Reconstruction esthétique des parties molles de la région fronto-temporale

La région fronto-temporale est une sous-unité esthétique dynamique très riche en expression. Les défects au niveau de cette localisation sont fréquents et très variables et il existe de nombreuses options thérapeutiques pour une réparation satisfaisante. La reconstruction de la région fronto-temporale doit être absolument maîtrisée. Après un rappel sur l'anatomie de la région frontale puis temporale, les différentes techniques générales de réparation seront détaillées. Les spécificités de la reconstruction de la région fronto-temporale seront ensuite abordées et les différents procédés seront décrits en fonction de sous régions prédéfinies. Le but de cette étude est d'essayer d'expliquer les différentes options thérapeutiques existantes et réaliser un algorithme des techniques qui nous ont parus les plus pertinentes en garantissant un résultat à la fois fonctionnel et cosmétique de qualité.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Lambeau libre de fibula en reconstruction osseuse des membres (à propos de 25 cas)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Recent advances in trigonocephaly

International audienceIntroduction - The aim of this review was to report on recent advances in trigonocephaly since the last report on craniosynostosis published in 2006.Material and methods - The review was conducted in accordance with the PRISMA guidelines. Research focused on four main topics: epidemiology, neurodevelopmental disorders, genetics and surgical techniques.Results - Forty reports were included. The prevalence of trigonocephaly increased during the last two decades both in Europe and in the United States, but no clear contributing factors have yet been identified. Neurodevelopmental disorders are frequent in syndromic trigonocephaly and not particularly rare in non-syndromic cases (up to 34%). Developmental retardation (speech, motor or global) was almost always present in children exposed to valproic acid. Chromosomal abnormalities described in metopic synostosis comprised deletion of chromosome 11q24, deletion or trisomy of 9p and deletion of 7p, deletions of 3q, 13q, 12pter, 22q11, and duplication of 15q25. SMAD6 mutations should be systematically screened for in familial cases. Recent advances in surgical techniques have mainly concerned endoscopic-assisted procedures, as they significantly reduce perioperative morbidity.Conclusions - Neurosurgeons, maxillofacial and plastic surgeons will be increasingly concerned with trigonocephaly because of the increase in prevalence observed over the last two decades. Cytogenetic alterations are probably underestimated in this craniosynostosis, considering the high rate of neurodevelopmental retardation compared to other single-suture synostoses. Genetic counselling is therefore more and more effective in this pathology. An objective method to evaluate the cosmetic results of both endoscopic and open surgeries is necessary, as some under-corrections have been reported with minimally invasive surgery

Non-congenital dorsal tumefaction with rapid growth in a young child identified as an intramuscular hemangioma

International audienceHere we report the case of a 3-year-old child who had an intramuscular hemangioma presenting as a rapidly growing mass

Exérèse des nævus congénitaux géants : jusqu'où aller avec la chirurgie ? [Surgical excision of giant congenital naevi: how far can we go with surgery?].

International audienceSurgical excision of giant congenital nevi is recommended by principle for dermatological reasons. Malignant potential is real but its incidence remains widely discussed. Their excision represents a surgical challenge but is also a real assault course for the child and his family. The sequelae and the psychological effects can be important. Can an incomplete excision to limit these aesthetic after-effects and relieve the surgical treatment be acceptable? We present the case of a child affected by a giant congenital nevi of the cephalic extremity where the excision was partial. A review of the literature on the degenerative risk of the giant congenital nevi allowed us of noticed that this one tends to be overestimated. The advantages and the disadvantages to practise a preventive, premature excision and complete of the giant congenital nevi are approached. We discuss the possibility to resort to a partial excision in certain cases delicate of reconstruction under the cover of a strict and moved closer dermatological surveillance

Safe monsplasty technique

International audienceIntroduction - To improve their health and quality of life, obese patients undergo consultation after weight loss. In these patients, the sub-umbilical abdominal and pubic regions are often characterized by redundant skin, creating aesthetic and functional discomfort. Monsplasty is an important step in abdominoplasty or bodylift procedures. We report on an original technique used to correct deformity in the pubic region following weight loss. Methods - All interventions were performed by the same surgeon between April and December 2015. On stretched skin, we drew two lines 5 cm lateral to the median line on both sides and connected them with the arc of a circle placed 7 cm from the vulvar fork. Then, monsplasty marks extend to abdominal fold. During lower abdominal contouring, we performed monsplasty with three separate stitches between the camper fascia and aponeurosis of the abdominal muscle. The aim was to bring tension to the pubic region without additional surgical procedure. Results - We report on 21 consecutive cases of monsplasty following lower trunk contouring. No reoperation was performed due to complication or aesthetic demand (no under- or over-correction occurred). No complication (e.g. edema, seroma, disturbance of sensibility) was observed in the pubic area. The results were stable 1 year after surgery. Conclusions - We report on a simple, rapid, and reproducible monsplasty technique for all stages of Pittsburgh classifications, which achieved favorable results with no complication. We recommend performance of this effective technique simultaneously with abdominoplasty or bodylift procedures. Level of evidence - IV

Does the participation of a senior plastic surgeon improve perioperative care in craniosynostosis repair surgery?

International audienceINTRODUCTION: The real impact of the participation of other surgical specialties together with neurosurgeons on perioperative care in craniosynostosis repair surgery has not been determined. The purpose of this study was to determine whether the participation of a second senior surgeon (plastic surgeon) during surgical repair of pediatric monosutural craniosynostosis improved perioperative medical care. MATERIAL AND METHODS: The authors retrospectively reviewed 2 cohorts of patients who had consecutively undergone primary repair surgery for trigonocephaly and unicoronal craniosynostosis. Infants were operated on by a single senior pediatric neurosurgeon before December 2017, and with the collaboration of a senior plastic surgeon after January 2018. RESULTS: Overall, 60 infants were included in the study: 29 in group 1 (single surgeon, 2011-2017), and 31 in group 2 (pair of surgeons, 2018-2021). Median surgery time was significantly shorter in group 2 than group 1: 180 vs 167 minutes; p = 0.0045. There was no significant difference between the 2 groups in blood loss or intra/postoperative packed erythrocyte transfusion. Postoperative drain output was significantly lower in group 2. Median length of hospital and intensive care stay were significantly shorter in group 2, by 1 and 2 days, respectively; p < 0.0001. Volume of infused solution, diuresis, immediate postoperative hemoglobin level, hematocrit, hemostasis (platelet count, fibrinogen, prothrombin time and activated partial thromboplastin time), and return to oral feeding did not differ from one group to the other. CONCLUSION: Results confirmed our impression of an improvement in perioperative medical care. However, the role of surgical experience and the influence of the medical/nursing staff must not be minimized in these complex surgical procedures

Impact of Lipo-Body Lift Compared to Classical Lower Body Lift on Postoperative Outcome and Patient's Satisfaction A Retrospective Study

International audienc