Chirurgie plastique humanitaire. Expérience personnelle et réflexions

After analysing their concept of humanitarian plastic surgery, the authors present their personal experience which started in the 1970s, concerning two aspects: in the field (Burkina-Faso, Mali, Niger) and in Geneva, Switzerland, where the more difficult cases are operated. They illustrate their approach by a clinical case of sequelae of noma. They analyse the problems and/or questions raised by humanitarian plastic surgery: sufficient training, choice of surgical techniques, postoperative follow-up, assessment of the results obtained, possible innovations

Infection in breast implants

Infection is the leading cause of morbidity that occurs after breast implantation and complicates 2.0-2.5% of interventions in most case series. Two-thirds of infections develop within the acute post-operative period, whereas some infections may develop years or even decades after surgery. Infection rates are higher after breast reconstruction and subsequent implantation than after breast augmentation. Risk factors for infection associated with breast implantation have not been carefully assessed in prospective studies with long-term follow-up. Surgical technique and the patient's underlying condition are the most important determinants. In particular, breast reconstruction after mastectomy and radiotherapy for cancer is associated with a higher risk for infection. The origin of infection in women with implants remains difficult to determine, but potential sources include a contaminated implant, contaminated saline, the surgery itself or the surgical environment, the patient's skin or mammary ducts, or, as suggested by many reports, seeding of the implant from remote infection sites. Late infection usually results from secondary bacteraemia or an invasive procedure at a location other than breasts. Diagnostic and management strategies are proposed and the value of peri-operative surgical prophylaxis is revisited. The current hypothesis of the possible role of low-grade or subclinical infection in the origin of capsular contracture is also reviewed

Reconstructionlabiale dans les séquelles du noma

Noma is a grangenous stomatitis which might extend to other facial structures leading to extensive soft tissue and bony defects. Reconstruction of noma sequellae should take into account a few principles in relation to the particular aspect of this disease: (1) correction of the mandibular constriction; (2) removal of scar tissue in order to recreate the initial defect; (3) reconstruction of the missing bony framework; (4) reconstruction of the maxilla and upper lip before building the nose in case it is destroyed; (5) anticipation of the facial growth. Reconstruction of the lips, in case of extensive defects often necessitates a distant skin flap. As free flaps, the forearm fascio-cutaneous flap or the serratus musculo-cutaneous flap were used according to the size of the defect. The mucosal part of the lip is usually reconstructed with a local flap from the adjacent lip or an heterolabial flap (Estlander flap)

Expansion labiale

Lip expansion is an old procedure used by some ethnic groups to follow traditions of their ancestry. Medically speaking since the beginning of the XIXth century, various devices have been designed for distending the angles of the mouth in order to recreate the normal width of the mouth aperture. In the recent years, thanks to the development and refinements of new flaps, expanding the lips is rarely necessary. In proper indications however, specially in the vermillon border, lip expansion remains a good indication