Annales De Chirurgie Plastique Esthetique最新文献

Background and objectives: Sensibility of the breast area is a key factor in quality-of-life evaluation after breast reconstruction (BR). Breast sensation can be assessed using numerous tools that are already largely described in the literature, including the Semmes Weinstein filaments which remain the most frequently used. Although different reconstruction techniques are available, post-BR sensitivity is rarely described. The aim of this study was to evaluate post-BR sensibility of the breast according to each reconstruction technique.

Material and methods: Fifteen patients were included in each group, i.e. 90 patients in total: before BR, Latissimus Dorsi (LD) flap with implant, LD flap with fat grafting, exclusive fat grafting, Deep Inferior Epigastric Perforator (DIEP) flap, implant. A single evaluator assessed the sensibility with Semmes Weinstein filaments testing 7 zones on both sides. The native breast was considered as control. Various potential confounding factors were collected.

Results: Patients who benefited from BR with fat grafting alone had a significantly better sensation of the reconstructed breast compared to the other groups (DIEP flap (P<0.0001), LD flap+implant (P=0.0013), LD flap with fat grafting (P=0.0073), implant (P=0.00315)). Comparing those results to the ones obtained in the group before reconstruction, only the fat grafting and DIEP flap groups showed a difference, the fat grafting group (P=0.0061) had higher sensibility whereas DIEP flaps were less sensitive (P=0.00233).

Conclusion: We compared mammary sensibility depending on the BR technique used. Our study is the first comparing breast sensitivity among all major breast reconstruction methods. Fat grafting resulted in better breast sensitivity in delayed breast reconstruction than implant or flap-based BR.

Background: Traumatic injuries and penetrating traumas of the upper limb are at high risk of combined neurovascular lesion, due to anatomical proximity of main vessels and nerves. Occasionally, post-traumatic pseudoaneurysms or thrombi can develop in the site of trauma or surgery; these vascular complications represent a real urgency and require an accurate and timely diagnosis. The neurophysiological investigation still represents the gold standard for quantification, localization of nerve injuries and outcome prediction.

Methods: We reviewed a database of cases of upper limb trauma from the last two years with concomitant vascular and nervous damage evaluated using a combined ultrasound imaging/neurophysiological approach. Furthermore, among these, we have selected two emblematic cases of proximal upper limb injury with late-onset of vascular complications which came to our attention almost a month after trauma. Compound motor action potentials (CMAP) and sensory nerve action potentials (SNAP) were recorded by superficial electrodes and compared with the contralateral electrodes to estimate the percentage of affected fibres and possible recovery. Maximal cross-sectional area (CSA) of each nerve in the traumatic site and in the typical entrapment zones was recorded measuring at the inner hyperechogenic part of each nerve. Finally, a literature review was conducted.

Results: Our study confirms the importance of the use of electrophysiology in the diagnostic process of post-traumatic nerve injuries, with a diagnostic accuracy that increases significantly if associated with ultrasonography possibly integrated by Doppler.

Conclusions: The results reported in this study are very encouraging in the combined use of neurophysiology and ultrasonography in the approach to upper limb trauma with concomitant vascular and nervous damage; larger-scale studies are desirable to strengthen results.

Facial lipoatrophy, a sign of normal aging, also occurs due to lipodystrophy from metabolic disorders affecting lipogenesis. It can be hereditary or acquired, localized or generalized. In HIV patients, prolonged antiretroviral therapy (ART) is a major cause, affecting around 55% of patients with 47% experiencing facial lipoatrophy. The exact changes in adipose tissue in HIV patients are unclear. Atrophic areas show immature adipose tissue, inflammation, and increased apoptosis. NRTIs cause mitochondrial toxicity, leading to energy depletion and adipocyte apoptosis. PIs disrupt protein expression related to adipocyte metabolism, causing apoptosis and metabolic issues. Lipoatrophy leads to fat loss in the cheeks, temporal, and sub-zygomatic regions, resulting in a cachectic appearance. Despite severe lipoatrophy, Bichat's fat pad often remains unaffected. Various scales assess lipodystrophy severity: James Scale, Fontdevilla Scale, Funk Scale, Facial Lipoatrophy Scale. Facial lipoatrophy significantly impacts patients' quality of life, leading to poor body image and depression. The MOS-HIV and ABCD questionnaires assess the impact on quality of life. Several therapeutic options are described: antiretroviral switch, growth hormone, glitazones, excision and suturing, human cadaveric dermis and Fascia, dermafat, fillers, lipofilling, implants and flaps.

