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International audience; BACKGROUNDWhen combined with vanadium salts, catecholamines strongly activate glucose uptake in rat and mouse adipocytes.AIMTo test whether catecholamines activate glucose transport in human adipocytes.METHODSThe uptake of 2-deoxyglucose (2-DG) was measured in adipocytes isolated from pieces of abdominal subcutaneous tissue removed from women undergoing reconstructive surgery. Pharmacological approaches with amine oxidase inhibitors, adrenoreceptor agonists and antioxidants were performed to unravel the mechanisms of action of noradrenaline or adrenaline (also named epinephrine).RESULTSIn human adipocytes, 45-min incubation with 100 µmol/L adrenaline or noradrenaline activated 2-DG uptake up to more than one-third of the maximal response to insulin. This stimulation was not reproduced with millimolar doses of dopamine or serotonin and was not enhanced by addition of vanadate to the incubation medium. Among various natural amines and adrenergic agonists tested, no other molecule was more efficient than adrenaline and noradrenaline in stimulating 2-DG uptake. The effect of the catecholamines was not impaired by pargyline and semicarbazide, contrarily to that of benzylamine or methylamine, which are recognized substrates of semicarbazide-sensitive amine oxidase. Hydrogen peroxide at 1 mmol/L activated hexose uptake but not pyrocatechol or benzoquinone, and only the former was potentiated by vanadate. Catalase and the phosphoinositide 3-kinase inhibitor wortmannin inhibited adrenaline-induced activation of 2-DG uptake.CONCLUSIONHigh doses of catecholamines exert insulin-like actions on glucose transport in human adipocytes. At submillimolar doses, vanadium did not enhance this catecholamine activation of glucose transport. Consequently, this dismantles our previous suggestion to combine the metal ion with catecholamines to improve the benefit/risk ratio of vanadium-based antidiabetic approaches.

International audience; Senescence is a key event in the impairment of adipose tissue (AT) function with obesity and aging but the underlying molecular and cellular players remain to be fully defined, particularly with respect to the human AT progenitors. We have found distinct profiles of senescent progenitors based on AT location between stroma from visceral versus subcutaneous AT. In addition to flow cytometry, we characterized the location differences with transcriptomic and proteomic approaches, uncovering the genes and developmental pathways that are underlying replicative senescence. We identified key components to include INBHA as well as SFRP4 and GREM1, antagonists for the WNT and BMP pathways, in the senescence-associated secretory phenotype and NOTCH3 in the senescence-associated intrinsic phenotype. Notch activation in AT progenitors inhibits adipogenesis and promotes myofibrogenesis independently of TGFβ. In addition, we demonstrate that NOTCH3 is enriched in the premyofibroblast progenitor subset, which preferentially accumulates in the visceral AT of patients with an early obesity trajectory. Herein, we reveal that NOTCH3 plays a role in the balance of progenitor fate determination preferring myofibrogenesis at the expense of adipogenesis. Progenitor NOTCH3 may constitute a tool to monitor replicative senescence and to limit AT dysfunction in obesity and aging.

Skin models mimicking features of psoriasis‐related inflammation are needed to support the development of new drugs in dermatology. Reconstructed skin models lack tissue complexity, including a fully competent skin barrier, and presence and/or diversity of immune cells. Here, we describe InflammaSkin®, a novel human Th17‐driven ex vivo skin inflammation model. In this model, skin‐resident T cells are in situ activated by intradermal injection of anti‐CD3 and anti‐CD28 antibodies and Th17 cell polarization is sustained by culture in a chemically defined medium supplemented with IL‐1β, IL‐23 and TGF‐β for seven days. The acquired Th17 signature is demonstrated by the sustained secretion of IL‐17A, IL‐17AF, IL‐17F, IL‐22, IFN‐γ, and to some degree IL‐15 and TNF‐α observed in the activated ex vivo skin inflammation model compared with the non‐activated skin model control. Furthermore, expression of S100A7 and Keratin‐16 by keratinocytes and loss of epidermal structure integrity occur subsequently to in situ Th17cell activation, demonstrating cellular crosstalk between Th17 cells and keratinocytes. Finally, we demonstrate the use of this model to investigate the modulation of the IL‐23/IL‐17 immune axis by topically applied anti‐inflammatory compounds. Taken together, we show that by in situ activation of skin‐resident Th17 cells, the InflammaSkin® model reproduces aspects of inflammatory responses observed in psoriatic lesions and could be used as a translational tool to assess efficacy of test compounds.

