Breast reconstruction through exclusive lipomodeling or in addition to a flap: Current status in Franche-Comté.

INTRODUCTION: Breast reconstruction after cancer surgery through lipomodeling can be performed alone or in combination with a flap. Our objective is to describe the proportion of techniques used on patients who underwent autologous reconstructive surgery after tumorectomy or mastectomy in Franche-Comté. MATERIALS AND METHODS: A bicentric retrospective observational study was conducted between October 2017 and December 2021 (NCT06101732), including three groups: those who underwent exclusive lipomodeling reconstruction after mastectomy (1) or in addition to a flap (2), and those who underwent exclusive lipomodeling reconstruction after tumorectomy (3). Socio-demographic, medical, and surgical data were collected and recorded in a specially designed software. RESULTS: Two hundred and fifty-one lipomodeling procedures were performed on 91 patients. In group 1, the average transferred volume was 1191mL with an average number of sessions of 4.4 spreads over 19.4months. In group 2, the average transferred volume was 676mL with an average operative time of 2.5 spread over 16.1months. In group 3, the average transferred volume was 223mL with an average number of sessions of 1.5 spreads over 6.2months. Regarding postoperative complications, 11% had cysts of fat necrosis, 4.4% had infections, and 2.2% had hematomas. CONCLUSION: Lipomodeling is a technique that has clearly established itself in the field of breast reconstructive surgery. It results in a few complications and improves the final aesthetic outcome whether used exclusively or in addition to a flap.

[Abdominoplasties: Do we still need to drain in 2021?] / Abdominoplasties : faut-il encore les drainer en 2021 ?

OBJECTIVE: The purpose of this study was to consider the use of drainage when performing an abdominoplasty with regards to postoperative complications for two groups of patients. PATIENTS AND METHOD: From January 1st 2017 to December 31th 2019, 215 patients underwent an abdominoplasty in our institution. In this retrospective, comparative, single institution study, patients were divided into two groups: "drainage" D (n=162) when suction completed abdominoplasty, "no drainage" ND (n=53) when suction didn't completed abdominoplasty. Early and distant complications were retrieved for each group and compared. RESULTS: There was no significant difference between the two groups concerning the occurrence of seroma postoperatively (8% of patients in group D and 11.3% of patients in group AD). The drainage group D experienced more seroma's punctures (2,3± 1,0) and the mean of punctured fluid was higher (386,5ml±350,4ml) compared to the no drainage group ND (1,3+- 0,5 number of punctures with a mean punctured fluid of 165,8mL± 224,2mL). The mean hospital stay was shorter for group ND (2,9± 1,8 days) than for group D (4,4+- 1,7 days), P<0,0001. CONCLUSION: Performing an abdominoplasty with quilting suture but drainless doesn't seem to increase postoperative complications statistically. The authors recommend, under the guise of a quilting suture, not to systematically drain the abdominoplasties and to reserve this technique for patients at risk of complications (high BMI, significant weight loss and co-morbidities).

[Limb necrotizing soft tissue infection (NSTI) and necrotising fasciitis: A bicentric study between 2000 and 2017 on the quality of life and functional impact]. / Atteinte des membres dans les DHBN-FN : étude bicentrique entre 2000 et 2017 sur la qualité de vie et impact fonctionnel.

INTRODUCTION: Limb necrotising soft tissue infection and necrotising fasciitis surgical debridement results in significant soft tissue losses. The purpose of this study was to evaluate the functional impact and the quality of life of survivors. PATIENTS AND METHODS: This bicentric retrospective study included 62 patients treated for limb necrotising soft tissue infection and necrotising fasciitis (NSTI-NF) between 2000 and 2017. Demographic, clinic, biologic and surgical data were found in Patients Medical Records. Survivors at the moment of data collection (2018) were met; their quality of life was assessed using SF-36, DLQI, BSHS-B scores and their active joints motions were measured using a goniometer. RESULTS: Twenty-one patients (87.1% of the living patients at this moment) were assessed. For the joint above the injury, mean loss of flexion was 9.19% and 5% for extension whereas for the joint under the injury, mean loss of flexion was 37.65% and 48.6% for extension compared to non-injured side. Mean quality of life scores were: SF-36p: 45.88, SF-36m: 51.31, DLQI: 10.48, BSHS-B: 105.81. The statistical analysis was not able to establish a correlation between loss of motion and quality of life. CONCLUSION: We have not found a relationship between loss of joints motions and long term quality of life for those patients. High excised body surface area and high length of stay are correlated with high DLQI and thus a lower quality of life.

