Febrile ulceronecrotic Mucha-Habermann disease.

The Mucha-Habermann disease is an inflammatory disease of the skin and is a variant of pityriasis lichenoides et varioliformis acuta. We describe the case of a 64-years-old woman who was admitted for erysipelas of the face. Despite treatment, evolution was marked by the appearance of a necrotising ulcerative area in the centre of the erysipelas associated with local oedema and headache. A skin biopsy revealed a pityriasis lichenoides et varioliformis acuta. Corticosteroids led to a rapid stabilisation of lesions, and after 6 months the patient shows only a small area of frontal hypopigmentation. The aetiology remains uncertain. There is no established standard treatment. We would like to draw attention of the medical and surgical specialists to this rare disease. The diagnosis should be considered in a necrotic lesion associated with rapid expansion of systemic and peripheral cutaneous signs. Diagnosis must be considered to avoid unnecessary debridement and extensive scars.

[Giant melanoma of the scalp: Case report]. / Mélanome géant du scalp: case report.

We present a case of giant melanoma of the scalp observed in our department. It is a rare but very aggressive pathology which is generally treated by radical surgery. We emphasize early diagnosis because a large extension of the tumor can lead to the need of a very extensive surgical resection. Prognosis is very severe despite adjuvant medical treatments.

[Neonatal cleft lip repair: perioperative safety and surgical outcomes]. / Chirurgie néonatale des fentes labiales : sécurité anesthésique et résultats chirurgicaux.

INTRODUCTION: There is no international consensus on timing for surgical repair of cleft lip and palate. We argue that neonatal timing for repair of the lip deformity allows a better integration of the baby in his family and is of major support for the parents. Recent studies tend to challenge this neonatal practice. PATIENTS AND METHODS: We want to study retrospectively the perioperative safety and the surgical outcomes of this procedure over the past 20 years in a series of 42 non-selected babies who had labial repair during the first four weeks of their life. All of them have been operated by the same senior surgeon. RESULTS: Median operative time is 45 minutes for unilateral cleft and 70 minutes in case of bilateral malformation. Oral feeding is initiated at the end of the operative day. Children's hospital stay is four days. The results show no anaesthetic complication. Four children had secondary lip correction. CONCLUSION: The risk of anaesthetic and surgical interventions limited to the lip before the age of 28 days is very low in a medical care environment specialized in neonatal surgery and postoperative care. The over all complication rate is very low.

[Otophyma, zygophyma and giant rhinophyma: a rare association]. / Otophyma, zygophyma et rhinophyma géant : une association rare.

A patient, 64-year-old, is referred for the treatment of a giant rhinophyma. He refused any treatment during eight years. The interest of this case report is the size and the weight of the rhinophyma, the obstruction of the nasal airways and the resulting social disturbance. This exceptional clinical rhinophyma was associated with an otophyma, a zygophyma and ophthalmic disease. To our knowledge, this clinical presentation has never been reported before. The management of the rhinophyma and the otophyma was surgical excision, secondary healing followed by a full thickness skin graft associated to a fullface mechanical dermabrasion.

[Pedunculated and pigmented basal cell carcinoma: an unusual presentation]. / Le cas clinique du mois. Carcinome basocellulaire pédiculé et pigmenté: une présentation inhabituelle.

Basal cell carcinomas (BCC) are the most common malignant neoplasms in humans. Clinical misdiagnoses are not uncommon. These cancers are classified according to their histological and clinical characteristics which exhibit distinct malignant behaviours. It is important to be aware of the different clinical presentations both for the accurate diagnosis and tumour management. We report the case of a 78-year-old man, who presented an unusual pedunculated and pigmented BCC. This combined aspect is rarely encountered.

[Vertical reduction mammaplasty for gigantomastia with massive fibroadenomatosis: a case report]. / Réduction mammaire selon la technique verticale pour gigantomastie avec fibroadénomatose massive: à propos d'un cas clinique.

