Trapeziectomy and tendon suspension with or without a mitek anchor fixation in the thumb basal joint osteoarthritis.

Partial trapeziectomy with suspension ligamentoplasty is a commonly performed treatment of thumb osteoarthritis. Nevertheless, the post-operative recovery remains long and critical reason for which different modifications of the surgical technique have been proposed. To compare two suspension ligamentoplasty techniques, one with a mitek anchor and another without, a retrospective study of 55 consecutive operated patients was performed. A detailed clinical analysis of pain, function and a radiologic assessment of the trapeziometacarpal space were performed. Mitek anchor fixation was associated with a shorter convalescence period. However, in spite of an improved radiological maintenance of the scaphometacarpal space, mitek anchor fixation was associated with an impaired postoperative function and residual pain when compared with the conventional suspension ligamentoplasty procedure. Patient's satisfaction was comparable in both groups. In our series stabilization of the suspension ligamentoplasty procedure by the insertion of a mitek anchor did not bring the hoped benefits to the patients with a trapeziometacarpal arthritis.

[Pyoderma gangrenosum: a rare pathology or an omitted diagnosis?]. / Le pyoderma gangrenosum: pathologie rare ou diagnostic omis ?

Pyoderma gangrenosum is a rare pathology of uncertain etiology. It is an inflammatory dermatosis that causes cutaneous necrosis with a characteristically rapid evolution. No precise diagnosis criteria has been established and pyoderma gangrenosum remains an exclusion diagnosis. In 40 to 50% of the cases, the evolution of pyoderma gangrenosum can be worsened by a nonspecific external stimulus such as a trauma or a surgery. This phenomenon, called pathergy, conduces to avoid any surgical excision of the lesion. However, the diagnosis is often omitted and the rapid evolution of the cutaneous necrosis forces the surgeon to perform a surgical debridement of the wound. It causes a worsening of the lesion. It can have disastrous consequences. We present here three different case reports.

[Body contouring surgery after massive weight loss]. / Chirurgie de la silhouette chez l'ancien obèse.

After massive weight loss, former obese patients have adipose and cutaneous excess, the skin has lost all its elasticity. Functional and psychological consequences can be significant. Between January 2000 and January 2005, 122 patients underwent some kind of plastic surgery following massive weight loss. In more than 90% of thecases, patients underwent abdominoplasty, associated with liposuction, breast surgery, thighs or arms dermolipectomy or facelift. Multiple simultaneous body contouring surgeries on a single patient is often performed because it's convenient and does not increase morbidity, as long as operative time and blood loss is limited. Overall patient's satisfaction is good, and a favorable impact on quality of life is demonstrated.

[Surgery for root arthrosis: retrospective study and search for an algorithm]. / Chirurgie de la rhizarthrose: étude rétrospective et recherche d'un algorithme.

Several treatments, conservative or surgical, have been proposed for painful arthritis of the base of the thumb with various outcomes. Swanson trapezium implant, arthrodesis of the trapezio-metacarpal (T.M.) joint and suspension arthroplasty are three of the most used techniques for treatment of this condition. Two hundred patients operated on using one of the three techniques were reviewed for a retrospective study to assess the advantages and disadvantages of each method of treatment and their indications. Patient satisfaction rate is high whatever the technique used. Complete pain relief was obtained more often with the Swanson implant (Alnot 0) but differences between the three methods decrease when patients with pain only for particular strains (Alnot 1) are included. Swanson implants (patient satisfaction Alnot 0 and 1: 85.5%) provide excellent subjective and objective results for patients with light activity of daily living causing little stress to the implant. Complication rate with reoperation is equal to other techniques. Surgical treatment is well come through and recovery is fast and not painful. Suspensioplasty (patient satisfaction Alnot 0 and 1: 78.2%) have a low complication and reoperation rate when the technique is well applied. Patient satisfaction rate is high but duration of recovery is long (strength, nimbleness). T.M. arthrodesis is the only type of surgery providing a good strength identical to the opposite side at the price of a limited decrease of range of motion. In conclusion, we propose the following algorithm: for patients over years of age: Swanson trapezium implant; for young and active patients presenting a radiological stage less than Dell III and an intact Scaphotrapezial joint: T.M. arthrodesis; for other patients: suspensioplasty using the A.P.L.

Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions.

