Annales De Chirurgie Plastique Esthetique最新文献

In Crouzon syndromes, there is an hypoplasia of the midface. An intermediate midfacial osteotomy between Lefort 2 and Lefort 3, called "butterfly osteotomy", associated wit a rigid external distraction on a Pooley helmet allows to pull the entire middle maxillary, orbital and zygomatic level in one step, and to project the tip of the nose, by a single endobuccal approach. The osteotomy concerns the entire middle level of the face while respecting the upper part of the nose. The external distractor with cranial support makes it possible to reposition the face, corrects the open bite and project the tip of the nose. This technique brings a ventilatory improvement in sleep apnea syndromes and an aesthetic improvement, beneficial on a psychological level.

Objective: Determine the epidemiology and frequency of complications, and compare the efficacy of different therapeutic approaches.

Methods: This prospective study included patients with venous malformation (VM) treated at the Vascular Anomalies Center between 2019 and 2023.

Results: Thirty-three patients were included in this study. The median age of the patients was 20 years, 17 patients were born with VM. 63% had symptomatic VM. The most common location was the face (42%). Aesthetic impact was significant in patients under 12 years old (P=0.01) and in the cephalic extremity (P=0.000). Treatment was initiated only in cases of symptomatic VM or with aesthetic impact. Compression garments were used in 6 patients, sclerotherapy in 14 patients, including 2 after surgery, and surgery in 16 patients, including 5 after non-successful sclerotherapy. Two patients received curative Low molecular weight heparin (LMWH) injection. Sirolimus was prescribed to 4 patients. These treatments resulted in complete regression in 10 patients and partial improvement in 12, with failure or recurrence in 7.

Conclusion: Most patients present with symptomatic VM with a functional or aesthetic impact. This study underlines the difficulty of managing VM, which must be adapted on a case-by-case basis, and confirms that medical and contention treatments can only bring about an often-transient improvement in symptoms. Only complete surgical excision can provide definitive cure.

Purpose: This study aimed to compare the efficacy of the WALANT (WA) technique with the infraclavicular brachial plexus block (IBPB) in patients undergoing anterior transposition and decompression of the ulnar nerve.

Methods: A total of 46 patients were included in this bicentric retrospective study. Twenty-two were in WA, 24 were in IBPB group. WA was done by a hand surgeon and IBPB was done by an anesthesiologist under ultrasonography guidance. The two groups were compared regarding demographic data, clinical results, and radiological outcomes.

Results: Preoperative preparation time and hospital stay were shorter in the WA group. VAS values at the 1st, 6th and 72nd hours after surgery were lower in the WA group. Intraoperative VAS-A values were higher in the WALANT group. Postoperative VAS-A values at the 6th hour were lower in the WA group. Return to work time was shorter in the WA group.

Conclusion: The WA technique in CuTS surgery is a method that can be easily applied, is safe and is not inferior to IBPB in terms of clinical results. WA shortens preoperative patient preparation time, pain, host stay, operating room usage and return to work time after CuTS surgery.

A new dimension in rhinoplasty emerged at the end of the 19th century, cosmetic surgery. Some authors recognized the importance of responding to the growing demand for cosmetic surgery, particularly for the nose. Although not the first, Joseph brought a new approach to rhinoplasty by laying the foundations for a technique that would later be known as the "structural technique", involving the resection and reduction of a pre-existing structure, beginning with the dorsal hump. Throughout his career, Joseph fought hard to impose his ideas and gain recognition from his peers despite not having a university education. His surgical skill and innovative spirit earned him the admiration of all who visited him, despite his sometimes challenging personality. His dexterity with a scalpel was matched only by his skill with a pen. In a difficult political and social context, he was a prolific author who wrote well-organised texts, thus facilitating the transmission of his knowledge and immense experience. For this reason, he fully deserves the title of "Father of Modern Rhinoplasty".

Facial feminization can be considered as an essential element of gender-affirming care and overall well-being of transgender women. This study explores a nonsurgical approach to facial gender-affirming procedures (FGAP) by assessing the efficacy of botulinum toxin (BT) injection for lower face transversal reduction. This cosmetic procedure was evaluated by administering the FACE-Q survey to participants, both pre- and post-procedure and at the three-month follow-up visit. A significant improvement in satisfaction was observed concerning the lower face appearance after BT injection in the masseter (P<0.001). These findings raise awareness towards alternative nonsurgical options in achieving lower facial feminization.

Introduction: Surgery for pelvic-trochanteric pressure ulcers requires complex multidisciplinary management. Perioperative complications are common, as are distant recurrences. Perforator flaps are currently widely used for this indication, with the main advantages being that they avoid muscle sacrifice, reduce skin detachment in useful perforasomes, and shift the skin tension associated with remote removal of the pressure ulcer.

Materials and methods: We conducted a systematic review of the literature and a retrospective study of patients treated in two French expert centres over the last nine years concerning the complication and recurrence rates of fasciocutaneous, musculocutaneous and perforating flaps. We used these data to propose a treatment algorithm for the use of perforator flaps in the therapeutic arsenal.

