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The aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation.Retrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes.94 patients were included, mean age was 51 (39-64) years; median total body surface area burned was 36 (25-54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3-8] vs. 2 [1-4], p0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not.Pulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.

International audience; Background: Tumor molecular deciphering is crucial in clinical management. Pan-cancer next-generation sequencing panels have moved towards exhaustive molecular characterization. However, because of treatment resistance and the growing emergence of pharmacological targets, tumor-specific customized panels are needed to guide therapeutic strategies.Objective: The objective of this study was to present such a customized next-generation sequencing panel in melanoma.Methods: Melanoma patients with somatic molecular profiling performed as part of routine care were included. High-throughput sequencing was performed with a melanoma tailored next-generation sequencing panel of 64 genes involved in molecular classification, prognosis, theranostic, and therapeutic resistance. Single nucleotide variants and copy number variations were screened, and a comprehensive molecular analysis identified clinically relevant alterations.Results: Four hundred and twenty-one melanoma cases were analyzed (before any treatment initiation for 94.8% of patients). After bioinformatic prioritization, we uncovered 561 single nucleotide variants, 164 copy number variations, and four splice-site mutations. At least one alteration was detected in 368 (87.4%) lesions, with BRAF, NRAS, CDKN2A, CCND1, and MET as the most frequently altered genes. Among patients with BRAFV600 mutated melanoma, 44.5% (77 of 173) harbored at least one concurrent alteration driving potential resistance to mitogen-activated protein kinase inhibitors. In patients with RAS hotspot mutated lesions and in patients with neither BRAFV600 nor RAS hotspot mutations, alterations constituting potential pharmacological targets were found in 56.9% (66 of 116) and 47.7% (63 of 132) of cases, respectively.Conclusions: Our tailored next-generation sequencing assay coupled with a comprehensive analysis may improve therapeutic management in a significant number of patients with melanoma. Updating such a panel and implementing multi-omic approaches will further enhance patients' clinical management.

Baker grade III and IV breast prosthesis capsular contractures represent a major problem for patients undergoing mammoplasties. The risk factors involved in recurrence are debated, and the best surgical approach for their prevention is not established. The objective was to identify these. We carried out a retrospective study of patients operated on for capsular contracture at the Saint-Louis Hospital in Paris from 2012 to 2014. The characteristics at inclusion were compared so as to determine the risk factors of recurrence. The surgical approaches were compared between the patients with recurrence and those without at 5 years. Of the 100 patients included, 24 had a recurrence. The minimal follow-up was 5 years. No risk factors of recurrence of capsular contracture were identified. The surgical approach associated with the lowest rate of recurrence was anterior capsulectomy [OR total capsulectomy = 2.36 (0.73; 8.037) OR capsulotomy = 4.33 (1.37; 14.81)] (p

The development of BRAF and MEK inhibitors (BRAFi/MEKi) has led to major advances in melanoma treatment. However, the emergence of resistance mechanisms limits the benefit duration and a complete response occurs in less than 20% of patients receiving BRAFi ± MEKi. In this study, we evaluated the impact of an intermittent versus continuous dosing schedule of BRAF/MEK inhibition in a melanoma model mildly sensitive to a BRAF inhibitor. The combination of a BRAFi with three different MEKi was studied with a continuous or intermittent dosing schedule in vivo, in a xenografted melanoma model and ex vivo using histoculture drug response assays (HDRAs) of patient-derived xenografts (PDX). To further understand the underlying molecular mechanisms of therapeutic efficacy, a biomarker pharmacodynamic readout was evaluated. An equal impact on tumor growth was observed in monotherapy or bitherapy regimens whether we used continuous and intermittent dosing schedules, with no significant differences in biomarkers expression between the treatments. The antitumoral effect was mostly due to modulations of expression of cell cycle and apoptotic mediators. Moreover, ex vivo studies did not show significant differences between the dosing schedules. In this context, our preclinical and pharmacodynamic results converged to show the similarity between intermittent and continuous treatments with either BRAFi or MEKi alone or with the combination of both.

