[Bilateral breast reduction and obesity: What is the ideal resection enabling significant improvement in back pain according to the body mass index?] / Mastoplastie bilatérale de réduction et obésité : quel est le poids de résection idéal pour obtenir une amélioration significative des douleurs rachidiennes en fonction de l'indice de masse corporelle ?

INTRODUCTION: Dorsal pain is the first symptoms about which patients with macromasty complain. Health insurance reimbursement takes place if the resection weight is at least 300grams per breast. However, this weight is not correlated with the body mass index (BMI). In this context, we sought to determine the ideal resection weight leading to significant BMI-based improvement. MATERIALS AND METHODS: This is a multicentre prospective study of patients operated between November 2016 and July 2017. In the year following the surgical procedure, we studied overall improvement using the INDIC questionnaire. Any INDIC improvement of at least 50% was considered positive. These data were then compared to tissue resection weights and BMI. In order to refine our results, age, bra size, comorbidities and complications were also identified. RESULTS: Forty-one patients were included in our study. Average age was 41.5±11.4years. Average BMI was 27.9±4.1kg/m2. The bra cap chosen after the procedure were C. Average resection weight was 663±352g per breast. The preoperative and postoperative INDIC scores were 734.9±226.6 points and 225.3±319.1 points, respectively (P=0.001). Significant improvement was achieved at 12months in 71.8% of patients. A correlation of 38.7g/kg/m2 was found between breast resection weight and BMI. CONCLUSION: This study clarifies the correlation between the breast resection weight required to relieve optimal back pain and BMI. It defines three categories of patients: patients with standard weights (1830). Overweight and obese patients require greater tissue excretion to be relieved optimally. These findings underline a need to adjust the health insurance threshold for these types of patients.

[Free flaps use in chronic wounds: Retrospective study about 91 cases]. / Utilisation des lambeaux libres dans la prise en charge des plaies chroniques.

INTRODUCTION: Chronic wounds represent a major health challenge with no current standardized surgical treatment. The use of free flaps is little discussed in the literature, with a supposed propensity to failure given unfavorable local conditions and land often debility. We present here the analysis of our monocentric experience of the use of free flaps in the curative treatment of chronic wounds. PATIENTS ET METHODS: We performed a retrospective monocentric study over 18 years of all free flaps used for the treatment of a chronic wound between January 2001 and September 2016. Several criteria were evaluated on patients, wounds, free flaps used and immediate to late outcomes. RESULTS: Ninety-one patients were included (sex ratio M/F: 3.55) with an average age of 41.6±16 years. Wounds were localized to the leg in 92.3% of cases and 58% of patients had initial osteomyelitis. The flaps used were predominantly muscle flaps (61.6%). The flaps survival rate was 92.3%. With a mean follow-up of 50 months, the reconstructive failure rate was 20.9%. The presence of a chronic osteomyelitis is the only statistically significant factor of reconstruction failure (P=0.0169) with a risk of failure multiplied by 5. CONCLUSION: Our study demonstrates that the reliability of free flaps in the treatment of chronic wounds is comparable, regardless of the time since the initial cutaneous lesion, to that existing in the treatment of acute wounds or in the reconstruction after oncological excision. The presence of a chronic osteomyelitis, however, represents a major risk of reconstruction failure by increasing 5 times the risk of failure. Recent changes in the integumentary reconstruction paradigm of the lower limb will undoubtedly allow in the next few years to establish more rationally the place of muscle free flaps in the therapeutic armamentarium of chronic wounds.

[Generalized eruptive keratoacanthomas of Grzybowski: A case report followed over 11 years]. / Kératoacanthomes généralisés multiples de Grzybowski : suivi d'un cas clinique sur 11 ans.

Since 1950, the year of Grzybowski's syndrome description by Marian Grzybowski in Warsaw, 30 cases have been described in the literature. This syndrome belongs to the family of multiple generalized keratoacanthomas (KA). It occurs in adults between 50 and 70 years. Clinically, it presents as a rash of hundreds or thousands of small papules 1 to 2mm with well-defined, sometimes keratotic center. The onset is sudden, the evolution is progressive and chronic. It is accompanied by severe and persistent pruritus. There is no family history of KA and histology is compatible with that of KA. Other criteria may be present to varying degrees: the type of facial rash Mask of Zorro, mucosal rash, ectropion, the presence of crater-like lesions. We studied the case of a 58-year-old patient followed in the plastic surgery department of Nîmes' hospital for excision of several skin tumors as part of a Grzybowski's syndrome evolving since 2005. Its handling global and multidisciplinary treatments combining early surgical and complex medical treatments represents a therapeutic challenge.

[Xeroderma pigmentosum: radical therapeutic procedure on the face using artificial skin]. / Xeroderma pigmentosum: proposition thérapeutique radicale utilisant le derme artificiel au niveau de la face.

Xeroderma pigmentosum is a rare and severe photodermatitis without cure. Skin cancers are inevitable and give rise to iterative skin resections often mutilating especially in the face. We report the case of two sisters suffering from severe forms of xeroderma pigmentosum. Given the rapid emergence of multicancerous lesions, we opted for a radical approach entailing successively all aesthetic sub-units of the face. The reconstruction uses an original method used initially in the great burned: the artificial dermis. This simple method, providing a quality sub-soil, has helped us in these two complex cases to ensure coverage of a large defect providing a tissue recovery of excellent trophic and aesthetics quality. Thanks to this treatment strategy, we were able to significantly delay the development of this disease. With a retreat of 35 months, the quality of reconstruction by artificial dermis is considered to be satisfactory for its elasticity and its trophicity.