[The surgical innovation: From the legal framework through the veritable ethics innovation - Technical aspects and practical applications]. / L'innovation chirurgicale : du cadre légal à une véritable éthique de l'innovation. Aspects théoriques et applications pratiques.

Grace to the creativity of surgeons and the introduction of new technologies, second half of the XXth century opened the era of innovations and decisive progress. At the same time, however, is born the feeling of distrust and claiming which has come with the graving and threatening juridiciarisation. The evolution of complex structures of our society joined the ingenuity researchers unlimited makes formal law and the legal framework constantly to adapt oneself to circumstances. In the field of surgery, it's necessary to make work in integrity the innovation and protection at the patient's and their dignity. The legal framework that governs today innovation in surgery must still to go further and will precise. Dignity, compelling paradigm for all those who seek to better understand and better protect human starred as impassable limit any search and any experimentation. To make this chapter more alive, we have supplemented it and illustrated by the testimony some of the most fruitful French last years innovative in order to enrich our thinking of the fruit of their large and brilliant experience.

The vertical midface lift. An improved procedure.

We describe a novel procedure for an anatomically-based face lift to correct vertical vectors in the ageing face. It has the advantage of surgical simplicity, minimal tissue removal and minimal risk. It provides an effective readjustment of cheek volume and correction of periorbital hollowness. Natural facial expression is preserved largely because there is no change in the position of the lateral canthus. The cheek is mobilised subperiosteally through a blepharoplasty incision. A second dissection is made via a short temporal incision, to join the infraorbital dissection. A Hagedorn needle is then inserted through a point inferior to the lateral canthus and in line horizontally with the nasal ala. It is passed to the orbital incision, charged with a loop of suture material, and pulled down again to the cheek incision, from where it is pushed back to the orbit to suspend the cheek. The upper border of orbicularis oculi is fixed firmly to the temporalis aponeurosis at the level of the temporal incision. We now frequently use an Endotine Midface device for fixation. Of the first 150 patients, results were excellent or good in 145. This represents a revival of the subperiosteal mask lift, and abandons the use of endoscopic techniques. In spite of its simplicity, the operation involves subperiosteal dissection as well as delicate eyelid surgery that necessitate plastic surgical skill.

[Madelung deformity: isolated ulnar wedge osteotomy]. / Maladie de Madelung: ostéotomie isolée de l'ulna.

OBJECTIVES: Madelung deformity is defined as a partial closure of the medial half of the distal radial growth plate, with anatomical consequences (wrist deformity), and functional impairment (decrease range of motion, loss of grip strength, and wrist pain). We report a new surgical procedure including a shortening of the ulna combined with slight anterior flexion osteotomy aiming to correct the radio-ulnar dislocation and to improve the range of forearm rotation, without correcting the global deformity. METHODS: This was a retrospective study of four symptomatic wrists in three patients. The follow-up was 24 months. Patients were assessed clinically and radiologically pre and post operatively. The ulnar shaft was shortened and anteriorly flexed through a dorsal and ulnar approach and fixed with a fitted internal DCP plate. The aim of this osteotomy was to reduce the dislocated distal radio-ulnar joint. RESULTS: At 24 months follow-up, the function was considerably improved with a correction of the ulno-carpial conflict. The range of painfree forearm rotation improved. The post-operative views showed a correction of the dorsal dislocation of the ulnar head. CONCLUSION: This technique seemed to be safe and demonstrated good results in these four wrists. It should be proposed in patients with Madelung deformity and assessed prospectively.

[Approach to augmentation mammaplasty]. / Les voies d'abord et les plans de l'augmentation mammaire par prothèse.

The anatomy give a description of the fixation of breast ligaments, on submammary fold, on the vascularisation of the areola-nipple complex and the surgical consequence on sensibility. The innervation areola-nipple complex comes from the 4th lateral cutaneous branch. The sensitive troubles are frequent but compensed by the sensual gratification of the breast. Skin incisions have been analyticly study. Periareolar incision is less pratice than submammary or axillary incision. The concept of adequation parenchyma-implant is fondamental however the pocket is pre- or retropectoral.

