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Copyright of Ethnologie Française is the property of Presses Universitaires de France and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In case of infertility due to obstructive azoospermia (OA), 2 main attitudes can be discussed: perform reconstructive surgery or perform epididymal or testicular sperm extraction followed by intracytoplasmic sperm injection (ICSI). Reconstructive surgeries include vasovasostomy (VV) and vasoepididymostomy (VE) and are the only option leading to natural conception. They cannot be considered in cases of bilateral absence of the vas deferens, or in cases of staged obstructions. They are particularly effective in cases of short obstructions such as after vasectomy. The average patency rate after vasectomy reversal is about 80 %, with an average pregnancy rate of about 50%. Obstruction interval, presence of a granuloma, surgeon experience, and sperm discovery intraoperatively are the main predictors of postoperative patency and postoperative fertility. In addition, female factors of hypofertility, including the age, are strongly correlated with the occurrence of pregnancy. In the case of OA, sperm retrieval techniques usually find enough sperm to perform ICSI. The incidence of postoperative hematoma, pain and infections are low regardless of the technique used (MESA, PESA, TESE, TESA). There is no significant difference in pregnancy rates with testicular and epididymal sperm in men with OA. However, MESA may result in higher live birth rates. In cases of distal obstructive AO (ejaculatory duct obstruction, prostatic cyst), endoscopies may be considered for curative purposes with high postoperative patency rates. In conclusion, the physician should present to the couple whose partner has OA the different possibilities available to them and involve them as much as possible in the choice of the most appropriate procedure to conceive. [ABSTRACT FROM AUTHOR]

Armenia and Azerbaijan fought between September and November 2020 in Nagorno-Karabagh. Several surgical missions were scheduled by Assistance Publique-Hôpitaux de Paris to help care for the warinjured Armenians. These missions included the evaluation of Armenian soldiers suspected of having been injured by phosphorus. Facing, during these missions, such infrequent burns, we were interested in their pathophysiology, care and complications. Repeated up-to-date information is necessary in order to better take care of phosphorus burns. Therefore, we conducted a literature review, using PubMed and the Mesh Terms "phosphorus" and "burns", without setting any date limit. The review acknowledges that phosphorus burns are deep, tend to spread and may be the cause of systemic toxicity including hypocalcaemia, which can lead to heart rate disturbance and even death. In the acute phase, burns should be extensively washed with normal saline or water before a mechanical decontamination. One should not use oily dressings, given the liposolubility of phosphorus. Subsequently, one or many debridements are necessary before starting wound coverage, for which any kind of plastic surgery may be used. Phosphorus burns are infrequent but serious. They mainly occur in warfare and should be known by any caregiver acting in this context. [ABSTRACT FROM AUTHOR]

When their treatment is not optimal, deep cervical burns often develop retractions, ranging between simple vertical retractions to major global ones. They generate functional, aesthetic and psychological sequelae. Surgical treatment, adapted to both the patient and the type of retraction, has several goals including restoring the neck-chin angle, restoring a correct aesthetic aspect, and allowing social rehabilitation. In our unit, we managed 47 patients (mean age 22) with neck contractures over 8 years, from 2012- 2020. Scald is more frequent in children while flame burns prevail in adults. Most (58%) patients healed spontaneously. Moderate and severe contractures (Achauer's classification) accounted for 30.6 and 38.8% respectively. In most (94%) patients, the contracture leads to a distortion of the neck-chin angle and limits the extension of the neck. Surgery techniques were skin grafts (67.3%), local plasties (24.5%) and flaps (8.2%). During the follow-up, results were considered as good in 83%, acceptable in 8.5%, while 8.5% needed another surgery. Plasties (Z, IC, VY...) and local flaps (with or without skin expansions) are indicated in minor contractures. Authors still debate on the best technique (graft or flap) for severe and major ones. Post-operative rehabilitation is a cornerstone for good results. [ABSTRACT FROM AUTHOR]

Man has always intervened in an insidious or overt manner on his biological constitution within the limits of his power. Attacks on the sacredness of the body can be explained by several purposes in African cultures. They start from therapeutic ambitions to aesthetic manipulations through canons of identity recognition. Cosmetic surgery has the potential to extend traditional aesthetic, tribal, community and medical practices of body sculpting. It can also mitigate their side effects when the subject is not in keeping with (or moreover) the primary intervention carried out that he considers to be an attack on his identity and / or on the aesthetics of his body. Thus, by examining cultural damage to the human body in the light of cosmetic surgery, this text aims to demonstrate that aesthetic surgery, ethically oriented, can contribute to the viable management of bodily identity. It offers African cultural paradigms capable of co-evolving manipulations of the body with cosmetic surgery. It is a question of considering bodily identity, subject to certain conditions, with cosmetic surgery without it necessarily being considered as detrimental to African ethical and cultural requirements. [ABSTRACT FROM AUTHOR]

An introduction is presented in which editor discusses various articles within the issue on topics including cosmetic surgery for a reassessment of body identity; analysis to the debates on homosexuality in Ouagadougou and acts of incivility of actors in the school environment.

Introduction: Federation of Hand Emergency Services (FESUM) is a European network of hand emergency centers (called SOS hand centers) in France, Belgium and Luxembourg. The FESUM network includes 64 SOS Hand centers in France. In our university hospital, the FESUM-certified SOS hand has been part of the plastic surgery department since 2001. It has included, since 2016, postgraduate students ("residents") training in hand surgery who participate independently in the patient follow-up. The objective of this study was to analyze the characteristics of this population of patients with hand injuries and their satisfaction with this mode of follow-up. The secondary objective was to study the characteristics of the patient population treated by our center., Material and Method: We conducted a study on the follow-up of patients undergoing emergency hand surgery, prospective, single-center, declarative, anonymized, between May and October 2021 at the SOS main center of our university hospital at the "SOS Main" intern consultation. The demographic data, the main characteristics of the pathology, the elements of initial care and follow-up of the patients as well as their satisfaction were analyzed, as well as the satisfaction of the interns., Results: We included 323 patients. The population of patients treated generally corresponded to a young man, manual worker, who was initially treated in an outpatient department or in an SOS Hand consultation. The lesions most often represented were fractures (24%), tendon wounds (18%) and wounds without damage to noble tissues (16%). Follow-up consultations took place mainly 15days after the emergency intervention, lasted on average 10minutes and did not present excessive delays. Patient (91.2%) and post-graduate student (87.2%) satisfaction was high. However, postoperative physiotherapy follow-up was insufficient, as was self-rehabilitation., Conclusion: The integration of post-graduate student in a university plastic surgery department into the care of SOS Hand patients seems beneficial for all those involved, and for their training. The characteristics of the follow-up consultations by the intern in autonomous supervision corresponded to the high quality standards of the FESUM. The patients showed a high satisfaction rate. Better valorization of this consultation in "office surgery" should be considered., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Copyright of Ethnologie Française is the property of Presses Universitaires de France and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Polyotia is an extremely rare congenital malformation of the external ear, characterised by the development of an accessory auricle. It is more often unilateral. We report the case of a Cameroonian infant whom we received at the age of three months. The infant´s mother had noticed a deformity concerning both ears since birth and did not observe any other associated symptom. On physical examination, we found an additional auricle fusing with the tragus on both sides. This unusual structure consisted of skin and cartilage. Their greater diameters measured 2.5cm and 2cm on the left and right respectively. Otoscopic evaluation and general physical examination were normal. A CT-scan of the temporal bones as well as an abdominal ultrasound scan were requested to explore other possibly associated anomalies. These imaging studies were normal. The diagnosis of isolated bilateral polyotia was made. An ear reconstructive surgery was proposed to the parents. An informed consent was obtained from the parents, pre-operative work-up was requested and the procedure was planned. A bilateral otoplasty was done under general anaesthesia. The procedure was simple, consisting of excision of the excess tissue to give a natural aesthetic result. Post-operative evolution was favourable, with good scarring on day 10, as illustrated on (A, B, C, D, E). Nine months following the procedure, the parents seemed satisfied with the aesthetic result. Polytia is a rare congenital malformation. Management requires adequate and comprehensive investigations to exclude enchondroma or associated malformations, prior to ear reconstructive surgery.