Restoration of a good hand function and limitation of the sequelae are the main concerns in burns treatment. The intrinsic plus position is known as the safe position for hand splinting. This article aims at describing the technique of external fixation that have been developed in Saint Louis’ Burn Center in management of burned hands during the acute phase. Since 2013, a technique of external fixation has been developed in our burn center using Hoffmann II External Fixation System from Stryker® and pins from Medicalex®. External fixation of a deep burned hand is an efficient and safe way to immobilize the hand in a correct intrinsic plus position, to secure the skin grafts to improve graft take and to permit changes of the dressings without removing the immobilization device.

In light of the concerns regarding the occurrence of anaplastic large-cell lymphoma, seromas, and scar capsules, there appears to be merit in analysis and presentation of the results of our series of inflatable smooth implants filled with saline solution, for which the follow-up was more than 10 years. We carried out a retrospective study, including all of the patients who underwent a first breast implant for cosmetic reasons, between 2003 and 2006. A total of 383 patients with 766 smooth implants filled with saline solution were included in our study. No cases of lymphoma and seroma were diagnosed. Eleven patients exhibited a postoperative hematoma, and four went on to develop a capsule. Twenty-two patients (5.7%) developed a Baker Grade III or IV capsule that required revision surgery. Two patients (0.5%) opted for a bilateral prosthesis replacement due to visual rippling. In total, there were 26 (3.4%) early deflations of prostheses. There is not a statistically significant correlation between the occurrence of hematomas and the formation of a capsule. We found a lower shell rate with smooth-walled versus textured implants. The fact of having a decline of 10 years allows to be exhaustive. As for wrinkling and ripples, their occurrence has not been increased by the use of inflatable retropectoral implants. Smooth inflatable implants filled with saline solution have numerous advantages such as the possibility of a very small approach route and perioperative adaptability of the volume. In light of the lack of indication of anaplastic large-cell lymphoma with smooth implants, they are clearly an attractive alternative to textured implants filled with silicone gel. 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 Patients with extensive burns are at risk of developing candidemia. OBJECTIVES To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. PATIENTS AND METHODS Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed. RESULTS Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38-68)%, SAPSII of 43 (36-58) and ABSI of 11 (8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056). CONCLUSIONS Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.

Objective: There are few means to treat large keloid scars, as exeresis—even if partial—impedes direct closure without tension in the absence of a flap or a skin graft. This study evaluates the efficacy, indications for use and limitations of a new therapeutic protocol, combining an extralesional keloid excision left to heal by secondary intention with a paraffin dressing and glucocorticoid ointment, followed by monthly intrascar injections of corticosteroids upon full re-epithelialisation. Method: A retrospective study of patients treated for keloid scars by using the new therapeutic protocol. Scars were categorised as either healed or recurring. Their recurrence was scored according to the changes in functional signs and the scar volume. Results: A total of 36 scars were studied. The mean follow-up was 14.1 months. Healing occurred in a mean of 6.8 weeks. The mean surface area was 21.6cm2. Healing rate was 30.5%. Scar volume was improved in 60% of recurrent cases and functional signs in 56%. Based on adherence with the corticotherapy, two patient groups could be discerned. For patients in the ‘adherent’ group, the healing rate was 40%, and scar volume was improved in 75% of recurrent cases and the functional signs in 83% of cases. Conclusions: The healing rate in this study was close to that reported in the literature. Excision-healing by secondary intention could therefore be offered to patients for whom adherence is uncertain. The protocol in this study offers a straightforward, fast, accessible solution that does not appear to entail any risk of additional keloids. It could potentially offer a treatment option in case of failure of other treatments, large keloid scars or scalp keloids.

