominoplasty: retightening of the musculo-aponeurotic plane when it is distended, correction, of more or less localized fat overload, resection of any excess skin. The desire to obtain scars as small and as hidden as possible has led to the development of a large number of techniques, performed with varying frequencies. However, there has been a renewed interest in some of these techniques since the development of liposuction. The abdominoplasty skin procedures can be divided into two groups: localized abdominoplasties, only concerning a limited part of the abdomen, and extensive abdominoplasties, concern all of the abdominal wall and requiring extensive skin detachment and a procedure on the umbilicus. The most classical method of abdominoplasty is low transverse abdominoplasty with umbilical transposition. This operation raises a number of aesthetic problems and one or several defects are fairly frequently observed during objective analysis of our results. It nevertheless provides a real personal gain for the patient, in the way he or she moves and dresses and can even allow weight loss after the operation. This gain is not related to the results observed on photographs. The introduction of liposuction techniques has radically modified the technical modalities and indications for these so-called "classical" operations.

[Complications of plastic surgery of the abdomen]. / Les complications de la chirurgie plastique de l'abdomen.

Plastic surgery of the abdomen remains difficult and is therefore associated with a number of complications of varying severity, but whose global incidence appears to justify a separate chapter. The most serious complications of abdominoplasty are thromboembolic complications, which may be life-threatening. The incidence of these complications must be minimized by rigorous preventive measures. Prevention is based on early mobilization of the patient, perioperative treatment with low molecular weight heparin and wearing of anti-thrombosis stockings. Skin necrosis is generally associated with one or several aetiological factors: excessive tension at the end of the operation, development of a haematoma, excessive or too superficial detachment. The so-called "Morel-Lavallée" fluid collection is best prevented by well performed postoperative compression applied continuously for three weeks after the operation. Complications of isolated abdominal liposuction are exceptional, or at least they should be, when the indication and technique are rigorously respected. The combination of liposuction and abdominoplasty does not add any complication not already described in the case of abdominoplasties and does not increase the incidence of these complications. Liposuction appears to decrease the number of abdominoplasties, but also their extent, which is beneficial in terms of the quality and safety of the postoperative course. A better definition of indications and improvement of techniques have therefore markedly decreased the severity and incidence of complications of plastic surgery of the abdomen. Truly effective preventive measures are available for each of these complications.

[A study of the influence of sutures and tension on skin cicatrization in loss of substance in 18 minipigs]. / Etude de la cicatrisation cutanée rapportée à la tension et au type de suture de pertes de substances chez dix-huit miniporcs.

This study concerned the evaluation of wound healing after extensive skin resections in 18 minipigs, sutured with: continuous intradermal Polyglactin 910 suture or Polyamide, an interrupted intradermal sutures using the same resorbable suture material. Three equivalent groups were studied: 0, 3 and 6 cm skin resections were studied after using a dynamometer to record the tension necessary to join the wound margins. Results were evaluated 1 month later by light and electron microscopy, and were statistically correlated by Pearson's test. The wound tension was correlated with skin resection (r = 0.97, p < 10-4). The scar width was exponentially correlated with tension (r = 0.70, p < 10-3); the fibrous and cellular appearances increased with the skin resection. The absence of any significant statistical results prevents any conclusion concerning the superiority of one suture material or suture technique, but the group with no resection led to homogenous results, regardless of the suture technique, or suture material used. 3 and 6 cm resection the groups led to unpredictable and various results. Granulous reactions were observed in 7 out of 12 cases with resorbable suture, and only 1 of the 8 cases with non resorbable suture, but these results are not significant.

[Prospective study of the specific liability of the plastic surgeon]. / Etude prospective sur la responsabilité spécifique du chirurgien plasticien.

The authors of the article first pose this question: might plastic surgery not fit into the general principles that guide any medical procedure? The general principles, especially as regards the distinction between liabilities in terms of means and liabilities in terms of results, are discussed in the first part of the survey. The authors then demonstrate that the plastic surgeon does differ from other surgeons: he has to comply with the same restraints as any surgeon. However, the survey then presents certain aspects specific to this branch of surgery, and their implications in terms of responsibilities. The article successively discusses: the patient's freedom of choice, the need for particularly thorough information and its form, the limits to the practitioner's freedom in choosing the technique, and most importantly the so-called obligation to avoid (which the authors study in particular detail in the field of analysis and responsibilities) of obviously useless operations. The authors, after recalling important recent legal precedents, come to the conclusion that it is necessary to establish an institution: "the medical ombundsman" defined by a bill in the 1988 sitting of the French Parliament.

[The role of an immunologic survey prior to using collagen implants. Theoretical aspects and practical methods]. / Place de l'enquête immunologique avant l'utilisation d'implants de collagène. Aspects théoriques et modalités pratiques.

Collagen implants (Zyderm and Zyplast) are effective and well tolerated. However, certain inflammatory reactions may occur. The immunological mechanisms responsible for such reactions are analysed: cell-mediated reactions, humoral reactions (specific antibodies) and the role--certainly major--of the genetic predisposition which modulates the expression of these reactions. The practical consequences are logically derived from the histological and serological findings observed, i.e. strict respect of the systemic contraindications (auto-immune diseases, severe atopy); rigorous conduct of a preoperative skin test to detect the great majority of reactive subjects; lastly, consideration, in the evaluation of the potential risk, of individual dysimmune susceptibility (family history, personal clinical or laboratory elements) in a very small proportion of patients.

The use of a porous hydroxylapatite implant in periodontal defects. II. Treatment of Class II furcation lesions in lower molars.

Twenty-three human subjects with two Class II furcation involvements in lower molars were treated with initial therapy following which presurgical measurements of pocket depth, gingival recession and attachment level were made. Periodontal flaps were used to expose the furcation defects, and one defect was implanted with porous hydroxylapatite while the other served as an unimplanted control. At the time of surgery, bone defects were measured obliquely and horizontally using a specially designed device to ensure reproducible probe angulation. Six months later the presurgical measurements were repeated, and reentry surgical procedures were carried out to measure the changes in the bone defects. Areas implanted with porous hydroxylapatite showed a statistically significant reduction in pocket depth and a statistically significant improvement in attachment level and fill of bone defects when compared with control defects. There was statistically less gingival recession in the implanted areas compared with the control sites. Control sites at six months showed no significant change in pocket depth, an increased loss of attachment and worsening of the bone defects.