[Patients' satisfaction after abdominal etching]. / Satisfaction des patients après lipoaspiration abdominale sculptante.

INTRODUCTION: The aim of this study is to analyze the patients' satisfaction after aesthetic abdominal etching or associated with an abdominoplasty. MATERIAL ET METHODS: All records of patients who underwent abdominal etching between 2016 and 2017 were analyzed. Eligible patients were contacted, by telephone and submitted to a questionnaire of satisfaction. The patients were then divided into 3 groups according to the operative indication: aesthetic abdominal etching, abdominal etching for breast lipofilling and abdominal etching associated with an abdominoplasty. RESULTS: Twenty-two out of 30 patients agreed to answer the questionnaire: 6 in the aesthetic abdominal etching group, 9 in the breast lipofilling group and 7 in the abdominoplasty group. For 41% of patients, the result was entirely in line with their expectations. It was fairly consistent in 50% of cases and non-compliant in 9% of cases. 50% of the patients were completely satisfied with the stability of the result over time and 45% were quite satisfied, an average satisfaction of 95%. Fourteen percent of patients rated their result as excellent, 41% as very good, 32% as good and 14% as average. No patient rated his result as mediocre. For 96% of patients, the choice of intervention was a good or very good decision and 77% would do it again without hesitation. CONCLUSION: Abdominal etching provides a high overall patients' satisfaction. It has a positive impact on the patient's life, with a low risk of complications.

[Functional or aesthetic labia minora reduction: Complications, revision surgeries and results - a comparative study]. / Nymphoplasties de réduction fonctionnelle ou esthétique. Complications, réinterventions, résultats : étude comparative.

OBJECTIVE: To evaluate and compare the complications, the rate of revision surgeries and the long-term patient postoperative satisfaction level for the two main indications of labia minora reduction: aesthetic or functional. METHODS: A comparative, retrospective and multicentered study was carried out in Belfort and Montbéliard hospitals between January 2010 and January 2017. Ninety-two primary labia minora reductions for labia minora hypertrophy have been listed. Each patient has been requested to fill in a questionnaire about the main indication of labiaplasty, any potential complication, a revision surgery and her level of the satisfaction. Patients who had agreed to respond were divided into two groups: a "functional indication" group (FI) and an "aesthetic indication" group (AI). RESULTS: Thirty-seven patients (40%) answered the survey: 19 (51%) have been included in the FI group and the remaining 18 (49%) in the AI group. The mean postoperative follow-up duration was 3.2 years. We identified 13 patients (35%) who encountered a postoperative complication. It predominates in the FI group (53% versus 17%, P=0.04). Seven patients (19%) were treated by revision surgeries. All of them belonged to the IF group. Whatever the indication of the labiaplasty, 86% of the patients have been satisfied by the outcomes. CONCLUSION: A labia minora reduction is a highly appreciated surgical treatment on the long term whatever the initial surgical indication. However, postoperative complications and revision surgeries are not negligible especially when the main indication is functional.

[Should surgeons keep performing drainage after breast reduction?] / Faut-il encore drainer les réductions mammaires ?

OBJECTIVE: Despite the absence of "evidence-based medicine", the use of closed suction drainage in breast surgery is currently the standard practice. Its goal is to minimize the amount of fluid at the operation site, the dead space that can involve postoperative complications. The purpose of this study is to demonstrate that with or without drainage the complication rate is unchanged. METHODS: We conducted a retrospective and comparative study of two groups of breast reduction with and without drainage. Every complication has been recorded and statistically analyzed: seroma and hematoma, infections, wound breakdown, skin flap or nipple-areola complex necrosis, fat necrosis and reoperation. RESULTS: A total of 138 breast reductions were performed (37 drained patients and 32 non-drained). Data collection of complications was done on average 10months after the operation (1-15). There was no statistical difference between the two groups regarding the complication rate. Our results confirm the ones found in the literature. CONCLUSION: Except for specific cases (e.g. gigantomasty), this study demonstrates that after breast reduction, drainage is not appropriate. Drains do not reduce postoperative complications and can increase hospitalization length of stay (inducing higher costs). Furthermore, it is often source of pain, anxiety and discomfort for patients.