Background Calf shape is an essential aesthetic parameter of the leg, and calf atrophy can lead to complex problems. The functional consequences of calf atrophy are generally moderate. Prefilled silicone gel implants represent the vast majority of currently placed prostheses, but this technique does not ensure optimal adaptation of the implant shape due to loss of volume. Objectives The aim of this study was to describe an innovative procedure for correcting acquired calf atrophy based on 3-dimensional (3D) modeling. Methods The study involved 22 patients treated for calf atrophy caused by illness. Implants were made with solid rubber silicone, and 3D reconstructions were created by computer-aided design based on computed tomography scans. The implants were introduced through a horizontal popliteal incision. Results Forty-one implants were placed. No cases of infection, hematoma, or compartment syndrome were encountered. We experienced 1 case of skin necrosis and 1 case of periprosthetic seroma. In addition, lipofilling was performed in 5 cases. Two patients sought to benefit from a surgical reduction in implant size. Conclusions Our innovative procedure to correct calf atrophy with custom solid rubber silicone implants produces a calf shape that better adapts to volume loss than prefilled silicone gel implants. The material maintains its shape and facilitates retrofitting of the prosthesis. There is no risk of hull formation or breakage, and the life span of the implants is limitless. This 3D computer-aided design approach has optimized our reconstructions. Level of Evidence: 4

Isolated scaphotrapeziotrapezoid (STT) osteoarthritis has functional consequences on the wrist. The main objective of our study was to evaluate the functional outcomes of patients managed surgically during the last 12 years at the Toulouse University Hospital, regardless of the surgical technique used, for isolated STT osteoarthritis. We performed a single-center retrospective observational study using the CCAM database. The inclusion criteria were patients treated surgically for isolated STT osteoarthritis who did not respond to conservative treatment, with at least 6 months of clinical and radiological follow-up. Twenty-four patients were treated between 2006 and 2018. Partial arthroplasty of the distal pole of the scaphoid with or without interposition and total trapeziectomy had been performed on these patients. The mean follow-up was 79±46.8 months. The wrist range of motion (ROM) and the Kapandji score were not significantly reduced postoperatively. The mean postoperative QuickDASH score was 29.15±8.46. The mean pain assessed using a visual analog scale was 6.6±1.17 preoperatively versus 1.25±1.51 postoperatively (P=0.003). Statistical subgroup analysis found no predictive factor for a better postoperative QuickDASH score, and no surgical technique was superior at halting the progression of intracarpal misalignment and postoperative ROM. Surgical treatment of isolated STT osteoarthritis resistant to conservative treatment leads to significant functional improvement, particularly in terms of pain, without altering the wrist's overall mobility.

Resume Le pectus excavatum affecte environ une personne sur 500 : c’est la malformation du thorax la plus frequente. Plusieurs techniques chirurgicales ou medicales ont ete proposees. Certaines peuvent entrainer des complications ou des resultats insuffisants. La chirurgie secondaire du pectus excavatum par implants profonds sur mesure 3D est une solution elegante et efficace. Elle permet d’obtenir le bon resultat esthetique attendu par les patients en l’absence de contexte fonctionnel respiratoire ou cardiovasculaire.

Flap reconstruction techniques are increasingly desired by French's patients and it represents almost half of breast reconstruction indications in 2017. The main reasons of this statistics are the growing concerns of the patients with breast implant of developing BIA-ALCL, as well as their desire of having a more natural reconstruction results without having any foreign bodies. The multiplication of autologous reconstruction techniques, especially microsurgical techniques which has been popularized in the recent years, makes possible to propose a reconstruction to the majority of patients without an implant. This type of reconstructions is associated with a significant number of complications; thus, a proper selection of patient should be done and a good knowledge of the surgical technique by the surgeon to reduce the complication. Our proposed study is divided into two main parts, the complications of the flap and the complications at the donor site. Based on the experience of our plastic surgery department in immediate and delayed breast reconstruction, the objective of this article is to describe and to analyze the possible complications of breast reconstruction by a flap and their surgical management in intra and post operatively. Our goal is to provide an algorithm for our young colleagues in order to obtain better understanding of this type of interventions difficulties and to provide an appropriate care in the event of complication, also to provide optimal care to the patients who wish to undergo autologous flap reconstructions.

Among the dietary amines present in foods and beverages, tyramine has been widely studied since its excessive ingestion can cause catecholamine release and hypertensive crisis. However, tyramine exerts other actions than depleting nerve endings: it activates subtypes of trace amine associated receptors (TAARs) and is oxidized by monoamine oxidases (MAO). Although we have recently described that tyramine is antilipolytic in human adipocytes, no clear evidence has been reported about its effects on glucose transport in the same cell model, while tyramine mimics various insulin-like effects in rodent fat cells, such as activation of glucose transport, lipogenesis, and adipogenesis. Our aim was therefore to characterize the effects of tyramine on glucose transport in human adipocytes. The uptake of the non-metabolizable analogue 2-deoxyglucose (2-DG) was explored in adipocytes from human subcutaneous abdominal adipose tissue obtained from women undergoing reconstructive surgery. Human insulin used as reference agent multiplied by three times the basal 2-DG uptake. Tyramine was ineffective from 0.01 to 10 µM and stimulatory at 100 µM-1 mM, without reaching the maximal effect of insulin. This partial insulin-like effect was not improved by vanadium and was impaired by MAO-A and MAO-B inhibitors. Contrarily to benzylamine, mainly oxidized by semicarbazide-sensitive amine oxidase (SSAO), tyramine activation of glucose transport was not inhibited by semicarbazide. Tyramine effect was not dependent on the Gi-coupled receptor activation but was impaired by antioxidants and reproduced by hydrogen peroxide. In all, the oxidation of high doses of tyramine, already reported to inhibit lipolysis in human fat cells, also partially mimic another effect of insulin in these cells, the glucose uptake activation. Thus, other MAO substrates are potentially able to modulate carbohydrate metabolism.

