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The forehead, although sometimes hidden by a fringe, is a major region of the face revealing many expressions such as fatigue, surprise, concern, anger In reconstructive surgery, the forehead is frequently used as a donor site. This article looks at three aspects: the used, traumatised and repaired forehead. The forehead, with its high-quality hairless skin and proximity to the noble structures of the face, is a central donor site. The forehead flap is commonly used for nasal reconstruction, with several variations to meet different needs. Other pedicled flaps, such as the supra-eyebrow flap and the crane flaps, are also used for various facial reconstructions. The forehead can be affected by trauma, burns, vascular lesions and skin tumours. We are particularly interested "en coup de sabre" linear scleroderma, an autoimmune disease that causes cutaneous and subcutaneous fibrosis, sometimes associated with Parry Romberg syndrome. In addition, lesions of the temporal branch of the facial nerve lead to muscular paralysis, affecting the aesthetics and function of the frontal region. Precise knowledge of the anatomy of the nerve pathway is crucial to avoid iatrogenic lesions. The entire arsenal of reconstructive surgery is useful for repairing the forehead. Controlled wound healing, tension suturing and the use of local flaps are key techniques for repairing the forehead. Tension sutures are particularly effective for small losses of substance, and their orientation depends on the location. Advancement, rotation and transposition flaps are used for larger losses of substance. Skin grafts, although less aesthetic, are sometimes necessary. Skin expansion, although socially restrictive, is used to treat congenital giant nevi and increase the surface area of forehead flaps.
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Several techniques for the stabilization and the reanimation of the paralyzed lower lip have been proposed, sometimes combined but the authors are rather vague. Thanks to our cases and a literature review, we suggest an algorithm. Sixty-six patients haven been reviewed. The static and dynamic clinical evaluation have been done thanks to the study of the medical files, photographs and videos samples. The different techniques we have used were: (a) botulinum toxin in the contralateral depressor labii inferioris (DLI) (n=66), contralateral DLI myectomy (n=1); (b) a strip of fascia lata (n=16) either combined with a lengthening temporalis myoplasty (MAT) (n=10) or only realizing a passive suspension thanks to one vector (n=4), or a passive suspension with two strips (n=2); (c) digastric muscle transfer (n=4). When the elevator muscles are sounds, botulin toxin (± myectomy) is proposed if the lower lip is not inverted. Otherwise, a suspension thanks to a digastric muscle transfer or a passive suspension with a horizontal and a vertical strips are recommended. If the elevator muscles are no more operational, a MAT with a passive suspension with one vector is considerated and if the lower lip is inverted, a digastric muscle transfer with a fascia lata strip or a MAT with two strips is proposed. This algorithm submission allows to refine the treatment of the stabilization and the reanimation of the lower lip.
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Paralisia Facial , Algoritmos , Músculos Faciais , Paralisia Facial/cirurgia , Humanos , Lábio/cirurgia , Estudos Retrospectivos , Músculo TemporalRESUMO
The authors present a new study on 789 cases of congenital thoracic malformations including 638 pectus excavatum and 151 Poland syndromes, according to a new classification which completes Chin's one. All these malformations were treated with silicone elastomer implants. The contribution of computer-aided design and manufacturing (CAD/CAM) since 2008 is essential. The one-stage surgical protocol is precisely described. The results are impressive, permanent, for life, and complications are rare. The authors evoke a common vascular etiopathogenesis theory at the embryonic stage and question the heavy techniques of invasive remodeling that are most often unjustified.
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Tórax em Funil , Síndrome de Poland , Desenho Assistido por Computador , Tórax em Funil/cirurgia , Humanos , Síndrome de Poland/cirurgia , Próteses e Implantes , Elastômeros de SiliconeRESUMO
AIM: Only few robust studies specify the indications of Mohs Surgery techniques in skin tumors. The aim of this work was to carry out a review of almost 10 years of experience, assessing the impact of reduced margins on reconstruction, and proposing a management algorithm in the light of the literature. PATIENT AND METHODS: All the records of patients having benefited from a Mohs technique in our center were retrospectively compiled from January 2011 until January 2020. A formalin-fixed tissue Mohs surgery was used. An impact assessment of reduced margins was made both on the excisional surface but also on the improvement of the reconstruction. RESULTS: 548 patients were included. Complete tumour clearance was achieved with one surgical stage in 71% of cases. The excisional surface of tumours located in the periorbital and nasal areas was significantly more often reduced compared to other areas (P=0,020). The improvement of the reconstruction was deemed significant in the periorbital and nasal areas; as well as for tumours located on limbs and trunk linked with Dermatofibrosarcoma management. CONCLUSION: This study underlines the interest of assessing the clinical relevance of reducing margins depending on the tumor location. Our single-center experience feedback on a large series allows to clarify Mohs technique indications by means of a literature review.