One of the major challenges of the 21Vieillissement cutané - Physiopathologie et thérapies innovantes.Un des enjeux majeurs de ce XXI

Un des enjeux majeurs de ce XXIesiècle est la lutte contre le vieillissement, défini comme un ensemble de mécanismes physiologiques altérant les capacités physiques et intellectuelles de l’organisme. Le vieillissement de la peau n’est qu’un trait visible de ce processus. Il est associé à des défauts de cicatrisation majeurs liés à l’altération des propriétés biomécaniques des cellules cutanées, essentiellement des fibroblastes dermiques. Le système immunitaire, autre composante clé du maintien de l’homéostasie cutanée et du bon déroulement de la cicatrisation des plaies, subit aussi les effets du temps : l’immunosénescence cutanée consécutive limiterait la réponse anti-infectieuse et vaccinale, tout en favorisant un environnement pro-tumoral. Les principales atteintes cutanées dues au vieillissement, que celui-ci soit intrinsèque ou extrinsèque, seront détaillées avant d’énumérer les stratégies anti-âges efficaces pour lutter contre les stigmates dermiques et épidermiques liées à l’âge.

Introduction Deep soft tissue defects next to the joints can rapidly lead to irreversible damages and have to be covered urgently and effectively. In severely burned patients the usual approach is to use a flap even though it has its limitations in regards to the extent of the burn and the general condition of the patient. Case report A twenty seven-year-old male was admitted at the Burn Treatment Center for a thermic burn of seventy-two percent of his body surface area. At first he has benefited from several skin grafts and later on a major open right elbow had to be treated urgently to rescue the joint. Results After the burn, a revascularization of the donor site was noticed, sufficient to use the radial forearm pedicled flap as a cover for the elbow. This case reports an innovative approach based on the use of an irrigation and drainage system placed underneath the flap. The elbow was rigidly immobilized with an external fixator in order to facilitate an optimal healing of the flap. Conclusion In this case, the choice of this flap, combined with the irrigation and drainage system and the immobilization by external fixation, provided an original and efficient treatment. Post operatively the healing of the flap and of the donor site was complete. The functional results exceeded the expectations with a complete recovery of the joint amplitude. Thus, in case of no other therapeutic options, it is probably possible to use a variety of flaps recently healed.

In burn patients, meshed split thickness skin grafts are commonly used on large and non-flat areas whom immobilization is difficult to achieve. The frequent mobilizations of burn patients can make the graft slip and prevent the revascularization and therefore the taking of the skin graft. In order to prevent this pitfall, we modified and adapted the tie-over dressing procedure. The giant running tie-over dressing enables large skin grafts to be applied to their wound bed and therefore helps revascularization. Some cautions are necessary in order to avoid any infection. This original and easy-to-perform procedure answers to the difficulties of large split-thickness skin grafts in burn patients.

Summary Our retrospective study of burn patients presents a three-step treatment of heterotopic ossification: excision surgery, early rehabilitation, and analgesia. We included patients admitted to the department for treatment of postburn heterotopic ossification between January 1, 1979, and September 30, 2015. The mean age at the time of the burn was 43.3 years. Men accounted for the majority of burn patients who developed an osteoma (70.8%). The mean total skin area burned was 38.4%. No osteoma justifying surgery was found for any patient with a total burned skin area less than 19%. The burned zones were related to the osteoma development in 94.3% of cases. On average, the surgery took place 10.8 months after the burn. The osteotomy was accompanied by surgical treatment of a contracture in 37.1% of patients. Most of the osteomata were found at the elbows (30), followed by the shoulders (3), and finally the knees (2). Rehabilitation began on D0 after the surgery, except if a flap or a thin-skin graft was used. Regarding analgesia, opiates were prescribed systematically during the immediate postoperative period. Elbow range of motion on flexion improved by a mean of 84.1°. During the postoperative period, we found 2 recurrences of osteoma and 1 elbow hematoma in two separate patients. There were no postoperative infections or neurological sequelae. Our retrospective French study confirmed results found in the international literature. The three-step treatment – excision surgery, early rehabilitation, and antalgia – seems to be the best means of treating osteoma with satisfactory results. Surgery is indicated only in the case of functional impairment and not simply based on imaging.