Summary Ectodermic dysplasia corresponds to genetic pathologies characterized by two or more defects that involved ectodermal-derived structures. Breast anomalies in female patients were uncommon. Just a few articles in the literature retrieved this association. The main anomalies concerning breast region were amastia and areolar complex malformation. Two types of reconstruction have been already studied: implants with or without tissue preexpansion, and autologous flap like latissimus dorsi or DIEP. We described in this article a series of three female patients issue from the same family. They presented various type of breast malformation with other defects characteristics of ectodermic dysplasia. They all benefit of a bilateral breast reconstruction by implants on a one-staged reconstruction. Patients and surgeon were satisfied of the reconstruction. This case series demonstrate that reconstruction by implants without tissue preexpansion was a good choice in this pathology.

L’eccesso cutaneo che interessa l’interno della coscia, legato all’invecchiamento della pelle o, il piu delle volte, secondario alla perdita di peso, e un problema che ogni chirurgo plastico deve affrontare nella sua pratica clinica quotidiana. La gestione chirurgica comporta il lifting della faccia interna della coscia, comunemente chiamato “cruroplastica”. Questo intervento, che e stato praticato per cinque decenni, ha beneficiato di numerosi sviluppi tecnici che gli hanno permesso di prosperare. L’obesita e una vera e propria piaga che colpisce molti paesi sviluppati, con un impatto socioeconomico significativo. Le tecniche di chirurgia bariatrica, in pieno sviluppo negli ultimi anni, forniscono una massiccia perdita di peso sotto controllo medico e consentono una chirurgia della silhouette, una volta che il peso si e stabilizzato. Questa chirurgia postbariatrica fa ormai parte dell’arsenale terapeutico indispensabile per il chirurgo plastico per soddisfare al meglio le esigenze dei pazienti. Gli obiettivi di questo articolo sono esporre le tecniche moderne di lifting della faccia interna della coscia, specificare i risultati attesi con i loro limiti ed evidenziare le varie complicanze con la loro gestione.

El pectus excavatum es la malformacion toracica congenita mas frecuente. Se han descrito diferentes tecnicas quirurgicas, pero debido a la ausencia de repercusion funcional del pectus excavatum, en la experiencia de los autores de este articulo, la opcion quirurgica de eleccion es la correccion mediante la colocacion de una protesis en posicion profunda. Se obtiene un prototipo en resina de la protesis a partir de imagenes virtuales de sintesis procedentes de cortes tomograficos (diseno asistido por ordenador). A traves de una via de acceso preesternal media, de 5-7 cm de longitud, se diseca la celda para la protesis en proximal, en posicion retropectoral, colocando el implante por debajo de las fibras caudales del pectoral mayor y entre la vaina anterior y el musculo recto abdominal en distal. Al contrario que las tecnicas agresivas de cirugia toracica y pediatrica, se trata de una tecnica simple, muy precisa, independientemente de la profundidad y de la asimetria, con una mortalidad nula y una baja morbilidad. La tasa de satisfaccion de los pacientes es casi del 90%. La complicacion mas frecuente es el seroma, cuyo tratamiento es sencillo y esta bien codificado. La tecnica de reconstruccion mediante implante a medida se puede considerar como una tecnica de referencia, que permite responder a la demanda morfologica real de los pacientes cuando no existen problemas funcionales.

La pelle in eccesso delle braccia, legata all’invecchiamento cutaneo o, il piu delle volte, secondaria alla massiccia perdita di peso, e un problema che deve affrontare ogni chirurgo plastico nella sua pratica clinica quotidiana. L’obesita colpisce oltre il 13% della popolazione mondiale. Pertanto, parallelamente allo sviluppo della chirurgia bariatrica, la chirurgia morfologica volta a correggere i difetti residui della massiccia perdita di peso e in aumento da circa una decina d’anni. Inoltre, l’invecchiamento causa un rilassamento tegumentario, che puo essere disarmonico e che diventa una ragione frequente di consulto medico. Questo eccesso cutaneo o cutaneoadiposo puo essere corretto mediante brachioplastica, chiamata anche dermolipectomia brachiale o, comunemente, “lifting delle braccia”. Lo scopo di questo articolo e di descrivere le diverse forme cliniche insieme alle classificazioni chirurgiche. Di seguito, vengono esposte le tecniche chirurgiche e le potenziali complicanze di queste procedure.

