Surgical rhinoplasty after prior hyaluronic acid based nose remodeling.

BACKGROUND: Medical rhinoplasty by hyaluronic acid injection (HA) has become nowadays a common practice. The number of patients requesting surgical rhinoplasty and having already undergone one or more injections of HA is increasing. However, the literature lacks publications regarding the management of these patients. OBJECTIVES: The aim of this study is to discuss the management of patients who have been treated with previous nasal HA injections and who seek surgical rhinoplasty, and elaborate a treatment protocol and algorithm to standardize surgical plans. METHODS: We are reporting case studies based on our clinical experience. We also reviewed the literature to suggest perioperative management for rhinoplasty with previous HA injections. RESULTS: Hyaluronidase injection preoperatively allows to carry out an accurate preoperative analysis of the nasal deformities to treat, in order to make an adapted treatment plan. Postoperative course is similar to other rhinoplasty cases without the use of this enzyme. CONCLUSION: Hyaluronidase should be used in all patients with nasal injections of HA (unless contraindications), who are willing to undergo a surgical rhinoplasty. The operation can be undertaken at one-week interval as soon as the edema subsides and no further treatments are necessary.

Use of autologous adipose tissue in acute burn wound management: A systematic review.

Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in burn wounds and reconstructive surgery. The present systematic review aimed to evaluate the effectiveness of autologous fat transfer for acute burn wound management. A systematic review of the US National Library of Medicine, Cochrane Library, Web of Science, and Embase was conducted on October 15, 2022 (registration number CDR42022369726). A database watch was performed until submission of the manuscript. The review focused on wound healing. All studies reporting fat transfer in adult patients (at least 5 patients reported) with deep 2nd degree burn wounds were included. The database search yielded a total of 720 records and 367 patients were included from 3 studies. A statistically significant improvement in scar texture, scar appearance, and time to healing was reported in one study in the fat transfer group versus control (P<0.001). Similarly, scores for scar color, scar thickness, scar stiffness, and scar regularity increased significantly. The small number of included studies and their heterogeneity did not allow a meta-regression to be performed. This systematic review emphasizes the limited evidence currently available regarding the use of autologous fat transfer to improve burn wound healing in adult patients, even though it seems promising. Future search should focus on randomized controlled trials with a larger number of participants.

Primary management of the inframammary fold in breast reconstruction using the thoracoabdominal advancement flap: Surgical technique.

Our experience in breast reconstruction confirms the significant importance of reconstructing the inframammary fold in achieving overall aesthetic satisfaction. We describe our technique for primary fixation of the inframammary fold in breast reconstruction using a thoracoabdominal advancement flap. This technique is suitable for patients with a vertical skin laxity of at least 5cm in the future inframammary fold. Prior to the procedure, it requires preparation through physiotherapy, the use of adhesive external breast prosthesis, and skin expansion using an inflatable prosthesis in extreme cases. The surgical approach follows the existing mastectomy scar. After subfascial dissection of the thoracoabdominal advancement flap, the surgeon proceeds to create two separate rows of sutures. The first row mimics the deep attachment of the inframammary fold, fixing the superficial fascia of the flap to the rib periosteum. The second row mimics the superficial attachment of the inframammary fold, fixing the dermis of the flap to the rib periosteum. The main advantage of this technique is its applicability to all breast reconstruction programs.

[Local administration of amphotericin B by VAC instillation: Therapeutic aid in the treatment of mucormycosis]. / Application locale d'amphotéricine B par VAC instillation : aide thérapeutique dans le traitement de la mucormycose.

Mucormycosis is a rare and serious fungal infection, occurring mainly in immunocompromised, diabetic, polytrauma or burn patients. Current standard treatments include iterative carcinological surgical trimming, systemic treatment with liposomal amphotericin B and second-line Posaconazole or Isavuconazole. We report the case of a 37-year-old female patient with no previous medical history who developed a disseminated mucormycosis, with an estimated 25 % loss of skin substance and major decay of the chest wall. In addition to standard treatment, local instillations of amphotericin B using the VAC Veraflow® system were performed. We believe that local instillations of amphotericin B by VAC could improve the functional prognosis of patients with skin involvement.

[Vulvoplasty after gender-affirmating genital surgery]. / Vulvoplastie chez les patientes en incongruence de genre.

Functional and aesthetic results after vaginoplasty in sexual reassignment surgery have improved in recent years. Improved surgical techniques, well-established expert teams and a growing demand for and interest in this type of surgery are some of the reasons for these results. However, there is a growing demand for genital cosmetic surgery, not only among cis women, but also among trans women. The main shortcomings in results are therefore presented and listed. The aesthetic revision surgery techniques specifically indicated are described. Labiaplasty and clitoridoplasty appear to be the two main requests for secondary surgery following trans vaginoplasty.