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Cirurgia de Mohs , Neoplasias Cutâneas , Formaldeído , Humanos , Margens de Excisão , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgiaRESUMO
INTRODUCTION: Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision. RESULTS: Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059). CONCLUSION: Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure.
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Álcalis/efeitos adversos , Queimaduras Químicas/cirurgia , Transplante de Pele/métodos , Pele/lesões , Adulto , Queimaduras Químicas/etiologia , Queimaduras Químicas/patologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: Cleft palate requires surgery in the first years of life, furthermore repairing anatomically the soft and hard palate is complex on a surgical level because of the fine tissues and the local intraoral configuration. It is valuable to train first on simulators before going to the operating room. However, there is no material dedicated to learning how to perform intraoral sutures in cleft palate surgery. We made one, in an artisanal manner, in order to practice before the real surgical gesture. BUILDING THE SIMULATOR: The simulator was designed based on precise anatomical data. A steel pipe, fixed on a rigid base represented the oral cavity. An adapted split spoon represented the palate. All pieces could be removed in order to apply a hydrocellular dressing before training for sutures. USE OF THE SIMULATOR: Our simulator was tested by 3 senior surgeons in our department in close to real-life conditions in order to evaluate its anatomical accuracy. CONCLUSION: It is valuable to have a simulator to train on cleft palate sutures within teaching university hospitals that manage this pathology. Our simulator has a very low cost, it is easy to make and is anatomically accurate.
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Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Modelos Anatômicos , Procedimentos Cirúrgicos Bucais/educação , Técnicas de Sutura/educação , Hospitais de Ensino , Humanos , Lactente , Recém-NascidoRESUMO
Physical, non-painful processes guide the scar reshaping in children in order to prevent growth anomalies due to cutaneous shrinkage. The objective of the surgical treatment, coordinated with the reeducation care, is to improve the physical abilities of the skin, to restore the function and avoid the deformations. Reeducation uses various techniques (i.e. sensitive-motility, massage and mobilizations) with or without physical agent (water, aspiration and touch-drive technique). Posture and positioning rely on the small or major aids, from orthosis to prosthesis. Compression is obtained by the adjustment of aids on molding and compression garment. Indications of the reeducation treatment depend on the timing of cutaneous covering and the advance of the healing process. It also depends on the underlying condition including skin traumas (frictions, wounds, burns), skin surgeries (purpura fulminans consequences, skin graft reconstruction after giant nevus resection, malignant lesion or vascular malformations). The final goal is the rehabilitation and development of the child and the adolescent in its entire somatopsychic dimension.
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Cicatriz/reabilitação , Modalidades de Fisioterapia , Queimaduras/complicações , Criança , Cicatriz/etiologia , Contratura/etiologia , Contratura/reabilitação , Humanos , Nevo Pigmentado/complicações , Nevo Pigmentado/cirurgia , Manejo da Dor , Púrpura Fulminante/terapia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgia , Fenômenos Fisiológicos da Pele , Doenças Vasculares/complicações , Doenças Vasculares/cirurgiaRESUMO
Facial palsy (FP) in children is congenital or acquired. When present at birth (congenital), etiologies are mostly traumatic and rarely developmental. Acquired FP needs investigation. Research on the etiology helps to determine prognostic and treatment. At most times, no specific cause is found. Treatment of idiopathic FP consists of early oral corticosteroid therapy and ocular protection. Treating the sequelae is essential and the physician has to consider the dynamic balance of both sides of the face. Dynamic rehabilitation should mainly concern the inferior facial third. We recommend the lengthening temporalis myoplasty (LTM). This relevant technique ensures replicable and reliable results with a harmonious smile. Facial dynamic rehabilitation after surgical procedure (muscle tranfer or free muscle flap) must be directed toward control of voluntary movement, to move from a mandibular smile to a spontaneous and voluntary smile, thanks to brain plasticity. Furthermore, botulinum toxin is well tolerated and remains a great tool to treat a child who can support injections.