El exceso cutaneo de los brazos, relacionado con el envejecimiento cutaneo o, con mas frecuencia, secundario a una perdida de peso masiva, es un problema actual con el que se enfrenta todo cirujano plastico en su practica clinica cotidiana. La obesidad afecta a mas del 13% de la poblacion mundial. Asi, paralelamente al desarrollo de la cirugia bariatrica, la cirugia morfologica con fines de corregir los defectos residuales del adelgazamiento masivo ha experimentado un florecimiento desde hace una decada. Igualmente, el envejecimiento da lugar a una relajacion cutanea que puede ser antiestetica y se convierte en un motivo frecuente de consulta. Este excedente cutaneo o cutaneoadiposo se puede corregir con la braquioplastia, tambien denominada dermolipectomia braquial o, comunmente, «lifting de los brazos». El objetivo de este articulo es describir las diferentes formas clinicas asi como las clasificaciones quirurgicas. A continuacion se exponen las tecnicas quirurgicas y las posibles complicaciones de estos procedimientos.

Background:The purpose of this study was to assess the efficacy of botulinum toxin in reducing the frequency of migraine headaches.Methods:The MEDLINE, Embase, and Cochrane Library databases were searched to identify randomized, double-blind, placebo-controlled trials that compared patients receivin

International audience; The proximally based medial plantar flap is considered to be the reference standard for heel reconstruction. Although less well-studied, a distally based medial plantar flap is a suitable alternative when used to cover a distal foot defect, especially of the hallux, first metatarsal, or metatarsophalangeal joint. Our objective was to provide a complete description and propose a classification of the different surgical procedures used to harvest this flap. A review of the data reported in the MEDLINE database until May 2017 concerning the distally based medial plantar flap was performed. We have illustrated the different surgical procedures through a case series. Three approaches or "types" of flap have been described, and we have proposed a classification for reconstructive surgeons. In type 1, the plantar pedicle is ligatured before division into the medial and lateral plantar artery. In type 2, the medial plantar pedicle is cut proximally just after division. In type 3, the flap is harvested to include the fasciocutaneous perforator vessels, as an advancement flap or a propeller perforator flap. A distally based medial plantar flap affords adequate and reliable coverage of the weightbearing zone. Because the donor site drawbacks are minimal, this flap is a useful option for distal foot reconstruction, and reconstructive surgeons should remember this flap. The type 1 flap appears to be associated with a minimal risk of flap necrosis, even in those with diabetes or arteriopathy, and can cover even the most distal defect.

Background: The thumb plays a key role in hand function for precise dexterity. The surgical treatment of full avulsions of the digital skin sheath by tearing (ring syndrome) is complex and the management of these lesions is challenging for the reconstructive surgeon. When replantation is not possible, other alternatives are available if the covering tissue is thin and flexible. Case presentation: A 30-year-old male, tobacco addict, had a thumbsequelae similar to a stage III ring finger. Revascularization attempt failed and the skin envelope necrosed secondarily. A groin pocket flapgraft allowed a conservation of his thumb with a satisfactory aesthetic and functional result. Conclusions: We described a thumb coverage by a groin flapgraft using an original pocket design. This simple and safe procedure, in the carefully selected patient can successfully address functional and aesthetic concerns simultaneously, with minimal sequelae at the donor site. This technique can be used to treat a cutaneous tearing of the other fingers.

International audience; Following a long period dominated by random fasciocutaneous flaps or muscle flaps, solutions to cover the lower limb have been largely diversified by the advent of so-called "perforator" flaps. Extended knowledge of vascular anatomy has propagated the development of this innovative procedure, in the objective of reducing morbidity. The existence of close to 400 perforator vessels in the body makes it possible to offer new flap perspectives for many defects, which were sometimes previously impossible to manage before except by free flap. For us, perforator flaps have become the current first-line solutions for small to medium size loss of substances. Understanding of vascular physiology and surgical experience are essential in choosing indications, detecting perforators, and modeling flaps to be optimally positioned in the reconstructive decisional algorithm. New skills are needed to master this type of reconstruction and limit failures, which implies a learning curve not only for flap design, perforator detection and surgical procedure, but also for monitoring and management of complications. In this manuscript, we outline the concepts and principles of the majority of the pedicled perforator flaps available for coverage of the lower limb, based on experience of more than 400 perforator flaps suitable for this localization.

