[Post-inflammatory cutis laxa. A case report]. / Cutis laxa postinflammatoire. A propos d'un cas clinique.

Cutis laxa (CL) is a rare disorder in which the skin hangs in loose fields, so that affected individuals appear to be prematurely aged. The changes are more evident when effect the face with a prematurely-aged appearance. The acute form follows an inflammatory skin lesions. Its aetiology is not well known. We report a case of a head acute CL of a 17 years patient, secondary to a generalized skin eruption. The prematurely-aged appearance concern especially forehead, ear lobes and nasolabial folds. A two stages surgical treatment has associated: a forehead lifting associated to a Coleman lipofilling and an ear lobe reduction, a secondary Coleman lipofilling of the nasolabial folds. The skin biopsy confirm the diagnosis. The correction is stable and satisfactory after one year. The confrontation of our findings to those previously described confirm complexity of diagnosis and histological observations of this rare disorder.

Use of tissue expansion in revision of unhealed below-knee amputation stumps.

When local tissue is insufficient for the revision of unhealed below-knee stumps tissue expansion offers an interesting alternative for local coverage. We used this method in seven patients (five men, two women; mean age 30 years) who had had below-knee amputations, six of them after injury to a healthy limb and one for purpura fulminans. Ten tissue expanders were inflated slowly and intermittently either weekly or twice weekly depending on the patients. The mean expansion period was 92 days. Mean hospital stay for the two operations was 5.8 (range 4-9) and 7.6 (range 6-10) days, respectively. Using subjective and objective criteria, functional outcome was excellent in five patients and good in one. Expansion failed in one because of infection. Expanded skin flaps allow good cover with a minimal scar area in appropriate cases, while preserving the skin sensitivity and length of the tibial shaft.

[Value of pulsed color Doppler before transverse rectus abdominis musculocutaneous flap breast reconstruction. 45 cases]. / Apport du Doppler pulsé couleur avant reconstruction mammaire par lambeau myocutané de grand droit de l'abdomen. A propos de 45 cas.

The transverse rectus abdominis musculocutaneous TRAM flap is an interesting alternative for breast reconstruction after mastectomy for cancer disease in patients who refuse mammary prosthesis and when the clinical situation allows it. There is however a risk of unpredictable partial necrosis even after rigorous surgical procedure. Some authors have proposed a Doppler evaluation before reconstruction surgery to better identify the vascular network and optimize patient selection. We performed a preliminary study in 45 patients between January 1996 and December 1999. An echo-Doppler Ultramark 9 HDI (Advanced Technology Laboratories) equipped with a high frequency (10 MHz) linear probe was used to compare blood flow and vessel caliber in the superior epigastric artery and the perforating vessels (number, localization, peak flow). The results obtained in this series could be used to determine indications for TRAM flap with or without delay procedure.

[Tuberous breast syndrome. Report on a series of 22 operated patients]. / Le syndrome du sein tubéreux. A propos d'une série de 22 patientes opérées.

The tuberous breast syndrome is a rare unilateral or bilateral breast malformation presenting at the age of mammary development. It requires surgical correction, depending on the severity of the clinical expression, because of its inaesthetic appearance. We report a series of 22 patients (35 breasts) treated and followed up in the plastic and reconstructive surgery department of Rennes over a period of nearly ten years. The average age was 18 +/- 3.2 years (range: 15-26 years old). Long-term results were assessed by the surgical team and the patients on the basis of objective and subjective criteria with an average follow-up of 36 months (12 to 116 months). In our opinion, surgical correction should be proposed after puberty with, whenever possible, section of the basal fibrous ring and glandular plasty via a periareolar incision. The use of mammary implant alone or in combination with breast tissue remodelling must be reserved for hypoplastic cases only.