Resume But de l’etude L’ombilic a un role majeur dans l’esthetique de la paroi abdominale anterieure. De nombreuses publications portent sur les dermolipectomies abdominales, mais peu se focalisent sur les ombilicoplasties. Celles-ci sont pourtant essentielles dans l’appreciation du resultat esthetique. L’ombilicoplastie en aile de mouette utilisee dans notre service est fiable et facilement reproductible. Dans cet article, nous evaluons la satisfaction des patientes ayant eu une dermolipectomie abdominale avec cette technique de transposition. Materiel et methode Une etude retrospective a ete realisee dans le service de chirurgie plastique de l’hopital Saint-Louis a Paris, elle concernait les patientes operees d’une dermolipectomie abdominale avec transposition de l’ombilic, entre le 1er janvier 2012 et le 31 decembre 2012. Toutes les patientes ont ete operees selon notre technique d’ombilicoplastie : desinsertion de l’ombilic en V, reinsertion de l’ombilic en « aile de mouette », un degraissage periombilical associe a une plicature de la tige ombilicale. Les complications recensees dans les dossiers medicaux des patients et la satisfaction ont ete evaluees par un questionnaire telephonique. Resultats Quatre-vingt-seize patientes ont ete incluses. Aucune patiente n’a presente de souffrance ou de necrose ombilicale. Le resultat global de la transposition ombilicale etait juge de bon a excellent pour 92,7 % des patientes. Conclusion L’ombilicoplastie en aile de mouette presente de nombreux avantages : c’est une technique simple, facilement reproductible, fiable, dont les patientes sont pour la plupart tres satisfaites.

Resume Introduction La cicatrisation apres amputation abdomino-perineale est souvent difficile notamment chez les patients ayant beneficie d’une radiotherapie. La reconstruction vaginale est egalement un enjeu important pour les femmes ayant beneficie de cette chirurgie. Nous decrivons et analysons ici notre serie de reconstructions perineales par lambeau de Taylor modifie. Materiel et methode Entre 2010 et 2016, 68 (52 femmes, 16 hommes) patients ont beneficie d’une reconstruction par lambeau musculocutane de grand droit de l’abdomen a pedicule inferieur et a palette oblique dans les suites d’un cancer du canal anal (53), d’adenocarcinome du bas rectum (9) ou d’autres tumeurs malignes du perinee. Resultats A distance de l’intervention, tous les patients ont cicatrise avec une mediane a 30 jours. Le taux de reprises chirurgicales etait de 11,7 % dont 1 pour eventration. Les principales causes de retard de cicatrisation etaient les desunions cicatricielles, les abces et les necroses partielles. Aucun lambeau n’a ainsi ete depose. La duree moyenne d’hospitalisation etait de 23,7 jours. Conclusion La reconstruction des pertes de substance perineales post-amputation abdomino-perineale a ete grandement amelioree et fiabilise par la realisation de lambeaux de Taylor modifies. Elle permet une cicatrisation complete et rapide avec un faible comorbidite.

