Dermatofibrosarcoma protuberans of Darier and Ferrand

Individualized as a real anatomo-clinical entity in 1924 by Darier and Ferrand, the dermatofibrosarcoma protuberans is a rare cutaneous tumor of intermediate wickedness, which is characterized by its slow evolution, its local aggressiveness, a high power of recurrence and the rarity of metastases. Our casuistry lasts from february 2001 to october 2010 when 22 cases were supported. We distinguish 15 men and 7 women, whose average age was 42 years, ranging from 11 years to 64 years. Surgical excision of the tumor was large, with safety margins of 5 cm in 21 patients and 3 cm for a neck tumor. Of the 13 patients treated in first intention, none has recurred with a mean of 7 years. Other patients complain only one recurrence. None of our patients presented metastasis. The dermatofibrosarcoma mainly affects young adults with a slight male predominance. Its clinical diagnosis is difficult in the beginning stage, but he is more evident in the state phase. Histology, immunohistochemistry and the immunolabelling of the CD34 antigen, confirm the diagnosis. Different techniques can cover losses of substance caused by this mutilating surgery. Tumors are all of size greater than 5cm. Treatment is always surgical and must satisfy two principles: a wide margin of excision in the area and the sacrifice of a healthy anatomical barrier in depth

Principles of surgical treatment of malignant tumors skin

Malignant skin tumors are the most common human cancers in general, their incidence is steadily increasing due to longer life and behavioral habits, especially repeated sun exposure. We describe a series of 150 cases of skin tumors between October 1995 and January 2007. Most tumors are at the head. The age of the patients ranged from 10-75 years. Oncologic resection must meet specific margins for each type of tumor. The reconstruction is made after histological confirmation. Re We regret no serious complications postoperatively . One case of recurrence in a spinocellular carcinoma of the cheek, 1 year after treatment, is to report. If the vast majority of skin cancer have a good prognosis, their recurrent and multiple character and the fact that they affect more elderly population are so brittle they still represent a serious public health problem . Basocellular carcinomas are the most frequent tumors, they are slow growing, mostly local, which virtually never metastasize . Spinocellular carcinomas have a much more aggressive local development and can metastasize . Melanomas are the most dangerous malignant cutaneous tumors. Dermatofibrosarcoma protuberans never metastasis, its evolution is slow, his aggressiveness is local but has a tendency to relapse .The treatment of malignant skin tumors is surgical in the majority of cases. Oncologic resection must meet specific margins for each type of tumor. The cover is made after histological confirmation, it uses a skin graft or local flap coverage

[Care of a gigantomasty]

This is a rare, benign and of unknown etiology illness that is characterized by abnormal and excessive development of the breasts. It occurs most often during puberty or during pregnancy. Its physical and psychological impacts requires a quick and efficient care. This is a 15 years old patient who received a breast reduction called Thorek. This technique is particularly suitable for the treatment of advanced gigantomasty. The intervention was successful in removing more than 4 kgs in each of two breasts. The postoperative course is simple and the patient is very satisfied with the result with a decline of 18 months. The disease is defined by a breast volume superior to 1500 cm3. This results in a psychological distress and physical discomfort. Its treatment is surgical and involves the reduction mammoplasty that can be either conservative or radical. The most common techniques used are the Mc Kissock and Thorek. Our preference goes to the Thorek because it respects the viability of the areola and minimizes the risk of local complications: oedema, ulceration, necrosis, infection. The technique of Thorek used to treat the gigantomasty of our patient gave satisfactory results in terms of function and aesthetics. However, she remains under regular survey because of recurrences that are common and may require reoperation

[Gynecomastia support]

Called gynecomastia, the hyperplasia unilateral or bilateral, non-tumor mammary gland in men, is observed in adolescent or adult with an important psychological impact. Common condition that always requires an etiological prior to surgery. Mastectomy by periareolar incision and liposuction are often associated in this surgery. We must respect the position specific chest male in the position of the areola. 15 patients operated in service in the period from January 2006 to December 2011, there were three cases with unilateral and twelve cases with bilateral, the average age was 32 years [22-47 years]. An unsightly appearance was observed in all patients. Breast pain was observed in three patients with fear of cancer in one patient. On examination the lymph nodes was free and there were no nipple discharge. Gynecomastia stage II bilateral is the most frequent. Echo mammography was performed in all patients and was normal. Hormonal balance was: Testosterone, Estradiol, LH, FSH, liver function tests. Testicular and abdominal ultra-sonography were good. When idiopathic gynecomastia was observed, the etiological was negative in all patients. Gynecomastia is common in 30% of adults. Which causes the most common were the para-pubertal gynaecomastia, the gynecomastia acquired in adulthood, also referred to other causes such as hypogonadias, hepatic and renal failure, hyperthyroidism and the sexual ambiguity. The gynecomastia is a common reason for consultation in plastic surgery. The surgical technique is based on common principles of breast surgery adapted with some details on the thorax male. Liposuction and mastectomy are often associated. Patients were satisfied to find a male figure, leaving an clear ambivalence that can weigh in their socio-professional activity

[Reconstruction of the lower lip by the Karapandzic flap]