[Endoscopic axillary breast augmentation]. / Augmentation mammaire endoscopique par voie axillaire.

Endoscopic axillary breast augmentation combine advantages against few inconvenients. The authors discribe the surgical endoscopic technique and the medical patient management. A study on 48 patients shows the efficiency on quick professional activity (3 days) thanks to the control of inflamatory syndrom with a quick procedure and perioperatoire treatment.

[Descriptive analysis of the various mammary implants available on European market in 2005]. / Analyse descriptive des différents implants mammaires disponibles sur le marché européen en 2005.

Laboratories propose a large variety of mammary implants, in which the multiplicity makes it difficult for the surgeons to choose. The objective of this work was to analyze the various features of the implants proposed by manufacturers, in particular the characteristics of the shell, the specificities of the filling, and the morphology of the implants. Nine laboratories sell ten brands of mammary implants on the European market. The laboratories are: Arion, Eurosilicone, Inamed Aesthetics, Mentor, Nagor, Perouse Plastie, Poly Implants Protheses, Polytech Silimed and Sebbin. All laboratories propose smooth or textured surfaces on the shell. Only one laboratory uses a surface covered by micropolyurethane foam. The fillings consist of a saline solution or a silicone gel. One laboratory provides a filling with hydrogel containing carboxymethylcellulose. The forms suggested are round or anatomical. The various models propose a variation on the projection for the round implants and a variation on the height for the anatomical implants. Analysis of the different catalogues makes it possible to underline the lack of precision in the terms of usage, in particular for the description of the form and the texture. It is unfortunate to have very little technical information and no clinical or biological information imposed by the European standard EN 12180. This prevents the surgeon from making his choice according to the real quality of the implants.

[Injectable collagen]. / Collagène injectable.

The aim of this paper is to evaluate the so-called "American" injectable collagen, produced since 1975 by Collagen Corporation. Main interest of that work concerns an actual follow-up on millions of patients, treated since 25 years, with more than 280 clinic studies published throughout international literature. Everybody knows that--in human therapeutic--a very long follow-up and a great number of patients is a warranty for a complete security. This Collagen is natural, extracted from bovine dermis; this is the first "true cosmetic drug". Therefore, rigorous practice conditions have to be respected.

[Longitudinal melanic nail bands (melanonychia): report of 22 cases]. / Bandes mélaniques longitudinales unguéales (mélanonychies): conduite à tenir à propos de 22 cas.

INTRODUCTION: Longitudinal melanonychia is a diagnostic and treatment problem for the surgeon. Fear of melanoma most frequently leads to total excision of nail bed, matrix and plate. METHOD: Twenty two patients, aged from 7 to 77, were operated on from 89 to 98 in our department, using different techniques (total matrix biopsy, total excision of melanonichia with direct suture, Schernberg flap). RESULTS: Thumb and index are predominant locations (11 out of 16). No malignant lesions were found histologically. Aesthetic sequellae were frequent and directly linked to the width and location of the melanonychia. Limited matrix biopsy produce the best aesthetic result. DISCUSSION: Malignant lesions are rare and our series is short. Therefore an additional multicentric study is required. Our choice is to make a limited matrix biopsy in the first place with a minimal aesthetic prejudice. Histology determines the treatment choice: excision or follow up.

[On the development of carcasses disposal in Israel paying particular attention to the industrial slaughtering of poultry (author's transl)]. / Uber die Entwicklung der Tierkörperbeseitigung in Israel mit besonderer Berücksichtigung der industriellen Geflügelschlachtung.

Although a regulation has been in force in Israel since 1930 which committed the communities to provide for knackers' yards, until some years ago packs of jackals took care of the carcass disposal. Owing to the increase of large slaughter houses for fowl some rendering plants were also erected, which however, eliminated only the waste from these plants. For this reason the government decided to build rendering plants on the European pattern and to legislate pertinent veterinary acts. In Israel 20,000 tons fish-meal is imported annually, worth millions of dollars for feeding purposes, while no attention is as yet being paid to the processing of the national raw materials.