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Paralisia Facial/terapia , Toxinas Botulínicas/uso terapêutico , Criança , Paralisia Facial/etiologia , Humanos , Músculo Esquelético/inervação , Músculo Esquelético/cirurgia , Neurotoxinas/uso terapêutico , Procedimentos de Cirurgia PlásticaRESUMO
Distraction osteogenesis, initially developed by Ilizarov for limb, is the tissular extension caused by the progressive space of the osseous pieces following an osteotomy. Distraction is osteogenesic and histogenic. Twenty-five years ago, at the instigation of McCarthy, this technique was used to handle the craniofacial malformations in the various floors of the face : mandibular, mediofacial and cranial. The most wide-spread protocols respect a latency period from 0 to 7 days, a rhythm of distraction from 1 to 2mm a day in 2 at 4 times and a period of consolidation from 4 to 8 weeks. Distraction is the result of the inventiveness of the pioneers then the work to always adapt to the multiple complex clinical situations. The surgeon has to choose between internal or external materials allowing a mono- or multi-vectorial extension, in osseous and/or dental anchoring. The mandibular distraction is very effective for the treatment of the secondary obstructive syndromes in the unilateral or bilateral severe hypomandibular malformations. She also allows desobstruction of the superior airways within the framework of the mediofacial hypoplasies as well as the secondary treatment of the growth defects in cleft lips and palates. Finally, the distraction osteogenesis enhanced reliability of the fronto-facial advancement in early and secondary treatment of craniofaciosynostosis. This is a real support of the facial growth, which has to be included in a plan of global treatment.
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Anormalidades Craniofaciais/cirurgia , Osteogênese por Distração , Humanos , Osteogênese por Distração/instrumentaçãoRESUMO
INTRODUCTION: Lacrimal cysts are rarely described and must be differentiated from diseases of the lacrimal gland. We present a rare case of lacrimal cyst developed from an accessory lacrimal gland. CASE REPORT: The management consisted of excision using a tarsoconjonctivale approach. DISCUSSION: Most cysts are diagnosed from the third decade, manifested by progressive exophthalmos. It is a benign disease. However, the differential diagnosis with malignancy is not excluded. Surgical resection is desirable if tumors become symptomatic.
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Cistos/patologia , Doenças do Aparelho Lacrimal/patologia , Aparelho Lacrimal/anormalidades , Cistos/cirurgia , Feminino , Humanos , Doenças do Aparelho Lacrimal/cirurgia , Adulto JovemRESUMO
Huriez disease is a rare autosomal dominant pathology characterized by the triad hypoplastic nail, hyperkeratosis and scleroatrophy of distal extremities. One of its most principal complications is the development of an aggressive squamous cell carcinoma. We present a case of a 62-year old patient who had an acute two hands scleroatrophy associated with recurrent squamous cell carcinoma treated by large excision and covered by trophic and thick radial forearm flap. This flap allowed us to treat the wound and the sclerosis shrinkage with aim to give back the functional benefit to the patient. It also gave the patient an oncological treatment despite aggressive management in one step surgery. Furthermore, one year later we did not observe cutaneous flap histological modification that could have degenerated into cancer. A multidisciplinary approach with dermatologists, geneticists and plastic surgeons is essential in addition with close medical supervision because of high cancer risks.
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Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Ceratose/complicações , Esclerodermia Localizada/complicações , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Carcinoma de Células Escamosas/etiologia , Seguimentos , Antebraço/cirurgia , Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Raras , Procedimentos de Cirurgia Plástica , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/etiologia , Resultado do TratamentoRESUMO
Rhinophyma, final stage of rosacea is considered as benign pathology. We present the case of a patient with basal cell carcinoma diagnosed on rhinophyma. The removal of all cutaneous nasal unit and its analysis has diagnosed the presence of three basal cell carcinomas and two in situ squamous cell carcinomas. Reconstruction was performed by full-thickness skin graft. The literature reports a few cases of association between rhinophyma and skin cancers but none ever reported the simultaneous presence of basal cell carcinoma and squamous cell carcinomas. The low number of articles does not reveal statistically significant relationship between rhinophyma and skin cancer, which would consider the rhinophyma as a risk factor. Monitoring of these patients should be as rigorous as possible and surgical care requires histologic analysis not to omit the presence of cancerous lesions.
