Annales De Chirurgie Plastique Esthetique最新文献

Objective: To evaluate, in long-term, the functional abilities and the occurrence of osteoarthritis in patients treated for a posterior perilunate carpal dislocation without bone lesion associated.

Patients and method: This was a monocentric retrospective observational study on patients operated on at the University Hospital of Guadeloupe for a posterior perilunate dislocation without bone lesion associated with a minimum of 18years of follow-up. Ten patients were included with a mean follow-up of 22.8years. The evaluation criteria were clinical (PRWE, QuickDASH, pain, grip strength, wrist joint mobility, Watson and Reagan tests, Cooney functional score) and radiographic (Gilula curves, carpal height, carpal ulnar translation, scapholunate and radiolunar angles, scapholunate and triquetro-lunar interlines in statics and dynamics, Herzberg's classification of complications).

Results: The average Cooney score was 67.5/100. Mean PRWE and QuickDASH scores were 33.9 and 24.8 respectively. The mean flexion-extension arc on the injured side was 71.5° (66.7% compared to the healthy side). Mean grip strength was 27kg (72.8% compared to the healthy side). The prevalence of osteoarthritis was 60%, with three A types, two A1 types, one B type and four B1 types according to Herzberg.

Conclusion: The factors influencing the long-term prognosis are the initial displacement of the lunate, the quality of the reduction and the presence of chronic carpal instability, particularly scapholunate. The high prevalence of osteoarthritis in our series (60%) is apparently not correlated with the functional capacities of patients over the long term.

Level of evidence: 4:

Reconstruction of the chin region represents a technical challenge due to its three-dimensional configuration and its location close to the mouth. It requires both a functional approach by restoring mobility and an aesthetic approach by restoring the perioral furrows. For men who want to wear a beard, it becomes more difficult to choose the donor site for hairy skin. In that case, strategies of full thickness skin graft or pre-expanded loco-regional flaps are unusable. We propose here a functional, aesthetic and hairy reconstruction by performing a pre-expanded temporal free flap which allowed to resolve the problem of adjacent cervical contractures and to restore an integrated the bearded chin subunit.

Introduction: The success of surgeries involving free flaps largely depends on accurate preoperative mapping of perforator arteries. Various imaging techniques, such as Doppler ultrasound and CT angiography, are typically used, each having its advantages and disadvantages in terms of cost, accuracy, and patient risk. The main objective of our study is to compare the effectiveness of the FLIR One device for detecting these arteries compared with traditional methods. Thermal imaging appears to be a simpler, less expensive, and less invasive alternative for surgical planning.

Material and method: The study, conducted at the Regional Hospital Center of Nancy, included 25 free flaps (DIEP) on an exclusively female cohort of 22 patients, with follow-up from 2022 to 2023. Before the procedure, an abdominal-pelvic CT angiography was performed, followed by additional evaluation with thermal imaging using FLIR One and acoustic Doppler examination on the eve of the operation. This approach aimed to provide precise mapping of vascular perforators for each patient. Three different operators performed these markings, and the results were then compared with intraoperative observations. The imaging protocol also included a Doppler examination to validate the results of the thermal imaging. Statistical analyses with intraclass correlation coefficients (ICC) were performed to evaluate the correlation between different preoperative localization methods of perforating vessels.

Results: In 22 patients undergoing 25 DIEP flaps for breast reconstructions, three imaging techniques were used to identify vascular perforators: thermal imaging with FLIR, acoustic Doppler, and CT angiography. FLIR identified the most perforators (n=137), followed by acoustic Doppler (n=128) and CT angiography (n=126). Comparing these with intraoperative results, 66% of perforators identified by FLIR were confirmed, 70% for acoustic Doppler, and 95% for CT angiography. The ICCs shows a significant correlation between these imaging techniques and intraoperative results. FLIR demonstrated a strong correlation with intraoperative observations (ICC of 0.74, P<0.001), followed by a moderate correlation with acoustic Doppler (ICC of 0.56, P<0.03) and CT angiography (ICC of 0.52, P<0.006).

