[Brachioplasty and its complications]. / Brachioplastie et complications.

Due to an increasing number of major weight loss after bariatic surgery, the demand for body-coutouring surgery increase in paralell. Among all the technics which can be realized, brachioplastyis one of them. The goal is to reach a functionnal but an aesthetic improvement too. The literature show that the rate of major complication is very low (or not reported in the majority of the series). Minor complication is more common : hypertrophic scar, large scar, paresthesia, and wound dehiscence. Re-operation can be asked by the patient in order to improve the result. With the help of clinical cases and literature review the authors try to analyse the balance between benefice and risk to realize a second operation.

[Hand burns in children and Aquacel(®) Burn gloves, an alternative to prolonged hospital stays]. / Brûlures des mains de l'enfant et gants Aquacel(®) Burn, une alternative aux hospitalisations prolongées. À propos de 20 cas.

AIM OF THE STUDY: Occlusive dressings for second-degree hand burns in children must prevent infection and promote healing. For good management of analgesia, these treatments often require children to be hospitalized. Our goal was to find an alternative to conventional care protocol that would reduce the number of dressings and therefore the length of hospitalization. We report our experience with the use of Aquacel(®) Burn. PATIENTS AND METHOD: Non-randomized monocentric prospective study was conducted from 2012 to 2014. The glove was used in the operating room within 72hours after the burn in children younger than 15 years old with isolated superficial to deep 2nd degree hand burns. Once the glove was perfectly stuck to the burn, the children could go back home. We saw them 10 to 12 days after the accident to be sure there was no indication of skin graft. RESULTS: Twenty gloves were used in 16 children aged from 16 months to 13 years. The average length of stay (ALOS) was five days to put the glove on and one day to remove it. Four hands were grafted. CONCLUSION: Once we get used to the product, Aquacel(®) Burn gloves have reduced the ALOS before skin graft in cases of isolated hand burns in children.

Sepsis of the hip due to pressure sore in spinal cord injured patients: advocacy for a one-stage surgical procedure.

STUDY DESIGN: Retrospective study reporting characteristics and management of septic arthritis of the hip due to pressure sores in spinal cord-injured patients. OBJECTIVES: To describe clinical and biological data of septic arthritis of the hip and its treating management. SETTING: The database of the regional SCI referral center, Nantes, France. METHODS: We retrospectively collected data from 33 cases of septic arthritis of the hip in the medical files of 26 patients. RESULTS: We analyzed 33 cases of septic arthritis of the hip treated in one French referent center for spinal cord-injured patients from January 1988 to December 2009. Most patients had a thoracic complete paraplegia and nearly two-third (17 out of 26) had no systematic follow-up. In 25 out of 33 cases, the septic arthritis of the hip was due to a trochanteric pressure sore. The causal pressure sore was most frequently associated with a persistent drainage. The standard radiological examination led to the diagnosis in 30 cases and, in 7 questionable cases, magnetic resonance imaging was more contributory. Surgery always consisted of a wide carcinological-like excision and of a subtrochanteric proximal femoral resection including both greater and lesser trochanters. A musculocutaneous flap was realized for all cases and the choice of the muscle depended on the localization of the causal pressure sore but also of the remaining choices, as most of the patients had already undergone a prior surgery. An antibiotic treatment was adapted to multiple samples during surgery. CONCLUSION: We do advocate for a one-stage procedure including a subtrochanteric proximal femoral resection and a musculocutaneous flap.

[The pedicled temporal fascia flap for facial defect coverage]. / Le lambeau de fascia superficialis temporalis pédiculé pour la couverture des pertes de substance de la face.

INTRODUCTION: The fascia superficialis temporalis (FST) can be used as a pedicled flap. Its span allows covering important head and neck defects. We present our experience with four patients. OBSERVATION: The FST flap, grafted with thin skin allowed covering: zygomatic defect after resection of Merkel cell carcinoma; the upper part of the right auricle after exeresis due to an arterial and venous malformation; the left orbital and palpebral region after exeresis of a basal cell carcinoma; the total auricle amputation site after exeresis of a squamous cell carcinoma. The cosmetic results were satisfactory in every case. DISCUSSION: The thinness and the plasticity of the FST make it an excellent flap for facial reconstruction. Rapid surgery and low rate of sampling morbidity are assets for reconstruction in patients often fragile and old.

