Annales De Chirurgie Plastique Esthetique最新文献

Lip augmentation is a procedure frequently performed by cosmetic physicians, as well as cosmetic and reconstructive surgeons. Atrophy of the lips and the surrounding areas or even in the perioral region is often the result of malformations related to insufficient development of structures during embryogenesis, but also the consequence of tissue aging, which affects patients unequally. The general principle of lip and midfacial augmentation involves injections using needles or cannulas that directly puncture the skin at certain strategic points, in order to correctly position the substance intended to increase tissue thickness. One of the adverse consequences of this approach is sometimes excessive augmentation, which occurs even unintentionally, as it is difficult to precisely control the amount to be injected, even with extensive experience. This is why an alternative approach, which is not new, consists of performing these injections, in certain indications, not transcutaneously but rather intraorally. This approach has already been used for around thirty years by a number of surgeons, notably by a French school of aesthetic surgery and medicine. The depth of the injection is therefore of some interest because it allows for less transformation of the face, since the product will be deposited in contact with the periosteum or soft tissues but relatively far from the skin or labial mucosa. In this technical note, the principles of this deep intraoral injection are detailed, and results are presented as well as rare complications.

Background: Evidence suggests that altering the surface roughness significantly improves implant osseointegration. Enhancing the hydrophilicity of the implants is a similar strategy as hydrophilic surfaces encourage early osseointegration at 14 and 21 days and hasten the bone-healing process after implant placement. Hence, we evaluate and compare the marginal bone level of hydrophilic and non-hydrophilic implants in mandibular implant overdenture.

Methods and material: The study was a non-randomized, prospective split-mouth design with ten patients, each receiving a hydrophilic implant (Group A) and a non-hydrophilic implant (Group B) on opposite sides of the mandibular arch. An implant-supported overdenture was fitted and monitored at baseline, one month, three months, and six months. Marginal bone loss for the early-loaded hydrophilic implant and conventionally loaded non-hydrophilic implant was measured on each side of the mandibular ridge using an XCP holder and RVG radiographs at each interval. Data was obtained and subjected to statistical analysis using the Wilcoxon signed-rank test and Mann-Whitney U test.

Results: Although there was no statistically significant difference in marginal bone loss between the two implants, the hydrophilic implant achieved similar success with a faster healing time compared to the non-hydrophilic implant.

Conclusions: Hydrophilic implants offer a faster-healing alternative to conventional implants for mandibular overdentures.

Introduction: Microsurgery is becoming increasingly important in many surgical specialities. In France, it is taught as part of university certificates (UC), which are organised in different ways. A previous study carried out in 2014 highlighted several challenges, particularly in terms of finance and structure. This study aims to update this data ten years later to analyse the evolution of microsurgery teaching in France and identify future challenges related to new practices and constraints.

Methods: A descriptive observational survey was performed between January and March 2025 at 28 French university hospitals. The educational referents of the microsurgery university certificates were interviewed using a standardised questionnaire covering teaching methods, hours, assessment methods, registration costs and difficulties encountered. The data collected was compared with that of the 2014 study.

Results: Seventeen centres offered a university certificate in microsurgery, including 14 that already existed in 2014. The average number of hours per year decreased by 24%, while the total number of places offered increased by 86%. Assessment methods remained heterogeneous. The average cost of enrolment in initial training increased by 292 euros. The main challenges identified concerned access to animal models, economic constraints and lack of supervision.

Conclusions: Despite a growing interest in microsurgery training, major disparities persist between university certificates. Standardising programmes, optimising resources and introducing a progressive training pathway could help harmonise practices, while addressing current ethical and logistical issues. We therefore suggest a three-stage model (inert materials, living models, advanced training) to structure learning.

To reconstruct a lower eyelid defect involving two aesthetic cutaneous subunits, we propose the use of bilateral upper eyelid dermatochalasis. A homolateral heteropalpebral flap combined with a contralateral upper eyelid skin graft is our first-line option for cutaneous coverage. In the case of full-thickness defects, a composite tarsoconjunctival graft harvested from the three healthy eyelids provides satisfactory and functionally competent tissue reconstruction.

Introduction: Ballistic injuries to the knee present a complex reconstructive challenge due to associated bone, tendon, and soft tissue loss. Early coordinated management between orthopedic and plastic surgery teams is essential to optimize functional outcomes.

Case report: We report the case of a 22-year-old male who sustained a Gustilo IIIb open fracture of the proximal tibia following a gunshot wound, with avulsion of the tibial tuberosity and complete patellar tendon rupture. Initial debridement and negative pressure therapy were followed, 48hours later, by anatomical reconstruction of the extensor apparatus using an iliac cortico-cancellous graft in continuity with a gluteal fascia strip, reinforced with pedicled semitendinosus and synthetic tape. Skin coverage was achieved with a pedicled lateral genicular artery perforator (LGAP) flap. Rehabilitation included immobilization in extension and progressive physiotherapy-assisted knee flexion.

Discussion: At 18months, the patient presented complete wound healing, no pain at rest, and partial recovery of function (extension deficit 10°, flexion limited to 80°). The Knee injury and Osteoarthritis Outcome Score (KOOS) was 47. Early pedicled perforator flap coverage provided reliable soft tissue reconstruction while avoiding the complexity of microsurgical free flaps in this anatomically challenging region. The composite reconstruction restored mechanical continuity of the extensor apparatus, enabling stable joint function.

Conclusion: This case illustrates the feasibility and functional benefit of early, coordinated orthopedic-plastic reconstruction for complex ballistic knee injuries, combining bone-tendon reconstruction with local perforator flap coverage. Pedicled perforator flaps are a valuable option for small to medium-sized skin defects in the knee region.