Autologous fat grafting for the treatment of sclerotic lesions and scars.

INTRODUCTION: Microfat grafting is a well-known technique that is underutilized in dermatology. Instead of removing sclerotic tissue, microfat grafting preserves the tissue and uses stem cells for remodeling its structure into normal tissue. We performed a retrospective study of patients treated with microfat grafting for sclerotic and atrophic skin lesions and scars. PATIENTS AND METHODS: Seventy-two microfat grafts were performed using the Magalon technique under general anaesthesia for the treatment of sclerotic and atrophic skin lesions. We performed grafts for different indications, such as scars (n=55) and sclerotic and atrophic skin lesions (n=17: Parry-Romberg syndrome, morphea). The main outcome was assessed for satisfaction during follow-up. In addition, an independent committee judged the results based on photographs. RESULTS: Satisfaction levels (e.g. results were judged to be "good") were almost 91% (n=50/55) for scars and 100% (n=17/17) for atrophic and sclerotic skin lesions. Satisfaction levels according to the independent committee were 94.1% for sclerotic and atrophic lesions and nearly 51% for scars. CONCLUSION: Satisfaction was high after microfat grafting for atrophic and sclerotic skin lesions. Microfat grafting enabled restoration of the skin texture by exploiting stem cell properties. It is an efficient dermatological therapy for sclerotic and atrophic lesions, for which there are few alternative treatments.

[Palato velar fistulae in cleft palate]. / La fistule palatine ou vélaire dans les fentes.

Palatal fistulas after primary closure of a cleft palate are extremely variable ranging from 15 to 35%. When they are symptomatic, these fistulas affect feeding (nasal regurgitation to liquids, discharge, bad smells) and phonation (hypernasality that can hinder the precise assessment of velar incompetence). First of all, it is important to analyze the cause of the fistula, it helps to avoid early recurrences. The correction must apply to respect the 2 mucosal planes (nasal mucosa and oral mucosa), the only guarantee of surgical success. Different techniques are usually described: lingual flap, lifting of all palatal mucosa, flap hinge, blaster, FAMM. In all cases, postoperative care plays a key role in the success of the surgical correction.

Facial surgery for cosmetic purposes: Practice guidelines.

OBJECTIVES: Facial surgery for cosmetic purposes aims to improve the physical appearance and self-image of normal individuals. The aim of the guidelines is to answer questions related to legislation, patient evaluation and motivations, relevance and risk assessment, patient information and patient follow-up. METHODOLOGY: Analysis and synthesis of the medical literature through research of bibliographic databases in French and English from 2000 to 2017. Research and use of guidelines from evaluation agencies and academic societies. Drafting of guidelines with indications on levels of evidence. RESULTS: 24 guidelines with levels of evidence B (scientific presumption), C (low level of evidence) or EO (expert opinion) were selected to answer the questions. Cosmetic facial surgery must be performed by certified, qualified professionals in authorized structures. It must follow certain specific rules as well as a charter and code of ethics so as to enforce the rules of practice.

The role of telemedicine in the management of maxillofacial trauma in emergency departments - preliminary results.

New technologies have over the past forty years become widespread across all domains of basic and applied research particularly in health-related fields. Telemedicine is a form of remote medical practice using information and communication technologies. It connects one or more health professionals with other health professionals or with patients. Within the framework of emergencies in maxillofacial surgery, requests received for specialist advice often pertain to procedures to be followed for facial wounds, bites, burns, maxillofacial bone trauma or facial cellulitis. These requests for specialist advice were previously made by phone between emergency physicians and maxillofacial specialists, with exchange of patient photos by text messaging, which raised security issues. We collaborated with the Telehealth Normandy Health Cooperation Group (GCS TSBN) for the implementation of a mobile application using the "Therap-e" telemedicine platform. This platform links together websites and remote health professionals via the Internet. Physicians communicate over a mobile network or from a health institution, in online or offline mode, synchronously or asynchronously, using any medium (tablet, PC, Mac, smartphone). This scheme both ensures secure transmission of personal and clinical data (especially facial photographs) and records specialist advice in patient medical records. The purpose of tele-expertise applications in an emergency context is to provide a solution to the demographic problems facing healthcare professionals and to rise to the growing challenges surrounding quality and security issues.

