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Introduction: Biological glue is already used as a hemostatic agent and tissue adhesive in plastic surgery. This study evaluates the use of this glue as an alternative to suction drainage for the adhesion of tissue-expanded flaps in pediatric patients. Methods: This is a retrospective, multicenter case-control study on 48 flap procedures conducted on 42 children (5 months-12 years of age) between 2004 and 2017, comparing a "glue" group (n = 24) with a control group (n = 24), in which a classic redon drain was used. The control patients were matched according to age, etiology, location of the lesion, and the size of the expander. The primary end point was the duration of hospital stay. Results: The conditions were 24 cases of congenital nevus, 14 of cicatricial alopecia, and 10 of sebaceous hamartoma. Twenty-nine lesions were located on the scalp, 15 on the back, 2 on the thigh, and 2 on the buttocks.The average surgical durations (48 ± 24 vs 63 ± 32 minutes, P = 0.13) and average room occupancy time (126 ± 21 vs 139 ± 44 minutes, P = 0.29) were similar between the glue group and the control group. However, the average duration of hospital stay was lower in the glue group (1.5 ± 1.5 days) than in the control group (3.6 ± 1.3 days, P < 0.0001). The complication rates between the groups were similar. Conclusions: The application of glue on expanded flaps is as reliable as suction drainage with the advantage of reducing the duration of hospital stay and potentially enabling outpatient treatment for certain patients.

Resume Introduction Les cas de melanomes se developpant chez le nourrisson sont rares et de diagnostic difficile. Nous rapportons le cas d’une enfant presentant un naevus congenital geant du cuir chevelu complique d’un melanome d’apparition precoce explore par les nouveaux outils diagnostiques disponibles. Observation Notre patiente presentait a la naissance une tumeur congenitale cervico-mandibulaire de 15 cm de grand axe avec extension para-pharyngee et osteolyse sous-jacente. L’histologie a 7 mois de vie, couplee a de l’immunohistochimie (IHC), concluait a un melanome developpe sur un naevus congenital, en raison de la presence de nombreuses atypies cytonucleaires, de mitoses, de foyers de necrose et d’une forte expression de P53 ainsi que d’un index de proliferation (Ki67) eleve. Le bilan d’extension etait negatif. Des chirurgies iteratives et une surveillance etaient realisees jusqu’a l’âge de 7 ans. A cette echeance, l’absence de metastases conduisait a realiser de nouvelles analyses sur les prelevements initiaux pour authentifier le diagnostic. L’etude de l’expression de certains facteurs de transcription par IHC recemment decrite, l’hybridation genomique comparative et la spectrometrie de masse guidee par l’histologie, bien que suspects, ne permettaient pas, a eux seuls, de conclure formellement a une lesion maligne. A 7 ans et demi, l’enfant developpait des metastases hepatiques et pulmonaires traitees par l’association ipilimumab + nivolumab. L’enfant decedait 5 mois plus tard. Conclusion Ce cas illustre la complexite du diagnostic de melanome chez le nourrisson et la possibilite d’une evolution metastatique tardive. Il rappelle la necessite d’un avis d’expert et parfois de combiner plusieurs outils pour affirmer le diagnostic et adapter la prise en charge.