[Forehead burns]. / Les brûlures du front.

Severe burns on the forehead are rare; well-conducted initial surgical treatment also limits the occurrence of sequelae. Therefore, indications for repairing the forehead arise from complex burns often extending to adjacent units. Repair techniques depend on the location and size of the lesions, associated nearby damage, and the patient's ability to withstand the burden of treatment. Management at the acute stage determines the sequelae; excision-grafting is the standard treatment, but it yields good results only if the fundamental principles of repair are respected: intervention within the 10th and 15th days post-burn, graft harvesting from the cephalic extremity or the upper part of the thorax and arms, and respect for the frontal unit. Sequelae management follows the same imperatives and typically requires skin expansion: front expansion for skin flaps if enough frontal skin is still available, upper thorax expansion for full thickness skin grafts if the frontal scar is too extensive. However, the excellent results obtained should not conceal the significant constraints associated with skin expansion.

[Increased risk of bleeding during abdominal dermolipectomies in men: Myth or reality?] / Surrisque hémorragique au cours des dermolipectomies abdominales chez les hommes : mythe ou réalité ?

INTRODUCTION: Abdominoplasty is the most frequently performed procedure for the treatment of weight loss sequelaes. It carries risks of complications, especially in patients with multiple metabolic comorbidities. It is commonly accepted that the male population develops more postoperative complications, particularly haemorrhage, but there are very few studies showing this excessive morbidity. The aim of this study was to determine the increased risk of bleeding after anterior and circular abdominoplasty in men by comparing two series of 105 male and female patients. MATERIALS AND METHODS: This is a retrospective, single-center study including 105 male subjects undergoing simple or circular abdominoplasty between 2013 and 2022. The control group was composed of 105 women screened on the same terms. The data collection focused on different pre-, intra-, and postoperative variables, with the occurrence of a hematoma or the need for a transfusion during follow-up as the primary outcome. The analysis was performed according to a univariate and multivariate models. RESULTS: The rate of hematoma or transfusion, seroma, infection, amount of blood loss, and length of hospital stay were significantly greater in the male group. Multivariate analysis confirmed the independence of gender on the risk of developing a hematoma or requiring a transfusion. CONCLUSION: This study shows the excess morbidity in men, particularly haemorrhage, after abdominoplasty. This underlines the importance of a rigorous haemostasis and follow-up in this at risk population.

[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.

The range of the waveform score of the ocular response analyzer (ora) in healthy subjects.

PURPOSE: The waveform score (WS) indicates the reliability of each intraocular pressure (lOP) measurement signal performed with the Ocular Response Analyzer (ORA, Reichert). We aimed to assess i) the range of waveform score in IOP measurements with ORA in healthy subjects and to ii) identify a cut-off WS value under which an ORA measurement should be discarded. METHODS: Prospective study including three ORA IOP measurements performed in the right eye of 80 healthy normal subjects. The different WS were recorded and the highest WS of the three measurements was analysed. ANOVA test was used to assess variance in repeated measurements. RESULTS: Mean age of 80 subjects was 46.7+/-15.6 years. Mean WS of the first IOP measurement was 4.8+/-2.0 and 4.8+/-1.7 and 5.0+/-1.9 respectively for the second and third measurements (p= 0.74). Mean WS of the analysed 240 signals (3 measurements per eye) was 4.9+/-1.9 (range: 1.2-9.5). The mean value of all the highest values per eye was 6.2+/-1.8 (range: 2.9 -9.5 and was significantly higher than the mean WS of the 240 signals together (p <0.001). The 10th percentile of all the best values was 3.7 and the 75th percentile 7.5. CONCLUSION: ORA measurements with WS <3.7 should be discarded in healthy normal subjects. As much as that the corresponding quality of the waveform ORA scan is satisfying, one single measurement with a WS >7.5 could be considered as sufficient. If this score cannot be reached after three consecutive measurements, the signal with the highest WS should be selected.

[Complications Following Treatment for Excessive Axillary Sweating With Microwaves: A Case Report]. / Complications D'Un traitement De L'Hyperhydrose Axillaire Par Micro-Ondes: À Propos D'Un Cas.

Excessive axillary sweating is a frequent reason for seeking consultation in aesthetic medicine. Botulic toxin therapies have been used for years for this condition. A microwave-based treatment (MiraDry®) has been used in France since 2011. We present the case of a patient who developed complications following such a treatment for excessive axillary sweating, namely dermal detachment, subcutaneous collections, dermal thickening, retractile scars responsible for pain and limitation of axillary amplitudes. These complications mimic the natural evolution of deep axillary burns. In this paper, we propose a management method for patients with this type of complication.

Épilepsie et brûlure : épidémiologie et interactions.

A retrospective study was conducted to assess the interactions between epileptic seizure and burn. The study was conducted on all patients treated at the Saint Luc Saint Joseph Hospital Burn Unit from 2000 to 2015 with a diagnosis of epilepsy. Forty-eight cases associating burns and epilepsy were reviewed. Twenty-eight patients had a burn following an epileptic seizure. The average age was 43, and the burned area was 9%. Injuries resulted from contact with hot surface (32%), scald burn (50% - 32% with cooking water and 17.8% by accidental exposure to hot tap water (shower)). Burns by flames were rare (4 cases/28: 14.3%). The burns were deep, and all required surgical treatment by excision - split thickness skin graft. All the cases of tap water burns occurred before 2010 and the changes to hot tap water temperature legislation. Three patients presented a new epileptic seizure during their hospitalization. Primary prevention of domestic accidents, particularly regulation of hot tap water temperature, appears effective. Educating epileptic patients on the importance of therapeutic compliance and the elimination of risky activities during periods of therapeutic modification should further reduce the incidence of seizure-related burns.

Neurocysticercosis: a poorly understood disease.

A 22-year-old male patient of Indian origin presented with generalized seizures. Brain magnetic resonance imaging (MRI) showed two cystic lesions. Extensive screening only revealed positive skin tests for tuberculosis. Immunoassays for cysticerosis were negative in serum and cerebrospinal fluid. Biopsy of the temporal lesion revealed a cysticercus. Although neurocysticercosis is a common cause of seizures in patients from countries where cysticercosis is endemic, the diagnosis can be difficult in a patient with evidence of multiple infections or in whom serological evidence is lacking, as is illustrated by the present case. Furthermore, because the pathogenic factors determining the activity of the disease are poorly understood, its management represents a similar problem as it depends upon the activity of the disease as estimated by clinical, radiological and laboratory tests. The present case report illustrates these difficulties.