Conclusion: The study concludes that thermal imaging with FLIR is a reliable and effective tool for locating vascular perforators. Although the study and FLIR have their own limitations, the tool presents several advantages such as ease of use, speed, and affordability. These characteristics make FLIR particularly attractive as a complement to traditional detection methods, such as acoustic Doppler and CT angiography.

Introduction: Federation of Hand Emergency Services (FESUM) is a European network of hand emergency centers (called SOS hand centers) in France, Belgium and Luxembourg. The FESUM network includes 64 SOS Hand centers in France. In our university hospital, the FESUM-certified SOS hand has been part of the plastic surgery department since 2001. It has included, since 2016, postgraduate students ("residents") training in hand surgery who participate independently in the patient follow-up. The objective of this study was to analyze the characteristics of this population of patients with hand injuries and their satisfaction with this mode of follow-up. The secondary objective was to study the characteristics of the patient population treated by our center.

Material and method: We conducted a study on the follow-up of patients undergoing emergency hand surgery, prospective, single-center, declarative, anonymized, between May and October 2021 at the SOS main center of our university hospital at the "SOS Main" intern consultation. The demographic data, the main characteristics of the pathology, the elements of initial care and follow-up of the patients as well as their satisfaction were analyzed, as well as the satisfaction of the interns.

Results: We included 323 patients. The population of patients treated generally corresponded to a young man, manual worker, who was initially treated in an outpatient department or in an SOS Hand consultation. The lesions most often represented were fractures (24%), tendon wounds (18%) and wounds without damage to noble tissues (16%). Follow-up consultations took place mainly 15days after the emergency intervention, lasted on average 10minutes and did not present excessive delays. Patient (91.2%) and post-graduate student (87.2%) satisfaction was high. However, postoperative physiotherapy follow-up was insufficient, as was self-rehabilitation.

Conclusion: The integration of post-graduate student in a university plastic surgery department into the care of SOS Hand patients seems beneficial for all those involved, and for their training. The characteristics of the follow-up consultations by the intern in autonomous supervision corresponded to the high quality standards of the FESUM. The patients showed a high satisfaction rate. Better valorization of this consultation in "office surgery" should be considered.

There is more and more non-invasive treatment proposed in face rejuvenation. However, there are only a few treatments that decrease volume of the tissue efficiently. Submental liposuction is not classically considered as a non-invasive treatment.

Material and method: We reviewed from October 2020 until August 2022; 695 patients were operated by the first author under local anesthesia.

Results: Complications exist but are minimal. The most important is irregularity that can be managed by massage and ultrasound treatment.

Discussion: With our experience of over 600 cases, we believe that submental liposuction should be considered and proposed to patient as non-invasive before of this efficiency and very low drawbacks, was presented.

We report on using a pedicled posterior brachial perforator flap to cover a defect of the infraspinous fossa. The first description of the posterior brachial flap came from Masquelet in 1985, and there are very few reports of this flap in the literature, mainly in its pedicled form limited to axillary covers. Scapular soft tissue defect with bone exposure can be covered by several techniques. However, in the event of scapular radiotherapy, some conventional flaps used to cover this type of skin defect may have their pedicle damaged. The posterior arm flap was designed along a line joining the apex of the axillary fossa to the epitrochlea, opposite the medial brachial intermuscular septum. The width of the paddle was defined by a pinch test. The dissection was retrograde, subaponeurotic down to the medial brachial intermuscular septum. To our knowledge, this report is the first to describe the use of this flap to cover the scapular area; the outcome was excellent, with a low donor site morbidity.

