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Résumé: Nous rapportons la découverte d’une rupture subtotale du nerf médian par usure « sur chevalet » de celui-ci sur une séquelle de fracture du poignet datant de l’enfance. Cette observation inédite a été faite lors d’une chirurgie de reprise du canal carpien chez un patient de 80ans, pour qui l’indication de neurolyse avait été posée devant la récidive d’un syndrome sévère du canal carpien à 30ans d’une première intervention de neurolyse. Si les ruptures par usure des tendons fléchisseurs sont largement relatées dans la littérature, de même que la survenue de plaies nerveuses aiguës dans le cadre de traumatismes à haute énergie, la survenue d’une rupture secondaire d’un nerf par usure de celui-ci sur un relief osseux n’a, à notre connaissance, jamais été décrite. [ABSTRACT FROM AUTHOR]

Résumé: L’objectif de cette étude préliminaire rétrospective était de rapporter notre expérience sur l’efficacité de la réinjection de graisse autologue dans la prise en charge des cicatrices douloureuses. Entre 2010 et 2012, tous les patients présentant des douleurs cicatricielles persistantes, malgré un traitement médical d’au moins six mois, ont bénéficié d’une réinjection de graisse autologue selon la technique décrite initialement par Coleman. L’évaluation des résultats était basée sur l’amélioration des douleurs (EVA), la satisfaction postopératoire des patients et sur la diminution de la consommation de traitement antalgique. Chez les 11 patients inclus, la quantité moyenne de graisse réinjectée après centrifugation était de 11cm3. Neuf patients (soit 81,5 %) ont noté une disparition complète ou une diminution significative des douleurs cicatricielles ; 74,5 % se sont déclarés très satisfaits ou satisfaits du résultat. La diminution moyenne de la douleur sur l’EVA a été de 3,5 points. Nous n’avons déploré aucune complication. La réinjection de tissu adipeux autologue, thérapeutique novatrice, apparaît comme un concept séduisant dans la prise en charge des cicatrices douloureuses résistant au traitement médicamenteux, en apportant un traitement chirurgical simple, efficace et dénué d’effets secondaires indésirables. [ABSTRACT FROM AUTHOR]

Lipofilling or fat grafting transfer is defined as a technique of filling soft tissue by autologous fat grafting. The basic principle of lipofilling is based on a harvest of adipose tissue, followed by a reinjection after treatment. Lipofilling main objective is a volume defect filling, but also improving cutaneous trophicity. Lipofilling specificities among children is mainly based on these indications. Complications of autologous fat grafting among children are the same as those in adults: we distinguish short-term complications (intraoperative and perioperative) and the medium and long-term complications. The harvesting of fat tissue is the main limiting factor of the technique, due to low percentage of body fat of children. Indications of lipofilling among children may be specific or similar to those in adults. There are two types of indications: cosmetic, in which the aim of lipofilling is correcting a defect density, acquired (iatrogenic, post-traumatic scar) or malformation (otomandibular dysplasia, craniosynostosis, Parry Romberg syndrom, Poland syndrom, pectus excavatum…). The aim of functional indications is correcting a velar insufficiency or lagophthalmos. In the paediatric sector, lipofilling has become an alternative to the conventional techniques, by its reliability, safety, reproducibility, and good results., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Aim of the Study: We present the case of a patient with Goldenhar syndrome associated with congenital fistula in the middle of philtrum at the upper lip., Patients and Methods: The patient was supported from birth for Goldenhar syndrome. Several procedures were performed in childhood to correct a macrostomia and mandibular hypoplasia right. At 14 years old, she has a rhinoplasty to correct a complex nasal malformation. During the procedure, a hole in the upper central incisor inter-space is found. It is extended by a fistula which runs through the front palate towards the vomer rail at the base of the partition. This fistula is blind behind the vomer and can be completely resected. Pathological examination of the resection reveals a squamous lining., Results: The median fistula of the upper lip are extremely rare : less than 30 cases reported in the literature. The unusual run of the fistula and the recent appearance of a pituitary syndrome in this patient makes us look for a continuity between it and Rathke's pocket by computed tomography imaging type., Conclusion: The association of Goldenhar syndrome and median congenital fistula of the upper lip was never yet described in the literature. The association with hypopituitarism was suspected with the posterior extension of the malformation, not confirmed by the scanner, but strongly suspected jointly by the neurosurgical and plastic surgery team., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Revision rhinoplasty can be very challenging especially in cases of thin skin. Autologous fat graft is utilized in numerous applications in plastic surgery; however, its use relative to the nasal region remains uncommon. Adipose tissue, by virtue of its volumetric qualities and its action on skin trophicity, can be considered to be a gold standard implant. From 2006 until 2012, we have treated patients by lipofilling in order to correct sequelae of rhinoplasty. The mean quantity of adipose tissue injected was 2.1cm(3) depending on the importance of the deformity and the area of injection: irregularity of the nasal dorsum, visible lateral osteotomies, saddle nose. Following the course of our practice, we conceived micro-cannulas that allow a much greater accuracy in the placement of the graft and enable to perform interventions under local anesthesia. These non-traumatic micro-cannulas do not cause post-operative ecchymosis and swelling which shorten the recovery time for the patient. On patients who have undergone multiple operations, lipofilling can be a simple and reliable alternative to correct imperfections that may take place after a rhinoplasty., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The purpose of this study was to report our experience about the effectiveness of autologous fat injections in the management of painful scars. Between 2010 and 2012, all patients with persistent incisional pain despite a well-conduced 6 months medical treatment received an autologous fat graft according to the technique originally described by Coleman. Results interpretation was based on pain improvement thanks to a Visual Analogic Scale (VAS), postoperative patient satisfaction, reduction on analgesics intake and quality of life improvement. Eleven patients were included, the mean quantity of fat injected was 11cm(3). Nine patients (1.5%) benefited from a complete or significant pain decrease, 74.5% reported being very satisfied or satisfied with the result. The mean reduction of VAS was 3.5 points. We did not observe any complication. Autologous fat grafting is an innovative therapeutic approach and appears to be an attractive concept in the management of scar neuromas resistant to drug treatment, by providing an easy effective and safe surgical treatment., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

We report the finding of a subtotal rupture of the median nerve caused by a "bridge" or"easel" erosion due to a sequela of childhood wrist fracture. This unpublished observation was made during a carpal tunnel release procedure on an 80-year-old patient who was operated on for recurrence of a severe carpal tunnel syndrome 30 years after a previous neurolysis. If the flexor tendon ruptures are widely described, as well as nerve sections following high energy trauma, the median nerve rupture caused by its erosion over a bony projection has never been published at the best of our knowledge., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)