Copyright of Recherches Feministes is the property of Groupe de Recherche et d'Echange Multidisciplinaires Feministes and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the COVID-19´s crisis, elective surgery and non-emergent cases were postponed; all other procedures have to be minimized. A 17-year male patient with severe crush and degloving injury over the thigh, gluteal, sacral, and perineum areas was admitted to our Department on the 16thMarch 2020. The patient presented soft tissue skin and muscle loss. A double Latissimus Dorsi and Anterolateral Thigh free flaps were indicated. However, due to the particular circumstance of the COVID-19 crisis, we applied domestic negative wound therapy (NPWT) using gauzes and wall suction. We obtained suitable granulating tissue after 17 consecutive days with this treatment. The raw area was then covered with an expanded split-thickness skin graft. The wound healed at 95%, and the patient was discharged on 25th April 2020. He was followed up in an outpatient setting with wound care and physiotherapy. This case showed that in a limited-resource setting, with available wall suction, the domestic NPWT is a versatile tool to promote granulation tissue.

Copyright of Droit et Cultures is the property of Revue Droit et Cultures - Universite Paris Nanterre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The authors report the case of a 33 years old patient post-traumatic paraplegic with a large sacral pressure ulcer which was treated for 6 months without healing out of any graft or flap. A covering surgery by a musculocutaneous flap of gluteus maximus with an upper pedicle was performed after detersion of necrotic tissues by the service of plastic surgery. Daily dressing and preventive procedures were accomplished before the coverage of the ulcer. The post operative was characterised by disunion of 5 sutures (upon44) at the left corner. A thin skin graft was performed at the 17th day after filling of the virtual lost substances by granulation tissue. The complete healing was obtained shortly after 30 days. [ABSTRACT FROM AUTHOR]

Copyright of Droit et Cultures is the property of Revue Droit et Cultures - Universite Paris Nanterre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Droit et Cultures is the property of Revue Droit et Cultures - Universite Paris Nanterre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Droit et Cultures is the property of Revue Droit et Cultures - Universite Paris Nanterre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Droit et Cultures is the property of Revue Droit et Cultures - Universite Paris Nanterre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Droit et Cultures is the property of Revue Droit et Cultures - Universite Paris Nanterre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumor with intermediate grade of malignity. Wide surgical resection with disease-free margin offers an excellent probability of cure. These large excisions cause large skin defect that can be difficult to cover. Through this case report we describe a surgically treated DFSP that was covered by a Mc Gregor flap; which despite its seniority is still relevant and continues to serve plastic surgery.

INTRODUCTION: Plastic surgery for Down syndrome has not been embraced in sub-Saharan Africa. This study sought to determine the attitudes of some parents from sub-Saharan Africa to plastic surgery for their Down syndrome child. METHODS: consenting parents completed a questionnaire survey instrument that obtained demographic characteristics and contained a likert scale on attitudes to plastic surgery. Internal consistency of the scale was determined with Chronbach's alpha and Pearsons chi square analysis was used to analyze relationships between demographic variables and attitudes scores. Values less than 0.05 were considered statistically significant. RESULTS: most (61.9%) of the 42 consenting mothers were above 35 years of age. The most disturbing of the Down syndrome characteristics were the protruding tongue, 18(42.9%), slanting palpebral fissures, 14(33.3%) and the flattened nasal bridge 14(33.3%). Although the mothers had low awareness of plastic surgery most of them had favourable attitudes towards it. A reliability analysis of the mother's attitudes on the likert scale showed good internal consistency. Chronbachs alpha 0.87. CONCLUSION: the parents in this study have favourable attitudes towards plastic surgery for Down syndrome. The prominent tongue was the most disturbing feature.

3D printing has been used in the medical field since the beginning of the 21st century. Over the years, it has been democratized and has become an accessible tool at almost no cost, provided that a 3D printer is available. The surgeon can thus easily integrate it into his practice and techniques in the operating room, provided that he learns to use 3D image processing software. In order to illustrate the whole process, from the genesis and processing of the 3D image to its application in the operating room, we describe the case of a patient with a left auricle amputation, whose reconstruction was guided by a 3D model printed from his right ear., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The use of skin substitutes in burn surgery and in the treatment of acute or chronic wounds is constantly evolving. For years, scientists have been researching skin substitutes that can be used in place of autologous skin. New products are regularly developed and approved for clinical use. In this article, we take a look at the skin substitutes most commonly used in Europe and briefly summarize the current clinical experience of our centre.

The use of recombinant human factor in intralesional diabetic foot has been the subject of several studies that have proven its effectiveness, to the extent of avoiding amputation. Its effectiveness on chronic wounds is currently being studied, with relevant results. We analyzed the results of a series of patients with chronic wounds treated in the Plastic Surgery Department of the Mohammed VI Medical Center in Marrakech. This is a prospective study conducted between January and April 2019, involving ten patients with chronic wounds, who benefited from intra- and peri-lesional infiltration of recombinant human factor. The average age was 48.8 years with extremes of 17 and 69 years. All our patients were male. 80% of our patients lived in adverse conditions. The average duration of the lesions was 8.1 years with extremes ranging from 6 months to 37 years. The average size of the loss of substance was 10.4 cm2 with extremes ranging from 04 to 18 cm2. The etiologies of the loss of substance were variable, dominated by loss of substance post-accident on a public road in more than 60% of the cases. 40% of our patients reported pain at the level of the site and 20% vertigo. Evolution of the lesions was regularly evaluated by clinical examination and photographs. Budding was obtained in 30% of the cases after grafting, epidermalization in 40% of the cases, and a very significant reduction in the size of the loss area in 30% of cases. The use of recombinant human factor is one of the encouraging therapeutic advances in regenerative medicine that has proven effective on chronic wounds with a reduced overall cost. [ABSTRACT FROM AUTHOR]

Background: Pott's puffy tumour is a rare complication of sinusitis. This osteomyelitis can affect the outer and inner tables of the frontal sinus. The treatment of Pott's puffy tumour combines medical and surgical approaches. Surgical approaches have traditionally been open, but endoscopic techniques have been adopted recently in select cases. The bony defect from debridement can be left alone, or closed with autografts or allografts. Objective: To describe a technique for the reconstruction of a large skull vault after the debridement of extensive osteomyelitis of the anterior cranial vault. Methods: Modified distraction osteogenesis is used in the cranial vault, to induce new bone formation. This is customarily used to lengthen long bones. The advantages of this technique include avoiding autologous grafts or alloplastic cranioplasty in the infected surgical bed, and allowing primary closure. Results: Early post-operative imaging results have been encouraging, with no reported complications. Conclusion: Modified distraction osteogenesis is a novel technique in the primary reconstruction of calvarial bone. [ABSTRACT FROM AUTHOR]