Background Plastic surgery is a transversal discipline that many people misunderstand, including general practitioners, medical students, paramedics and the public. Plastic surgeons often collaborate with physiotherapists for post-acute care and rehabilitation. They ensure optimal post-operative recovery of the patient. Herein, the authors assessed the medical knowledge and perceptions of plastic surgery by physiotherapists working outside health centers and explored their attitudes towards classic reconstructive surgery scenarios. Methods To assess physiotherapists' medical knowledge and perceptions of plastic surgery, the authors conducted an online questionnaire survey. A total of 1,262 physiotherapists responded. Results The physiotherapists confirmed the suspected lack of knowledge regarding the plastic surgery field. Although they were generally aware that plastic surgeons perform cosmetic procedures and treat burns, they were largely unaware that plastic surgeons perform hand surgeries and microsurgical operations. More than 70% of them stated that they did not have the necessary knowledge to properly manage patients in this specialty. This lack of knowledge can sometimes have a negative impact on patients' recovery, particularly for fear of making a mistake. Conclusions Physiotherapists, outside the hospital, have an incomplete conception of plastic surgery. They would need a specific plastic surgery training in order to manage these patients in an optimal way.

To achieve adequate nasal proportions, nostril surgery can be a complementary technique useful in facial surgery. To help surgeons with the decision to realize nostril surgery, we conducted a systematic review to summarize reported cases on surgical procedures with a specific interest on indications, surgical procedures and postoperative outcomes. A therapeutic algorithm is also proposed. We carried out this review in accordance with the PRISMA criteria. Twenty-two eligible studies were identified using Medical databases, including 1599 patients. A qualitative and quantitative analysis was carried out. Excision techniques were realized on 728 patients (45.5%), followed by cinching sutures on 642 patients (40%) and combined techniques: excision techniques with flap advancement techniques in 189 cases (12%), excision techniques with flap advancement techniques and cinching suture in 40 patients (2.5%). When excessive alar flaring was present, alar wedge resection was preferred in the 92% of followed by alar and sill resection. Cinching sutures were realized when excessive alar flaring was associated with a vertical alar axis, in cases of wide alar base, of associated orthognathic surgery. When excessive alar flaring was associated with wide alar bases, indications changed basing on the associated deformities. In 795 patients, nostril surgery was conducted simultaneously with rhinoplasty. Nostril surgery through excision techniques, cinching sutures or flaps advancement techniques, reveals good outcomes and can be complementary to rhinoplasty or orthognathic surgery. Through this systematic review, we tried to orient surgeons to find the best treatment for nostril base surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Methylxanthines including caffeine and theobromine are widely consumed compounds and were recently shown to interact with bovine copper-containing amine oxidase. To the best of our knowledge, no direct demonstration of any interplay between these phytochemicals and human primary amine oxidase (PrAO) has been reported to date. We took advantage of the coexistence of PrAO and monoamine oxidase (MAO) activities in human subcutaneous adipose tissue (hScAT) to test the interaction between several methylxanthines and these enzymes, which are involved in many key pathophysiological processes. Methods: Benzylamine, methylamine, and tyramine were used as substrates for PrAO and MAO in homogenates of subcutaneous adipose depots obtained from overweight women undergoing plastic surgery. Methylxanthines were tested as substrates or inhibitors by fluorimetric determination of hydrogen peroxide, an end-product of amine oxidation. Results: Semicarbazide-sensitive PrAO activity was inhibited by theobromine, caffeine, and isobutylmethylxanthine (IBMX) while theophylline, paraxanthine, and 7-methylxanthine had little effect. Theobromine inhibited PrAO activity by 54% at 2.5 mM. Overall, the relationship between methylxanthine structure and the degree of inhibition was similar to that seen with bovine PrAO, although higher concentrations (mM) were required for inhibition. Theobromine also inhibited oxidation of tyramine by MAO, at the limits of its solubility in a DMSO vehicle. At doses higher than 12 % v/v, DMSO impaired MAO activity. MAO was also inhibited by millimolar doses of IBMX, caffeine and by other methylxanthines to a lesser extent. Conclusions: This preclinical study extrapolates previous findings with bovine PrAO to human tissues. Given that PrAO is a potential target for anti-inflammatory drugs, it indicates that alongside phosphodiesterase inhibition and adenosine receptor antagonism, PrAO and MAO inhibition could contribute to the health benefits of methylxanthines, especially their anti-inflammatory effects.

