[Subperiostal temporomalar lifting]. / Place du lifting sous-périosté temporomalaire dans la chirurgie du rajeunissement de la face.

The subperiosteal face-lift is a procedure designed to rejuvenate the middle third of the face. We present in this study the technical procedure we have developed, based on the subperiosteal detachment of the soft tissues of the midface and their attachment to the deep temporal fascia with a vertical vector of suspension. We reviewed 69 patients who undergone superiosteal temporomalar rhytidectomy, between March 2002 and January 2006, ranged in age from 42 to 65 years (mean 46). All of the patients presented preoperatively prominents nasolabial folds, malar fat pad ptosis. None of them presented a cervical soft tissue ptosis. The mean follow-up period was 32 months. The postoperative complication rate was 11.5 percent and included transient temporal branch weakness (N=4), transient infraorbital nerve paresthesia (N=1), asymmetrical result (N=1); scleral show (N=1) and ectropion (N=1) which required a secondary surgery. The overall aesthetic results were good; with attenuation of the prominent nasolabial folds in 100 percent and diminution of the height of the lower eyelid in 80 percent of the patients. In conclusion, the subperiosteal midace lift is a procedure designed to rejuvenate the middle third of the face.

[Chest wall reconstruction for recurrent breast cancer]. / Reconstruction des pariétectomies thoraciques effectuées pour récidive de cancer du sein.

Some recurrences of breast cancer require wide chest wall resection as curative or palliative therapy. We report a retrospective review of 14 chest wall resections and reconstructions. The width of the anterior chest wall excision was 150 cm(2) (80 to 360 cm(2)). Two defects were full-thickness ones, with sternal or costal resection. The reconstruction required synthetic mesh covered by a latissimus dorsi musculocutaneous flap. The 12 other resections were superficial ones, and have been covered by a skin graft in 5 patients, and by a regional flap in 7 patients (5 latissimus dorsi, 1 DIEP, and 1 bilobed flap). Two patients had a chest wall irradiation after the surgical procedure. We have analysed the factors, which had influenced our choice of the type of reconstruction. The reconstruction is performed by a regional flap, most commonly a latissimus dorsi pedicled flap, in case of full-thickness defect, of nodular isolated recurrence, or when a radiation therapy is provided after the surgical procedure. The coverage is made by a skin graft in case of palliative excision, or of multiple nodular chest wall recurrence (which have a high risk of recurrence in the same form).