[Carpal tunnel syndrome in children. About 10 clinical cases]. / Syndrome du canal carpien chez l'enfant. À propos de 10 cas cliniques.

INTRODUCTION: The carpal tunnel syndrome is a common peripheral neuropathy in adults but is rare in children. We report a series of 10 carpal tunnel syndromes in children. METHODS: We have supported five children, two males and three females, with a bilateral carpal tunnel syndrome. We studied the clinical history (history, symptoms, stage of disease), therapeutic management and remote development. Three children were diagnosed with a mucopolysaccharidosis, the fourth with VATER association. For the last child, it was a form considered idiopathic. Two children were referred for night pains, the others for under-utilization of their first three fingers, two of which had a thenar atrophy. Four children underwent an electromyogram for diagnostic confirmation. We realized open surgical treatment at one time, by section of the carpal ligament. RESULTS: The average age of our patients was 4years. The average decline in the surgical study was 19 months. Postoperatively, we noted, in all patients, complete regression of the painful symptoms, a sensory improvement and recovery of the opposition of the thumb. CONCLUSION: The scarcity of carpal tunnel syndrome in children and the atypical symptoms may cause diagnostic delay, with serious consequences. We keep vigilant and ready to access to additional tests (electromyogram). For our team, the therapeutic approach is a systematic open surgical treatment.

[Microsurgery and burn sequelae: what is practical use?]. / Microchirurgie et séquelles de brûlures : quelles applications pratiques ?

The use of microsurgery in the management of burn sequelae is not a new idea and free flaps have been used in this context since the 1970s. New technologies like negative pressure treatment and skin substitute have certainly decreased the indication of free flaps. The authors with their experience combined to a review of the literature, try to clarify these indications for each anatomical location. From a technical point of view, they find that realizing a free flap for these patients is more complicated (venous damage, lack of donor site who has been burned…). Despite this, microsurgery must still belong in the decision tree and there are some irreplaceable indication specially for hand reconstruction.

[The Adams-Oliver syndrome. A case report]. / Le syndrome d'Adams-Oliver. A propos d'un cas clinique.

The authors report a case of Adams-Oliver syndrome in an 11 months child. This child was referred to our unit at the age of six months with right hand brachydactyly and alopecia on the vertex. We decided not to treat hand malformations, given the lack of functional impact. Alopecia of the vertex was corrected by tissue expansion of the scalp, with a satisfactory cosmetic result at five months.

[Surgical treatment for giant congenital nevi: what are the psychosocial consequences for the child and family?]. / Prise en charge chirurgicale des naevi géants congénitaux : quel retentissement psychosocial sur l'enfant et son entourage ?

Giant congenital nevus is a rare pathology. The incidence of malignant transformation exists and his unsightly aspect requires a early surgical treatment. All techniques of plastic surgery must have to be used. The management of the skin capital is a real surgical challenge with complications which are difficult to bear psychologically and physically for these young children. Authors present psychosocial effects of this pathology then surgical practice through 105 cases analysed. The majority of the patients had axial disposition of the nevus (head and trunk) and tissue expansion was the most utilised technique. A questionnaire estimated the notion of other's looking, congenital deformity's acceptance, surgical story's transmission, family's opinion of the surgical treatment. More than the half of families feel that their child was cast-off because of deformity. A lot of family would forget the nevus and never photographed their child with nevus. Sometimes, children could not explain their scars. Despite many hospitalisations, all the children have normal schooling and extra-school activities. It's important to begin surgical plan very early so that child could integrate their scars in their corporal schema.

[Free-flap reconstruction in the elderly patient]. / La reconstruction par lambeau libre chez le sujet âgé

The objective of the study was to evaluate the safety and the efficacity of microsurgery in the elderly patient population. Between 2003 and 2005, 10 free-flaps were performed in 10 patients who were aged 70 years or older. One flap underwent reexploration, for an overall success rate of 100%. Medical complications in the postoperative period were further evaluated. Effects of American Society of Anesthesiologists (ASA) status, operation time, and age on complication rate were evaluated. Only ASA status was significant for the occurrence of postoperative medical complications; class 3 and 4 patients were at higher risk than class 1 and 2. Neither operation time nor age was predictive of postoperative complications. Microvascular free-tissue transfer is a safe and reliable option in the elderly population. The success rate of free-flaps is not different from that for other age groups. The rate of postoperative medical complications was 20%: most complications were in ASA class 3 and 4 patients.