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Carcinoma Basocelular/complicações , Rinofima/complicações , Neoplasias Cutâneas/complicações , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Humanos , Masculino , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: Basal cell carcinoma is the most common type of skin cancer in humans. OBJECTIVES: The aim of our study was to determine the histologic risk factors involved in recurrence of basal cell carcinomas of the face. PATIENTS AND METHODS: We conducted a retrospective study of patients with primary basal cell carcinoma (BCC) of the face treated between March 2003 and December 2005. We analyzed the size of lateral and deep margins of tumor, histologic subtype, perineural invasion, and ulcerations. Clinical follow-up was observed until June 2011. RESULTS: We note that 184 cases of BCC were included. Eleven recurrences occurred during the follow-up, i.e. 6%. The population was divided into two groups according to histologic safety margins (1 mm for all basal cell carcinomas, 0.8 mm for nodular and 2 mm for aggressive-growth (AG-BCC) subtypes). There was a significant difference between groups in regards to cancer recurrence. Tumor size above 2 cm and presence of perineural invasion increased the risk of recurrence. DISCUSSION: Low histological safety margins appear to be critical on tumor recurrence. Depending on the tumor characteristics, and the patient, we advocate a re-excision in cases of histological safety margins inferior to 0.8 mm for the nodular subtypes and 2 mm for aggressive subtypes. Tumor size, and perineural invasion should be taken into consideration so as to make a well-informed decision between re-excision and a watching strategy in critical cases.
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Carcinoma Basocelular/etiologia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Neoplasias Faciais/etiologia , Neoplasias Faciais/patologia , Neoplasias Faciais/cirurgia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Idoso , Carcinoma Basocelular/mortalidade , Neoplasias Faciais/mortalidade , Feminino , Predisposição Genética para Doença , Humanos , Estimativa de Kaplan-Meier , Masculino , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/mortalidade , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Pele/patologia , Neoplasias Cutâneas/mortalidade , Raios Ultravioleta/efeitos adversosRESUMO
Armenia and Azerbaijan fought between September and November 2020 in Nagorno-Karabagh. Several surgical missions were scheduled by Assistance Publique- Hôpitaux de Paris to help care for the warinjured Armenians. These missions included the evaluation of Armenian soldiers suspected of having been injured by phosphorus. Facing, during these missions, such infrequent burns, we were interested in their pathophysiology, care and complications. Repeated up-to-date information is necessary in order to better take care of phosphorus burns. Therefore, we conducted a literature review, using PubMed and the Mesh Terms "phosphorus" and "burns", without setting any date limit. The review acknowledges that phosphorus burns are deep, tend to spread and may be the cause of systemic toxicity including hypocalcaemia, which can lead to heart rate disturbance and even death. In the acute phase, burns should be extensively washed with normal saline or water before a mechanical decontamination. One should not use oily dressings, given the liposolubility of phosphorus. Subsequently, one or many debridements are necessary before starting wound coverage, for which any kind of plastic surgery may be used. Phosphorus burns are infrequent but serious. They mainly occur in warfare and should be known by any caregiver acting in this context.
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BACKGROUND: Cutting the excess of skin body contouring surgery in post-massive weight loss patients seems to only improve functional and aesthetic disorders. But other benefits can be determinated such as psychosocial effects. The first two are usually evaluated. The last two are rarely researched. The goal of this study is to evaluate the benefits of body contouring surgery by comparing patient satisfaction on these different aspects. METHODS: One hundred thirty-four patients with more that 30 kg's weight loss had body contouring surgery at the university hospital in Lille between June 2004 and June 2008. Seventy-eight patients agreed to respond to a study on quality-of-life improvements after body contouring surgery which evaluated aesthetic, functional, and psychosocial aspects. The data were compared before and after the surgery to assess the benefits of the surgery in these areas. RESULTS: All the aforementioned aspects were clearly improved with the body contouring surgery. However, the improvement in the physical aspects seems to be somehow disappointing, not living up to the patients expectations. Exactly 52.5 % of the patients wanted morphologic alteration, while the scars were well tolerated in 78.2 % of the cases. On the other hand, psychosocial discomfort was improved in ways not expected by the patients. Two new findings were remarkable: a decrease of 56.7 % in the sense of feeling depressed and an improvement in finding a job after body contouring surgery. CONCLUSION: The psychosocial improvements represent the true benefits of body contouring surgery.