Vertical reduction mammaplasty is one of the most debated << short-scar >> breast reduction technique. Advantages and drawbacks of the technique are discussed; most of the authors do not accept it as the technique of choice for high glandular resection weights. In our case report we achieve it for a resection weight up to two kilograms with an areolar transposition distance of more than ten centimetres. We show that it is reasonable to realize it dealing with gigantomastia. The massive fibroadenomatosis is observed following immunosuppressive treatment for kidney transplantation. Cyclosporine intake, even sporadic, is at the origin of the growth of these multiple, bilateral and large fibroadenomas. Drug-induced cytokines stimulate their development.

[Report of 243 vertical mammoplasties for very large, heavy breasts and/or severe ptosis. Analysis of the result and technical]. / A propos de 243 plasties mammaires verticales pour hypertrophie et/ou ptôse importantes. Etude rétrospective, analyse des résultats et description des modifications techniques.

Vertical mammaplasties for very large breasts and/or severe ptosis were evaluated in 124 patients who underwent operation in our unit between September 1993 and June 2001. In 119 cases it was reduction mammaplasty and in 5 cases unilateral symmetrization after contralateral reconstruction. The mean age was 36 years (13-62 years). Among inclusion criteriae, we choose the resection weight > or = 700 g and/or a ptosis > or = 30 cm. We report a few technical modifications of the initial Lejour vertical technique. About hypertrophic breasts (179 breasts): mean resection weight was 905 g (710-1750 g), mean ptosis was 33.5 cm (30-42 cm). The following complications were noted: 3 haematomas with only one evacuation on the same day, no seroma, 4 infections controlled by local treatment, 44 wound dehiscence or delayed skin healing (> 30 d), 8 partial necrosis, 12 secondary correction under local anaesthesia, 1 cheloïd scar of the areolar complex. About breasts with severe ptosis (64 breasts): the mean value was 31.8 cm (30 cm). Complications were as follow: 2 haematoma, 0 seroma, 16 healing delay, 3 partial necrosis, 6 secondary correction under local anaesthesia. The mean procedure time was 94 mn. The mean stay in hospital was 2.8 days, same as the suction drains. The vertical mammaplasty is a fast technique, giving good results. Scarring amount is reduced. Breasts are well projected, well shaped and remain stable in time. Their base can be modified. We think this technique can safely be applied to large breasts and/or severe ptosis.

[Soft tissue sarcomas of the hand: report of a radiation-induced case]. / Les sarcomes des tissus mous de la main. A propos d'un cas de sarcome radio-induit.

Soft tissue sarcoma surgery is based on techniques that are in the process of ongoing development. In this study, the case is reported of a female patient who was operated on at the age of 14 years for a primary synoviosarcoma of the dominant hand, which was treated by conservative surgery and 60 Gy adjuvant radiotherapy. Twenty-two years later, she presented with a clinical picture of recurrence, but with no detectable metastases. Amputation of the distal third of the forearm was performed. The anatomopathological examination showed the presence of a myxoid malignant fibrous histiocytoma. It was considered that this tumor had been radiation-induced. All the distinct diagnostic criteria were met, i.e., a latency of over two years, different diagnosis and the appearance of the tumor within (or next to) the irradiated field. Both the diagnostic methods (MRI, tumor biopsy, and CT scan of the chest to investigate possible tumor spread) and the surgical approach have been discussed. The latter has altered over the years from being systematically radical (amputation or compartimental resection) to systematically conservative (good local control via radiotherapy). The modern attitude reflects a return to a more balanced approach. The frequency of such tumors has probably been underestimated in reports in the literature, as the latency period can sometimes exceed 30 years, and an accurate determination of the etiology is not always possible. Two main factors should be taken into account in treatment strategy: i) distant metastases of high-grade soft tissue sarcomas often appear early in the course of the disease, and are not affected by surgery at the primary site; ii) local recurrence, which is associated with high morbidity, and is directly connected with incomplete resection. Technical progress and a multidisciplinary approach have resulted in more sophisticated treatment (allowing a larger surgical resection area, and better residual function). Surgical management remains the treatment of choice, as radiotherapy and chemotherapy have not demonstrated any positive effect on patient survival.

