[Deleated breast reconstruction, witch strategy?]. / Reconstructions mammaires différées, quelles stratégies?

Breast reconstruction is part of the treatment of breast cancer needing mastectomy. To deal with the numbering technics in breast reconstruction surgery and with the number of patients seeking reconstruction, the authors proposed a strategy taking care of the patients wishes, of the patients morphology and of the surgicals limits of the different technics. On this aim, the authors reviewed a 30 patients series of secondary breast reconstruction composed of 23 inferior gluteal free flaps, 4 transverse rectus abdominus myocutaneous flaps and 3 latissimus dorsi musculocutaneous flaps.

[Role of lipo-filling in the treatment of sequelae in craniosynostosis surgery]. / Intérêt du lipofilling dans le traitement des séquelles de chirurgie des craniosténoses.

AIM: This study presents an innovative technique of correction of cranioplasty sequelae by lipo-filling in 9 patients treated for cranioplasty in childhood with a long-term follow-up. PATIENTS AND METHODS: A prospective study was conducted from January 2001 to February 2005, including all patients treated with lipo-filling technique in the Plastic Surgery department of Lille. For a period of 4 years and 5 months, 144 patients were operated on with 206 lipo-filling procedures: 30 patients for cosmetic purposes and 114 patients for reconstructive surgery. In the current investigation, we examined the 9 cases of lipo-filling which were performed in complement to craniofacial surgery. All patients presented with a sub-cutaneous fronto-temporal deformation which in 3 of the cases was associated to a frontal medial defect. The assessment of results was performed in the context of post-operative follow-up visits by an observer. RESULTS: Nine patients, with a mean age of 16,7 years and a ratio of 1 female for 2 males underwent a total of 17 lipo-filling procedures. The mean time lapse was 15,06 months. 9 patients judged the result to be good. No complication was observed. CONCLUSION: The S.R. Coleman technique of fat grafting seems to offer several advantages, namely the simplicity of the procedure itself, its apparent innocuity, its reproducibility, as well as patients and surgeons satisfaction. It appears to be an alternative of choice in the corrective surgery of craniosynostosis.

[The lateral brachial flap: retrospective study of its face's utilisation between 1995 and 2002]. / Le lambeau brachial externe à la face: étude de dix cas opérés entre 1995 et 2002.

The lateral brachial flap is a fascio-cutaneus flap. This flap is secured. The functional and cosmetic sequelae are limited. The authors propose in this paper its utilisation as free flap in the reconstruction of facial defects. Thanks to its low morbidity, this free flap may be used in old patients.

[Eyelid crease incision for lateral orbitotomy]. / Orbitotomie latérale par voie palpébrale supérieure.

Lateral orbital approach by eyelid crease incision constitutes a good way to the lateral sectors of the orbit allowing a good exposure, an invisible scar and light postoperative course. It constitutes a good alternative to the supero-lateral approach which certainly, offers a good view but the heaviness of the postoperative course gives to the lateral orbitotomy all its interest. By a review of the literature, we try to report the advantages and the indications of this approach.

[Galactorrhea after mammary plastic surgery]. / Galactorrhée après chirurgie plastique mammaire.

Galactorrhoea is a complication rarely observed after mammary plastic surgery. Our experience in the domain extends to three clinical cases - two after prosthetic insertion and one after breast reduction - wich will be presented here. The origin of this complication is uncertain. Nevertheless, it is likely to be multifocal, as surgery alone is not the only cause. Postsurgical galactorrhoea often follows a benign course culminating in spontaneous resolution. However, it may reveal the presence of o prolactin secreting adenoma, as was the case with one of our patients. A detailed history, exploring antecedent factors, is an essential step in guiding subsequent management. When faced with postsurgical galactorrhoea, serum prolactin levels should be measured. If serum prolactin levels exceed 150 ng/ml further investigation by way of an MRI of the sella turcica is advisable to rule out pituitary adenoma. Depending on symptom severity, treatment may be medical with the prescription of dopaminergic agonists, and/or surgical with drainage or removal of prostheses. Increased awareness of galactorrhea as a possible complication of plastic surgery to the breast will improve management.

Choanal atresia and rare craniofacial clefts: report of three cases with a review of the literature.