Resume Objectif L’hypopigmentation definitive des cicatrices est une complication frequente apres les brulures profondes traitees par cicatrisation dirigee, et peut entrainer des sequelles esthetiques importantes. Le traitement chirurgical a pour but d’enlever les tissus cicatriciels puis d’apporter des melanocytes sains, en limitant la surface des zones donneuses. Cette revue detaille les differents traitements proposes pour prendre en charge les cicatrices hypopigmentees post-brulures, et en precise les indications. Methodes Les articles publies entre 1985 et 2016 ont ete recherches sur Pubmed. Les etudes sur le traitement des cicatrices hypopigmentees etaient incluses uniquement si elles etaient secondaires a des brulures. Les traitements ont ete evalues en fonction de la region et la surface de la cicatrice, la couleur de la peau et l’efficacite de la repigmentation. Resultats Seize etudes ont ete incluses. Les traitements non chirurgicaux comme le maquillage et le tatouage, et les traitements chirurgicaux comme la greffe de peau mince pleine, les microgreffes, les greffes enfouies, la suspension cellulaire de melanocytes et keratinocytes autologues, et la culture de cellules epitheliales, ont ete compares. Conclusion La greffe de peau mince pleine est un traitement fiable, particulierement pour les petites lesions hypopigmentees car cette methode necessite une zone donneuse de la meme taille que la zone traitee. La suspension cellulaire peut etre une alternative pour les lesions plus etendues. De plus une demarcation entre la greffe et la peau normale peut exister, et quand une couleur precise est attendue en particulier sur la face, le tatouage et la microgreffe sont efficaces.

Resume Introduction Les complications cicatricielles post-chirurgie abdominale ou pelvienne sont plus frequentes chez les patientes obeses. L’infection, les seromes et les retards de cicatrisation occasionnes peuvent dans ce cas etre extremement difficiles a traiter. L’objectif de cette note technique est de vous presenter un cas original d’une patiente de 48 ans obese, operee neuf ans auparavant d’une hysterectomie par laparotomie et presentant de maniere chronique une fistule chronique associee a une lymphorree septique non resolutive malgre de multiples interventions chirurgicales, dont la guerison a pu etre obtenue par un lambeau de grand epiploon. Technique chirurgicale L’ideal est de realiser cette intervention en double equipe avec un chirurgien digestif en cas de survenue de plaie viscerale ou vasculaire intra-abdominale durant la dissection. Le lambeau de grand epiploon etait leve de maniere classique sur l’artere gastro-epiploique droite. Un orifice suffisamment large doit etre laisse au niveau de l’aponevrose abdominale afin d’eviter toute compression du pedicule. Enfin, le lambeau doit etre etale sur toute la surface du decollement et fixe a l’aponevrose anterieure. Conclusion La fiabilite et la richesse a la fois vasculaire et lymphatique font du lambeau de grand epiploon une methode tres efficace dans les cas de plaies chroniques associees a une lymphorrhee majeure. La cicatrisation obtenue dans le cas clinique presente met ainsi en valeur les qualites specifiques de ce lambeau.

Introduction With more than 10 million of daily users, e-cigarettes encountered a great success. But in the past few years, the number of medical reports of injuries caused by the explosion of e-cigarettes has significantly increased. This article aims at reporting our series and reviewing the literature to propose a new classification based on the mechanisms of injuries related to e-cigarettes that can guide non-specialists and specialists in the management of these patients. Method We performed a retrospective review of our institutional burn database from June 2016 to July 2017 for injuries caused by or in the context of using an e-cigarette. The patients’ demographics (age, gender), burn injury mechanisms, depth, localization, surface and interventions were described. Results Ten patients suffered from burns related to the use of e-cigarettes. The burns were located at the thigh (80%) and the hand (50%) with a mean surface of 3% of TBSA. Four different mechanisms could be described: Type A: thermal burns with flames due to the phenomenon of “thermal runaway”, Type B: blasts lesions secondary to the explosion, Type C: chemical alkali burns caused by spreading of the electrolyte solution and Type D: thermal burns without flames due to overheating. These different mechanisms suggest specific surgical and non-surgical management. Conclusion Management of injuries sustained from e-cigarettes’ explosions should be approached from the standpoint of mechanisms. Different mechanisms could be associated and should be considered in specific management.