État Des Lieux De L'Utilisation Du Prp Dans Le Traitement De La Brûlure.

Platelet rich plasma (PRP) has trophic functions due to a high concentration of growth factors and cytokines. These properties may be of therapeutic interest in the management of burn injuries. In preparation for a clinical study at the Lyon Burn Centre on PRP as an inducer of healing in burns, we carried out a review of the literature looking at the results of the use of this therapy. A review of the literature on the use of PRP for the treatment of burn injuries was performed by querying the PUBMED database using the keywords [platelet rich plasma] AND [burns]. Controlled clinical or pre-clinical studies in English or French were included. Eleven articles were identified, consisting of eight preclinical animal model studies and three clinical studies. These looked at the effects of PRP on the healing of burned areas whether they were grafted or not, on the improvement of neuropathic pain, and on distant skin trophicity. The results of recent preclinical studies show shorter epithelialization times thanks to PRP. In humans, a significant study (201 patients) validates its use in combination with thin skin grafts, and another shows benefits on distant cutaneous trophicity. In conclusion, the use of PRP topically or by injection under the skin has a potential benefit in the management of acute burns. A large-scale series validates its use in clinical practice.

The bilateral scrotal flap: Anatomical study and it's use for the management of inflammatory granulomas following custom-made injections.

INTRODUCTION: The management of 10 cases of penile inflammatory granulomas following a subcutaneous injection of non-absorbable substance for the purpose of penile augmentation is presented. We subsequently used the bilateral scrotal flaps to cover the post-excision skin defect. A simple decision aid chart outlining the management of penile foreign body injections is proposed. METHODS: A total of 10 patients were included in this study. All required surgical management by penile degloving, followed by complete excision of the inflammatory granuloma and overlying skin. The dissection of 14 cadavers was carried out to study the blood supply to the anterior scrotal flap. Penile reconstruction was then performed using a bilateral scrotal flap in all but two cases. Post-operatively, the patients were followed up for a 1 year period. RESULTS: We obtained good results in terms of the aesthetic outcome with all of our ten patients with the area covered having similar color to penile skin. There were no major post-operative complications. There were two minor complications involving wound healing. Sensory function was maintained and no penile shortening or curvatures were noted, in addition all patients were satisfied with both the shape and function of the penis. CONCLUSION: Although much rarer, penile augmentation related complications are still seen in western countries. The treating doctor should be aware of its management. We had achieved acceptable outcomes in our experience with the bilateral scrotal flap. We believe it is a good and simple option for soft tissue coverage of the penis in cases following the complete inflammatory granuloma excision. It can achieve satisfactory aesthetic and functional results for this group of patients.

Self-injection: Inescapable DIY and real danger? A case study and literature review.

Aesthetic medicine is booming, and expanding Internet delivery is not controlled by health authorities. More than ever, conditions are thus favorable for patient self-injection. We present the case of a 45-year-old woman self-injected in breast with hyaluronic acid purchased on the Internet. She developed a bilateral breast infection treated with antibiotic treatment. Despite the ban on the use of filler in the breast by our health authorities since 2011, we will talk about the management of this type of patient. In light of this complication, we will discuss the public health issue raised by the development of the injectable products market. We wish to emphasize in France the emergency of establishing a strict legal framework for the use of fillers.

[Tissue expansion in child's burn reconstruction. Management principles and eleven years retrospective study of 42 patients]. / Expansion cutanée pour séquelles de brûlure de l'enfant. Principes de prise en charge et étude rétrospective de 42 patients sur 11 ans.

PURPOSE: With constraints and a risk of complication, tissue expansion in child's burn sequelae need a controlled surgical procedure, and a therapeutic plan appropriate to the specific pediatric healing, growth, and development. MATERIAL AND METHODS: Our principles of management and technical points are described. A retrospective study of tissue expansion in child's burn sequelae between 2005 and 2016 is submitted. RESULTS: There are 185 expanders, 98 protocols in 41 children, over half of sequelae concerning scalp, neck and chest. Mean age at the first expansion was 10.3 years old (5.8 years after burn). There are in average 2,4 (1-8) protocols by patient, with 1.9 (1-4) expanders by procedure. Surgical repair was a flap (78.8%), a full-thickness skin graft (13.3%) or both. Fifteen patients (30 expanders (14.6%) and 22 protocols (22.4%)), had expansion's complications, mostly infections and expositions. Eight patients (14 expanders (7.6%) and 10 protocols (10.2%)) had reconstructive's complications. An increase of burn area was a risk factor of complication (significant). Complicated expanders rate by location was 7.9% (scalp), 12.5% (neck), 9.8% (supraclavicular), 10.5% (chest), 19.4% (abdomen), 30% (buttock), 29.4% (lower limb), 1/2 (face). CONCLUSION: Tissue expansion in child's burn sequelae is ideal in scalp, good in neck, chest and proximal upper limb, and to do carefully in lower limb and face.