Psychiatric disorders in burn victims are well known and studied, but few articles treat the impact of pre-existing psychiatric pathologies on the evolution of burns. The aim of our study is to compare the evolution in terms of complications, length of stay and survival between patients with and without pre-existing mental disorders. This is a bi-centric case-control study (N = 92), conducted at the Plastic Surgery Department of Rabat University Hospital, and the Plastic Surgery Department of the Tangier-Morocco Regional Hospital, between January 2012 and February 2018. Characteristics of the patients were collected and two groups of patients were identified and compared (n = 67): a preexisting mental disorder group (n = 22) and a control group (n = 45). TBSA (total body surface area) burned and 2nd and 3rd degree burned TBSA were significantly greater in the group with a history of mental disorders compared to the control group (p = 0.012, p <0.001, p = 0.014). Mean length of stay before discharge was greater (p = 0.005). Finally, mortality in the group with pre-existing mental illness was 31.8% versus 6.7% in the control group (p = 0.011). Patients with pre-existing mental disorders seem to present worse burns and need more time to recover from them, resulting in higher morbidity and mortality and a higher cost of care. The systematic screening of burned patients in search of a psychiatric diagnosis and early management of these disorders could improve the prognosis and quality of life of these patients. [ABSTRACT FROM AUTHOR]

René Sève recalls that Contemporary Law in the Western World is based on autonomy of equal subjects, mutually recognizing the right to each carry out their own life project. The LGBTQIA+ person therefore exercises their ability to be their own species, according to Kirkegaard's word. It remains that "life project" also implies a constraint of stability and rationality. The author then shows, using Canadian and French statistical data, the difficulties of achieving this ideal for minors and, for adults, the other medical, paramedical and social conditions required. The rights of LGBT people cannot be considered independently of the physical and financial limits of the health system and therefore of the public debate on its priorities., (Copyright © 2023. Published by Elsevier Masson SAS.)

Esthetic and functional surgeries in the periocular region fall into the domain of oculoplastic, or plastic and reconstructive surgery and otorhinolaryngology. Oculoplasty is the largest surgical spectrum in ophthalmology including eyelids, orbits and the lacrimal system. Our purpose was to study the frequency of eyelid, lacrimal and orbital (oculoplastic) surgery at the CHU IOTA. Material and methods: Retrospective medical chart review of all the patients who underwent oculoplastic surgery was conducted from October 2015 to September 2016. Results: A total of 233 patients were included with 52% female and 48% male. Patients were 37 years old on average. In total, the surgery was performed on the eyelids in83 cases (35.6%), the orbits in 113 cases (48.5%) and the lachrymal system in 37 cases (15.9%).Eyelid surgery commonly resulted from eye trauma (43,3%), followed by malpositions (30,2%). Mutilating surgery accounted for 92% of the orbital surgery. External dacryocystorhinostomy was the main lacrimal surgery (42%) followed by canalicular lacerations 25%. Conclusion: Oculoplasticsurgeryoccupies an important place in the surgical activities of the ophthalmologic University hospital despite a larger volume for cataractsurgery. Our studydoesn't highlight the outcome of the surgery itself but the epidemiology to help decision makers in their eye health policy including the reduction of mutilating surgery and oculoplastic training. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude Démontrer que la chirurgie du lifting cervicofacial est particulièrement adaptée à l’hospitalisation ambulatoire. Patients et méthodes De 2010 à 2016 inclus : 246 patients ont été opérés d’un lifting cervicofacial en ambulatoire. Résultats Aucune complication majeure n’est survenue dans cette série. Parmi les patients, 98 % ont exprimé leur satisfaction et accepteraient à nouveau cette intervention en ambulatoire. Conclusion Les lifting cervicofaciaux peuvent être réalisés en ambulatoire en toute sécurité. Le taux de satisfaction mesuré montre une très forte adhésion des patientes à la prise en charge ambulatoire. Summary Objective The proposal is to demonstrate that facelift surgery is particularly suitable for the care in ambulatory. Methods Between 2010 and 2016, 246 patients were operated for a facelift in ambulatory. Results No major complication arose in this series (241). Among the patients, 98% expressed their satisfaction and would accept again this intervention in ambulatory. Conclusion The facelift can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care. [ABSTRACT FROM AUTHOR]