[Lower bodylift after massive weight loss: Retrospective study of satisfaction, complications and quality of life. About 76 patients over 4years]. / Bodylift inférieur après amaigrissement massif : étude rétrospective de la satisfaction, des complications et de la qualité de vie. À propos de 76 patients sur 4ans.

INTRODUCTION: Massive weight loss leads to important cutaneous deformities with physical and psychological repercussions for patients. Lower bodylift is a procedure, which can restore the body contour. The aim of this study is to evaluate satisfaction and quality of life in patients who underwent lower bodylift and to review the complications of these procedures. MEANS AND METHODS: This is a retrospective study of 76 patients who underwent lower bodylift between 2012 and 2016. We reviewed the complications of these procedures. Satisfaction and quality of life were assessed using Body-QoL questionnaire. RESULTS: Seventy-six patients were included with a mean age of 39.2years. The average body mass index was 27.6kg/m2 with a mean weight of 71.2kg at the time of surgery and a mean weight loss of 48.6kg. Twenty-three patients developed one complication: 22 minor and 1 major. Forty-eight patients answered the questionnaire. Satisfaction was rated "very good" by 41 patients (85.4%) and "good" by 5 patients (10.4%). The Body-QoL questionnaire's analysis showed an improvement of quality of life socially, sexually, in the body regard and in physical symptoms. CONCLUSIONS: Lower bodylift is the only procedure, which can restore circumferential body contour. Despite the minor complications reviewed, the degree of satisfaction of the patients is very high. The quality of life of these patients, after massive weight loss, is also highly improved by these procedures. With the worldwide development of obesity and bariatric surgery, this study demonstrated that the operation should be proposed to patients with massive weight loss to improve quality of life.

[Abdominoplasty: towards a two procedures surgery? Retrospective study of postoperative complications about 100 cases]. / L'abdominoplastie: vers une chirurgie en deux temps? Etude rétrospective des complications postopératoires à propos de 100 cas.

Abdominoplasty has become in France a frequent, appearing to be technically easy but nevertheless source of potentially serious complications clearly deteriorating the aesthetic results and the satisfaction rate of the patients. By studying the results of a hundred abdominoplasties performed between 2001 and 2004, we could count the incidence of the various complications by seeking their possible factors of risk (tobacco or ponderal overload). In spite of the use of a lymphatic preserving technique, the percentage of séroma reaches 12%. The high complications rate or the number of insufficient results explains a rate of surgical reoperation of 31%. Abdominoplasty passed from the statute of repairing surgery to that of aesthetic surgery. The level standard in terms of result became equivalent to the other purely aesthetic interventions. Obtaining an optimal result thus requires often two operational stages, data element that it henceforth seems essential to us to provide to the patients.

[Mid-plantar pedicle skin flap. Apropos of 5 clinical cases]. / Le lambeau cutané pédiculé médio-plantaire. A propos de cinq cas cliniques.

The blood supply to the non-weight bearing midsole area is not derived exclusively from the medial plantar artery. This allows elevation of a subfascial mid-plantar cutaneous flap for the reconstruction of the heel. The technique of elevation of the flap is described. This plantar flap can be designed to include sensation without the need for deep dissection. Five clinical cases are discussed. This flap is useful for medium-sized chronic ulcerations of the heel.

[Tocokinetics of infected newborn infants]. / Tococinétique des nouveau-nés infectés.

The diagnosis of fetal infection, other than in association with premature rupture of the membranes, requires the evaluation of various parameters. Children suspected are four to five times greater in number than those truly threatened. A new and important parameter has emerged as a result of tocokinetic investigation: in one case out of two 48 hours before birth and in three cases out of four during the day before birth, fetal motility, together with cardiac reactivity or not, appear to be very markedly decreased when the newborn will in fact be found to be infected. Tocokinetic study is thus a new source of help in the obstetric/pediatric decisions which must be taken in this context.

[Orbital neurofibrosarcoma. Clinical and etiological study; apropos of a case]. / Neurofibrosarcome orbitaire. Etude clinique et étiologique; à propos d'un cas.

This case report is about a relapsing conjunctive sarcoma affecting a 67 year old woman, involved with Von Recklinghausen's neurofibromatosis. Surgical orbital exenteration was necessary for curative treatment and reconstruction used a temporal muscle flap. Through this report, emphasis is placed on diagnosis difficulties and possibility of serious development concerning these malignant tumors in the scope of neurofibromatosis.