[Idiopathic lipoatrophic panniculitis in an adult treated with hydroxychloroquine and adipocyte grafting]. / Panniculite lipoatrophiante idiopathique de l'adulte traitée par hydroxychloroquine et autogreffe de cellules graisseuses.

BACKGROUND: Idiopathic lipoatrophic panniculitis is a rare disease. Various terms are used in the literature to describe similar entities: annular lipoatrophy of the ankles, lipophagic panniculitis and lipoatrophic panniculitis. In any event, it consists of an inflammatory process progressing to necrosis of the fatty tissue. PATIENTS AND METHODS: Herein we report the case of a 37-year-old woman presenting characteristic signs: erythematous, annular, symmetrical, painful, inflammatory lesions of the lower extremities, progressing to areas of atrophy with an indurated inflammatory periphery. Histopathology showed lobular panniculitis composed primarily of lymphocytes and macrophages. The etiological investigations ruled out all other causes of lobular panniculitis. The patient was successfully treated with hydroxychloroquine 400mg/day for 1 year and she subsequently underwent fat grafting on the secondary lesions. DISCUSSION: Our literature review identified 23 reported cases of idiopathic lipoatrophic panniculitis since 2006, including 10 cases of annular ankle lipoatrophy. The most commonly used treatments are corticosteroids, hydroxychloroquine and methotrexate, with good efficacy being seen on the inflammatory phase. This disease seems a good indication for fat grafting to limit aesthetic sequelae. CONCLUSION: Lipoatrophic panniculitis, a rare disease, results in significant aesthetic sequelae which may be limited by early treatment initiation. The benefit-risk ratio of hydroxychloroquine suggests its value as first-line therapy in this pathology. Our case also demonstrates the value of filling of the secondary atrophy by fat grafting after the inflammatory period has ended.

Lengthening temporalis myoplasty and brain plasticity: a functional magnetic resonance imaging study.

BACKGROUND: Lengthening temporalis myoplasty (LTM) is a technique developed since ten years for facial paralysis. A spontaneous smile is acquired after this surgery explains by brain plasticity and the aim of the study is to confirm this plasticity by functional magnetic resonance imaging. MATERIALS AND METHODS: A functional magnetic resonance imaging (fMRI) was performed at various time points in ten patients who were operated on LTM during one year. RESULTS: Two different areas were found to be involved in chewing and smiling. We observed changes in the areas involved in smiling and chewing three months after surgery, and these changes persisted for at least one year. CONCLUSIONS: Our findings thus confirm that brain plasticity underlies the clinical observation of acquisition of a spontaneous smile.

[Benign cartilaginous tumors of the jaws]. / Tumeurs cartilagineuses bénignes des mâchoires.

Benign cartilaginous tumors are a rare entity in jaw bones. The histogenesis is still discussed but an embryological hypothesis is suggested. Chondroma, osteochondroma, chondroblastoma and chondromyxoid fibroma are the main benign maxillary cartilaginous tumors.

[The role of Versajet in the surgical treatment of rhinophyma. Case report]. / Intérêt du Versajet dans le traitement chirurgical du rhinophyma. A propos d'un cas.

Rhinophyma is an hypertrophy of the nose occurring primarily in men, from the age of 40, secondary to hyperplasia and fibrosis of sebaceous glands. This pathology is particularly unsightly and sometimes responsible of nasal obstruction. The treatment of this pathology is primarily surgical and the purpose of all techniques is to carry out a decortication. The authors describe one case of surgical treatment of rhinophyma by hydro-dissection using Versajet. After having presented the other possibilities of surgical technics for the treatment of this pathology, the authors compare the advantages and drawbacks of this new technique compared to those described in the international literature.