The main etiology of the defects of the face is the excision of skin tumors. Lip reconstruction or cheiloplasty can use several techniques. Karapandzic flap provides good coverage of these losses of substances with good aesthetic and functional results. A 67 years old patient presents a spinocellular carcinoma of the lower lip measuring 4.5 cm × 4 cm. Resection repects a margin of 1cm. A bilateral rotation flap wich incisions are parallel to the free edges of the lips and equal to the height of the defect was performed. A back cut on the mucosal side allows better advancement of the flaps. They are sutured to each other. The postoperative course is simple. The aesthetic and functional results are very satisfactory with a decline of 6 months. This is an excellent technique because it bends to the principles that are functional, morphological and aesthetic. It respects vessels: coronary facial artery, sensory and motor branches of the myocutaneous flap to obtain a buccal sphincter effective immediately. The mouth opening is satisfactory due to the elasticity of the tissue flap. Secondary commissuroplasty is not systematic. Most often, the incision seat in the nasolabial fold and goes higher or lower depending on the size of the defect. The upper limit of the incision is a few millimeters below the nostril. The Karapandzic flap used to the lower lip reconstruction after tumor resection gave good functional, morphological and aesthetic results

[ Mc Kissock breast reduction]

Breast hypertrophy is an excessive volume of breasts compared to the morphology of the woman. Among the many existing surgical techniques to treat it the Mc Kissock technique has widely recognized benefits. This is a 36 years old patient who has breasts hypertrophy, pain, postural changes with an impact on the static spine. The technique of breast reduction used is a vertical bipedicle flap. The postoperative course is simple and the patient is very satisfied with of the results with a decline of 6 months. This technique can be used for all types of hypertrophy. It is characterized by the ease and reproducibility of preoperative design, the simplicity of gesture and high vascular safety. The disadvantages are large inframammary scars and the difficulty of adequately plicaturing the double pedicle in large hypertrophy and ptosis. The Mc Kissock Breast reduction gives good functional and aesthetic results, it is a technique of choice in the treatment of breast hypertrophy

[ bilobed flap in facial reconstruction]

The spinocellular carcinoma occurs mainly after 40 years old. The excision of these tumors in the cause of loss of substances that pose the problem of reconstruction, especially for tumors localized to the face. The bilobed flap is a useful technique to cover the losses of substances. We describe a 72 years old patient who presents an advanced tumor of the right cheek measuring 6 x 4 cm. we performed a resection of the tumor with a safety margin of 1cm. the reconstruction uses the bilobed flap. The postoperative result is very satisfying. More common for men than for women, this tumor is favored by excessive sun exposure, precancerous skin lesions, genetic diseases [xeroderma pigmentosum], chronic irritation [leukoplakia]. Any suspect lesion should be biopsed. The spinocellular carcinoma spreads quickly locally, spreading to some nearby lump nodes. The treatment of choice for this tumor is surgery. The bilobed flap is particularly suited to reconstract the losses of substances of medium or large size localized to the face. The bilobed flap is a very interesting technique to cover the defect left by excision of a spinocellular carcinoma

[ Mustarde flap]

The main cause of substance loss of the face is a removal of skin tumors by surgical excision which remains an essential treatment of skin cancers. The coverage of these losses of substances must comply with functional and aesthetic requirements. We use in our work the Mustarde flap to cover the defect. We describe the case of a patient who suffers of a basocellular carcinoma. The loss of substance left by the excision is 3 x 4 cm. the flap design goes back horizontally 1 cm below the lower eyelid, extending to the temporal region and down to the front of the ear lobe. A large detachment followed by a rotation of the flap can easily cover the defect. The postoperative course are simple. The aesthetic and functional result is very satisfactory. As an incontestable social element, the face requires a functional and also aesthetic reconstruction to be the closest possible to "ad integrum" restitution as the socio-professional pressure is presently considerable. The Mustarde flap is a flap of skin, thick, with large area and inferior pedicle. The flap design goes above and beyond to outer canthus, swells around the temple area and down to the front of the ear lobe. A movement of medial rotation is printed an external cantholysis allows the possible mobilization of the lateral part when it is stored. To avoid ectropion, it should be securely moored at the temporal and orbital periosteum. The wide separation allowed by subcutaneous flap Mustarde can cover large medial, paranasal, losses of substance. The Mustarde flap is a very interesting technique in the treatment of loss of substance of the face

[Areolar approach to augmentation mammaplasty]

Treatment of breast hypoplasya or hypomastia requires a breast augmentation surgery using implants. The request for surgery remains always a voluntary step of each patient. Beyond the aesthetic improvement that this intervention offers, the psychological repercussion is generally beneficial. However, these implants have side effects and insufficiencies compared to the natural breast. These facts must be perfectly explained to the women who want the breast implants. Let us quote in particular the risk of hematoma or periprosthetic hull which counts among the most serious complications of this type of intervention and which requires an immediate surgical recovery. The aerolar approach to augmentation mammaplasty by implants is an interesting technique in breast augmentation. We report the case of a 36 years old patient who present a breast hypomastia and who profited from this technique

chondrosarcome mesenchymateux a localisation musculaire

This article deals with the extra skeletal mesenchymal chondrosarcoma especially the muscular localisation, through a report of one case and review of literature. It concerns a 38 years old female patient who developed a muscular tumor in her right calf, since 18 months. Treated by wide surgical resection without any adjuvant treatment. Follow up for 6 years showed a good general condition and no signs of local recurrence or distal metastasis. The extra skeletal mesenchymal chondrosarcoma exceptionally affects young patients. Treatment is essentially surgical. Radiotherapy and chemotherapy do not prove their efficiency. Local recurrence rate is about 52% in the subsequent 2 years, that is why a very rigorous surveillance should be done in this period. prognosis is bad wirh a 10 years survival rate of 32%

Rectal prolapse

Twenty-five interventions for rectal prolapse have been done for 23 patients during 20 years, 12 direct rectopexies, 9 Orr-Loygue procedures, 2 resections, Delorme's procedure for 1 patient and one cystectomy. We observed 4 recurrences i.e. 17,3%. Abdominal rectopexy seems to be the best treatment for rectal prolapse