Patients who underwent cleft lip surgery in childhood may develop nasal malformation later in life. Various procedures have been described to correct these malformations. This study aims to describe our surgical approach and assess the morphometric outcomes of secondary cleft-lip rhinoplasty performed at the plastic surgery department in Marseille between 2002 and 2022. We conducted an analysis of surgical procedures and nasal morphometrics results by measuring pre- and postoperative images. Both surgical procedures and nasal morphometric analyses have been performed. This study included 43 patients, with 70% presenting unilateral cleft lip and 30% bilateral cleft-lip. An open approach was performed in 90% of cases. Regarding the surgical steps, a tip rhinoplasty, tip reinforcement, and crus lateral reinforcement by cartilage grafting was performed in 98%, 96%, and 32% of cases. A septal extension graft, a columellar strut, and a "tongue in groove" technique were performed in 54%, 33%, and 4% of cases, respectively, to reinforce the tip. Cartilage harvested from the nasal septum, ribs, and ear was utilized in 44%, 23%, and 20% of cases. An osteotomy, septoplasty associated with a spreader-flap, alar base reduction, and alar to triangular cartilage fixation were performed in 67%, 79%, 16%, and 16% of cases. All pre- and postoperative nasal morphometrics measurements have demonstrated a statistical significant improvement in nasal morphology following surgery. An open approach rhinoplasty, facilitating alar cartilage dissection and reinforcement by septal, rib, or ear cartilage is crucial to preserve postoperative outcomes. Our technique enables favorable mid-term results on secondary cleft-lip rhinoplasty.

In the literature, we do not find any published study on the clinical signs of thermal skin burns in the acute phase in black-skinned patients. The present study, which fills this gap, reports for the very first time the results of clinical observations in 214 black-skinned burn victims. This was a prospective study that collected the clinical signs of burns in the acute phase. This study included all burn patients with black skin who consulted in the acute phase without initial local treatment and whose burn was less than 4hours old. It covered a period of 13 years, from January 1st, 2011 to December 31st, 2023. Males (54.6%) and children aged 5 years and under were the most affected (46.3%). Boiling liquids were the most common causative agent (67.4%). Burns of 20% or more of the body surface area represented the largest proportion (39.1%) followed by those between 10 and 19% (35.5%). All 214 patients included in the study had at least one first-degree burn and there were several associated degrees. Second-degree burns, as a whole, were also among the most encountered, i.e. 89.1% of cases. In our burn patients with black skin, we observed some clinical differences in the assessment of burn depth with the description reported in the literature. The erythema described in first-degree burns on "white" skin was reflected in the burned patient with black skin by a dark, darker or grayish appearance of the skin; and the dermis for second- and third-degree burns appeared whiter in patients with black skin compared to patients with "white skin". The semiology of thermal skin burns in the acute phase should be revisited and adapted to the patient's skin color.

Introduction: The anterolateral thigh flap is sometimes harvested with a portion of the quadriceps muscle fascia, which can lead to muscle hernias or adhesions at the donor site. Studies report an 11 to 32% incidence of muscle hernias and an 8 to 26% incidence of persistent weakness at the donor site. There is no data in the scientific literature presenting a surgical technique for the prevention of muscle hernias at the donor site of the anterolateral thigh flap. The objective of our study is to describe our technique for placing a synthetic mesh when closure of the fascia is not possible during the harvesting of an anterolateral thigh flap, in order to reduce the risk of postoperative muscle hernias and to analyze its benefits.

Materials and methods: As part of a prospective study, we present here our technique for reconstructing the fascia by placing a non-resorbable synthetic mesh.

Results: Twenty-two patients underwent the placement of a mesh for the reconstruction of the fascial defect, which averaged 9.6cm. One year after the procedure, none of the patients presented with a muscle hernia or adhesions at the donor site.