Résumé Introduction La consommation de tabac augmente les risques périopératoires notamment de cicatrisation pathologique, d’infection, d’échec des gestes microchirurgicaux. Il n’existe pas de consensus actuel sur les indications chirurgicales chez le patient tabagique en chirurgie plastique. L’objectif de cette étude est de recueillir les pratiques des chirurgiens plasticiens français vis-à-vis des patients tabagiques. Matériel et méthodes Un questionnaire a été envoyé par courriel aux chirurgiens plasticiens français afin d’évaluer leurs indications opératoires chez le patient fumeur : information du patient sur les risques du tabac, délais de sevrage pré- et postopératoire, type d’interventions pratiquées, aide au sevrage, test de dépistage, consommation seuil faisant récuser le patient ont été étudiés. Des comparaisons à l’aide de tests statistiques, en fonction du mode d’exercice du chirurgien (privé ou public), de sa consommation tabagique personnelle et du nombre d’années d’installation ont été effectuées. Résultats Sur 148 questionnaires, un seul chirurgien n’expliquait pas au patient les risques du tabac. Parmi les chirurgiens, 49,3 % proposaient une aide au sevrage, plus fréquemment dans le secteur public ( p = 0,019). Au total, 85,4 % des chirurgiens n’effectuaient pas de test de dépistage. L’ancienneté d’installation influençait l’indication opératoire chez le patient tabagique ( p = 0,02). Les délais de sevrage pré- et postopératoires étaient en moyenne respectivement de 4 et 3 semaines, conformément à ce qui est retrouvé dans la littérature. Conclusion Des améliorations sont à apporter concernant la prise en charge du patient tabagique : aide au sevrage, test de dépistage, contre-indication formelle pour certaines interventions ou seuil de consommation à déterminer. Summary Introduction Smoking increases perioperative risk regarding wound healing, infection rate and failure of microsurgical procedures. There is no present consensus about plastic and aesthetic surgical indications concerning smoking patients. The aim of our study is to analyze French plastic surgeons practices concerning smokers. Method A questionnaire was send by e-mail to French plastic surgeons in order to evaluate their own operative indications: patient information about smoking dangers, pre- and postoperative delay of smoking cessation, type of intervention carried out, smoking cessation supports, use of screening test and smoking limit associated to surgery refusing were studied. Statistical tests were used to compare results according to practitioner activity (liberal or public), own smoking habits and time of installation. Results In 148 questionnaires, only one surgeon did not explain smoking risk. Of the surgeons, 49.3% proposed smoking-cessation supports, more frequently with public practice ( P = 0.019). In total, 85.4% of surgeons did not use screening tests. Years of installation affected operative indication with smoking patients ( P = 0.02). Pre- and postoperative smoking cessation delay were on average respectively 4 and 3 weeks in accordance with literature. Conclusion Potential improvements could be proposed to smoking patients’ care: smoking cessation assistance, screening tests, absolute contraindication of some procedures or level of consumption to determine. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les fentes vélopalatines imposent une fermeture chirurgicale au cours des premières années de vie. La réparation du voile et du palais de manière anatomique est complexe sur le plan chirurgical, du fait de la finesse des tissus et de la configuration locale endobuccale. L’apprentissage par la répétition sur simulateur est utile avant de réaliser le geste au bloc opératoire. Or, il n’existe aucun matériel dédié à l’apprentissage des sutures endobuccales dans la chirurgie vélopalatine. Nous en avons donc confectionné un de manière artisanale afin de s’entraîner avant le geste chirurgical. Construction du simulateur Le simulateur a été construit à partir de données anatomiques précises. Un tuyau en acier, fixé sur un socle rigide, formait la cavité buccale. Une cuillère fendue retravaillée permettait de reproduire le palais. L’ensemble était amovible, ce qui permettait d’appliquer un pansement hydrocellulaire avant l’entraînement aux sutures. Utilisation du simulateur Notre simulateur a été testé par 3 chirurgiens seniors de notre service dans des conditions proches de la réalité afin d’évaluer sa fidélité. Conclusion Disposer d’un simulateur de suture de fentes vélopalatines au sein des centres prenant en charge cette pathologie est bénéfique pour l’apprentissage. Notre simulateur a un coût de revient faible, il est facile à réaliser de manière artisanale et fidèle à la réalité anatomique des patients. Summary Introduction Cleft palate requires surgery in the first years of life, furthermore repairing anatomically the soft and hard palate is complex on a surgical level because of the fine tissues and the local intraoral configuration. It is valuable to train first on simulators before going to the operating room. However, there is no material dedicated to learning how to perform intraoral sutures in cleft palate surgery. We made one, in an artisanal manner, in order to practice before the real surgical gesture. Building the simulator The simulator was designed based on precise anatomical data. A steel pipe, fixed on a rigid base represented the oral cavity. An adapted split spoon represented the palate. All pieces could be removed in order to apply a hydrocellular dressing before training for sutures. Use of the simulator Our simulator was tested by 3 senior surgeons in our department in close to real-life conditions in order to evaluate its anatomical accuracy. Conclusion It is valuable to have a simulator to train on cleft palate sutures within teaching university hospitals that manage this pathology. Our simulator has a very low cost, it is easy to make and is anatomically accurate. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) in plastic, reconstructive and aesthetic surgery (ERCP) is quite uncommon compared to other surgical specialities but remains one of the main complications. The aim of our study was to provide feedback on the systematic investigation of SSI in ERCP. This is a monocentric retrospective study, including all paediatric and adult patients who have undergone ERCP surgery between 01/01/2014 and 31/12/2021. During this period, the department systematically investigated all SSI cases. Eight thousand eight hundred and seventy-eight surgical procedures were performed. The SSI rate was 0.34%. Thirty SSIs (19W,11M), with a mean age of 56 years (none paediatric), were investigated. Twenty-seven patients suffered from comorbidities. The surgical indications included 17 cases of skin cancer, 7 cases of weight loss, 4 cases of breast reconstruction, 1 lipoma, 1 pectus excavatum. Eleven surgeries consisted in lymphnode procedures (8 sentinel lymphnodes, 3 curage). The average operating time was 116minutes. Nineteen patients received antibiotic prophylaxis. The average time to onset of SSI after surgery was 10 days. The most prevalent bacteria were commensals of the skin flora and the digestive tract. Apart from surgical management, 100% of patients were treated with antibiotics. High age, multiple comorbidities, long, combined procedures, placement of equipment, lymph node surgery, post-operative punctures on implanted equipment, are all risks factors for SSI. The implementation of a systematic monitoring of SSI within our department has provided us with the opportunity to analyse our data in real time and allow us to adjust our practices if necessary. This process can be used in other plastic reconstructive and aesthetic surgery departments. The collection and analysis of SSIs is both easily done and the procedure is well standardized. The assistance of the operational hygiene team is a key asset for the success of this project. The development of this type of procedure on a national level could be an asset to improve the management of SSI by taking advantage of the experience of a larger number of centres., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Hidradenitis Suppurativa (HS) is a frequent disease (1% in the French population) but underestimated in clinical practice with a long delay of several years before diagnosis in patients consulting (or not) their general practitioner, a dermatologist, a proctologist, a gynecologist or a surgeon. An optimization of the patient's management should be implemented by informing theses stakeholders. The very evocative and the suppuration at different preferred locations of this disease (axillary, mammary, inguinal, scrotum, pubis, anal margin areas) should easily led to a diagnostic. The differential diagnoses are pilonidal cyst and anal fistula more or less as part of Crohn's disease, but an increased risk of association of both diseases exists. The treatment depends on the extension and the activity of the disease. Therapeutic abstinence could be an option. As first line, antibiotics have shown their efficacy with a low level of evidence. In case of localized disabling disease, surgical excision of all lesions with second intention healing seems to be the preferred treatment. In case of a very extensive disease, in particular in the axillary area, flap plasty or skin grafting can be realized after radical excision of the lesions. In case of severe and extensive HS which is not controlled by these treatments, anti-TNF drugs have demonstrated their efficacy in terms of control of the expansion of the lesions and quality of life with currently a higher level of proof for adalimumab. The future may lie in a combination of these different therapies which remains to be defined: anti-TNF drugs before surgery, then which maintenance treatment in which case?, which associations (antibiotics and anti-TNF drugs …)? [ABSTRACT FROM AUTHOR]

Résumé La chirurgie esthétique des enfants et adolescents connaît un essor international. Leur développement physique et psychique est inachevé ; poser l’indication d’une chirurgie esthétique demande plusieurs prérequis indispensables. Les motivations de la chirurgie, souvent multiples et intriquées, doivent être comprises. Il existe une différence de motivation entre l’adulte, cherchant à être plus « compétitif », et le jeune patient, souhaitant être conforme à un groupe social pour l’intégrer. Il faut cerner de qui émane la demande pour ne répondre qu’aux demandes de l’enfant lui-même. La place des parents est un élément capital. Leur présence, obligation légale, est d’apport variable : atout devant un enfant non participant, rôle de relais de l’information délivrée, organisation pratique des soins mais parfois pourvoyeuse de difficultés si la relation parents–enfant est conflictuelle. Selon l’American Society of Plastic Surgery, 63 623 gestes de chirurgie esthétique ont été réalisés en 2013 chez des adolescents de 13 à 19 ans. Principalement des rhinoplasties, otoplasties, chirurgies mammaires (poses de prothèses, réductions mammaires, cures de gynécomasties). Sur le plan strictement technique, la chirurgie esthétique n’est pas plus à risque chez le jeune patient. Cependant la chirurgie ne cible que des « problèmes chirurgicaux » ; il faut distinguer « complexe » et « dépression », savoir dépister une pathologie psychiatrique sous-jacente ou comprendre que la chirurgie est un appel pour un autre problème. Si l’art chirurgical nécessite un réel savoir-faire, il ne donnera de bon résultat que si l’indication est bien posée. Summary Cosmetic surgery for children and adolescents experiencing an international increase. Their physical and psychological development is incomplete; establishment of an indication for cosmetic surgery requires several essential prerequisites. The motivations of surgery, often multiple and intricate, must be understood. There is a difference in motivation between adult, trying to be more “competitive” and the young patient, wishing to comply with a social group to integrate. We must identify who made the request to respond to requests from the child himself. The role of parents is crucial. Their presence, legal obligation, gives variable contribution: asset to a non-participating children, role of information relay delivered, organizational aspects of care but sometimes leads to difficulties if parent–child relationship is confrontational. According to the American Society of Plastic Surgery, 63,623 cosmetic surgery procedures occurred in 2013 in adolescents from 13 to 19 years old. Mainly rhinoplasties, otoplasties, breast surgery (breast augmentations, breast reductions, gynecomasties). From a purely technical viewpoint, cosmetic surgery is not riskier in young patients. However, surgery only targets “surgical problems”; we must make a distinction between “complex” and “depression”, be able to identify a psychiatric underlying disease or understand that surgery is a hidden demand. If surgical art requires a real expertise, only a well-indication establishment will process to a successful result. [ABSTRACT FROM AUTHOR]

