Tissue expanders in post-burn alopecia: with or without galeotomies?

The tissue expansion technique is part of the reconstructive surgeon's armamentarium. It provides donor skin that is an optimal match in terms of skin colour, texture, sensation and hair-bearing characteristics. Tissue expansion of the scalp is one of the methods used for the management of alopecia. This method allows the expansion of normal hair-bearing scalp to cover the area of alopecia. Unfortunately, the tough galeal layer prevents easy and fast expansion of the scalp and increases the rate of expander extrusion. A prospective and retrospective comparative analysis of the use of subgaleal expanders with or without galeotomies to manage post-burn alopecia was conducted in the Burn Unit of the Menofia University Hospital, in the period from September 2010 to November 2014. Thirty expanders in 30 patients with alopecia were included in the study. These constitute the experience of a single surgeon. Twenty expanders were applied to the subgaleal plane without galeotomies and 10 were applied with galeotomies. Indications for scalp expansion were mainly post-burn alopecia and scarring. Complications and failures were recorded. Adding galeotomies to subgaleal tissue expander placement for scalp alopecia decreases the time of expansion, allows a larger amount of fluid to be injected each time without inducing pain, and decreases the rate of expander extrusion. Adding galeotomies to subgaleal tissue expander placement for post-burn alopecia ensures preservation of galeal blood supply for easier and faster expansion of the scalp and fewer expander extrusion complications.

L'expansion cutanée fait partie des techniques de reconstruction. Elle permet d'obtenir une zone donneuse ayant des caractéristiques cutanées proches de la zone à traiter en termes de couleur, texture, sensibilité et pilosité. L'expansion cutanée du cuir chevelu est une des méthodes utilisées dans le traitement de l'alopécie, permettant de recouvrir une zone alopécique avec du cuir chevelu normal. Cependant, la solidité du fascia galéal rend cette expansion difficle et lente et augmente le risque d'exposition prothétique. Nous avons conduit une étude comparative avant-après sur l'expansion de cuir chevelu (prothèse en position sousgaléale), avec ou sans galéotomie, dans le traitement d'alopécies cicatricielles post-brûlures. Cette étude a été conduite par un seul chirurgien, travaillant dans le CHU Ménofia, entre septembre 2010 et novembre 2014. Trente patients ont été inclus dans l'étude, présentant tous une alopécie, le plus souvent post-brûlure, ailleurs post-traumatique. Vingt ont eu une expansion sans galéotomie, 10 avec. Les complications et les échecs ont été colligés. La réalisation d'une galéotomie lors de la mise en place de l'expandeur permet de raccourcir la durée d'expansion, d'augmenter le volume injecté à chaque gonflage sans augmenter la douleur, et de diminuer le taux d'exposition. La réalisation d'une galéotomie lors de la mise en place d'un expandeur de cuir chevelu, tout en préservant la vascularisation galéale, permet la réalisation plus rapide et plus aisée de l'expansion désirée, tout en diminuant le risque d'exposition prothétique.

Return migration: changing roles of men and women.

PIP: This article addresses changes in gender roles among returning migrant families. It focuses on Greek returnees from the Federal Republic of Germany and explores changes in task sharing behavior and gender role attitudes resulting from changes in the sociocultural environments. A group of return migrants was compared with a group of non-migrants, both living in villages in the District of Drama, Greece. Groups were interviewed to investigate the extent to which each spouse shared house tasks, as well as their attitudes towards sharing and gender role in the family. The t-test for independent samples was used to determine mean differences between the two groups. In addition to demographic variables, those concerning the "time lived abroad" and the "number of years in Greece" after return were inserted into a series of regression analyses. Findings showed that migrants' task sharing and gender role attitudes were influenced differently by the migration-repatriation experience and subsequent cultural alternation. Results also suggest that migrant couples either take on new patterns of behavior or maintain traditional ones only when these were congruent with the financial aims of the family or can be integrated into living conditions in Greece upon return. Furthermore, migrants seem to adopt a more "traditional" attitude than non-migrants toward the participation of women in family decision making. From the study, it is suggested that gender role change is an on-going process influenced by the migration-repatriation experience, as well the factors, which accompany movement between the two countries.^ieng

Maternal attitudes of Greek migrant women.

PIP: This study examines groups of Greek migrant mothers and their attitudes towards their children in different stages of the migratory process. There were 2 lots of samples of Greek migrants mothers who had at least 2 children 8-10 years old, 1 from the home country (5 villages of the District Drama in East Macedonia) and 1 from the receiving country (the area of Baden-Wurtenberg, where most of the migrants from East Macedonia are living). The 4 groups are: 1) 20 mothers who have always lived with their child in the host country; 2) 20 mothers who live in the host country where their child has joined them in the last 2-4 years; 3) 27 mothers who have lived in the host country with their child and have returned home in the last 2-4 years; and 4) 24 non-migrant mothers who have always lived with their families in the home country (control group). Women were interviewed using 2 questionnaires: a survey and an attitude questionnaire. The range of mothers' ages was 20-50 years. The youngest mothers were in the control group whereas group 1 mothers were the oldest. Groups 1 and 2 were mostly unskilled workers; groups 3 and 4 were mostly housewives. The returnees stayed in the host country a mean of 10 years, whereas the other 2 migrant groups were there 14.6 years. There were significantly fewer children in the families of groups 1 and 2 than 3 and 4. The attitude questionnaire covered the following child rearing practices: 1) training the child to participate in home duties; 2) keeping clean and tidy; 3) self-reliance and social behavior towards visitors; 4) ways of dealing with a child's obedience/disobedience; 5) dealing with favor-seeking behavior, food, and sleeping problems; and 6) mother's degree of permissiveness, supervision, and intervention on child's personal and interpersonal sphere of life. Findings show that moving from home to host country and coming back home creates the most controlling mothers, probably because mothers and children face anxiety-producing situations as they redefine family roles and readjust to the social environment. Returnees are as emotionally involved with their children as mothers who have always lived with their children in the host country. There are more similarities than differences between the 2 migrant groups. Both groups show similar attitudes to the control on 5 out of 7 composite variables. These findings suggest there is a strong cultural pattern in maternal attitudes which has not been affected by the sociocultural environment. The 2 groups of migrant mothers are similar to the returnees in their attitudes towards boys and girls except that returnees were more overprotective of boys than girls.^ieng