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Dermal and subcutaneous inflammation following direct trauma is initially evocative of soft-tissue infection. However, two differential diagnoses must be considered: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis.Case 1: a 51-year-old woman fell off her motorbike and had dermabrasions on her right and left tibial ridges that rapidly developed into dermo-hypodermitis of the entire limb. There was no improvement after 3 weeks of antibiotics. The patient was apyretic. She had a soft, non-inflammatory tumefaction on the inner aspect of her left knee. Ultrasound revealed subcutaneous collection in both legs. The surgeons confirmed a diagnosis of Morel-Lavallée syndrome and drained the two collections. Progress was good and the patient healed without major consequences. Case 2: following a fall on her stairs, a 40-year-old woman presented dermabrasions and haematomas on her left leg. Antibiotic therapy failed to prevent the progression of dermo-hypodermitis. The patient remained apyretic and there was no inflammatory syndrome. A CT scan showed thickening of a subcutaneous fat and fluid collection, resulting in diagnosis of post-traumatic nodular fat necrosis. Management was surgical and the outcome was good.These two cases show two post-traumatic cutaneous complications: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis. Morel-Lavallée syndrome occurs after tangential trauma next to richly vascularized tissue. Post-traumatic nodular fat necrosis is defined as necrosis of adipocytes. In both cases, diagnosis is confirmed by imagery (Ultrasonography, tomography).Our two case reports show that inflammatory presentation of both Morel-Lavallée syndrome and post-traumatic nodular fat necrosis can lead to diagnostic and therapeutic errors while a surgical procedure is necessary since tissue necrosis can occur.

Introduction La fente cervicale mediane est une anomalie congenitale rare de la partie anterieure du cou. Observation Les auteurs rapportent le cas d’un nourrisson de sexe feminin, âge de neuf jours, presentant une bride cervicale mediane congenitale et ayant beneficie d’une intervention chirurgicale a l’âge de 7 mois. L’evolution a ete tres satisfaisante sans recidive, a deux ans post-operatoires. Discussion Les auteurs discutent la presentation clinique de cette anomalie, l’embryologie, la prise en charge therapeutique et l’evolution. Cette malformation rare se traduit dans sa forme complete par une bride cervicale verticale mediane sous-cutanee mento-sternale, associee a une fente cutanee. Cette fente cutanee consiste en une ulceration surmontee d’une protuberance cutanee fibromateuse et prolongee vers le bas par un trajet fistuleux borgne. Le mecanisme embryologique de formation n’est pas formellement etabli, mais la plupart des auteurs s’accordent sur le defaut de fusion des arcs brachiaux sur la ligne mediane par anomalie de mesodermisation. Le traitement est chirurgical et doit etre realise dans les premiers mois de la vie afin d’eviter les troubles fonctionnels et morphologiques sur le cou et la mandibule. La chirurgie doit comporter l’exerese complete de l’ulceration cutanee et du tissu fibreux sous-jacent, suivie par la fermeture du site a l’aide de plasties en « Z » multiples. La frequence des recidives par retraction fibreuse impose une surveillance post-operatoire rigoureuse, a long terme.

The midline cervical cleft is a rare congenital anomaly of the anterior part of the neck.We report the case of a 9-year old girl, presenting a congenital midline cervical cleft who underwent corrective surgery at the age of 7 months. Currently, outome is quite satisfactory two years post-operatively; no recurrence has developed.We discuss the clinical manifestation of this anomaly, the embryology, the surgical treatment and the clinical course. In its complete form, this rare disorder presents as a subcutaneous midline vertical cervical cord, associated with a cutaneous cleft. The cutaneous cleft consists of an ulceration with an overhanging cutaneous fibromatous protuberance which prolongs downwards to a blind-ended sinus tract. The embryologic mechanism is not formally established, but the majority of the authors agree on the imperfect midline fusion of the paired branchial arch tissue by anomaly of mesodermisation. Surgical treatment is required and must be carried out in the first month of the life in order to avoid neck and mandible functional and morphological disorders. Surgery involves complete excision of the cutaneous ulceration and subjacent fibrous cord followed by site closure using multiples "Z" plasties. Long postoperative monitoring is needed due to the frequency of the recurrence.

In breast cancer treatment axillary lymphadenectomy remains essential and necessary because of its role in prognosis and in treatment. Lymphatic nodal involvement is the most important finding for prognosis and indicates the necessity of adjuvant chemotherapy. Axillary lymphadenectomy decreases the risk of local and/or regional recurrence, but it does not modify the survival rate. Unfortunately, axillary lymphadenectomy has a high morbidity rate, despite all improvements made in the last decades. The conventional surgical technique removes the intact axillary content, preserving large vascular and nervous elements, but destroys a certain amount of small arteries, veins, lymphatics and nerves. This leads to complications such as lymphorrhea and edema, hypoaesthesia, shoulder stiffness, pain, deformity of the axilla, long and unaesthetic scars and the most disabling of all, arm swelling.

Axillary lymphadenectomy is part of breast cancer treatment. It has two aims: prognosis and treatment. The high morbidity rate of conventional lymphadenectomy is unacceptable in conservative treatment of small tumors. Therefore we developed a new technique combining liposuction and endoscopic picking. So we are able to perform a conservative axillary lymphadenectomy with the same efficiency for prognosis and treatment with a near to zero morbidity. We report here our experience of 72 cases in endoscopic lymphadenectomy.

Introduction Nous presentons le cas d’un homme de 37 ans opere d’un mucocele du sinus maxillaire droit, avec une cecite monoculaire droite au reveil. Objectifs et Methodes Nous avons tente de comprendre, par les elements cliniques mais egalement grâce a l’imagerie, quel avait pu etre le mecanisme physiopathologique a l’origine de cette amaurose. Observation Cette chirurgie fut compliquee d’une plaie de l’artere ethmoidale et de lesions des tissus adjacents (plaie du muscle droit inferieur, plaie conjonctivale). Le patient fut transfere au bloc operatoire pour prise en charge urgente d’un hematome compressif de la region maxillaire et peri-maxillaire. Le lendemain, l’acuite visuelle du patient etait effondree avec perception lumineuse nulle malgre un examen clinique (LAF, fond d’œil) normal. On notait egalement, dans un contexte d’œdeme, une limitation des mouvements oculo-moteurs. Discussion Les examens complementaires (TDM, PEV) orientaient vers deux diagnostics principaux, a savoir : une section iatrogene du nerf optique ou une ischemie du nerf optique. Conclusion L’IRM et l’evolution clinique permettront de conclure plutot a une ischemie du nerf optique par hematome compressif retro-orbitaire d’origine iatrogene.