Discussion: According to studies, muscle hernias and scar adhesions occur in 11 to 32% of cases and are both unsightly and disabling for patients. Although it is difficult to quantify the benefit in terms of muscle strength, fascia reconstruction effectively prevents this type of complication. When the defect is greater than 8cm, we believe it is essential to reconstruct the fascia during harvesting to prevent the occurrence of hernia or adhesion at the donor site. While not affecting limb function, muscle hernia is at least aesthetically bothersome and should be systematically prevented.

Conclusion: Reconstruction of the muscle fascia at the donor site of the anterolateral thigh flap with a non-resorbable synthetic mesh, in cases of a defect greater than 8cm, prevents the occurrence of muscle hernias and adhesions, which can lead to aesthetic and functional complications.

Vascularized composite allografts (VCA) encompass the face, upper limb, trachea, penis, abdominal wall, and, more recently, uterus transplants. They offer unique reconstructive possibilities to overcome the limitations of traditional reconstructive techniques. Unlike solid organ transplants (heart, liver, kidney, lung, etc.), VCA is not generally performed in a life-threatening situation but aims to improve quality of life, at the cost of a major constraint to its expansion: the need for lifelong immunosuppressive treatment. Nevertheless, VCA is considered one of the five most important innovations of the modern era of the discipline, and a worldwide survey of plastic surgeons has confirmed that significant changes in reconstructive surgery will be related to VCA in the future. France pioneered this type of transplantation by successfully performing the first VCA (unilateral hand transplant), the first double hand transplant, the first face transplant, the first face retransplant, and the first bilateral shoulder and arm transplant, and continues to demonstrate unprecedented surgical prowess. This activity continues to expand across the country, with active VCA programs notably in the upper limb, face, uterus and penis. This article aims to provide an update on the clinical advances made in France in the field of composite tissue allografts.

Peripheral facial palsy (PFP) is an alteration in the functioning of some facial muscles following an injury to the facial nerve. This pathology has functional and aesthetic consequences that impact the quality of life of patients. Their care is essential and begins with an accurate assessment. Currently, scoring scales such as Sunnybrook Facial Grading System (SFGS) or House-Brackmann Grading System (HBGS) are used, based on clinician judgment. However, these evaluation methods can be subject to a certain degree of subjectivity. Recent advances in technology have led to increased interest in artificial intelligence (AI). AI could make it possible to develop an objective, automated and quantitative assessment tool, applicable in a clinical setting. This approach aims to reduce the subjectivity induced by current evaluation. We conducted a retrospective study of 38 patients with moderate-severe to total PFPs. The objective of the study is to identify the benefits and limitations of Emotrics+, a facial metrics tool based on AI, in order to determine whether the tool is applicable in the clinic. This protocol took place at two different time periods (14days and 1year post-PFP) using the SFGS scale and the Emotrics+ software. We evaluated the inter-rater and intra-rater reliability in order to determine the reliability and the reproducibility of the two tools. Then, we established a correlation between the two tools to determine if Emotrics+ followed SFGS's trend. Our currents results do not support the immediate applicability of this software. However, with appropriates adjustments, Emotrics+ has a certain potential.

Purpose: To investigate the leg perforator arterial system, identify the perforator flap's pedicle artery and its projected cutaneous point using a 320-slice computed tomography (CT 320) scanner.

Methods: A total of 24 patients with leg soft-tissue defects unilaterally underwent 320-slice CT angiography scanning (CTA 320) with 47 legs. The used method enabled investigation of the perforator arteries originating from the tibial, peroneal arteries, perforator flap's pedicle artery and its projected cutaneous point. These data were used to preoperatively design an improved flap. Then, the CT-confirmed location and length of the flap's pedicle artery were compared with intraoperative findings.

Results: Findings of the CTA 320 on 47 legs showed that 217 perforator arteries with diameters of ≥0.5mm were detected; the average number of arteries per leg, their average length and diameter were 4.6±2.1, 30.7±10.4mm and 1.16±0.27mm, respectively. The perforator arteries originating from the anterior tibial artery were mainly distributed in the proximal and middle thirds of the leg. Perforators from the posterior tibial and peroneal arteries were distributed abundantly in the middle and distal thirds of the leg. As identified in the CT, the location and length of the flap's pedicle artery and its projected cutaneous point were consistent with those observed during the surgery.

Conclusions: The CTA 320 is a minimally invasive imaging method that provides high-quality images of the leg perforator arterial system and can identify the exact location and projected cutaneous point of the perforator flap's pedicle artery.