[Light sources usable by the plastic surgeon in the absence of photographic studio]. / Sources lumineuses utilisables par le chirurgien plasticien en l'absence de studio photographique.

Medical photography is an important part of the medical file and is widely used in medical communication, especially in our discipline. His practice has to be the most standardized and reproducible as possible, which distinguishes it from artistic photography. Photography fix the light reflecting from a subject, so surgeon have to control of the light source in any environment. In the absence of dedicated studio, using external cobra or ring flashes with special diffusers allow the surgeon to have light sources adapted to the different conditions encountered in daily practice.

[Patient-reported outcome of their breast reconstruction after mastectomy]. / Évaluation de la satisfaction des patientes de leur reconstruction mammaire après mammectomie.

BACKGROUND: The overall care of patients with breast cancer is a major public health issue. Breast reconstruction is a part of it, and could be modulated by factors related to their personal life or surgical management. The aim of our study was to investigate a statistical link between these factors of variability, and overall satisfaction after breast reconstruction. PATIENTS AND METHODS: We evaluated in a retrospective study patients' satisfaction in Plastic, Reconstructive and Aesthetic Surgery Department of the University Hospital, Poitiers, after breast reconstruction using different sources of variability: elements of life at the moment of reconstruction decision, reconstruction management and the feeling of involvement in decisions related to reconstruction. Satisfaction was quantified by modified BREAST-Q pre- and postoperative questionnaires ("reconstruction" module) complemented by an open question to address patients experience. RESULTS: From January 2005 to May 2011, 148 patients underwent surgery, 60.1% accepted to complete the survey (89 patients). Postoperative overall satisfaction was 89.1 out of 100. Satisfaction gradually decreased (P=0.022), postoperative overall satisfaction was non-significantly higher with autologous reconstruction, regardless of the variability factor studied. Secondary reconstruction with autologous reconstruction enhanced physical well-being (P<0.001). Patients expressed a high request for information about the different kinds of reconstruction, postoperative, as well as support groups. CONCLUSION: This study shows that patients are generally very satisfied, but do not explain the causes of dissatisfaction. It paves the way for development of satisfaction with breast reconstruction databases.

[Rose necrosis: Necrotizing granulomatous reaction with infected node at red pigment of a tattoo]. / La nécrose de la rose : réaction granulomateuse et nécrotique avec adénite au pigment rouge d'un tatouage.

INTRODUCTION: Nowadays, necrotizing cutaneous reaction after a tattoo is rare especially with the sterile tattoo equipment and antisepsis rules. We report the rare case of a necrotizing reaction secondary to a granulomatous reaction after a red tattoo, with a satellite node. CASE REPORT: A 40-year-old patient suffering from a granulomatous reaction to red dye of a large pectoral tattoo, with cutaneous and sub-cutaneous necrosis, and an infected axillary node. This pectoral tattoo also triggered a necrotizing granulomatous reaction on red-pigmented areas of other older tattoos. Local treatments (dressings, antibiotics, repeated excisions of necrotizing tissues) did not stop the allergic reaction, and an infectious origin was eliminated. The patient asked for a complete excision of the pectoral tattoo. Black intramacrophagic pigment was found in the black lymph node analysed. We did not experience any complications and the patient is satisfied with the results. DISCUSSION: Very few examples of cutaneous necrotizing secondary to a tattoo have been found in the literature. The hypothesis of a primitive infection that had secondarily led to necrosis is refuted by the lack of infective structures found in the analysed node, and most of all by the same reaction on other older tattoos on red-pigmented areas. This rare complication must be known by plastic surgeons, who will probably be called upon to take care of more and more tattooed patients. CONCLUSION: Even if it's rare, necrosis with a granulomatous reaction to red pigment after a tattoo must be known. This case illustrates a very violent immune reaction where infection was not proved.

[Cheek reconstruction]. / Reconstruction jugale.

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.

[Reconstruction of nasal skin defect]. / Reconstruction des pertes de substance superficielles du nez.

There are many possibilities for nasal skin defect reconstruction. The purpose of this article is to highlight the important points to respect in order to achieve aesthetic results. The principles that must be observed in nasal reconstruction are recalled. The most interesting techniques are detailed and illustrated with clinical cases.

[Aesthetic reconstructive surgery of the lip]. / Chirurgie réparatrice et esthétique labiale.

Lip reconstruction can be performed with numerous surgical techniques. The aim was here to present these usual techniques and to focus on the details that can be used to obtain the most favourable results. The goal of this surgery, that represents a compromise between function and aesthetic, has to be kept in mind to prevent mistakes that decrease the quality of the result.

[Forehead and temple aesthetic reconstruction]. / La reconstruction fronto-temporale esthétique.

