[Diagnostic pitfall: Early arising, multiple and recurrent Marjolin's ulcer. About 8 patients (16 tumors) and literature review]. / Piège diagnostique : l'ulcère de Marjolin d'apparition précoce, multiple ou récidivant. À propos d'une série de 8 patients (16 tumeurs) et revue de la littérature.

INTRODUCTION: Marjolin's ulcer (MU) is a large entity representing skin cancers resulting from the transformation of chronic wounds of a heterogeneous nature. Burn scars are the most at risk of degeneration, in particular because there are the sites of important skin tension. Atypical forms are not uncommon. The objective of this study is to present these exceptions which are underestimated. MATERIALS AND METHODS: All patients with UM in our centre between January 2011 and February 2019 have been included permitting to report the initial pathology, the location, the latency time, the histology and the management carried out. RESULTS: Eight patients were treated in our center for MU, they developed 16 skin cancers. Fourteen were squamous cell carcinomas (SCC). The shortest latency period was 2 months. The youngest patient was 22 years old when she was diagnosed with MU. Three patients had at least 2 synchronous SCC. One patient had a recurrence after a split-thickness skin grafting on artificial dermis and 2 patients had second locations. CONCLUSION: Atypic forms are not rare. MU is commonly recurrent, multiple, early arising and may appear in young people. The treatment of chronic wounds cannot be dissociated from the treatment of contractures, otherwise the wound will inevitably reappear.

[Contribution of the scrotal flap for the coverage of ischial and perineal pressure ulcers]. / Apport du lambeau scrotal pour la couverture des escarres ischiatiques et périnéales.

INTRODUCTION: The ischiatric pressure sore is a common pathology in rehabilitated spinal cord injured people, despite careful prevention. Medical treatment by discharge and directed healing is not always sufficient and surgery using local musculocutaneous flaps is often essential. Unfortunately, recidivism is frequent and the availability of local flaps is limited. The scrotal flap is an excellent complement to classic flaps, gluteal flaps or hamstrings. It can be used alone or in addition to another musculocutaneous flap, in first or second intention. MATERIAL AND METHODS: The scrotal flap is a musculocutaneous flap, using the Dartos, the platys muscle of the scrotum. It is richly vascularized, extensible and resistant. Its great plasticity makes it adaptable to any form of loss of substance, with an arc of rotation that can reach the anal margin. It can also be desepidermized and buried to fill a deep defect. Ten cases of scrotal flaps and their different indications are reviewed: some are used in first intention, others in addition to musculocutaneous flaps. RESULTS: The removal of a scrotal flap is fast and extremely easy. The simple closure of the donor site allows the sampling of half of the scrotum due to the great local laxity. The scrotal flaps achieved quickly healed, as well as the donor sites. Only one recurrence was observed after an inappropriate treatment of underlying osteitis. No complications have occurred. CONCLUSION: The scrotal musculocutaneous flap, reliable, resistant, quick and easy to remove is an excellent means of coverage of the perineal region. It can be used for the treatment of any loss of perineal substance in humans, but remains particularly useful for the treatment of ischial or perineal pressure sores.

[Long-term strategy of the initial management of facial burns: About 3 cases]. / Stratégie de prise en charge initiale des brûlures de la face : à propos de 3 cas.

INTRODUCTION: The management of facial burns in their acute stage determines most of the sequelae aspect. An initial treatment of good quality should reduce and even prevent scar ransom and should not compromise potential future corrections. This treatment is based on the respect of facial surgery standards and on the use of some particular technical points. CASE REPORTS: We described our surgical protocol through three case reports. We are performing a surgical excision of the unhealed lesions between the 12th and 15th postburn day. This excision is followed by a dermoepidermal skin graft in the same operative time. This graft must be harvested from the scalp every time it is possible and must be manually perforated. All the aesthetic units junctions are necessarily respected. Flaps can be necessary at this stage. DISCUSSION AND CONCLUSION: The long-term functional and cosmetic results observed in patients with facial burns vary a lot depending on the initial treatment. Patients with severe burns that benefited from an appropriate initial treatment may thus present better results than patients with less severe burns who were badly treated.

[Congenital auricular anomalies: Early non-surgical correction by splinting]. / Anomalies congénitales de l'oreille externe : traitement néonatal par conformation.

