A modified nasolabial flap for reconstruction of transfixing alar wing defects.

Reconstruction of an entire alar wing is a frequently encountered reconstructive challenge in onco-dermatologic surgery. The aim of this technical note was to describe a surgical technique total for reconstruction of the alar wing, with a modified nasolabial flap with an inferior pedicle associated with a cartilaginous graft. This rapid procedure seems to be a well alternative for elderly people and patients who do not want a forehead flap. The aesthetic and functional outcomes of the donor and recipient sites were satisfactory.

Mandibular reconstruction after cancer: an in-house approach to manufacturing cutting guides.

The restoration of mandibular bone defects after cancer can be facilitated by computer-assisted preoperative planning. The aim of this study was to assess an in-house manufacturing approach to customized cutting guides for use in the reconstruction of the mandible with osteocutaneous free flaps. A retrospective cohort study was performed, involving 18 patients who underwent mandibular reconstruction with a fibula free flap at three institutions during the period July 2012 to March 2015. A single surgeon designed and manufactured fibula and mandible cutting guides using a computer-aided design process and three-dimensional (3D) printing technology. The oncological outcomes, production parameters, and quality of the reconstructions performed for each patient were recorded. Computed tomography scans were acquired after surgery, and these were compared with the preoperative 3D models. Eighteen consecutive patients with squamous cell carcinoma underwent surgery and then reconstruction using this customized in-house surgical approach. The lengths of the fibula bone segments and the angle measurements in the simulations were similar to those of the postoperative volume rendering (P=0.61). The ease of access to 3D printing technology has enabled the computer-aided design and manufacturing of customized cutting guides for oral cancer treatment without the need for input from external laboratories.

Surgical management of necrotizing cellulitis: Results of a survey conducted in French plastic surgery departments.

OBJECTIVE: Necrotizing cellulitis (NC) is a severe infection of the skin and soft tissues, requiring an urgent multidisciplinary approach. We aimed to clarify the surgical management of NC in French plastic surgery departments. PATIENTS AND METHOD: Thirty-two French plastic surgery departments were invited to complete a survey sent by email. Questions focused on diagnostic and therapeutic management of NC in France. RESULTS: Twenty-five plastic surgery departments completed the survey (78%) and each center had a lead plastic surgeon. Overall, 88% of surgeons declared to have managed at least five NC patients within the year. The plastic surgeon was the lead surgical specialist for NC in 80% of cases. Conversely, 76% of interviewed facilities reported not to have any lead medical specialist. Time between surgical indication and surgical management was less than six hours in 92% of cases. Overall, 24% of responding facilities declared that access to the operating room never delayed management. Finally, 80% of facilities declared to be in favor of dedicated care pathways to improve the management of necrotizing cellulitis patients. CONCLUSION: Our study results highlight the heterogeneity of necrotizing cellulitis management in France. The lack of a dedicated care pathway may lead to diagnostic and treatment delays.

Current indications for low level laser treatment in maxillofacial surgery: a review.

Low level laser treatment (LLLT) is currently being used for various disorders, but with no convincing scientific evidence. Most recently we have noticed an increase in published randomised controlled trials (RCTs) that have focused on its applications in wound healing, scarring, disorders of the temporomandibular joint (TMJ), oral mucositis, and dental pain. Our aim therefore was to assess the scientific evidence about its current efficacy in maxillofacial surgery. We reviewed PubMed from January 2003 to January 2013 using the key phrase "low level laser treatment". Our inclusion criterion was intervention studies in humans of more than 10 patients. We excluded animal studies and papers in languages other than English, French, and German. We found 45 papers that we screened independently. The resulting full texts were scrutinised by two authors who awarded a maximum of 5 points using the Jadad scale for assessing the quality of RCT, and extracted the data according to sample size, variables of LLLT, the authors' conclusions, and the significance of the result. LLLT seems to be effective for the treatment of oral mucositis after treatment for head and neck cancer. However, it cannot yet be considered a valid treatment for disorders of the TMJ. It seems to improve gingival healing, and myofacial and dental pain.

[Lactation after breast plastic surgery: literature review]. / Montée laiteuse après chirurgie plastique du sein: revue de la littérature.

The occurrence of lactation is a rare complication of breast plastic surgery. During the course of his practice, the plastic surgeon will probably encounter this complication. The goal of this article is to carry out a literature review of all published galactorrhea and/or galactocele cases following a breast-reduction or a breast-augmentation, representing a total of 34 cases reported in 21 articles. The physiopathology of this complication is linked to an inappropriate secretion of prolactin in a surgical context. The factors favoring this complication would be the number of pregnancies, a history of recent and extensive nursing, and the intake of certain medicines such as an oestro-progestative pill. The main symptom of this complication is the occurrence of a uni- or bilateral galactorrhea, on average 12.6 days after the surgery. The main differential diagnosis is a postoperative infection. The explorations presented a hyperprolactinemia in 69% of cases. No biological inflammatory syndrome was reported. A fluid collection evoking a galactocele was visible on the ultrasound in 65% of cases. One case of prolactin-secreting pituitary adenoma was reported. Depending on the case, the treatment varied from a simple surveillance to the association of a dopamine agonist, an antibiotic therapy, and a surgical revision. A diagnostic and therapeutic management strategy is proposed.