The purpose of this article is to address the techniques of reconstruction of the forehead and the temple trying to add an "aesthetic" dimension, as the fourth dimension introduced by Burget for the reconstructive surgery of the nose. Achieve "aesthetic" reconstruction is to have constant attention to details. This is how to choose the right indication depending on the age and the etiology of the defect. This is to place incisions to perfection. And it is to be humble and open oneself to criticism, always seeking to improve the quality of its results.

[Post-traumatic reconstruction of the lower lip after total or subtotal amputation using the Webster's modification of the Bernard cheiloplasty -- advantages, disadvantages and limitations: three cases]. / Reconstruction post-traumatique de la lèvre inférieure après amputation totale ou subtotale selon la technique de Camille-Bernard modifiée Webster - avantages, inconvénients, limites : à propos de trois cas.

Webster's modification of the Bernard cheiloplasty is a well-known technique, usually applied to the reconstruction of total or subtotal amputations of the lower lip following oncological resection. We present three cases of post-traumatic reconstructions with interesting results.

[Eyelid, medial canthus and medial orbital wall reconstruction using a combination of Hübner and conchal grafts with two illustrative cases]. / Reconstruction par greffons de Hübner et conque après exérèse étendue palpébro-cantho-orbitaire médiale - Présentation de deux cas.

Post-ablative medial canthus and medial orbital wall reconstruction may involve various materials. Few articles present such reconstructions using cartilage homografts, and very few opt for conchal cartilage. In some cases of medial orbital wall excision, at least half of the eyelid must also be removed. We present two cases where we decided to use conchal cartilage to reconstruct the medial orbital wall and tarsomarginal Hübner grafts to reconstruct the eyelid. This combination offers several advantages: a very limited resorption, only one operative field and a reduced infection risk.

Knee dermolipectomy: a simple operation with significant functional improvement.

BACKGROUND: Obesity is a major public health problem in Western societies. It may lead to difficulties in daily life that have an impact on quality of life and create psychological disorders. After failure of diet and exercise, patients can undergo bariatric surgery, but some obese patients are not motivated to undergo a bariatric procedure. For such patients, plastic surgeons can correct some excess fat to improve their quality of life. This report describes an original technique for correcting the excess fat at the medial part of the knees to regain a normal walking perimeter. METHODS: A 68-year-old woman was admitted to the authors' center for correction of a functional walking disorder. Indeed, her clinical examination found a static disorder, with a valgus knee morphotype related to a major excess of skin and fat in the medial part of the knees. She underwent a knee dermolipectomy to obtain a solely functional result. RESULTS: No complications were observed in the woman's postoperative course. At this writing, the result is stable 18 months after the surgical procedure, with a minimal visible scar hidden in the internal face of the knees. The woman has experienced a loss of her genu valgum and regained a walking distance longer than 1 km. She also has lost 10 kg of weight. CONCLUSIONS: Knee dermolipectomy is a simple procedure with good results and few complications that improves the quality of life for obese patients. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Importance of thorough removal of all affected tissues before grafting epidermolysis bullosa lesions: ten-year follow-up of one patient with multiple grafts]. / Nécessité d'une exérèse complète des tissus lésés dans les épidermolyses bulleuses : suivi sur dix ans d'une patiente multigreffée.

We present the case of a patient suffering from dominantly inherited dystrophic epidermolysis bullosa and followed over a period of ten years. Skin lesions of this patient have been treated with multiple thin skin grafts applied over Integra®. The experience proved that, in order to have a perfect graft take, it was necessary to remove all the affected tissues, which includes an abnormally thickened dermis, and also a portion of the subcutaneous tissue.

[Gorlin syndrome: photodynamic therapy, as a useful adjunct to surgery]. / Syndrome de Gorlin : la photothérapie dynamique, technique complémentaire du traitement chirurgical.

Gorlin syndrome, also called nevoid basal cell carcinoma syndrome, is well known by dermatologists. Since its onset, 10 years ago, photodynamic therapy has found new applications and is now currently used to cure single or multiple basal cell carcinomas, with good results and without residual scars. We recall some of the basic principles of this technique, as well as its indications in Gorlin syndrome, which we illustrate with one case. Plastic surgeons must consider this relatively new technique, developed by dermatologists, as a useful adjunct to surgery in the management of Gorlin syndrome.

[The complete dorsum nasal island flap based on the superior alar artery]. / Lambeau total du dos du nez basé sur l'artère alaire supérieure.

The complete dorsal nasal aesthetic unit can be raised in a vascular island flap based on the superior alar artery, at the level of the nasalis muscle. This flap uses the vertical glabellar cutaneous laxity. It hides scars between the nasal aesthetics units and its distal rotation point allows a pure translation of the nasal skin without distortions encountered when using medial canthal rotation flaps. This local flap is reliable and had been successfully used for four patients without complications or secondary procedures. It allows large reconstructions for up to 25 mm defects leaving minimal scars. It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose, and has also been used for alar reconstructions.