Rare and dreaded, necrosis of the nipple-areola complex (NAC) is one of the major complications of breast reduction surgery. Our objective was to establish a management algorithm summarizing the different possible treatments reported in the literature. The data extracted from the articles selected for this literature review covered surgical techniques, frequency of NAC necrosis, type of necrosis, and management proposed for women who have had this surgery for macromastia. In the 54 articles finally selected, the mean frequency of NAC necrosis was 5.1%. The risk factors for necrosis were the weight of the tissue resected, smoking, obesity, the surgical technique used, and stretch marks. The treatments proposed were listed according to four categories of issues: patient-specific susceptibility, type of breast, surgical technique, and its technical performance. No consensus exists about the management of NAC necrosis, which remains a complication feared by surgeons. We propose a management algorithm that simplifies the therapeutic indications. Level of Evidence: Not ratable

Introduction La peau au cours de l’âge subit plusieurs changements morphologiques: apparition de rides, perte de tonicite, associes a des problemes de cicatrisation comme les escarres lies a une alteration de la fermeture des plaies. Notre comparaison precedente du proteome de fibroblastes de peaux jeunes et matures avait mis en evidence des differences significatives de l’expression de molecules associees au cytosquelette d’actine et a la matrice extracellulaire. L’objectif de cette presente etude etait d’etablir les differences mecaniques entre fibroblastes de peau jeune et peau âgee et leur capacite a reparer une lesion. Materiel et methodes Pour ce faire, nous comparons ici les proprietes mecaniques des fibroblastes cultives a partir de peau de femmes jeunes ( 55 ans, n = 6). Une contrainte mecanique est exercee sur les deux sets de fibroblastes en utilisant des patterns en forme de rectangle sur differentes rigidites de gel de polyacrylamide (1-30 kPa), mimant ainsi la rigidite de la peau au cours de differentes etapes de cicatrisation. L’energie cellulaire produite en reponse a ces contraintes mecaniques est mesuree par Traction Force Microscopy (TFM). Resultats L’analyse en TFM montre que les forces mecaniques des fibroblastes matures sont significativement diminuees d’un facteur 1000 par rapport aux fibroblastes jeunes. La modulation par transfection de SiRNA de certaines proteines differentiellement exprimees entre les fibroblastes jeunes et âges et liees au cytosquelette d’actine demontre leur implication majeure dans les capacites mecaniques des fibroblastes. L’analyse immunohistochimique vient illustrer ces differences d’expression. Discussion En conclusion, l’etude des forces liees au cytosquelette des fibroblastes met en evidence des differences majeures entre cellules dermiques de peaux jeunes et celles de peaux matures. Elle met en evidence de nouvelles cibles proteiques et des capacites fonctionnelles qui peuvent etre modulees au niveau cellulaire pour ameliorer la texture et la reparation des peaux matures.

In cases involving small burns in patients without a comorbidity or associated pathology, a referral from a surgeon is necessary and sometimes it cannot be ascertained when the patient is not brought in by a specialized team. The purpose of this retrospective study was to evaluate the quality of our method for performing telemedicine. This retrospective study included the 323 patients who were initially treated using the telemedicine system implemented between 2011 and 2016. This procedure only involved patients burned over a small portion of their body's surface area (ie, ≤15%) who were between 15 and 75 years of age and who did not have a major comorbidity. The purpose of the procedure was to evaluate the need for surgery. The initial diagnosis regarding the need for a surgical procedure was accurate in 94.4% (305/323) of the cases. Eleven patients (3.4%) were transferred unnecessarily as they ultimately did not require surgery, and seven patients (2.2%) were ultimately transferred even though the need for surgery was not initially established at the time that the pictures were viewed. No initial errors in the photographic evaluation caused a worsening in the life-threatening, functional, or aesthetic prognoses. We have recently opted to use telemedicine for initial patient management. In 94.4% of cases, the opinion that was provided was accurate. Only 3.2% of the patients for whom outpatient treatment was recommended ultimately underwent surgery without subsequently experiencing the slightest injury due to any delay in therapy. Although it will never replace clinical examination, these results have encouraged us to develop telemedicine based on digital photography.