A new culture model was developed to study the role of proliferation and apoptosis in the etiology of keloids. Fibroblasts were isolated from the superficial, central, and basal regions of six different keloid lesions by using Dulbecco's Modified Eagle Medium containing 10% fetal calf serum as a culture medium. The growth behavior of each fibroblast fraction was examined in short-term and long-term cultures, and the percentage of apoptotic cells was assessed by in situ end labeling of fragmented DNA. The fibroblasts obtained from the superficial and basal regions of keloid tissue showed population doubling times and saturation densities that were similar to those of age-matched normal fibroblasts. In contrast, the fibroblasts from the center of the keloid lesions showed significantly reduced doubling times (25.9 +/- 6.3 hours versus 43.5 +/- 6.3 hours for normal fibroblasts) and reached higher cell densities. In long-term culture, central keloid fibroblasts formed a stratified three-dimensional structure, contracted the self-produced extracellular matrix, and gave rise to nodular cell aggregates, mimicking the formation of keloid tissue. Apoptotic cells were detected in both normal and keloid-derived fibroblasts, but their numbers were twofold higher in normal cells compared with all keloid fibroblasts. To examine whether apoptosis mediates the therapeutic effect of ionizing radiation on keloids, the cells were exposed to gamma rays at a dose of 8 Gy. Under these conditions, a twofold increase in the population of apoptotic cells was detected. These results indicate that the balance between proliferation and apoptosis is impaired in keloid fibroblasts, which could be responsible for the formation of keloid tumors. The results also suggest that keloids contain at least two different fibroblast fractions that vary in growth behavior and extracellular matrix metabolism.

Anterolateral thigh fasciocutaneous flap in the difficult perineogenital reconstruction.

A pedicled anterolateral thigh fasciocutaneous flap that was used to cover a complicated perineogenital defect after bilateral gracilis myocutaneous flap for perineal reconstruction is presented. The indications and advantages of this approach are outlined. This technique offers to the plastic surgeon and gynecologic oncologist a new option in the armamentarium for reconstruction of the perineum, and it offers the patient reduced donor-site morbidity.

[Hypertrophic scars and keloids: which therapeutic options today?]. / Cicatrices hypertrophiques et chéloïdes: quelles options thérapeutiques aujourd'hui?

Hypertrophic scars and keloids are a hyperproliferative response of connective tissue to trauma. Histologically the difference between the two is that keloids invade normal tissue whereas hypertrophic scars remain confined within the original wound. A variety of treatments have been proposed, which we will review according to their efficiency. Prevention of pathological scarring will also be discussed, and we will present our current attitude to treat these scars. As a surgical treatment for keloids, we have been using the intralesional technique which we think gives better results.

[Breast augmentation: indications, types of prostheses, surgical techniques, complications, results]. / L'augmentation mammaire: indications, types de prothèses, techniques opératoires, complications, résultats.

Augmentation mammaplasty is one of the most frequent surgical procedures in plastic surgery. The indications and techniques are precise and should be closely observed. Silicone gel implants are still used in Europe and multiple epidemiologic studies have failed to demonstrate an association between silicone breast implants and autoimmune disease. After a short historical review, we will present the indications, techniques and complications. As capsular contracture is the main complication, we shall discuss the latest issues. Data was collected on a group of patients using a systematic questionnaire and clinical follow-up. Patients' satisfaction is optimal in the absence of capsular contracture. We are convinced that silicone breast implants have an appropriate texture and give excellent aesthetic results. We are satisfied with silicone breast implants and continue to think that this device has an appropriate texture and gives excellent aesthetic results.

[Principles of physics and application of the laser in plastic surgery]. / Principes physiques et application du laser en chirurgie esthétique.

Recent advances in laser technology have expanded the surgeon's possibilities to treat various cutaneous lesions, as well as proposing a new tool for skin rejuvenation. Review of the basic physical principles of laser energy then overview of the different lasers used in plastic surgery as well as some of their clinical applications.

Anterolateral thigh flap: A review of 168 cases.

The anterolateral thigh flap based on the descending branch of the lateral circumflex femoral vessel is one of the musculocutaneous or septocutaneous flaps in the thigh. The descending branch of the lateral circumflex femoral vessel has either perforating branches or direct cutaneous branches from the intermuscular space to the anterolateral femoral skin. Since 1983, we have transferred 168 anterolateral thigh flaps for reconstruction of old burn scars, infected wounds, carcinoma excisions, for coverage of open bone fracture of the lower leg, and for congenital diseases. One hundred fifty-two cases were free flaps. The other 16 cases were pedicled flaps. The skin branches were divided into four types in our clinical series: musculocutaneous perforators (135/168 [80.4%]); intermuscular cutaneous perforators (16/168 [9.5%]); direct cutaneous branches (14/168 [8.3%]); and tiny cutaneous perforators (3/168 [1.8%]). The results were satisfactory. Only one case resulted in a failure due to tiny cutaneous branches.