OBJECTIVE: This retrospective study reports three cases associating choanal atresia (CA) and rare craniofacial clefts (RCFCs) described in Tessier's classification. Although still discussed, these two malformations could derive from the same embryopathogenic context, with an anomaly of migration of the neural crest cells as a common factor. In two of the three cases presented, the RCFC was diagnosed during the neonatal period, and the third case (case 3) was diagnosed at the age of 12 years. The knowledge of this malformative association must permit the diagnosis of CA as early as the neonatal period or through the thorough and directed examination of the children as part of the follow-up.

Lower lip repair in Van der Woude syndrome.

Van der Woude syndrome is an unusual congenital malformation. It combines lower lip sinuses with a cleft lip and/or palate. The asymmetry appears more pronounced due to lower lip hypotonia and procheilia, which are more unaesthetic than the fistulae themselves. The malformation of the orbicularis oris muscle in its medial part induces the hypotonic aspect of the lower lip, which contrasts with the retracted scarred upper lip after the cleft has been repaired. It is also responsible for a real bilabial asymmetry. For many years, the most common surgical treatment was simple excision of the sinuses. Bad functional repair results prompted the authors to try another surgical procedure, the split-lip advancement technique as described by Mutaf. The authors report here on 8 operated children out of 25 patients followed up for Van der Woude syndrome. They evaluated the results according to the appearance of the lip when relaxed, its functional aspect, and the satisfaction of the parents or the child. Our results point to the importance of early surgical treatment, radical excision of dysplastic tissue and the repair of lip muscles to restore good lip functionality and satisfactory bilabial symmetry. The technique now used in our department has made it possible for us to achieve these goals.

[Familial pyoderma gangrenosum following a mammoplasty reduction: a case report]. / Pyoderma gangrenosum familial après chirurgie de réduction mammaire: à propos d'un cas clinique.

The authors report a case of familial pyoderma gangrenosum following a mammoplasty reduction. This disease should be known by all surgeons, because its occurrence may follow all surgical procedure. The only efficient treatment is based on steroids and large surgical excisions must be contraindicated.

[Cleft lip and palate treatment in the plastic surgery department in the university hospital center in Lille]. / Prise en charge des fentes labio-maxillo-palatines au sein du service de chirurgie plastique du centre hospitalier universitaire de Lille.

The aim of cleft care is to favor a normal socialization of patients with fewer therapeutic coercion. It supposes a full multidisciplinary team including psychologist, speech therapeutic, dental orthopedist, oto-rhino-laryngologist and surgeons. All of them have to be well trained which supposes a sufficient amount of cases: anglo-saxon studies have proven that a mean of at least 20 new cases per year of primary cleft were necessary. With purposes to enhance the effectiveness of treatment: prospective studies and measurements of results must be evaluated with the help of objective criteria. These are the goals of our team in lille. Our surgical principles are those of functional procedures, which privilege the muscle function's repair.

[Facial burns in children. 197 patients]. / Les brûlures de la face chez l'enfant. A propos de 197 patients.

Facial burns frequently occur in child. A total of 197 burned patients with facial localisation were seen during the time period (1991-1996) covered by this retrospective study. One hundred and sixteen patients were less than three years old. A quarter of the child were issued from poor social classes with nine cases of child abuse by burning. One hundred and thirteen injuries were performed by hot water or drinks. The total burn area was less than 10% in 63% of the cases. The average facial burned area was 4%. The cheek, the front and the chin were often concerned. Low limbs and trunk were unjured in all cases. 130 patients needed hospitalisation, and stayed in average 17.31 days at hospital. Four patients died from respiratory complications, all after flame injuries. Fifty two child needed skin split grafts. Complete cicatrisation was observed after 21 days of treatment in child without grafts, and after 35.65 days in child with skin grafts. Twenty eight patients needed physiotherapy in center. The scars had a correct cosmetic appearance, without retraction and inflammatory signs in 158 child after two years. Eleven patients needed other surgical treatment. The authors analyse the results and insist on prevention.

[Extended nasal reconstruction with forehead flap. Report of a series of 12 adults]. / Rhinopoïèses étendues par lambeau frontal. A propos d'une série de 12 cas chez l'adulte.

The authors report a study about 12 cases of partial, total and extensive rhinectomy treated by a median "gingko flower" forehead flap. Technical adaptations are described to resolve the difficult problem of support and lining reconstruction. The authors compare their technique with the various other methods: the classical one (Converse scalping and sea-gull Millard's flaps) or more recent surgical solutions (distal composite flaps and expansion).