A giant metastatic inguinal lymph node from melanoma.

A 49-year-old woman was admitted to our institution with a giant necrotizing and ulcerative inguinal mass that measured 17 × 11 centimeters. She had a history of dorsal ulcerated nodular melanoma with a Breslow thickness to 10 mm, clark's level was 4 and an mitotic activity of 1 mitosis per 40 high-power fields. She was operated in emergency for an ilioinguinal dissection, then 15 days later, a secondary coverage by Taylor's flap. The pathological examination found a melanoma metastasis. She is alive at fourteen months after the operation.

Improving the colour match of free tissue transfers to the face with non-cultured autologous cellular spray--a case report on a chin reconstruction.

INTRODUCTION: Animal bites can result in extensive avulsion injuries of the face justifying microsurgical replantation attempts. Reconstruction using local tissue harvesting increases the local morbidity while distant tissues can result in colour and skin texture mismatching. Skin grafting of the skin paddle by a split-thickness skin graft is a conventional approach to help overcome this problem. PATIENT AND METHODS: An 18-year-old patient was treated for a chin avulsion after a dog bite injury. The avulsed segment included the whole chin aesthetic unit and one-fifth of the lower lip. The segment was replanted on the inferior labial artery. The replantation failed and a reconstruction with a parascapular free flap was performed. Despite a debulking at 1 month, the aesthetic result had a poor colour match. The technique used to improve this was to de-epithelialise the skin and apply non-cultured autologous epidermal cells (NCAECs) 100 days after the reconstruction. RESULTS: The reconstruction was uneventful. At 3 months follow-up, the patient was able to purse her lips and had regained sensation. After 5 months, the free flap paddle was consistent in colour, pigmentation and texture with the surrounding skin. At 10 months, the patient's only complaint was residual firmness in her scar and flap. The long-term follow-up, over 23 months, confirmed the stability of the results. CONCLUSION: The use of an NCAEC spray to treat the dyschromia on a parascapular flap used for facial reconstruction is less invasive than split-thickness overgrafting and could extend the use of distant flaps that have been avoided due to poor colour match.

Large necrosis: a rare complication of medial thighplasty.

Obesity is a major public health problem in Western societies. After failure of diet and exercise, patients can have bariatric surgery. Weight loss causes excess skin on the body, including the thighs. This leads to difficulty walking and psychological disorders such as devalued self-image. Medial thighplasty is an intervention to reduce excess skin and fat in the thighs. The main complications are scar migration, scar infection, hematoma, lymphedema, gaping vulva, and, rarely, skin necrosis. We describe a case of flap necrosis after a reoperation of medial thighplasty. Treatment included debridement of necrotic tissue and healing of the wound by secondary intention (vacuum-assisted closure and dressings with calcium alginate). Complete healing was achieved in 4 months. As the patient refused any new procedure, skin grafting was not performed. The aesthetic results of plastic surgery procedures are often imperfect. Patients should be clearly prepared and informed about the results expected from the operation. Surgeons should know contraindications for reoperation.

[Fibrin sealant significantly decrease postoperative drainage in breast reconstruction by deep inferior epigastric perforator (DIEP) flap]. / Diminution significative des volumes de drainage postopératoires en reconstruction mammaire différée par lambeau libre DIEP par utilisation de colle de fibrine.

PURPOSE: Serosanguinous drainage after breast reconstruction by deep inferior epigastric perforator (DIEP) flap constitute with the microsurgical monitoring, the main limiting factors for patient discharge. Fibrin sealant has already been studied to reduce post breast surgery drainage. The authors are presenting their experience in secondary breast reconstruction by DIEP flap with the use of sprayed fibrin sealant. PATIENTS AND METHODS: Twenty-one female patients aged 28 to 63 years old who underwent secondary breast reconstruction after mastectomy for cancer between October 2004 and June 2007 have been reviewed. These patients were separated into two groups. In group 1, patients (n=9) received two drains placed under the flap and in the axillary area. In group 2, (n=12) the DIEP flaps and thoracic areas were sprayed with fibrin sealant (Tissucol(®)) before the two drains inset. RESULTS: No adverse effect were reported, with a 36-month median follow-up. Drainages volumes or durations were not correlated to the patients' Body Mass Index (BMI). Lower drained volumes were collected from the thoracic region (372ml versus 629mL) and thoracic drains were removed earlier (5.5 days versus 6.9 days) in group 2. The length of stay was also significantly reduced after fibrin sealant use (5.5 days versus 7.22 days with P=0.0305 by log rank test). CONCLUSION: This study is a rare clinical one on fibrin sealant use to decrease postoperative drainage in breast reconstruction by DIEP flap. Fibrin sealant significantly decreased the postoperative drainage volume and duration.