Résumé L’histoire de la chirurgie plastique pédiatrique est liée à celle de la pédiatrie. Avant le XIX e siècle, il n’y avait pas d’hôpitaux d’enfants. Seules, quelques interventions (la fermeture simple des fentes labiales, l’ablation d’un doigt surnuméraire) étaient pratiquées avant que l’anesthésie, l’asepsie et l’antisepsie les rendent moins dangereuses. Dès le XIX e siècle, des interventions furent proposées pour le traitement des fentes labiales, des divisions palatines, des hypospadias, des syndactylies. La première intervention de chirurgie esthétique pédiatrique fût une otoplastie en 1881. La chirurgie plastique pédiatrique se diversifia beaucoup dans la 2 e moitié du XX e siècle. Les fentes labiomaxillofaciales, les brûlures, la chirurgie craniofaciale, la chirurgie de la main sont devenues des parties autonomes de la discipline. Summary The history of pediatric plastic surgery is linked to that of paediatrics. Until the early 19th century, there was no children's hospital. Only some operations were performed before the discovery of anesthesia, aseptic and antisepsis: cleft lip repair, amputation for polydactyly. Many operations were described in the 19th century for cleft lip and palate repair, hypospadias, syndactylies. The first operation for protruding ears was performed in 1881. Pediatric plastic surgery is diversified in the 2nd half of the 20th century: cleft lip and palate, burns, craniofacial surgery, hand surgery become separate parts of the speciality. [ABSTRACT FROM AUTHOR]

Résumé Le remodelage cicatriciel chez l’enfant est guidé par des processus physiques, non douloureux, préventifs de troubles de croissance par rétraction cutanée. Le traitement chirurgical, coordonné avec les soins de rééducation, a pour objectif d’améliorer les capacités physiques de la peau pour restaurer la fonction et éviter les déformations. Les outils de rééducation appartiennent à différentes techniques (sensorimotricité, massage et mobilisations) avec ou sans utilisation d’agent physique (eau, aspiration et palper-rouler). Les moyens de posture et positionnement font appel au petit ou grand appareillage de l’orthèse à la prothèse. La compression est obtenue par l’ajustement d’appareillages sur moulage et de vêtements de pressothérapie. Les indications sont posées en fonction du moment de recouvrement cutané et de l’avancée du processus de cicatrisation mais aussi dans le traitement de différentes pathologies tels que les traumatismes cutanés (frictions, plaies, brûlures) ou les chirurgies cutanées (suite de purpura fulminans , reconstruction par greffe après exérèse de nævus géant, lésion maligne ou malformation vasculaire ou artérioveineuse). La finalité est la réadaptation, épanouissement de l’enfant et l’adolescent dans toute sa dimension somatopsychique. Summary Physical, non-painful processes guide the scar reshaping in children in order to prevent growth anomalies due to cutaneous shrinkage. The objective of the surgical treatment, coordinated with the reeducation care, is to improve the physical abilities of the skin, to restore the function and avoid the deformations. Reeducation uses various techniques (i.e. sensitive-motility, massage and mobilizations) with or without physical agent (water, aspiration and touch-drive technique). Posture and positioning rely on the small or major aids, from orthosis to prosthesis. Compression is obtained by the adjustment of aids on molding and compression garment. Indications of the reeducation treatment depend on the timing of cutaneous covering and the advance of the healing process. It also depends on the underlying condition including skin traumas (frictions, wounds, burns), skin surgeries ( purpura fulminans consequences, skin graft reconstruction after giant nevus resection, malignant lesion or vascular malformations). The final goal is the rehabilitation and development of the child and the adolescent in its entire somatopsychic dimension. [ABSTRACT FROM AUTHOR]

Résumé Les enfants constituent une population à risque de morsure de part leur taille, leur naïveté et leur attrait pour les animaux. Le visage et les mains sont des localisations plus spécifiques de l’enfant. Les plaies sont souvent multiples. Les animaux, chiens et chats par argument de fréquence sont connus de l’enfant dans plus de la moitié des cas. L’épisode de morsure survient principalement lorsque l’enfant est seul avec l’animal sans surveillance directe, lors du jeu ou de la caresse. Comme dans toutes morsures ces lésions pédiatriques constituent une urgence infectieuse, fonctionnelle et esthétique mais l’objectif de ce travail était avant tout de faire un point sur les principes de prise en charge chirurgicale des morsures animales de l’enfant en mettant en avant les spécificités pédiatriques. Les morsures animales nécessitent une prise en charge psychologique, anesthésique et chirurgicale adaptée à l’enfant dans le cadre d’une structure spécialisée. L’hospitalisation et l’anesthésie générale sont plus fréquentes chez les enfants. Toute suspicion de malveillance (et/ou de maltraitance) doit conduire à l’hospitalisation de l’enfant et ce même si les lésions ne justifient pas à elles seules la surveillance en milieu chirurgical. La chirurgie d’urgence est primordiale pour limiter les séquelles fonctionnelles et esthétiques. Les capacités cicatricielles de l’enfant, l’absence fréquente de comorbidités permettent de favoriser un traitement chirurgical conservateur avec une part belle aux sutures, repositionnement de lambeaux cutanés et à la cicatrisation dirigée. L’immobilisation, le drainage, et l’antibiothérapie viendront compléter le geste. L’évolution cicatricielle conduit toutefois à une prise en charge spécifique pendant la phase de remodelage cicatricielle et la croissance. L’abord psychologique de l’enfant et des parents ne doit pas être mis de côté et fait partie prenante de la prise en charge dès la phase aiguë. Summary Children represent a population at risk, because of their short size, their naivety and their attraction to animals. The face and hands are the most specific locations in young children. Wounds are often multiple. In more than half the cases, the child knows the animal, which are dogs and cats by frequency argument. The bite episode occurs mostly when the child is alone with the pet without direct supervision, while playing or stroking the animal. As in all bites, pediatric lesions are infectious, functional and aesthetic emergencies, but the goal of this work was primarily to make a point on principles of surgical management of animal bites in children, highlighting pediatric specificities. Animal bites require psychological, anesthetic and surgical treatment, adapted to the child, in a specialized structure. Hospitalization and general anesthesia are more frequent in children. Any suspicion of mistreatment (and/or abuse) should lead to the child's hospitalization, even if wounds do not justify monitoring in a surgical environment. Emergency surgery is essential to limit functional and aesthetic consequences. The healing capacities of the child and the frequent lack of co-morbidity allow a conservative surgical treatment with suture, repositioning skin flaps and controlled healing in the first place. Immobilization, drainage, and antibiotics will complete the surgery. The healing process, however, leads to a specific management during scar remodeling phase and growth. Psychological care of the child and parents should not be forgotten, and has to start at the same time as surgical treatment at in acute phase. [ABSTRACT FROM AUTHOR]