Introduction: Cancer-associated fibroblasts (CAFs), a component of tumor microenvironment, play a key role in oncogenesis and promote growth, invasion, metastasis and chemo-resistance of tumor cells. Our previous RNAseq results brought evidence of the contribution of dermal fibroblasts obtained from cutaneous T-cell lymphoma (CTCL) lesions to support tumor growth. Here, we further go on by analyzing the alteration of protein production by dermal fibroblasts obtained from CTCL lesions versus control fibroblasts. Materials and methods: Secretome and proteome was performed on fibroblast primary cultures skin biopsies of 6 cutaneous T-cell lymphoma (CTCL[GD1]) versus fibroblasts from healthy mammary skin controls (age-paired). The fibroblasts of the two groups were studied at the 3rd passage, after stimulation or not with 5 ng/ml TGF-β for 24 h. The supernatants and lysates collected underwent enzymatic digestion with trypsin before peptide analysis by HLPC/Mass spectrometry Results: The comparison of the secretomes from the CTCL groups (± TGF-s) and the control donors showed a global significant differential expression (fold >2, p-value 2, p-value Conclusion: The present data demonstrate the potent proteomic alteration of CTCL-associated dermal fibroblasts, confirming the involvement of mesenchymal cells on the behavior of CTCL.

We read the manuscript entitled “Closed-suction drains after subcutaneous mastectomy for gynecomastia: do they reduce complications? » published by Chao et al. (Aesthetic Plast Surg, 2017. https://doi.org/10.1007/s00266-017-0959-z ). They have concluded that drains may reduce rates of seromas requiring needle aspiration after surgical treatment, but also that there are several adverse effects of drains: patients’ discomfort, anxiety, cost and additional clinic visits. They also recalled several limitations: (1) bias in terms of surgeon decision to place a drain, (2) nuances in technique. Here we want to discuss our different technique of drainage. To prevent all the disadvantages, we have chosen to replace closed-suction drains with silicone blades and a wide scar opening at the level of the periareolar scar. We carried out a retrospective study in our department in 2016. This series consisted of 83 patients (153 breasts) aged 26.7 years of age (15–67), with an average BMI of 28.6 (19.5–39). All were followed during the 12 months postoperatively. We considered here only grade 1–2a gynecomastia with palpable fibrous glandular tissue. The surgical procedure consisted of initial liposuction, then open surgical excision via the periareolar approach. We did not notice any seroma or collection requiring intervention. However, 4 patients (4/153; 2.6%) had hematomas requiring intervention the day after surgery. Our technique presents a lot of advantages, reduced length of stay in the hospital, costs from drain site care and clinic visits, patients’ discomfort, and antibiotic prescriptions. 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 .