[Conchal flap with a superior pedicle to reconstruct the middle or upper third of the auricle]. / Le lambeau de conque à pédicule supérieur pour les reconstructions hélicéennes supérieures ou moyennes.

The middle or upper third of the auricle can be reconstructed with a composite chondro-cutaneous peninsular flap of the conchal part of the auricle. This peninsular flap is based on the anastomotic network between the posterior auricular and the superficial temporal artery. The authors report their experience about 24 clinical cases. Most of the cases were partial auricular amputations for squamous cell carcinoma. The surgical procedure allows a hidden cartilaginous donor site, the concha, allowing in a single operation a color- and texture-matched reconstruction. This flap represents an alternative to more complex surgical procedures, and can easily be realised under local anaesthesia.

[Laparoscopy coupled with classical abdominoplasty in 10 cases of large rectus diastasis]. / Couplage cœlioscopie-abdominoplastie dans dix cas d'important diastasis des grands droits.

UNLABELLED: In 10 cases of abdominoplasty where an important rectus diastasis had to be corrected, we completed the plication of the rectus sheath included in a classical abdominoplasty with the laparoscopic positioning of an intraperitoneal prosthesis. PURPOSE: To assess the middle-term results of this technique and present its advantages and drawbacks. PATIENTS AND METHOD: Fifteen patients have been operated from 2007 to 2011 by two surgeon teams. Ten of them have accepted to be included in our survey. RESULTS: All the patients said they were satisfied with their surgery. Four of them reported mild pain during the first postoperative weeks, and two of them mentioned very moderate pain at the time of the survey. The surgeons were not satisfied with the results obtained in two cases. Only one of these two patients accepted revision abdominoplasty with a good result. CONCLUSION: Laparoscopic positioning of an intraperitoneal prosthesis, coupled with a classical plication of the rectus sheath, gives excellent results in difficult cases of rectus diastasis.

[Eyelid reconstruction according to Hübner's technique: About the use of 12 tarsomarginal grafts]. / Reconstruction palpébrale selon la technique de Hübner : à propos de l'utilisation de 12 greffons tarsomarginaux.

PURPOSE: The repair of full-thickness eyelid defect must fulfill multiple surgical requirements that are determined by the anatomical and functional features of the eyelids. Many reconstructive procedures are available, each and anyone of them presenting their own peculiar goals and constraints. Among them, we have tried to determine the place and the reliability of Hübner's tarsomarginal grafts. PATIENTS AND METHOD: Through a retrospective study of 11 patients treated with 12 grafts, over a period of 3 years, we evaluated our indications, technical principles and results of this procedure. RESULTS: The full-thickness eyelid defects represented between one quarter and three quarter of the marginal border length. They principally resulted from malignant tumors resection. In most of the cases, their management required a single graft, harvested on the contralateral homologous eyelid. Complications were minor and rare. Functional and aesthetical results were satisfactory. There was no functional sequel on the donor site. CONCLUSION: Tarsomarginal grafts in eyelid reconstruction provide multiple advantages. With this simple and versatile technique, wide and complex eyelid repairs can be managed in a one-step surgery. This procedure is very reliable; it gives good functional and aesthetical results. Hübner's technique is a major tool in eyelid reconstructive surgery.

[The reversed dermis flap soon to be forgotten as a major filler?]. / Le "reversed dermis flap" bientôt détrôné comme lambeau de comblement?

In his paper entitled "The reversed dermis flap" published in 1978, Pakiam explained the advantages of de-epithelialising local flaps and applying them dermis-side down. We present a ten-year series of 107-reversed dermis flaps used to raise depressed scars. There have been no significant complications in this series except two cases of infection and six cases of postoperative haematoma. All patients were satisfied with the cosmetic outcome. We do not use this flap as much as we used to since Coleman demonstrated how efficient lipostructure could be especially when applied to thin depressed scars. The reversed dermis flap remains invaluable in cases of widespread scars or when lipostructure is dangerous or impossible.

Reconstruction of seventeen full-thickness defects of the eyelids with twenty-two Hübner tarsomarginal grafts.

In 1976, Hübner described a new technique to repair full-thickness defects of the eyelids. In 1993, we decided to adopt this simple and easily reproducible technique that guarantees restoration of the normal aspect of the margin. Subsequently, 17 eyelid reconstructions were performed on 13 patients, requiring the harvesting of 22 tarsomarginal grafts. No cosmetic or functional sequelae in the donor eyelids were observed. One or several functional complications were present in seven out of 17 reconstructed eyelids, including two cases of epiphora, one case of lagophtalmos and two cases of lid notch. Loss of the eyelids was observed in three cases out of six upper eyelid reconstructions and in nine cases out of 11 lower eyelid reconstructions. In all cases, the margin integrity was otherwise preserved. Very few simple techniques achieve that level of quality in the eyelid reconstruction process.