[Reconstructed breast burns following black clothes wearing and short sun exposure]. / Brûlures du sein reconstruit après port de vêtements noirs et exposition solaire modérée.

Breast reconstructions are plastic surgeries that female patients, who have undergone mastectomies, are increasingly using. While the morphological results are appreciated by patients themselves as being more and more satisfactory, results in terms of sensitivity remain uncertain and depend on type of reconstruction used. The chest wall skin already desensitized by mastectomy and exposed to radiotherapy presents disturbance of blood supply and innervation, likely responsible for impaired local thermoregulation that can easily lead to thermal burn injuries. Our paper presents a rare ethiopathological burn entity on the reconstructed breast: the association between short sun exposure and wearing black clothes. This aetiology of burns must be known by patients and by plastic surgeons in order to prevent dramatic clinical situations leading up to the loss of the reconstruction.

[Complex breast reconstruction after severe chest trauma by firearm]. / Reconstruction complexe de la région mammaire après traumatisme thoracique grave par arme à feu.

This case report is of a 47-year-old woman who suffered a ballistic chest trauma with severe left hemothorax and heart wound. She was treated in emergency for the collapse by heart surgery. Then the coverage for her soft thorax tissue loss was done by an ipsilateral musculocutaneous latissimus dorsi pedicled flap. The patient was subsequently addressed to our team for a repair, especially for reconstruction of the left breast. Initially, rehabilitation of aesthetics units breast was achieved through the realization of an abdominal advancement flap, and breast volume was restored by several sessions of lipomodeling. The surgical alternatives were very limited for this post-traumatic complex breast reconstruction. Due to ballistic trauma, no reliable recipient vessels allowed a microsurgical solution, and the ipsilateral latissimus dorsi was used for the coverage. In conclusion, the restoration of the aesthetics units with lipomodeling has achieved a very good result in this extreme thoracomammary region repair.

[Surgical issues and outcomes in ischial pressure sores treatment]. / Stratégie chirurgicale pour le traitement des escarres ischiatiques: quelles options? quels résultats?

INTRODUCTION: Ischiatic pressure sores are frequent in spinal cord injury patients, associated with bad prognosis and high recurrence rate. Many surgical techniques were described, including surgical debridement followed by pedicled flap coverage. We aim to propose a practical decision tree for primary or secondary ischial pressure sore treatment. PATIENTS AND METHOD: Our series of 48 operated ischial sores with an average follow up of 4 years (range 2 to 8years) is analyzed and compared to previously published reports. Surgical techniques are discussed according to their specific indications. RESULTS: The optimal recurrence rate in published reports about pressure sore treatment is 20%; a rate inferior to 19% is found in our series, showing the equal importance of flap selection and postoperative care and education. Depending on each situation, various available flaps are described and compared: gluteus maximus flap, biceps femoris flap, gracilis flap, tensor fascia lata flap, fasciocutaneous thigh flaps, rectus femoris and vastus lateralis flap, rectus abdominis flap. Specific surgical indications for more extensive wounds are studied: resection arthroplasty of the hip, hip disarticulation, fillet flaps from the leg, microsurgery. CONCLUSION: Based upon our experience, a decision tree summarizes our proposition of flap selection, depending on the wound size and the patient background.