Genital gender-affirming surgery (GAS) plays a crucial role in alleviating psychological discomfort and assisting transgender patients in achieving their transition goals. One of the most common procedures for primary genital reconstruction in transwomen is penile inversion vaginoplasty. But it presents a risk of vaginal stenosis and limited depth, particularly in cases with inadequate penile and scrotal tissue. This limitation becomes more relevant as transgender individuals increasingly seek early hormone therapy and puberty blockade. We conducted a literature review focusing on studies published between 2000 and 2022 to explore the application of peritoneal vaginoplasty, a technique primarily used in cisgender women with congenital vaginal agenesis, to address these challenges in transwomen. Data were extracted from 13 selected articles reporting 313 patients who underwent peritoneal vaginoplasty. Peritoneal vaginoplasty was found to offer advantages in terms of neovaginal depth and width, with an average depth of 13.8cm and width of 3.5cm. Patient reporting satisfaction rates for sexual intercourse and dilatation achievement were high, with 96.2% and 94.4% respectively. The technique did not result in an increased rate of complications compared to traditional penile inversion vaginoplasty. This review suggests that peritoneal vaginoplasty could be consider first for transwomen genital GAS, especially in cases with limited penile tissue. The well-vascularized peritoneum provides tissue with regenerative capacities and reduces the risk of stenosis. Moreover, peritoneum remains unaffected by hormonal treatments and allows deep enough neovaginal canals. This method is safe and does not lead to increased complications compared to traditional techniques.

Basocellular carcinomas are characterized by their non-deep spread neoplastic nature. Although treatment typically proceeds without complication, excision in critical facial regions can lead to aesthetically undesirable defects. Furthermore, elderly patients often express aesthetic concerns, particularly regarding the thinning of the upper lip over time. This article presents the case of a 75-year-old patient with a basocellular carcinoma located on the tip of the nose, amidst a history of multiple neoplastic conditions. To address the defect, an inferiorly-based philtral advancement flap was employed, accompanied by a lip lift procedure, resulting in favorable aesthetic and functional outcomes.

The management of congenital syndactylies often requires the use of a full-thickness skin graft to reconstruct the affected web space. Traditionally, full-thickness skin grafts are harvested from the groin region, but using the anterior aspect of the wrist may offers benefits in terms of scar quality while simplifying surgical time. This descriptive study evaluates scar quality (at donor and recipient site) associated with full-thickness skin graft harvested from the volar wrist in syndactyly release. We conducted a retrospective single-center study including patients who underwent syndactyly release with full-thickness skin graft harvested from the anterior wrist. Scar assessment was performed using the Observer Scar Assesment Scale, the Vancouver Scar Scale and the Withey Score. Overall, our results show high scores for scars at both donor and recipient sites. In conclusion, harvesting full-thickness skin graft from the volar wrist in syndactyly release is a simple and effective option for covering defects on the digits, while producing high-quality scars.

Introduction: In Africa, rare publications have focused on phyllodes tumors (PTs). The aim of our study is to describe the special feature of PTs surgery.

Patients and method: Retrospective and descriptive study of 11 cases of PT operated from January 1, 2015 to March 31, 2023 at the medical-surgical clinic in Teaching Hospital Center of Sylvanus Olympio of Lome. The patients had a breast ultrasonography with or without mammography and core needle biopsy. Epidemiological, clinical and therapeutic data were record. The follow up was regularly at 1 month, 3 months and every 6 months.

Results: The PT was 4.9% of breast tumors operated on. The mean age was 29years (range 18 to 61). The 20-30 age group was the most represented in 5 cases. Self-examination of a breast nodule, breast pain, and fear of cancer were noted in 11, 4, and 2 cases, respectively. The mean time to admission was 8 months (range 6 to 18). The mean tumor size was 6.4cm (range 3-11). Breast-conserving surgery was performed in 10 patients and mastectomy in 1 case with R1 resection. We noted necrosis of the areola and nipple plate. The histopathology types are classified into benign (3), intermediate (6) and malignant (2). R1 resection noted local recurrence, then metastatic recurrence and death at 16months.

Conclusion: TPs were described as giant (size greater than 5cm). There is no preset technique to apply. Conservative surgery is our preference while respecting a Ro margin, a breast remaining aesthetic and a lower scar price.