[Systematic investigation of surgical site infections (SSI) in plastic reconstructive and aesthetic surgery (ERCS): Feedback]. / Investigation systématique des infections de site opératoire (ISO) en chirurgie plastique reconstructrice et esthétique (CPRE) : retour d'expérience.

Surgical site infection (SSI) in plastic, reconstructive and aesthetic surgery (ERCP) is quite uncommon compared to other surgical specialities but remains one of the main complications. The aim of our study was to provide feedback on the systematic investigation of SSI in ERCP. This is a monocentric retrospective study, including all paediatric and adult patients who have undergone ERCP surgery between 01/01/2014 and 31/12/2021. During this period, the department systematically investigated all SSI cases. Eight thousand eight hundred and seventy-eight surgical procedures were performed. The SSI rate was 0.34%. Thirty SSIs (19W,11M), with a mean age of 56 years (none paediatric), were investigated. Twenty-seven patients suffered from comorbidities. The surgical indications included 17 cases of skin cancer, 7 cases of weight loss, 4 cases of breast reconstruction, 1 lipoma, 1 pectus excavatum. Eleven surgeries consisted in lymphnode procedures (8 sentinel lymphnodes, 3 curage). The average operating time was 116minutes. Nineteen patients received antibiotic prophylaxis. The average time to onset of SSI after surgery was 10 days. The most prevalent bacteria were commensals of the skin flora and the digestive tract. Apart from surgical management, 100% of patients were treated with antibiotics. High age, multiple comorbidities, long, combined procedures, placement of equipment, lymph node surgery, post-operative punctures on implanted equipment, are all risks factors for SSI. The implementation of a systematic monitoring of SSI within our department has provided us with the opportunity to analyse our data in real time and allow us to adjust our practices if necessary. This process can be used in other plastic reconstructive and aesthetic surgery departments. The collection and analysis of SSIs is both easily done and the procedure is well standardized. The assistance of the operational hygiene team is a key asset for the success of this project. The development of this type of procedure on a national level could be an asset to improve the management of SSI by taking advantage of the experience of a larger number of centres.

[Osteosynthesis of subcondylar fractures using a rectangular 3-dimensional stabilization plate]. / Ostéosynthèse des fractures sous-condyliennes par une plaque rectangulaire de stabilisation tridimensionnelle.

The current international opinion for the treatment of displaced subcondylar fractures has become more aggressive after the rediscovery of the submandibular incision and the creation of new fixation material. We report 19 patients with displaced subcondylar fractures who were treated with reinforced rectangular plates. The pure titanium plates are slightly concave and measure 13 by 9 mm. We evaluated dental articulation, mouth opening, propulsion and duction and observed rapid recovery of mandibular kinetics and mandibular function. Use of this plate is a major progress in the treatment of fractures of the condyle.

[Loss of substance of the lateral region of the face]. / Pertes de substance de la région latérale de la face.

The lateral region of the face is often exposed to trauma and may also be the site of tumor localization. Exeresis may lead to major tissue loss. We report several surgical techniques, from the most simple to more complicated, available for facial repair. Neighboring regions in the frontal or temporal area are used but a submental flap may also be useful.

[Does the choice of mammoplasty pedicle influence the shape of reduced the reduced-sized breast?]. / Le choix du pédicule de mammoplastie influence-t-il la forme du sein réduit?

Thirty seven patients with breast hypertrophy were restrospectively reviewed with a mean follow-up of 2 years. Reduction mammoplasty was performed with 3 different pedicles (superior, inferior and both) involving a glandular resection of a least 500 g on each side in all cases. The results were evaluated according to both objective and subjective criteria. The choice of pedicle had a considerable influence on the results. The vertical limb usually increased with time (months), although its intraoperative length was 5 cm. The increasing length of the vertical limb varies according to the type of pedicle chosen. The mean length increase was 1.52 cm; 4.18 cm; 4.15 cm for superior, inferior, and both pedicles respectively. The different increase was statistically significant (p < 0.001) when the technic involving a superior pedicle was compared to a technic involving an inferior pedicle. No statistically significant difference was observed between technics using the inferior and both pedicles. A superior pedicle technic entails the lowest increase of the vertical limb length which in turns leads to better long-term cosmetic results.

[The value of 3-dimensional computed tomography in the preoperative evaluation of mandibular condyle fractures]. / Intérêt de la tomodensitométrie tridimensionnelle dans le bilan pré-opératoire des fractures du condyle mandibulaire.

The recent expansion of surgical treatment for displaced condylar neck fractures should rely on a precise and careful preoperative radiological assessment. Two goals must be achieved. First the diagnosis must be confirmed by usually sufficient conventional imaging. Secondly, all the features of the fracture have to be analysed to come to the surgical decision and to choose the best osteosynthesis technique. Compared to traditional imaging, three dimensional computed tomography offers the possibility of a direct viewing. The extend of the fracture, the aspect and degree of displacement of the condylar fragment in relation to the ramus or the fossa are easily assessed. The examination and the integration of multiple axial or coronal bidimensional CT scan sections are no more necessary. The clearer perception of both the spacial relationships and delineation of these condylar fractures results in a better choice for surgical planning.

[A simple procedure for the passive suspension of the paralyzed labial commissure]. / Procédé simple de suspension passive de la commissure labiale paralytique.

Different techniques can be used to repair paralytic labial commissurae. Ideally, microsurgical procedures or dynamic suspension methods can correct kinetic paralysis but in certain patients (elderly subjects, poor general health, precarious postsurgical rehabilitation) such procedures may represent an excessively aggressive procedure. We therefore used static suspension of the paralytic labial commissurae based on desepidermization of a nasogeneal flap. This simple technique is easy to perform and is our method of choice for static suspension because the flap pulls the paralysed commissurae upward and doubles the tissue cover, helping overcome buccinator incompetence.

Recurrent sclerosing Basal-cell carcinomas requiring ablative cranio facial surgery - a 3-case report.

The authors report on 3 cases of facial recurrent sclerosing basal cell carcinomas requiring large ablative cranio facial surgery and reconstruction involving regional or even free flaps. Special emphasis is made on the aggressive behavior of this specific histological form and on the necessity of an early diagnosis, a radical initial treatment and a close life time follow-up. Surgery with careful histological control of the margins is the treatment of choice whereas radiotherapy is an alternative for small lesions or nonsurgical patients. This early and aggressive therapeutic management is essential in order to avoid recurrences often requiring disfiguring surgery.

[Complex reconstruction of the lower lip. Apropos of various cases]. / Reconstruction complexe de la lèvre inférieure. A propos de quelques cas.

Preservation of buccal cavity relations raises problems when treating extensive defects of lower lip. After a review of anatomical features, several case reports are presented to illustrate the advantages and inconveniences of three interventions for labial reconstruction.

[Isolated sub-orbital plexiform neurofibroma]. / Neurofibrome plexiforme sous-orbitaire isolé.

An unexpected finding on histology in a 73 years old patient was an isolated suborbital plexiform neurofibroma. Since this tumor is specific for von Recklinghausen's disease, the diagnosis was that of a minor form of the disease. The different cephalic manifestations of von Recklinghausen's disease are reviewed.