[The use of an inferior dermo-glandular flap in Thorek's technique, based on a series of 21 cases]. / Utilisation d'un lambeau dermo-glandulaire inférieur dans la technique de Thorek. A propos de 21 cas.

Thorek's technique, first described in 1922 for breast reductions, has been progressively replaced by techniques using a dermoglandular pedicle. This first technique is still performed today in cases of major hypertrophy. But the major disadvantage is the tendency for the breast to be too flat post-reduction. We tried to correct this problem by preserving an inferior dermoglandular flap rolled into a cone shape before positioning it within the bulk of the breast, thus giving a better projection. The authors present a series of 21 patients operated by this technique with a median follow-up of two years. The preliminary results are encouraging and we think that this procedure is a treatment of choice in cases of gigantomastia.

[Rupture of a superficial femoral aneurysm in the context of neurofibromatosis. Report of a case]. / Anévrysme fémoral superficiel rompu dans le cadre d'une neurofibromatose. A propos d'un cas.

The authors observed the spontaneous rupture of a dysplastic superficial femoral artery in a 47 years old patient with Von Recklinghausen disease. The patient presents a gigantism of his right lower limb. On angiography, the femoropopliteal axis is polyaneurysmal and there is evidence of rupture at mid-thigh. The diseased artery is excluded by interposition of a dacron prosthesis, with reimplantation of the deep femoral artery. Histology shows fibrohyalin thickening of the intima. Dysplasia of large limb arteries is excessively rare in Von Recklinghausen disease.

Anatomic basis of the sural fascio-cutaneous flap: surgical applications.

Studies of the fascio-cutaneous vascularization and innervation of the leg seem incomplete. After reviewing the classical findings, the authors report on their anatomic study 15 dissections. Perforating pedicles, originating from the peroneal artery (3 to 5) and posterior tibial artery (4 to 5) destined for the skin and fascia of the posterior aspect of the leg were constantly found. This study suggests the possibility of a distally based sural fascio-cutaneous flap, a flap which has been successfully constructed clinically.

The action of piracetam in ischaemic flaps.

The effects of piracetam on skin flap viability, capillary blood flow and temperature were studied in abdominal cutaneous flaps in rats. The drug significantly increased the viability of the distal (random) portion of the flap and this response was dose-related. Compared with controls, the area of skin necrosis was 12.4% less in the piracetam-treated animals and extended necrosis was not observed. Piracetam appeared to act by increasing the capillary blood flow, mainly in the distal portion of the flap. The improved perfusion was reflected as a smaller drop in the recorded temperature compared with controls. Blood levels of this drug in animals receiving the maximum effective dose corresponded to the active drug concentration in human rheology.

[The distally based sural fascio-cutaneous flap. A new technic for the coverage of loss of substance of the lower leg]. / Le lambeau cutanéo-aponévrotique sural à base distale. Une arme nouvelle pour la couverture des pertes de substance du tiers inférieur de la jambe.

Prognosis of compound open fractures has been transformed by the use of plastic surgery to cover wounds. However, loss of substance of lower third of leg remains a delicate problem frequently requiring the use of microsurgical techniques by experienced teams. The sural cutaneo-aponeurotic distal base flap, the subject of a detailed anatomical study by the authors, can resolve the problem without affecting muscle capital and at the price of minor esthetic sequelae. Results in two clinical cases confirm reliability of this flap.

Tumor of the hypopharynx: free jejunal transfer with conservation of the larynx: a case report.

Resection of the hypopharynx or cervical esophagus for malignancy is always quite mutilating if reconstruction cannot be achieved with a one-stage procedure. Several techniques have been described, but they are often associated with laryngectomy. In the case reported, a free split jejunal segment transfer allowed reconstruction of the hypopharynx without laryngectomy, as the malignancy did not involve the larynx.