[Surgical excision of giant congenital naevi: how far can we go with surgery?]. / Exérèse des nævus congénitaux géants : jusqu'où aller avec la chirurgie ?

Surgical excision of giant congenital nevi is recommended by principle for dermatological reasons. Malignant potential is real but its incidence remains widely discussed. Their excision represents a surgical challenge but is also a real assault course for the child and his family. The sequelae and the psychological effects can be important. Can an incomplete excision to limit these aesthetic after-effects and relieve the surgical treatment be acceptable? We present the case of a child affected by a giant congenital nevi of the cephalic extremity where the excision was partial. A review of the literature on the degenerative risk of the giant congenital nevi allowed us of noticed that this one tends to be overestimated. The advantages and the disadvantages to practise a preventive, premature excision and complete of the giant congenital nevi are approached. We discuss the possibility to resort to a partial excision in certain cases delicate of reconstruction under the cover of a strict and moved closer dermatological surveillance.

[Leech-borne infection on a TRAM flap: a case report]. / Complication infectieuse d'un lambeau de TRAM liée aux sangsues: à propos d'un cas.

Leeches are used worldwide to treat venous congestion of flaps. Aeromonas hydrophila infections are recognized complications of leech use. We report a new case of delayed leech-borne infection in mammary reconstruction by a Transverse Rectus Abdominis Myocutaneous flap (TRAM), which caused the flap loss. The use of prophylactic antibiotics is a way to prevent A.hydrophila infection (third generation cephalosporin, ciprofloxacin). This antibioprophylaxy must be followed until wound closure of the venous congested tissue.

[Refinements in the labia minor reduction procedures]. / Mise au point sur les techniques de nymphoplastie de réduction.

AIM: The aim of this study is to appreciate the hypertrophy of labia minor, its psychological and functional effects and the different techniques of reduction available. PATIENTS AND METHODS: From August 2004 to June 2007, 14 patients have been operated with a posterior wedge resection technique associated with a Z plasty. A questionnaire has been sent to each patient in order to make a retrospective study of the different reasons of consultation and their degree of satisfaction after surgery. RESULTS: Among the 12 patients who answered the questionnaire, main part of them was satisfied or very satisfied of the morphologic and functional results. All of them were satisfied to have decided on this surgery. DISCUSSION: We can notice an increase of the requests concerning the vulvar morphologic changing, either due to aesthetics preoccupations or functional disorders. Technically, the wedge resection brings the most satisfactory results. The addition of a Z plasty and the posterior location of the scar should prevent dyspareunia and per-partum tears. CONCLUSION: This preliminary clinical study focuses on the different techniques, enables a better knowledge of these women expectations and confirms our technique.

[Can one propose aesthetic surgery to one male or female patient with an hereditary angio-oedema?]. / Peut-on proposer un acte de chirurgie esthétique à un(e) patient(e) atteint(e) d'un oedème angioneurotique?

The hereditary angio-oedema (HAE) is a rare disease characterised by the occurrence of spontaneous or secondary, subcutaneous and submucosal swellings within any part of the body and especially in the upper respiratory tract. Surgery, due to the stress and the oro-tracheal intubation is a high risk situation for severe attack occurrence that may engage the patient life. This explains reluctance for surgeons and anesthesiologists to perform surgical operations in these patients. We think that efficiency of the prophylaxis and the emergency care for acute attacks can allow them to propose to these patients, plastic and aesthetic surgery in optimal security conditions. Androgens represent the main part of HAE prophylaxis treatment but usually cause masculinization in the females. We report this case of a woman, affected by HAE, treated by danazol: Danatrol for long-term prophylaxis who developed a mammary hypotrophy for which she was desirous to correct with breast implant. This surgery provided good morphological results without complication and was enabled to increase the observance of the prophylaxis treatment. Through this case report we lend a practical view of the surgery management of these patients affected by hereditary angio-oedema.