OBJECTIVES: Auricular deformities therapy by external molding is possible. It must be undertaken early, ideally before the sixth week of life. Persistency of maternal hormones impregnation during the first six weeks of life permits to maintain the malleable cartilages. They can thus be molded into a new position. After the end of this hormonal therapy, the cartilages gradually become rigid in a specific position. MATERIAL AND METHODS: All infants under 6 weeks of age with isolated auricular deformities between July 2015 and July 2016 received a neonatal treatment with an external molding device called EarWell© or a custom-made one with silicone. The device was removed when the infant was 6 weeks old and had a treatment duration of at least 4 weeks. A 6 months minimum follow-up was carried out to evaluate the result. RESULTS: From July 2015 to July 2016, 42 deformed ears were treated in 38 newborns. The average age to apply the device was 2 weeks of life with a treatment duration of 5 weeks. The immediate outcome was evaluated as excellent by the parents in 81% of cases, with an ear judged as "normal" and as excellent by the surgeon in 75% of cases. There were no major complications. CONCLUSIONS: External molding therapy for infants with ear deformities has proved to be effective in 75 to 81% of cases. It is a non-invasive treatment that avoids subsequent surgical treatment for the majority of patients.

Gain fonctionnel, antalgique et esthétique de la lipostructure dans les séquelles de brûlures.

The use of lipostructure to treat burn sequelae is more and more common today. The regeneration capacities of mesenchymal stem cells appear promising on this sequelae skin, which is poorly vascularized, retractile and often painful. The aim of our study is to establish the analgesic properties, and the functional and aesthetic improvements gained by using lipostructure to treat burn sequelae. Forty-three patients who received lipostructure for burn sequelae according to the Coleman method between 2005 and 2017 were selected. Results regarding aesthetic, analgesic and mobility gain were recorded, with a minimum follow-up of one year postoperatively. Our patients consisted of 32 women and 11 men, with a mean age of 31.7 years (15 to 64 years). The mean follow-up during the study was 49.8 months (2 to 205 months). Patients received an average of 1.3 (1 to 3) sessions of lipostructure with an average of 153 cc (10 to 1040 cc) per session. Sequela sites were the face for 13 patients, the upper limb for 13 patients, the lower limb for 16 patients and the trunk for 4 patients. Twelve patients had lesions on multiple locations. Twenty patients benefited from this surgery for purely aesthetic or functional reasons, and 23 for painful sequelae. A significantly lower EVA was observed after surgery and a functional gain thanks to the restoration of no longer painful amplitudes. An aesthetic gain was also reported in more than three quarters of cases. In two cases, the analgesic effect decreased after one year and required a second lipostructure. The use of lipostructure in burn sequelae has already proved its efficiency with regard to the functional aspect, aesthetics and also analgesia. However, the evaluation of results is based on scales that are still imperfect. Lipostructure is not the only type of surgery used in burn sequelae. Local plasty or skin grafts are also used, but they are more invasive and have no direct analgesic effect. Lipostructure is only possible on mature, soft and non-adherent scars in order not to traumatize adipose cells. Post-burn skin is defined by retractions and adhesions to deep planes, requiring heavy rehabilitation work beforehand. Finally, the effect is not always sustainable and the duration of efficiency remains unknown. Lipostructure has its place in the treatment of hyperalgic and unsightly burn sequelae that are responsible for a functional and social disability in the patient.

[The advantages in using cyanoacrylate glue over skin staples as a method of skin graft fixation in the pediatric burns population]. / Fixation des greffes de peau mince dans les brûlures de l'enfant : étude des avantages de la colle de cyanoacrylate versus agrafes.

INTRODUCTION: Local postoperative care and burn wound management can present with a certain degree of difficulty in the pediatric population. While the use of skin staples as a method of skin graft fixation is a well-known, rapid and simple method, their removal can be painful and may necessitate some sedation or even general anesthesia. We studied in this article the advantages and economic value of using the cyanoacrylate glue as a fixation method for skin grafts. MATERIALS AND METHODS: A comparative study was carried out from 2012 to 2016. Hundred and eighteen infants with burns up to 5% of total body surface area were included in the study. Seventy-two infants had split thickness skin grafts fixed with skin staples. Forty-six infants had split thickness skin grafts fixed with cyanoacrylate glue. We compared the quality of graft, the sedation used during the first postoperative dressing, the length of hospital stay, the amount of glue used and the presence of complications. RESULTS: There is a difference between the two groups studied in terms of age and total burn surface area. The rate of graft take was 100% in both groups. The first postoperative dressing was carried out without the use of powerful analgesia in the cyanoacrylate group, while it was necessary to use general anesthesia in 64% of the skin staples group. The average length of stay in hospital after skin grafting was 4.9 days for the cyanoacrylate glue versus 6.5 days in the skin staples group. No complications were noted in the 2 groups. CONCLUSION: The use of cyanoacrylate glue allows rapid fixation of skin grafts and avoid general anesthesia for postoperative cares. Subsequently the length of hospital stay is reduced within 25%. The medico-economic value of glue protocol is highly significant compared to skin staples, while having similar good results and without significant problems.