Simultaneous lesions of both proper digital arteries of the thumb are common in hand trauma surgery. The purpose of this anatomical study was to determine if the dorsal arterial network could be sufficient to ensure the vascularization of the thumb skin sheath. We carried out a cadaveric study on 22 hands. The ulnar and radial proper digital arteries of the thumb were ligated at the base of the first phalanx. Red dye was injected into the radial artery and blue dye into the ulnar artery at the wrist level. Visual evaluation of skin staining and systematic photographs was done at 1, 3 and 10 min after injection of dyes. Staining of the thumb sheath was obtained in 100% of the dissections and complete in 91.91% of cases. Staining originated from mixed radial and ulnar artery origins in 81.82% of cases. It was incomplete in 9.09% of cases with a missing on the dorsoradial edge of the proximal phalanx. In one dissection, the whole hand skin was only stained red, and in another dissection only stained blue. The dorsal vascular network ensures the substitution of the skin vascularization in more than 90% of cases when ligating the proper digital arteries of the thumb. A clinical impression of good skin vascularization after injury of both proper digital arteries might lead the surgeon not to perform systematic revascularization, but the risk of variable damages of adjacent tissues due to an interruption of one major arterial system requires a palmar arterial anastomosis whenever possible.

International audience; We hypothesized that skeletal muscle contraction produces a cellular stress signal, triggering adipose tissue lipolysis to sustain fuel availability during exercise. The present study aimed at identifying exercise-regulated myokines, also known as exerkines, able to promote lipolysis. Human primary myotubes from lean healthy volunteers were submitted to electrical pulse stimulation (EPS) to mimic either acute intense or chronic moderate exercise. Conditioned media (CM) experiments with human adipocytes were performed. CM and human plasma samples were analyzed using unbiased proteomic screening and/or ELISA. Real-time qPCR was performed in cultured myotubes and muscle biopsy samples. CM from both acute intense and chronic moderate exercise increased basal lipolysis in human adipocytes. Growth and differentiation factor 15 (GDF15) gene expression and secretion increased rapidly upon skeletal muscle contraction. GDF15 protein was upregulated in CM from both acute and chronic exercise–stimulated myotubes. We further showed that physiological concentrations of recombinant GDF15 protein increased lipolysis in human adipose tissue, while blocking GDF15 with a neutralizing antibody abrogated EPS CM-mediated lipolysis. We herein provide the first evidence to our knowledge that GDF15 is a potentially novel exerkine produced by skeletal muscle contraction and able to target human adipose tissue to promote lipolysis.

Burns to the cephalic extremities are particularly implicated in problems of self-image and alterations to personal social relations. The aim of this study was to objectively assess the quality-of-life (QoL) of patients suffering from face-and-neck burns through our newly created scale: The Burn-Specific Health Scale for Face and Neck (BSHS-FN).After constructing the BSHS-FN, we compared QoL of patients with or without face-and-neck burns. SF-36, the French version of the BSHS-B (Burn Specific Health Scale-Brief), and the BSHS-FN were administrated to 53 patients divided into two groups: GB group (general burns, 26 patients) and FN group (face-neck burns, 27 patients).QoL evaluated using the SF-36 had a higher average total score in GB patients compared to FN patients, but there were no significant difference between the two groups (54.3±18.5 vs. 47.0±17.3, respectively, p=0.11). In contrast, in BSHS-B the total score was significantly different between the two groups with a higher score recorded for the GB group (71.9±13.4 [median: 72.8] in the GB group vs. 62.2±14.4 [median: 64.4] in the FN group). In percentage terms, total score of BSHS-FN for GB group was 79.1±10.1, while total score for FN group was 53.6±13.1 (p0.001), with the highest score for the Face and Neck domain in GB group (99.7±1.1, p0.001) CONCLUSION: The BSHS-FN seemed to be more appropriate to assess QoL for FN burn patients. This study supports its application in routine clinical practice and in international studies.

BACKGROUND Poland syndrome is historically associated with hypoplasia of the pectoral major muscle and abnormalities of the upper limbs. The authors propose an innovative procedure for correcting Poland syndrome thoracic malformations using three-dimensional modeling. Moreover, the authors evaluated aesthetic improvement, satisfaction, and quality of life after reconstruction with computer-aided design customized silicone implants. METHODS Since 1993, the authors have treated 129 patients for Poland syndrome. Before 2007, the implants were made from plaster molds; since 2007, they have been made using three-dimensional computer-aided design. Patient satisfaction was assessed using a standardized questionnaire, and quality of life was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS Lipofilling was performed in combination with computer-aided design in one-third of cases, and breast prostheses were required in 24 percent of cases. We found three exposed prostheses and two infections. Cosmetic results were excellent in more than 90 percent of cases, and more than 80 percent of patients were very satisfied or satisfied, with no significant difference between men and women (p = 0.382). The Medical Outcomes Study 36-Item Short-Form Health Survey scores revealed significant improvements in role emotional (p < 0.05), emotional well-being (p < 0.001), and social functioning (p < 0.001). CONCLUSIONS Correcting Poland syndrome using a computer-aided design silicone implant fulfilled aesthetic and psychological demands, and significant improvements were seen in quality of life. The technique is simple and reliable and yields high-quality results, and three-dimensional computer-aided design has optimized the authors' reconstructions. Nevertheless, associated procedures and secondary corrections remain necessary to obtain optimal results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