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Imagem Corporal , Procedimentos Cirúrgicos Dermatológicos , Obesidade Mórbida/psicologia , Obesidade Mórbida/cirurgia , Satisfação do Paciente , Procedimentos de Cirurgia Plástica/psicologia , Redução de Peso , Índice de Massa Corporal , Depressão , Emprego , França , Hospitais Universitários , Humanos , Qualidade de Vida , Estudos Retrospectivos , Autoimagem , Inquéritos e Questionários , Fatores de TempoRESUMO
Animal experimentation is the most common way to learn microsurgery. However, this practice should be performed according to ethical rules and financial cost. This study has a triple aim: improving students' skills in microsurgery, respecting ethics and reducing costs by using fewer animals. We propose an ethical, practical and inexpensive training method that uses sewing needles. This training consists in microsurgery wire's passages in the eye of sewing needles arranged into circle. Specifically, 24 needles were arranged into two circles on a polystyrene block representing a "double clock". A specific scorecard for this exercise was made to evaluate the students. In total, between November 2010 and June 2011, fifteen residents followed the university degree in microsurgery provided by the faculty of medicine Henri Warembourg (Lille, France). The "double clock" was added to the eight already existing microsurgical manipulations. All of the participants were tested and this exercise was found to be effective as a teaching procedure. Also, each student used an average of 20 rats per year. This year we have reduced our animal control by 10% or about 30 rats. Our goals were achieved as we have improved student's microsurgical skills and also limiting cost by using fewer animals.
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Cirurgia Geral/educação , Microcirurgia/educação , Animais , Educação Médica/métodos , Modelos AnimaisRESUMO
Hibernomas are uncommon tumors composed of brown fat. Their consistency is multiple but usually harder than a regular lipoma. It is a mobile, slow-growing mass. Clinical symptoms are exceptional (pain or massive weight loss). The case of a 26 years old patient who suffered of a cervical hibernoma is reported to discuss the clinical and paraclinical aspect of the diagnosis.
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Neoplasias de Cabeça e Pescoço/cirurgia , Lipoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Adipócitos/patologia , Adulto , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Lipoma/diagnóstico , Lipoma/patologia , Masculino , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/patologiaRESUMO
Skin graft is the most common and simple procedure to cover superficial defect. Skin of variable thickness and size is completely detached from its origin (donor site) to cover a defect (recipient site). This simple procedure is the result of a long and eventful technical and theoretical evolvement. The aim of this article is to re-trace the history of skin grafting, from its discovery until today.
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Transplante de Pele/história , França , Alemanha , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , Humanos , Índia , Transplante Homólogo/história , Estados Unidos , CicatrizaçãoRESUMO
We are reporting on an easy, reliable and reproducible nipple-areola complex reconstruction. The main feature is to perform a full-thickness skin graft to rebuild the areola and a subcutaneous pedicled island flap for the reconstruction of the nipple in the middle of the graft. Each step is described. This technique remains easily practical and allows to keep an appropriate nipple projection. Moreover, it fits to all kind of breast reconstruction.
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Mamoplastia/métodos , Mamilos/cirurgia , Transplante de Pele , Retalhos Cirúrgicos , Feminino , HumanosRESUMO
STUDY OBJECTIVE: The aim of this retrospective study is to describe and evaluate the long term morphologic results of patients who present unilateral complete cleft lip and palate. PATIENTS AND METHODS: Thirty-two patients with non syndromic unilateral complete cleft lip and palate were operated early by the same surgeon, at the mean age of 70,4 days old, with two operating procedures. The first group was operated of cheiloplasty with the Millard method during the neonatal period, associated to the closure of the palate in the same time. The second group was operated with a modified Millard method during the neonatal period associated to a closing of the palate by the Wardill method at the age of ten months old. The criteria of evaluation were the anatomic remaining abnormalities after surgery of nose, lips, primary and secondary palate (back of 17 years). RESULTS: Our results show that Millard method and derived are taken as a whole effective, even if the number of secondary surgery and supplementary adjustments was sizeable (87%). The postoperative abnormalities concerning red lip (discontinuity, mucous excess) were frequent (53%), but easily correctable. The secondary surgeries were mainly for minor touch up of lip (46%), second time palate surgeries (53%), and rhinoplasties (40%). CONCLUSION: Progress in anesthesia and reanimation allowed us to assure an early management of clefts. The absence of incorrigible after-effects by a secondary surgery of the first-operated patients encouraged the team to continue in this way.