Annales De Chirurgie Plastique Esthetique最新文献

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.

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.

Introduction: Complete hand degloving injuries are traumatic avulsion injuries causing the skin to pull away from the underlying tissues and are most often caused by industrial machinery. We present the case of a degloving trauma of the whole fingers, hand, and wrist resulting in a "watch hand" by analogy with the "ring finger" and discuss alternatives and recommendations from the rare cases described of similar traumas.

Case presentation: A 33-year-old manual worker, a non-smoker with no significant medical or surgical comorbidities, was admitted for a complete skin avulsion of the left hand and wrist following a work-related accident with a trommel-type industrial roller. Our approach covered the five fingers and the dorsal aspect of the hand and wrist with an artificial dermal matrix, while the palmar side of the hand and wrist was covered with a pedicled groin flap in emergency. At 15months, the patient's sensitivity was classified as S1 on the sensory evaluation scale, joint mobility was less than 30°, and the residual hand retained what we might call "basic" functions, i.e., a counterweight when carrying loads and the ability to pick up and hold a light object in the thumb-index grasp.

Conclusion: Complete soft tissue hand defects are exceptional and require urgent treatment. If re-implantation is not possible, combining a dermal matrix with a pedicled flap is a simple salvage solution. The risks of vascular, infectious, and stiffening complications in these traumas are high and must be prevented. Patients must be warned of the severity of the trauma, the need for secondary surgeries to restore a policy-digital grip, and the poor functional results expected.

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.

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:

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.

Purpose: There is no consensus on the utility of postoperative antibiotherapy in hand infections after surgical management. The aim of this study was to evaluate if the absence of postoperative antibiotic therapy was detrimental after surgical treatment.

Methods: We included 287 patients operated on for a hand infection between January 2018 and October 2023. Preoperative or postoperative antibiotic prescription was collected for every patient. Patients cured for their infection with a single surgery were classified as "simple evolution", while patients requiring repetitive surgery or who had at least one complication directly linked to the initial infection (extension of infection or necrosis) were considered "complicated".

Results: From a total of 287 patients, we included 188 paronychia, 40 phlegmons, 47 abscesses and 12 superinfected wounds. The revision surgery rate was 9.4%, and the complication rate was 27.2%. One hundred and seventeen (40.8%) patients received preoperative antibiotic therapy from emergency physicians or general practitioners, among whom a complication rate of 31.6% was observed. The causal link did not reach the significance threshold for the whole group of patients (P=0.079). However, preoperative antibiotic use in phlegmon patients was directly correlated with the occurrence of at least one complication (P=0.032). In all, 82.9% of patients did not require postoperative antibiotic therapy, 95% of whom had an uncomplicated course.

Conclusions: Preoperative probabilistic antibiotic therapy is an independent risk factor for complications, particularly if given at a collected stage. Antibiotics should not be routinely prescribed postoperatively in a correct debridement is performed. We recommend that antibiotics be used only in very specific cases (osteitis, arthritis, necrosis and/or high-risk patients).

Background: Pseudoxanthoma elasticum (PXE) is a hereditary disorder of connective tissue characterized by progressive calcification and fragmentation of elastic fibers, which primarily affects the skin, retinal and arterial walls. Skin damage takes the form of yellow papules that can merge to create a cutaneous fold. This is accompanied by an excess of skin on the different sides of the neck and in the largest folds. These changes to the skin have a significant aesthetic, functional and psychological impact, especially among women.

Patients and methods: We evaluated the treatment options in all patients with PXE of our University-Hospital. This group contains people who have been hospitalized for the assessment of their disease and applicants for surgical correction. The goal of the surgery was not the total removal of the lesions but instead a decrease in their size and a tightening of the skin.

Results: In total, 250 patients were seen between 2007 and 2022. Surgical treatment was advised for 29 women and 1 man. The main interventions were based on standard techniques such as cervico-facial facelifts, brachioplasties and cruroplasties. The results obtained during postoperative follow-up consultations were rated satisfactory to very good, both aesthetically and functionally. There were no postoperative complications recorded: neither bruising nor scarring issues. Patients with PXE heal as normal.

Conclusion: Surgical treatment for excess skin observed during PXE is poorly described. Yet, these excesses can be removed when they become troublesome by making use of and adapting the traditional methods of plastic surgery for tightening of the skin.

Introduction: Persistent postburn flexion contractions of the digits present challenging deformities. The surgical goal is to lengthen the linear scar band on the flexion surface of a finger through local tissue rearrangement using different z-plasty techniques. This study aimed to analyse the length gain and compare outcomes between 5-flap z-plasty and double serial z-plasty techniques for correcting digital flexion contracture.

Patients & method: This retrospective study was conducted from November 2022 to January 2024 on patients who presented with digital flexion contractures caused by volar linear scar contracture and who needed surgical intervention. All patients who underwent correction via the 5-flap z-plasty or double z-plasty technique were categorized into two groups.

Results: A total of 12 patients were included in this study. All patients successfully achieved complete release of their digital contracture in both groups. While there was a significant increase in the length of the contracture band and extensor lag angle postoperatively in both groups, the mean increase in band length for patients treated with five-flap Z-plasty was significantly greater than that for patients treated with double z-plasty (63.667±13.125% vs. 41.333±12.1764%, respectively).

Conclusion: The 5-flap Z-plasty technique could be a more favourable alternative to the frequently used double z-plasty method due to its ability to achieve a superior rate of elongation in the contracture band and restore finger function when treating linear digital flexion contractures.

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.