Résumé Les asymétries faciales aux pleurs sont rares. Nous rapportons un cas pédiatrique original de syndrome de Cayler. À travers sa présentation clinique, nous discuterons les diagnostics différentiels, les formes associées, l’étiologie de cette pathologie ainsi que sa prise en charge. Cas clinique À la maternité, chez un nourrisson de sexe masculin, après un accouchement à terme par voie basse sans extraction, est découvert un défaut de mobilité de la commissure labiale du côté droit, uniquement lors des pleurs. Le reste de l’examen est sans particularité, à part une microtie homolatérale. Sur le plan génétique, le caryotype est 46,XY, sans microdélétion 22q11. L’IRM cervico-faciale et l’échographie cardiaque sont normales. Discussion et conclusion L’asymétrie aux pleurs est décrite dans la littérature, dans le cadre d’association avec le syndrome de microdélétion 22q11. L’originalité de ce cas est la présence d’une anomalie musculaire isolée. Les muscles concernés par ce syndrome sont : le Musculus depressor labii inferioris, le Depressor anguli oris, et le Musculus mentalis. Les trois muscles peuvent être atteints de manière concomitante. Des atteintes isolées du muscle Depressor anguli oris sont aussi décrites. Le dysfonctionnement mécanique peut être soit lié à une agénésie musculaire, soit à un défaut d’innervation de ces derniers. Il n’existe pas de prise en charge spécifique. Les symptômes s’atténuent avec l’âge par diminution de la fréquence des pleurs. Il est toutefois utile de savoir diagnostiquer cette pathologie afin de pouvoir demander un bilan complémentaire optimum à la recherche d’anomalies associées (FISH 22q11, échographie Doppler cardiaque) qui sont le critère de gravité de ce syndrome. Il est aussi important de pouvoir informer et de rassurer les familles souvent inquiètes par la situation. Summary Background and purpose Facial asymmetries to the tears are rare. We report a pediatric original case that may fall within the framework of a Cayler syndrome. Through its clinical presentation, we will discuss differential diagnoses, associated forms, its etiology, and its management. Case report At the maternity unit, in a male infant, after vaginal delivery at term without extraction, was discovered a lack of mobility of the labial commissure on the right side, only when crying. The rest of the examination was unremarkable, except ipsilateral microtia. Genetically, karyotype was 46,XY, 22q11 without microdeletion. The head and neck MRI and echocardiogram were normal. Discussion and conclusion Asymmetry with tears has been described in the literature, through association with microdeletion 22q11 syndrome. The originality of this case was the presence of an isolated muscle abnormality. Muscles affected by this syndrome are: Musculus depressor labii inferioris, the Depressor anguli oris, and Mentalis musculus. The three muscles can be affected concomitantly. Isolated involvment of the Depressor anguli oris muscle has also been described. The mechanical dysfunction can be either linked to muscle innervation agenesis or to a defect thereof. There is no specific treatment. The symptoms improve with age by decreasing the frequency of crying. However, it is important to know this pathology in order to seek an optimum balance further in search of associated abnormalities (FISH 22q11, cardiac Doppler ultrasound) but also to educate, to reassure families often worried by the situation. [ABSTRACT FROM AUTHOR]

The World War I, due to the strong development of the artillery, caused a considerable number of new injuries: the maxillofacial lesions. These large dilapidations are gaping wounds which look so awful that many soldiers are left for dead on the battlefield. The maxillofacial injuries are characterized by significant loss of substance affecting jaws and soft tissues of the face. The facial reconstruction of these disabled ex-servicemen, the "gueules cassées", requires the invention of new surgical techniques and design of innovative prostheses. Health personnel such as maxillofacial surgeons and dentists have shown unprecedented inventiveness, thus contributing to the development of their specialties. [ABSTRACT FROM AUTHOR]