La reparacion del labio con tejido labial es el principio mas fundamental al que debe tenderse cuando se quiere realizar una cirugia reparadora de esta region. Los labios responden a una doble exigencia, tanto esfinteriana como estetica facial. Por consiguiente, se dispone de un arsenal muy amplio de procedimientos quirurgicos que el cirujano plastico debe dominar, no solo en cuanto a sus indicaciones, sino tambien en lo que respecta a su realizacion para intentar restituir de forma optima la doble funcion del organo labial. Estas indicaciones dependeran no solo de la etiologia de la perdida de sustancia inicial, sino tambien de sus caracteristicas y de las posibilidades de reconstruccion locales o a distancia. Por ultimo, las entidades anatomicas que constituyen el aparato labial deben respetarse al maximo, como la union cutaneomucosa, las comisuras o las subunidades esteticas para obtener el resultado mas optimo posible. La principal innovacion en estos ultimos anos es la aparicion de los colgajos de perforantes, en particular en «helice», que permiten reconstrucciones a medida.

Autologous fat transfer, or lipofilling, is a common technique used for soft tissue reconstruction. It has been used for many years, but the technique is associated with a significant graft resorption rate (20% to 80%). To improve the fat graft survival rate, several methods have been tested, and one has appeared more promising: cell-assisted lipotransfer (CAL). In the CAL method, fat is enriched with adipose-derived stromal cells (ASC), contained in the stromal vascular fraction (SVF) obtained after enzymatic digestion of fat or after cell culture to improve the fat survival rate. In this concise review, we present the clinical indications, and the technical principles of CAL, as well as a presentation of ASC. To conclude, we present the main results (efficacy, complications and safety) obtained from different studies of this technique.

Compelling evidence suggests that volatile organic compounds (VOCs) have potentially harmful effects to the skin. However, knowledge about cellular signaling events and toxicity subsequent to VOC exposure to human skin cells is still poorly documented. The aim of this study was to focus on the interaction between 5 different VOCs (hexane, toluene, acetaldehyde, formaldehyde and acetone) at doses mimicking chronic low level environmental exposure and the effect on human keratinocytes to get better insight into VOC-cell interactions. We provide evidence that the proteasome, a major intracellular proteolytic system which is involved in a broad array of processes such as cell cycle, apoptosis, transcription, DNA repair, protein quality control and antigen presentation, is a VOC target. Proteasome inactivation after VOC exposure is accompanied by apoptosis, DNA damage and protein oxidation. Lon protease, which degrades oxidized, dysfunctional, and misfolded proteins in the mitochondria is also a VOC target. Using human skin explants we found that VOCs prevent cell proliferation and also inhibit proteasome activity in vivo. Taken together, our findings provide insight into potential mechanisms of VOC-induced proteasome inactivation and the cellular consequences of these events.

La sindrome di Poland e una malformazione rara che associa a vari gradi anomalie del torace e anomalie dell’arto superiore omolaterale. L’anomalia costante e l’agenesia dei fasci sternocostali del grande pettorale. C’e spesso un’asimmetria mammaria con ipoplasia del seno e del complesso areolomammillare omolaterale. Le malformazioni della mano sono varie e complesse, ma la malformazione caratteristica della sindrome di Poland e una brachimesofalangia. Questo quadro clinico si riscontra piu frequentemente negli uomini e, di solito, a livello dell’emitorace destro. La patogenesi non e ancora chiara. Non c’e mai un danno funzionale nell’interessamento toracico della sindrome di Poland ed esiste solo un disagio estetico. Una classificazione in tre tipi aiuta a orientare le scelte terapeutiche. La ricostruzione ha beneficiato, negli ultimi anni, dell’utilizzo del digitale per gli impianti del torace su misura, partendo da una TC 3D. Possono essere utilizzate altre tecniche che comportano, a seconda dei casi, protesi mammarie e innesto adiposo. Solo il classico lembo di grande dorsale e definitivamente abbandonato. A seconda dell’eta, del sesso e della gravita delle anomalie toracomammarie, puo essere proposta una strategia terapeutica che si adatta ad ogni caso di sindrome di Poland.