Introduction Les analyses de genetique somatique sont desormais essentielles dans la prise en charge des patients cancereux. Dans le melanome, ces analyses se sont longtemps limitees a l’etude du codon 600 de BRAF, maintenant elargies a une approche « next generation sequencing » (NGS) ciblant plusieurs genes. Des panels NGS pan-cancer ont ainsi ete implementes mais, dans un contexte de medecine personnalisee et de resistance aux therapies, des panels specifiques a chaque pathologie et ciblant ses genes d’interet, sont necessaires. Notre but est de mettre en evidence l’interet clinique d’un tel panel dans le melanome. Materiel et methodes Les patients atteints de melanome chez lesquels un screening moleculaire tumoral initial a ete realise entre juin 2017 et aout 2019 dans le cadre de leur prise en charge clinique de routine ont ete inclus dans cette etude retrospective. Les analyses moleculaires ont ete realisees a l’aide d’un panel NGS de 64 genes d’interet dans le melanome, detectant a la fois variants nucleotidiques (SNV) et variations du nombre de copies (CNV). Ces genes ont ete selectionnes sur la base de leur implication dans la classification moleculaire, le pronostic, le theranostique et la resistance aux traitements. Une analyse comprehensive a ete realisee afin de mettre en evidence les alterations d’interet clinique majeur. Resultats Au total, 421 cas de melanome, dont 240 primitifs et 172 metastases (9 indetermines), ont ete analyses. Apres filtrage bio-informatique selectionnant les alterations potentiellement impactantes, 561 SNVs, 164 CNVs (96 amplifications et 68 deletions) et 4 mutations au site d’epissage ont ete mis en evidence. 87,4 % (368/421) des lesions presentaient au moins une alteration et les genes les plus frequemment alteres etaient : BRAF (192 SNVs et 20 CNVs), NRAS (114 SNVs), CDKN2A (60 CNVs et 2 mutations au site d’epissage), CCND1 (20 CNVs) et MET (16 CNVs). Parmi les patients BRAFV600 mutes, 44,5 % (77/173) presentaient au moins une alteration concomitante pouvant entrainer une resistance aux inhibiteurs de MAPK. Parmi les patients avec une mutation RAS hotspot et les patients sans mutation hotspot de BRAFV600 ni RAS, 56,9 % (66/116) et 47,7 % (63/132) respectivement possedaient une alteration constituant une cible therapeutique alternative potentielle. Discussion Notre panel NGS, couple a une analyse comprehensive des alterations detectees, represente un atout important pour la prise en charge des patients atteints de melanomes. Applique a une cohorte de 421 patients, il nous a permis de definir un paysage exhaustif des alterations somatiques dans les melanomes primitifs et metastatiques, et de mettre en evidence les profils moleculaires de resistance aux inhibiteurs de MAPK ainsi que de nouvelles pistes de therapies alternatives pour une proportion importante de patients.

Introduction Skin expansion in the lower limb is a difficult procedure with a significant rate of complications. We propose, in this retrospective mono centric study, a systematic review of our skin expansion procedures on the lower limb in burn sequelae with a 30-years follow-up. The objective was to evaluate the overall result of our procedure and present its technical specificities. Method We have included all of our skin expansion procedure in burn sequelae of the lower limb that had ended at least 6 months ago. The primary study endpoint was the occurrence of a complication during the procedure. The surgical approaches were juxta-lesional. A juxta-lesion or radial incisions were made for remote valves. When prosthesis were removed, we performed advancement flaps. Results From 1987 to 2017, we performed 141 lower limb expansions in 73 patients (62 women for 11 men). The average duration of the inflation procedure was 100.5 days. At least one complication occurred for 29.1% of procedures. We have identified 44 complications. Among the 41 complicated procedures, 26 procedures (63.4%) failed in the final achievement of an expanded skin flap and 15 procedures (36.6%) were rescued after complication, leading to perform flaps. We recorded 115 (81.6%) completed procedures. Conclusion The success of our expansion procedures in burn sequelae of lower limb is due to technical key points such as the choice of the prosthesis size, the position of the remote internal valve, the position of the drain and a delayed inflation start. Level IV

Over the course of several decades, abdominoplasty has undergone numerous improvements, thereby improving patient safety. The choice of the site of the incision and the extent of the detachment directly influence the occurrence of the main complications.A retrospective study was carried out involving 1128 patients who underwent abdominoplasty between January of 1990 and June of 2014. The main postoperative complications were analyzed.The hematoma rate was 5.7 percent; in addition, infections (4.5 percent), cutaneous necrosis (2.7 percent), seromas (2.7 percent), disunions (1.3 percent), and deep venous thrombosis (0.2 percent) were observed. Three main risk factors for complications were highlighted: age older than 40 years, obesity, and smoking. The authors noted a significant variation in the rate of complications depending on the technique used, with a substantial rate of necrosis in case of inverted-T abdominoplasty. Liposuction was not a source of complications, regardless of the patient's background or the type of intervention.Abdominoplasty is currently a reliable technique that allows the abdomen to be repaired and quality of life to be restored. Other means remain to be explored to improve the overall treatment and to move toward a maximal reduction of the risks.Therapeutic, IV.