Résumé La cure thermale peut faire partie de la filière de soins en chirurgie plastique. Les objectifs de cette étude étaient de faire un état des lieux des connaissances sur le thermalisme et de préciser la place réservée au thermalisme par les chirurgiens comme traitement adjuvant en chirurgie plastique et reconstructrice (adulte et enfant). Matériel et méthodes Étude multicentrique par questionnaire (Google Drive ® ) à l’attention des chirurgiens plasticiens et/ou pédiatriques. La fréquence, le moment de la prescription, les indications, le ressenti du chirurgien envers le thermalisme et la différence enfant/adulte dans la prescription étaient recherchés. Résultats Cinquante-quatre équipes contactées : 22 réponses (15 plasticiens « adultes », 9 plasticiens « pédiatriques », 6 chirurgiens pédiatriques, dont 12/22 traitaient des grands brûlés). Dix-huit sur 22 prescrivaient des cures thermales. Vingt sur 22 pensaient que le thermalisme avait sa place en traitement adjuvant en chirurgie plastique. Les indications étaient : brûlures (11/20), hypertrophie post-greffe (10/20), cicatrices inflammatoires, prurigineuses et troubles trophiques cutanés (9/20), psychologique (3/20), brides/rétractions (2/20), amaigrissement et tabagisme (1/20). Le moment de la prescription était : < 3 mois (2/20), < 6 mois (7/20), > 6 mois et < 1 an (15/20), > 1 an (8/20) après chirurgie/traumatisme. Vingt sur 22 avaient constaté un effet bénéfique : physique (19/20) : diminution des signes inflammatoires, prurit et douleurs, maturation cicatricielle, amélioration trophicité cutanée ; psychologique positif (14/20) : patient/sa famille. Différence enfant/adulte : 5/17 faisaient la différence entre les deux (maison d’enfants), 10/17 ne faisaient pas de différence mais traitaient exclusivement adultes ou enfants. Conclusion Les personnes ayant répondu à l’étude sont probablement plus sensibles aux effets du thermalisme que les non-répondants. Il existe une difficulté d’évaluation de l’impact réel du thermalisme dans le cadre de la chirurgie plastique car il est difficile de distinguer l’évolution favorable spontanée d’une cicatrice de celle uniquement imputable au thermalisme et de la prise en charge multidisciplinaire. Toutefois, le thermalisme semble avoir sa place parmi la prise en charge multidisciplinaire. Summary Balneology can be part of the plastic surgery care sector. The objectives of this study were firstly to the state of knowledge about the hydrotherapy and specify the place reserved for hydrotherapy by surgeons as an adjunct in plastic and reconstructive surgery (adult and child). Materials and methods Multicentric national study by poll (Google Drive ® ) focused at plastic and/or pediatric surgeons. The following information was analyzed: frequency, timing of prescription, indications, the surgeon's feelings towards hydrotherapy and the differences between adult's and children's prescriptions. Results Fifty-four teams were contacted: 22 responses were received (15 “adult” plastic surgeons, 9 “pediatric” plastic surgeons, 6 pediatric surgeons, with 12 out of 22 working with burnt patients). Eighteen out of 22 prescribed hydrotherapy. Twenty out of 22 thought that hydrotherapy had a role as adjuvant therapy in plastic surgery. The indications were: burns (11/20), skin-graft hypertrophy (10/20), inflammatory and pruritic scar and cutaneous trophic disorders (9/20), psychological (3/20), retractions (2/20), weight loss and smoking (1/20). The timing of the prescription was: < 3 months (2/20), < 6 months (7/20), > 6 months and < 1 year (15/20), > 1 year (8/20) after surgery/trauma. Twenty out of 22 found a beneficial effect: physical (19/20): reduction of inflammatory signs, pruritus and pain, scar maturation, skin thinning improvement; psychological (14/20): positive for patient/family. Five out of 17 made the difference between child/adult, 10/17 made no difference but only treated adults or children. Conclusion The respondents in the study are probably more sensitive to the effects of hydrotherapy that non-respondents. It is difficult to assess the real impact of hydrotherapy in plastic surgery because distinguishing spontaneous favorable evolution of a scar from one only due to the hydrotherapy or multidisciplinary management is difficult. However, hydrotherapy seems to have its role among multidisciplinary management. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’objectif de ce travail était d’évaluer la qualité des publications en chirurgie plastique, reconstructrice et esthétique, en termes de méthodologie, de niveau de preuve, d’approbation par un comité institutionnel et selon le domaine de la spécialité. Méthodes Nous avons sélectionné les huit revues généralistes de chirurgie plastique les mieux cotées par leur facteur d’impact. Nous avons inclus les 40 dernières publications originales de chaque revue, afin de couvrir au moins deux mois de publications et être le plus représentatif possible. Seuls les articles originaux traitant de sujets humains vivants ont été sélectionnés. Chaque article a été analysé par deux relecteurs, en cas de désaccord un auteur senior prenait la décision. Résultats Nous avons analysé 320 articles originaux, couvrant entre 3 et 17 mois de publications. L’origine géographique de ces publications étaient l’Asie à 32,5 %, puis l’Europe à 30 %, les États-Unis à 28,4 %, l’Amérique du Sud à 5,6 %, l’Afrique à 2,5 % et enfin l’Océanie pour 1 %. La chirurgie reconstructrice au sens large reste le domaine de spécialité le plus représenté dans nos revues avec presque la moitié des publications, suivi par la chirurgie mammaire (24 %) et la chirurgie esthétique (19 %). Au total, 75,6 % étaient des études rétrospectives. Près de 80 % des études étaient de faible niveau de preuve (IV et V). Seulement 3,5 % étaient des essais randomisés. Moins de 40 % des publications mentionnaient la validation par un comité institutionnel, et 22,6 % un consentement éclairé du patient. Conclusion Cette étude avait pour but d’analyser la qualité des publications en chirurgie plastique en prenant en compte les critères de l’ evidence based medicine . Ce travail a mis en évidence que plus de la moitié des études ne mentionnaient pas l’aval d’un comité institutionnel (comité d’éthique, CPP), et que les trois quarts des études ne précisaient pas la présence d’un consentement éclairé. En définitive, plus de 80 % des études étaient de faible niveau de preuve. Les revues à fort impact factor ont déjà imposé des guidelines correspondant à la méthodologie requise pour publier des études cliniques dans leurs pages, tel que les critères EQUATOR pour le journal PRS. Des efforts restent donc à faire pour élever le niveau scientifique des publications de notre spécialité. Summary Introduction The objective of this study is to describe plastic surgery publications in terms of methodology, level of evidence, approval by institutional review board, method of consent, and subspecialty. Methods The 8 top-ranked plastic surgery journals were selected. We manually reviewed the last 40 original articles in each plastic surgery journal, to represent more than 2 months of publications for all journals (range: 3–17 months). Only clinical original articles on human subjects were included. Each article was read at least twice by two different reviewers to ensure accurate data transcription, and then graded by written criteria. One of the senior authors was asked to make a final decision in case of doubt. Results Among the articles reviewed, 320 were analyzed. The geographical origin of these publications were Asia (32.5%), Europe (30%), US (28.4%), South America (5.6%), Africa (2.5%), and finally Oceania (1%). Reconstructive surgery remains the specialty area most represented in the journals with almost half of the publications, followed by breast surgery (24%) and plastic surgery (19%). A total of 75.6% were retrospective studies. Nearly 80% of the studies were of low level of evidence. Only 3.5% were randomized trials. Less than 40% of the publications mentioned approval by an institutional committee, and 22.6% a patient's informed consent. Conclusion This study aimed to analyze the quality of plastic surgery publications, taking into account the criteria of Evidence Based Medicine. This work showed that more than half of the studies did not mention an institutional review board approval (Ethics Committee), and that three quarter of the studies did not indicate the presence of patient's informed consent. Ultimately, over 80% of the studies were of low level of evidence. The top-ranked journals have already imposed guidelines corresponding to the methodology requirements to publish clinical studies in their pages, such as EQUATOR criteria for the PRS journal. Efforts are therefore to be done to raise the scientific level of the publications of our specialty. [ABSTRACT FROM AUTHOR]

A 46 year old man presented to the plastic surgery clinic with a painless, progressive swelling of the right leg of seven years duration. He reported difficulty with ambulation and recurrent ulceration in the past three years. The patient's medical history was significant for hypertension. He had no allergies and no family history of lymphedema. On physical examination, the right leg was markedly enlarged from mid thigh to the foot. There were edematous changes with skin thickening. He had a septic ulcer on the medial surface of the leg (A). The mid leg circumference was 128 cm (B). Doppler findings of the leg were normal. Lymphedema tarda is a congenital disease characterized by underdevelopment of lymphatic pathways. It manifests commonly after the third decade as accumulation of lymph in the interstitial spaces of the skin. Wound healing is significantly impaired. Ulcerations which occur during the course of the disease heal slowly or not at all. The cause of this impairment is the continued lymphatic drainage as well as a regional oxygen deficiency in the diseased tissue. Wounds are managed by limiting infection and wound debridement. Due to the difficulty in managing wounds in lymphedema, prevention should be emphasized through rigorous skin care. Keeping the skin clean and dry as well as avoiding any form of trauma are essential components of prevention. Excisional surgery is indicated in ambulatory dysfunction and recurrent cellulitis. Surgery is usually successful, but can have a recurrence rate up to 50% over 10 years.

The skill set of a plastic surgeon, which addresses a broad range of soft tissue conditions that are prevalent in sub-Saharan Africa, remains relevant in the unmet need for surgical care. Recently, there has being a major paradigm shift from discipline-based to disease-based care, resulting in an emerging component of patient-centered care; adequate access to subspecialty care in plastic and reconstructive surgery. Given the need for an evolution in sub-specialization, this article focuses on the benefits and future role of differentiation of plastic surgeons into sub-specialty training pathways in sub-Saharan Africa.

Nipple necrosis is a usual complication after breast plastic surgery, however a spontaneous necrosis of the nipple is exceptional and especially without any apparent etiology. We searched in all accessible databases without finding a similar case in the literature. It's a about a 14 years old girl, refugee in Zaatari camp in Jordan. In her medical history, we found a purulent pleurisy of atypical germs treated two years ago, she presented in the last two months a spontaneous bilateral nipple necrosis (A et B). Physical examination showed no pubertal or gynecologic abnormalities. Breast ultrasound was normal. A hormonal balance and an assessment of vacuities were without abnormalities. Otherwise, a Chest -X-Rays was normal. Histopathological examination of a nipple biopsy revealed a necrotic tissue without specific lesions. The evolution was marked by a spontaneous drop in both necrotic nipples (C).