[Use of Harmonic blade in face lifting]. / Apport de l'ultracision dans les liftings cervico-faciaux.

INTRODUCTION: Rapid recovery and return to social activities are what every patient wishes when considering to undergo a face lifting procedure. In our practice, the use of the Harmonic scalpel in order to achieve this goal has greatly improved the postoperative period. PATIENTS AND METHODS: We have performed 920 face lifting procedures exclusively using the Harmonic scalpel from 2001 to May 2017. RESULTS: A retrospective chart review was performed. Mean operative time was 110minutes for facelift involving SMAS plication only, and 180minutes for facelift involving SMAS plication with the addition of submental approach for anterior platysma plasty. Return to normal social life was achieved on the 8th postoperative day for the majority of cases. CONCLUSION: The use of the Harmonic scalpel, once properly integrated in the face lifting procedure, significantly reduces postoperative ecchymosis and oedema and allows a prompt return to normal social life.

[The gluteus maximus inferior split-muscle flap for the cover of ischiatic pressure ulcers: Study of 61 cases]. / Le lambeau de faisceau inférieur de muscle gluteus maximus dans la couverture des escarres ischiatiques : étude d'une série de 61 cas.

AIM OF THE STUDY: The coverage of ischiatic pressure ulcers is characterized by a significant recurrence rate (8-64% depending on the series). It therefore seems necessary to introduce the concept of saving in the use of muscle flaps available to avoid being in a situation of therapeutic impasse. The gluteus maximus inferior split-muscle flap allows a tailored coverage to the ischiatic pressure ulcers grade IV with skin defect less than 8cm after surgical debridement. It is associated with an advancement-rotation skin flap removed above the sub-gluteal fold. PATIENTS AND METHODS: The surgical treatment is performed in a single-stage (care+coverage), undercovered by probabilistic antibiotic per- and postoperative then secondarily adapted. After excision of the cavity, a gluteus maximus inferior split-muscle flap was realized. The inferior gluteal artery ensures the muscular flap vascularization. Afterwards, patients follow a rehabilitation program in a specialized center. RESULTS: Sixty-one flaps were performed in 55 patients between September 2000 and January 2015. Fifty-nine (97%) were conducted in first-line and 2 (3%) for covering recurrent pressure ulcers. After a mean duration of 4 years and 8 months follow-up, 13 pressure ulcers (21.3%) relapsed. If reoperation, a simple remobilization of the muscle flap was achieved in 54% of cases, a myocutaneous flap of biceps femoris in 23% and surgical abstention in a patient with non-compliant perioperative care. CONCLUSIONS: The gluteus maximus inferior split-muscle flap, simple to implement, provides coverage of ischial pressure sores while sparing muscle flaps usually used for this indication. The recurrence rate associated with the gluteus maximus inferior split-muscle flap is comparable to biceps femoris and gluteus maximus muscle flaps (totally harvested). It does not sacrifice function gluteus maximus muscle and can be performed in the valid patient. This flap keeps the Superior split-muscle, mobilized in case of sacral pressure ulcer. The gluteus maximus inferior split-muscle flap is the first intention flap indicated for the cover of cover of ischiatic pressure ulcers of less than 8cm in diameter.

Carboxylmethylation of calmodulin in cultured pituitary cells.

We have used fast protein liquid chromatography (FPLC) and reverse-phase HPLC to rapidly resolve carboxylmethylated proteins in cultured pituitary GH3 cells. This procedure preserves labile carboxylmethyl esters, which are lost under the usual procedures employed for protein fractionation. GH3 cells were incubated with [methyl-3H]-methionine in culture and incorporation of label into the soluble fraction, total cell protein, and protein carboxylmethyl esters was determined; protein carboxylmethyl ester formation was shown to be resistant to cycloheximide. Fractionation of protein carboxylmethyl esters from GH3 cells by gel permeation FPLC, anion-exchange FPLC, and reverse-phase HPLC in the presence of calcium and in the presence of EGTA identified two proteins that are major substrates for protein carboxylmethyltransferase and indicated that one of these proteins is calmodulin. Similar results were obtained when a cytosolic fraction from GH3 cells was incubated with S-adenosyl-L-[methyl-3H]methionine. These results indicate that rapid chromatography at low temperature and low pH is useful for the analysis of eucaryotic carboxylmethylated proteins and that contrary to reports obtained in other systems, calmodulin is carboxylmethylated in intact pituitary cells.