The value of a new filler material in corrective and cosmetic surgery: DermaLive and DermaDeep.

DermaLive is a long-term wrinkle reduction product including two types of components: pure hyaluronic acid, produced in cell culture, and an acrylic hydrogel. The product was first marketed in France and the rest of Europe in 1998. We have over three years of experience with this product. Several studies have been conducted simultaneously, mainly in Germany and in France. At present, DermaLive is used in the long-term correction of natural or acquired skin depressions (caused by aging, trauma) or the creation of volume (lips, sunken cheekbones). It provides a worthwhile alternative to good-quality bioresorbable materials (pure hyaluronic acid or collagen)--materials that are so resorbable, in fact, that most patients are ultimately dissatisfied with the results--and to other so-called permanent materials that patients do not tolerate well. Filling involving the use of autologous fat transplantations, which yields satisfactory results, is not appropriate for ambulatory injection and, therefore, will not be examined in detail. The tolerance experienced with DermaLive three years on is, at present, considered highly satisfactory. The wrinkle reduction effect obtained after the first injection is long-lasting with 60% resorption of the initial material. Two or three injections, with an interval of at least three months between each, may be required to bring about the reduction of some wrinkles or the correction of post-scar depressions. Side effects occurring long after the injection are rare (1.2 for 1,000). They appear mainly as palpable nodules occurring about six months after injection. They are treated by intralesional injection of corticoids. DermaLive and DermaDeep are both filler implants with a long-lasting effect designed for corrective and aesthetic surgery. Instruction of use and intervals between injection sessions must be respected. After DermaLive or DermaDeep injection, injections of pure hyaluronic acid (Juvederm or Restylane) for treatment of fine lines and superficial defects yield safe and excellent aesthetic results.

Congenital soft tissue dysplasia: a new malformation entity and concept.

We report 185 children with clinical manifestations of various conditions classically described as giant hamartoma, angiodysplasia, congenital hypertrophy, congenital trophoedema, localised gigantism (e.g. macrodactyly), etc. It is proposed to group all these conditions into a single entity: congenital soft-tissue dysplasia (CSTD). According to recent advances in fundamental embryology and cell biology, CSTD appears to be a consequence of embryonal or fetal cell biosynthetic dysregulation. The concept of the CSTD entity leads to a common protocol for clinical investigation and a common therapeutic plan, with special reference to the stability and the benign nature of the condition. Treatment should be confined to improving function rather than attempting to correct cosmetic deficits.

[Thoracopagus. Possibilities of surgical separation]. / Contribution à l'étude des thoracopages. Possibilités de séparation chirurgicale.

A new case of thoracopagus twins is reported. Radiological, hemodynamical and surgical explorations showed a communication between the two hearts, situated at the atrial level and associated with digestive and cardiovascular malformations. These abnormalities were definned by the anatomical study realized after vascular injection:hypoplastic pulmonary artery (associated with a persistent atrio-ventricular canal in one case, with a tricuspid atresia in the other case), a large fused liver, common pancreas and ileum. A bibliographic study allows the authors to define surgical separation possibilities. The prognosis depends essentially on cardiovascular abnormalities associating abnormal connections between the twins' hearts with malformations often too severe for surgical repair.

[Paronychia, the general practitioner, the surgeon and antibiotics (author's transl)]. / Le panaris, le praticien, les antibiotiques, et le chirurgien.

Antibiotic therapy for paronychia has seen its day. It is indicated only rarely and justified only when on the day following infection or during the next few days there are signs of regional or systemic spread. The surgical treatment of infections of the hand is not difficult but should be known, if not learned. A paronychia which has been opened but not cured should be reoperated upon rapidly. An "old" paronychia is a major catastrophe: small fistula, great damage. No surgical quarter for evil organisms!

[Sinus of the cerebellar tentorium]. / Sinus de la tente du cervelet

Post-mortem anatomical study on the "Tentorial sinus", in 23 skulls, using a retrograde veinous injection of a mixture of Rhodopas and lead tetroxide. Present in more than half the cases, this sinus actually constitutes a true sinus, principally draining the superior and inferior hemispheric veins of the cerebellum, traversing the posterior section of the tentorium cerebelli and opening into the lateral or straight sinus.