Nevoid hyperkeratosis of the nipple areola complex (NAC) is a rare dermatological pathology of unknown etiology, first described in 1923. It is a benign condition characterized by verrucous thickening and brownish discoloration of the NAC. We described the case of a 26-year-old woman with bilateral nevoid hyperkeratosis of the NAC. Several lines of treatment have been used with varying efficacy: conservative (calcipotriol and local retinoids), semi-conservative (CO2 laser) and surgical (excision and total skin graft). The final result is very satisfactory and without recurrence at 1 year follow-up., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: Concerns have been growing for several years among masters, as to the quality and quantity of training in plastic surgery in France. They are mainly based on the reduction in the working time of residents, the appearance of new residents from generation Z to be trained, and finally the multidisciplinarity of plastic surgery in the current context of overspecialization of training center., Methods: In order to objectify these concerns, a survey was carried out among French residents and young heads of plastic surgery to assess their training in the specialty since 2019. We then looked in the law for possibilities to alleviate these concerns., Results: All the respondents think that their training in the specialty is incomplete, and few of them have been able to supplement it with rotations outside the subdivision or visits from private practitioners. However, in the law, it is possible to carry out: three residents rotations outside the subdivision, clinics rotations and international exchanges., Discussion: At the end of this analysis, we propose three solutions to optimize training in plastic surgery in France: a system of exchange of residents, the opening of residents rotations in clinics, and finally, to facilitate the realization of operating aids with private practitioners., Conclusion: With these solutions, the field of training for residents could extend from one region to the whole of France. These solutions could easily be applied to other specialties, surgical and medical., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Résumé La pathomimie se définit comme une pathologie factice volontairement auto-induite sans troubles confusionnels ou de conscience avérés. Ce cas clinique expose le cas d’une pathomimie en chirurgie esthétique. Une patiente, porteuse d’implants mammaires, s’était délibérément injectée du sérum physiologique dans ses prothèses afin d’en augmenter le volume. L’explantation a dû être réalisée devant les signes inflammatoires locaux. Le bilan psychiatrique révélait une dysmorphophobie sur personnalité hystérique expliquant les lésions auto-infligées. Cette entité nosologique doit être connue car son diagnostic reste difficile et nécessite une prise en charge pluridisciplinaire. Summary Pathomimia is defined as a dummy pathology self-induced deliberately and is neither associated with mental confusion nor disturbance of consciousness. This article reports a case of pathomimia in plastic surgery. One of our patients had intentionally injected physiological saline solution into her breast implants in order to increase their volume. Implants removal was necessary because of severe local inflammatory signs. Psychiatric assessment revealed body dysmorphic disorder (BDD) developed on an hysterical personality, which explained the self-induced injuries. This nosologic entity must be promptly identified because it's diagnosis remains problematic and a multidisciplinary medical management is essential. [ABSTRACT FROM AUTHOR]

Résumé Considéré comme l’un des pères de la chirurgie pédiatrique en France, Louis Ombrédanne (1871–1956) fut aussi un grand chirurgien plasticien. Assistant de Nélaton (1851–1911), il écrivit avec lui deux livres sur la rhinoplastie et les autoplasties faisant le point sur ces techniques au début du xx e siècle. En 1906, il décrivit une technique de reconstruction du sein utilisant le muscle petit pectoral et un lambeau axillaire et thoracique. De 1908 à 1941, Louis Ombrédanne se consacra à la chirurgie pédiatrique principalement dans le domaine des malformations congénitales. De 1924 à 1941, il fut titulaire de la chaire de « Chirurgie infantile et orthopédie » à l’hôpital des Enfants–Malades à Paris. En 1907, Louis Ombrédanne mis au point un appareil d’anesthésie par inhalation qui fut utilisé avec succès en Europe pendant cinquante ans. Summary One of the fathers of pediatric surgery in France, Louis Ombrédanne (1871–1956) was a great plastic surgeon. During his residency he was initiated to plastic surgery by Charles Nélaton (1851–1911). Both wrote two books: “La rhinoplastie” and “Les autoplasties”, taking stock of these techniques in the early 20th century. In 1906, he was the first to describe the pectoral muscle flap for immediate breast reconstruction after mastectomy. He used this flap in conjunction with an axillo thoracic flap. From 1908 to 1941, Louis Ombrédanne practised pediatric surgery, most of which was devoted in reconstruction of congenital and acquire anomalies. From 1924 to 1941, he was Professor of pediatric surgery at the hospital Enfants–Malades in Paris. In 1907, Louis Ombrédanne created a prototype of an ether inhaler as a safe anesthetic device. The device was successfully used for fifty years in Europe. [ABSTRACT FROM AUTHOR]

Résumé Introduction La photographie en chirurgie plastique est omniprésente. Par ses usages divers, elle peut présenter des dangers sur les plans médico-légaux et éthiques. L’objectif de cette étude est d’analyser l’usage de la photographie par le chirurgien plasticien, la perception de cet usage par le patient, et ses conséquences. Méthode Un questionnaire concernant leur usage de la photographie, a été adressé à 629 chirurgiens plasticiens . Un questionnaire a été remis aux patients sur leur perception de la photographie par le chirurgien. Résultats Cent soixante-seize questionnaires de plasticiens et 93 questionnaires de patients ont été analysés. Pour 97,7 % des chirurgiens répondants, la proportion de patients refusant d’être photographiée était inférieure à 1/20. L’objectif des photographies était qualifié majoritairement de : « surtout » pour le médico-légal par 62,5 % des chirurgiens, et pour le suivi des patients (87,5 %) ; d’« en partie » pour la formation (72,1 %) et pour les publications scientifiques (57,8 %) ; et de « pas du tout » pour la publicité personnelle (73,1 %). Le chirurgien partageait « souvent » ses photographies avec d’autres chirurgiens (71,1 %), « parfois » avec d’autres personnels de santé (48,8 %). La sûreté et l’accès aux photographies, sont jugés corrects pour 67,6 % des chirurgiens et parfaits pour 23,3 %. Un total de 17,2 % des chirurgiens recueillent le consentement du patient par écrit ; 41,4 % par oral, et 38,5 % ne le recueillent pas. Au total, 48,3 % des chirurgiens et 40,2 % des patients pensent que les droits de la photographie appartiennent au patient. Conclusion La photographie expose le chirurgien plasticien à des risques médico-légaux. Il se doit alors de connaître la loi et ainsi pouvoir se prémunir contre d’éventuelles poursuites judiciaires. Summary Introduction Photography in plastic surgery is omnipresent. Through its various uses, it may present both ethical and forensic risks. The objective of this study is to analyze the use of medical photography by the plastic surgeon, the perception of this use by the patient, and consequence of such use. Method A questionnaire about the use of medical photography was assessed to 629 plastic surgeons. A questionnaire was given to patients, about their perception of the use of photography by their surgeon. Results One hundred and seventy-six surgeon's questionnaires and 93 patient's questionnaires were analyzed. For 97.7% of the responding surgeons, the proportion of patients refusing to be photographed was less then 1/20. The objective of the photography was especially medicolegal for 62.5% of the surgeons, especially for following the patient progress (87.5%), partially for the formation (72.1%), partially for scientific publications (57.8%) and not at all for the personal publicity (73.1%). Surgeons often share his photographs with others surgeons (71.1%), sometimes with others medical personnel (48.8%). The security and the access to photographs were determined to be correct for 67.6% of the surgeons and perfect for 23.3%. In total, 17.2% of the surgeons obtained a written consent, 41.4% obtained an oral consent, and 38.5% did not request patient consent. It was found that 48.3% of the surgeons and 40.2% of the patients think that the right to the photographic images belong to the patient. Conclusion Medical photographs expose the plastic surgeon to medico-legal risks. He must know and follow the law in order to prevent eventual legal proceedings. [ABSTRACT FROM AUTHOR]