An anatomic study of deep inferior epigastric artery diameters at the origin from external iliac and at the lateral border of rectus abdominis muscle by computed tomographic angiography from autologous breast reconstruction patients.

BACKGROUND: Autologous breast reconstruction by means of microsurgical abdominal flaps is an very well described technique. The flap harvest dissection under inguinal ligament would cause the risk of parietal weakening in this zone and postoperative bulging. The goal of our study is to investigate whether the deep inferior epigastric artery diameter remains constant from its exit of the external iliac artery to its entrance in the rectus muscle sheath. PATIENTS AND METHOD: One hundred arteries were studied on fifty preoperative computed tomographic angiographies made before a DIEAP flap for breast reconstruction. We measured the caliber of the left and right deep inferior epigastric arteries at these two landmarks. The length of this artery between these was also calculated. This data were collected with specific angiography reconstruction. RESULTS: At the caudal landmark, the mean DIEA diameter was 2.1±0.27mm on the left side and 2.1±0.31mm on the right side. At the cephalic landmark, the mean DIEA diameter was 2.0±0.28mm on the left and 2.0±0.27mm on the right side (P=0.00035 at left side; P=0.0089 at right side). The mean pedicle length between the two landmarks was 22.3±2.85mm on the left side and 22.2±2.98mm on the right side. CONCLUSION: This computed tomographic angiography study showed that the diameter of DIEA is equivalent at its origin and at the lateral border of muscle. Flap harvest without dissection under inguinal ligament provides sufficient pedicle length and caliber to allow for comfortable and reliable sutures.

[Profunda femoral artery perforator flap: Anatomical study]. / Le lambeau perforant de l'artère fémorale profonde : une étude anatomique morphométrique.

BACKGROUND: Within the framework of mammary reconstruction, since 2012 when Allen first described it, the profunda femoral artery perforator flap (PAP) takes an important place in the current therapeutic options. OBJECTIVE: This anatomical study aims to analyze the anatomy and morphologic consideration of the PAP : position of the perforating artery; length of the pedicle, area and volume of vascularization. METHODS: Sixteen flaps were harvested on fresh subjects at the University Department of Anatomy of Rockfeller, Lyon. The first direct cutaneous branch from the deep femoral vessels was located between or through the adductor magnus and gracilis muscles. Pedicle location, diameter, length and position regard to the great saphenous vein were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area and volume of cutaneous territory supplied by the studied perforator. RESULTS: On the 16 analyzed flaps, localization of the perforating artery is on average to 8.2cm of the pubic tuber and 3.7cm behind a line connecting the pubic tuber to the internal femoral condyle. The length of the pedicle is on average of 11.7cm and the average area of skin perfused was 94,68cm2. The way of this perforating arterty is primarily through the adductor magnus. On the radiological images of the 8 flaps, the analysis shows an average surface of 111,25cm2 and a mean volume of 325.3cm3. DISCUSSION: PAP is an interesting therapeutic choice within the framework of a mammary reconstruction. Its surface and its volume associated with a discrete scar make a valid indication within the framework of this surgery.

Mandibular angle resection using cervicofacial lifting surgical approach: Technical note.

Facial feminization surgery brings a set of surgical procedures that address the three thirds of the face and aims to give feminine characteristics to a masculine face. The characteristics of the lower third of a male face are a long, broad chin, a prominent mandible with sharp angles (in connection with the insertions of the masseter muscles). Mandibular angle reduction is an important procedure of the male-to-female transformation. It allows to modify the appearance of the lower third of the face, reducing the bi-mandibular distance in the coronal plane and opening the mandibular angle in profile. The classical procedure uses trans-oral surgical approach. However, patients undergoing male-to-female sexual transformation frequently present a mixed indication of cervicofacial lift and angular resection. We present an innovative surgical technique associating cervicofacial lifting and mandibular angle resection using the same cutaneous surgical approach. We describe its advantages and discuss its disadvantages.

Abdominoplasty with simultaneous laparoscopic umbilical hernia repair: A practical approach to preserve the umbilical vascularization.