Resume Introduction La prise en charge des patients presentant des sequelles d’amaigrissement, parfois majeures, est de mieux en mieux codifiee. Cependant, cette chirurgie n’est pas denuee de risques. Les complications des dermolipectomies abdominales circulaires sont plus frequentes que celles des dermolipectomies abdominales anterieures. L’objectif de cette etude etait d’evaluer la morbidite en rapport avec cette chirurgie au travers d’une etude retrospective et monocentrique. Materiel et methodes Cent onze dermolipectomies abdominales circulaires ont ete realisees entre juin 2011 et septembre 2015 dans le service de chirurgie plastique du CHU de Toulouse. Les complications mineures et majeures ont ete repertoriees et analysees. Resultats La frequence des complications postoperatoires etait de 44,1 % dans notre serie. Les complications majeures ont concerne 15,3 % des patients. Les transfusions de culots globulaires (9 %) et les hematomes ayant necessite une reprise chirurgicale (7,2 %) representaient les complications majeures les plus frequentes. Nous avons retrouve significativement plus de complications majeures chez les patients avec une resection cutaneograisseuse importante avec un seuil de significativite a 3200 g (p = 0,02). Les hommes presentaient significativement plus de complications majeures que les femmes (p = 0,005). La moyenne du delta-IMC (avant et apres amaigrissement) etait significativement plus elevee dans le groupe de patients ayant presente le plus de complications mineures (p = 0,045). En effet, un delta-IMC eleve (superieur a 19,5) etait associe a un sur-risque de complications mineures dans notre population. Conclusion La democratisation et les progres realises dans le domaine de la dermolipectomie abdominale circulaire ne doivent pas faire oublier qu’il s’agit d’une intervention a risque. Meme si nous maitrisons de mieux en mieux les resultats cosmetiques et les complications thromboemboliques, il persiste encore de nombreuses complications.

The management of pilonidal sinus disease is still not standardized. Currently, the two main procedures are a lay-open excision procedure with secondary healing or coverage with local flaps. The authors present their experience with a one-stage excision-coverage with an innovative parasacral artery perforator flap propeller designed to respect the aesthetic unity of the buttocks.Study patients were managed with this procedure in the Toulouse, Montpellier, and Rennes university hospitals between 2012 and 2018. Data were collected on clinical and surgical details, immediate and late postoperative complications, and long-term recurrence. Aesthetic satisfaction was evaluated with a self-evaluation questionnaire.The authors operated on 228 consecutive patients for pilonidal sinus disease with an aesthetically shaped parasacral artery perforator flap. The median patient age was 23.5 years, the median operative time was 46 minutes, the median flap length was 9.3 cm (range, 6.5 to 14 cm), and the median flap width was 4.1 cm (range, 4 to 6.5 cm). There were five distal necroses but no complete flap necrosis. There were six postoperative hematomas, 11 infections, and 18 wound dehiscences. The median follow-up period was 27.9 months. Median hospital length of stay was 4.2 days. Three recurrences of pilonidal sinus disease and six instances of hidradenitis suppurativa were detected. Approximately 82 percent of the women and more than 85 percent of the men were "satisfied" or "very satisfied" with the aesthetic outcome, without significant differences between the sexes (p = 0.901).The aesthetically shaped parasacral artery perforator flap combines very satisfactory results regarding recurrence and postoperative recovery with cosmetic outcome. This procedure is technically more demanding than other flap procedures, although it is accessible to numerous surgeons as the first-line treatment for pilonidal sinus disease after initial learning.Therapeutic, IV.

International audience; Many treatments have been described for pilonidal disease, but recurrence cannot be completely eliminated. The aim of this study was to perform a meta-analysis of randomised, controlled trials comparing flap repair vs the laying open technique and/or excision and direct closure techniques in the treatment of chronic pilonidal sinus disease. The primary outcome measure was the recurrence rate. Secondary outcomes were complete wound-healing time, duration of the incapacity to work, quality of life and patient satisfaction, postoperative pain, wound infection, bleeding or haematoma, skin wound complications, and duration of hospital stay. Seventeen studies were included. The meta-analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure. A shorter time to complete wound healing and a shorter duration of incapacity to work for flap vs the laying open technique were observed. Superiority of flap repair vs direct closure in pilonidal sinus treatment was demonstrated in this meta-analysis. These results suggest avoiding primary direct closure in clinical practice. Compared with the laying open technique, flaps result in faster healing and a shorter time to return to activities.

Poland syndrome is associated with varying degrees of thoracic abnormalities and malformations of the upper limbs. The pathognomonic anomaly is agenesis of the sternocostal fibers of the pectoralis major [1]. Breast asymmetry occurs frequently in women [2] but the rate of hand malformations varies widely [3]. Poland syndrome is a rare malformation, as the incidence is estimated at only 1 per 30,000 births [4]. There appears to be a male predominance (3:1), and the majority of studies attest to lateralization of Poland syndrome on the right side. The etiology of the syndrome remains unknown but a vascular origin, as supported by Bavinck and Weaver [5], could explain the existence of associated syndromes (pectus, tuberous breasts).

Pectus excavatum, or “funnel chest,” is the most common congenital malformation of the thorax. In the literature, the sex ratio is mostly 5 men to 1 woman; in our 25-year experience of 600 cases, it was 3 men to 2 women owing to the quality of our plastic surgeon and the specific recruitment of breast anomalies due partly or totally to pectus excavatum.