Results: Out of 1210 publications studied, 92 articles were selected covering 4105 patients. The overall complication rate was 23.9% (CI 95% 23.44-24.42) and the recurrence rate was 12.4% (CI 95% 11.90-12.82) with a significant advantage in both cases for perforator flaps. We included in our cohort study 416 flaps performed on 399 patients with spinal cord injuries between 2015 and 2024. A significant reduction in the recurrence rate was observed with the use of a perforator flap (OR 0.47 [0.30; 0.74], P=0.001).

Conclusion: Perforator flaps are an indispensable solution in the current therapeutic arsenal for pelvic-trochanteric pressure ulcers coverage. More reliable and reducing long-term recurrence, they do not replace other types of flaps, which remain highly indicated. Our algorithm allows for the use of different types of flaps with a view to preserving muscle and skin in a population at risk of recurrence.

Introduction: Martin's first description of the submental flap in 1990 (Martins, 1990) made it possible to reliably cover the lower two-thirds of the face. Although deemed difficult due to its intricated vascular, muscular and nerve anatomy, this flap has quickly gained in popularity. Its increasingly frequent use has made it possible to describe dissection steps at the level of the facial vessels and venous drainage system to gain arc of rotation. However, to date, no study has measured the gain in arc of rotation related of the dissection performed.

Objective: To find out the gain in arc of rotation depending of the dissection performed at arterial and venous level. We also describe the course of the submental artery in relation to the anterior belly of the digastric muscle.

Method: Twelve flaps were made on six fresh cadavers, previously injected with colored latex. Measurements were taken with a reference line between the external canthus and the root of the helix.

Results: Of the eleven flaps including the submental artery, dissection of the facial artery to its origin at the level of the external carotid artery resulted in an average gain of 2.3cm. The YV venous lengthening resulted in an additional average gain of 0.8cm. In all cases, the submental artery was located deeper than the anterior belly of the digastric muscle.

Conclusion: Pedicle elongation techniques include dissection of the facial artery to its origin, as well as YV venous procedure. The choice should be dictated by the area to be covered. The gain in arc of rotation is substantial after dissection of the facial artery and appears moderate and technically difficult with venous lengthening.

3D skin bioprinting is a transformative innovation in regenerative medicine, offering new possibilities for wound healing, reconstructive surgery, and disease modeling. By enabling the precise fabrication of patient-specific skin grafts, this technology addresses critical medical challenges, including severe burns, chronic ulcers, traumatic injuries, and genetic skin disorders. Advances in bioprinting techniques, bioink formulations, and vascularization strategies have enhanced graft integration and functional restoration, avoiding immune rejection risks. Beyond transplantation, 3D skin models provide a powerful platform for dermatological research, pharmacological testing, and tissue engineering, accelerating drug discovery while minimizing reliance on animal testing. Additionally, 3D bioprinting is revolutionizing cosmetic and reconstructive dermatology, enabling personalized aesthetic procedures, scar treatments, and anti-aging interventions that complement clinical applications. The future of 3D skin bioprinting lies in multi-tissue fabrication, AI-assisted biofabrication, and immunomodulatory grafts, which could revolutionize personalized medicine and regenerative healthcare. Despite ongoing challenges in clinical scalability and regulatory pathways, continued interdisciplinary research is driving the field closer to real-world medical applications. This review provides a structured timeline of advancements, compares bioprinting techniques, and offers specific examples of clinical and commercial applications. It concludes with a discussion of future directions, emphasizing sustainable bioinks, AI-assisted fabrication, and ethical frameworks.

Background: The deep inferior epigastric perforator flap (DIEP) is the gold standard for autologous breast reconstruction (ABR), but its viability can be challenged in resource-reduced environments like Mexico, where bilateral DIEP reconstructions are rare due to their complexity. A two-stage procedure has been introduced to improve flap viability and mitigate surgeon-related factors.

Objective: This study is to describe the two-stage technique to improve flap survival in bilateral DIEP flap reconstructions and to report the results in a center with limited hours and resources.

Methods: A retrospective case series included women aged≥18years who underwent two-stage bilateral DIEP flap procedures, either immediately or delayed, from January 2021 to July 2024. Key variables assessed included flap success rates, demographics, risk factors, complications, and surgical times.

Results: Twenty breasts were reconstructed in 10 patients. The mean age was 49.5years, 4 were smokers, 3 had prior abdominal surgeries, and 7 had received radiotherapy. The first-stage surgery averaged 145.5minutes, with a 4.3-day interval before the second stage, which lasted 243minutes. The overall flap success was 100%, with one case of partial flap loss, which did not compromise the final outcome. Complications included wound dehiscence (10%) and venous congestion (5%). The average hospital stay was 9.6days.

Conclusions: The two-stage DIEP flap technique is a viable option for high-risk patients, yielding satisfactory outcomes and reducing complications. This method addresses surgeon-related challenges, enhancing overall results. Further research on flap delay in free flaps is recommended for improved practices in difficult settings.