BACKGROUND: Umbilical necrosis is a well-known complication of abdominoplasty, the risk of this complication can be increased when an associated umbilical hernia requires further dissection in peri-umbilical region, potentially leading to umbilical devascularisation. Multiple minimally invasive open techniques were described to avoid this problem. The combined approach of abdominoplasty with laparoscopic umbilical hernia repair is one promising solution to avoid devascularising the umbilicus. METHODS: A retrospective evaluation of patients who underwent concomitant abdominoplasty with laparoscopic umbilical hernia repair from 2007 to 2017 was carried out. All patients were followed up and evaluated for complications, including the incidence of umbilical skin necrosis. RESULTS: A total of 47 patients were included in this study. The average operative duration was 3.3hours with an average hospital stay of 2.5 days. No cases of postoperative umbilical necrosis were encountered. A mean follow-up period was 2.4 years showed no cases of hernia or rectus abdominis diastasis recurrence. Minor complications included 4 cases of dehiscence, one hematoma. There was no major complications. CONCLUSION: The concomitant use of laparoscopic umbilical hernia repair and abdominoplasty is a feasible approach to reduce the risks of umbilical devascularization. Especially in larger hernias and in patients with higher risk of recurrence.

[Breast reconstruction with Muscle-Sparing Latissimus Dorsi flap combined to a Thoraco-Abdominal advancement flap and fat grafting]. / Reconstruction mammaire par lambeau dorsal épargnant le muscle grand dorsal (Muscle-Sparing Latissimus Dorsi, MSLD) associé à un lambeau d'avancement thoraco-abdominal et greffe de tissu adipeux autologue.

The Latissimus Dorsi flap (or LD flap) was first described by the Tansini in 1896 and published in 1906. It concerned a case of chest wall reconstruction after breast amputation. The use of the LD flap in all its variants is very frequent in breast reconstruction. In these indications, the muscle is harvested for skin paddle vascularization and/or for bringing volume to the reconstructed breast. When all or most of the muscle is taken, its motor function is completely lost. The functional sequelae due to the loss of the latissimus dorsi muscle are then definitive. Tobin et al. showed that the LD muscle can be separated into two flaps based on the division of the thoracodorsal artery; the concept of muscle-sparing was then posed (Muscle-Sparing Latissimus Dorsi [MSLD]). The MSLD as we perform now, concerns only a thin muscle strip and preserves 95% of the LD muscle with its vascularization and motor innervation. This technique is quick with very low donor site morbidity. The functional sequelae and postoperative complications appear limited compared to the harvest of a total LD whatever the posterior scar. The volume of the breast to be reconstructed is obtained by several sessions of fat grafting. We present here the anatomical bases and the surgical technique of the muscle-sparing latissimus dorsi associated with a thoracoabdominal advancement flap and fat grafting in breast reconstruction.

[Stereophotogrammetry and facial surgery: Principles, applications and prospects]. / Photographie 3D en chirurgie de la face : principes, intérêts et perspectives.

The clinical examination of the face needs a reliable, objective and innocuous tool. Stereophotogrammetry for a medical use has been available for more than fifteen years but its popularity is still limited by a high cost. We hereby define the principles of stereophotogrammetry, its fields of application in facial surgery and the prospects, which might soon be offered by a wider access to this technique.

[Fasciocutaneous flap reliable by deep femoral artery perforator for the treatment of ischial pressure ulcers]. / Lambeau fasciocutané sous fessier fiabilisé par une perforante de l'artère fémorale profonde en reconstruction d'escarre ischiatique.

INTRODUCTION: The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. PATIENTS AND METHOD: A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. RESULTS: A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. CONCLUSION: Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

Reconstruction of soft tissue defects of the distal third of the arm using a muscle-sparing latissimus dorsi musculocutaneous flap.

Use of a latissimus dorsi (LD) flap has been widely described for upper limb reconstruction. However, donor site sequelae have led to the development of muscle-sparing techniques for the LD flap. We present the technical principles of a muscle-sparing LD flap and its use as a pedicled flap to reconstruct the distal third of the arm.

Anatomy of lower eyelid and eyelid-cheek junction.

BACKGROUND: Understanding the anatomy of the lower eyelid and the lid-cheek junction is important for surgical and non-surgical approaches. It is important to understand the correlation between the clinical presentation and the individual anatomy to direct an adequate treatment. METHODS: A review of the literature based on the authors experience combined with anatomical dissections was conducted to reveal the current concepts of the surgical and non-surgical anatomy. The various anatomical structures important for the understanding of the symptoms and the proposed treatment are described in this article. RESULTS: The anatomy of the lower eyelid and the lid-cheek junction has to be understood as a unit. Structures are continuous from the eyelid to the cheek influencing each other during aging. The concept of superficial, i.e. superficial to the orbicularis oculi muscle and deep facial fat compartments, i.e. deep to the orbicularis oculi muscle has to be applied in order to understand the relevant anatomy regarding the ligaments, fat compartments, muscular and tarsal structures and the vascularization. CONCLUSION: The understanding of the layered arrangement of the lower eyelid and eyelid-cheek junction anatomy enables practitioners to perform safe and effective surgical and non-surgical procedures.