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Background: Fibroblastic connective tissue nevi (FCTN) are benign skin conditions characterized by bland spindle cells infiltrating the reticular dermis and the upper subcutis with preservation of adnexal structures. A subset of FCTN expresses CD34, which may cause difficulties in the differential diagnosis, in particular with dermatofibrosarcoma (DFSP). We aim to study clinical and histological main features of congenital FCTN to better understand their heterogeneity., Methods: We present 3 cases of congenital FCTN with misleading pseudo-tumoral presentations and compare them with published cases in literature. We provide a diagnostic algorithm for congenital neonatal connective tissue tumors., Results: Clinically, FCTN mostly present as well-limited and nontender plaques or nodules mainly located in the neck and face areas or in the trunk. Histologically, FCTN are composed of irregularly distributed fascicles of bland spindled cells and are defined by a list of fundamental features: (i) no atypia, pleomorphism, or mitotic activity; (ii) skin appendages entrapped but unaffected; (iii) no evidence for malignancy. In most cases CD34 is positive, but in some cases, cells can express SMA or are even CD34- and SMA-., Conclusion: The initial presentation and natural history of FCTN fit better with a neoplasm than with a hamartoma. Thus, we suggest replacing the term "nevus" with tumor and considering fibroblastic connective tissue tumor (FCTT) as the right denomination of this clinico-pathological entity. FCTTs are difficult to diagnose due to their clinical heterogeneity. Clinical and histological malignant and benign differential diagnoses are discussed., (© 2018 Wiley Periodicals, Inc.)

Vacuum-assisted closure(VAC) is a simple wound healing tool in plastic surgery. We report a large thoracic defect in a child, in which the VAC was used to cover an exposed polytetrafluoroethylene prosthesis. The VAC saved the prosthesis and induced complete granulation of the wound, which healed completely in five weeks.

Unlabelled: Convergence of medicine and Internet may be one of the most remarkable transformations in the health care business. Following the path led by the United States, the number of French websites related to cosmetic surgery is growing rapidly. In this study, we intend to assess the quality of French websites dedicated to cosmetic surgery regarding good quality criteria currently available and recommendations suggested by the French Medical Association., Materials and Methods: We browsed the main French search engines on the Web that initially answering the following question: how many webpages are available regarding cosmetic surgery and what are the best referenced websites. For each website, we surveyed the following data: author's name and qualification, date of creation and last update, sources of information, level of interactivity, and adherence to a chart of quality such as HON., Results: Eighty-five websites were surveyed and assessed. Forty-five French websites were active websites dedicated to cosmetic surgery. Websites are mainly hosted by private clinics (18 sites = 40%), with informative content. We found that no website adheres to any chart of quality, and the French Society for Plastic Surgery (SOF.C.P.R.E.) is never mentioned. Intrinsic quality criteria for websites (author's identification, last update, sources of information, confidentiality) are only partially present., Discussion: We recall the key statistics regarding e-health business in the world, the various charts of quality available for medical websites, and recommendations provided by the French Medical Association. We suggest that websites should be available as a service (for information to the patient, for managing the office, for setting up medical records) rather than a poor personal webpage or a showcase., Conclusion: The quality of websites for cosmetic surgery is poor; however, as in the USA, the number of web surfers on medical sites is growing. Online presence of our speciality should evolve. To improve medical websites, collective awareness is required. We recommend using a specific chart of quality, with recommendations rather than constraints.

The treatment of cleft lip and palate at Saint-Vincent-de-Paul hospital is realized by a multidisciplinary team. The calendar of the primary treatment is adapted according to the eventual antenatal diagnosis: it may be early and in two sessions, or late at 4 months but in one session. The calendar of the secondary treatment is more classical.

The use of the circumflex scapular pedicle as a recipient vessel for breast reconstruction in a series of 40 consecutive cases in 37 patients is reported. There were 3 bilateral reconstructions and 34 unilateral reconstructions. Twenty-one cases were immediate reconstructions, and 19 cases were secondary reconstructions. The diameter of the artery varied from 1.5 mm to 3 mm and systematically matched with the diameter of the epigastric artery. The artery was a branch of the subscapular system in 82.5 percent of cases (33 of 40). In 17.5 percent of cases (7 of 40), the artery was a direct branch of the axillary artery. The length of available pedicle between the axillary vessel and the distal part where it can be divided (on its division between scapular and parascapular artery) was of 76 +/- 13 mm for the artery and 72 +/- 12 mm for the vein. The vein was unique in 77.5 percent of cases. The diameter was similar to the artery diameter when unique. There was a dual venous system in 21 of 40 cases (52.5 percent) but in 15 cases (37.5 percent), one of the two veins was dominant. In the seven cases for which the veins were dual and of equivalent diameter, the epigastric veins were also dual and allowed a second anastomosis. Clinically, the anastomosis was always possible on the artery. In one case of reconstruction after Halstedt mastectomy, no vein could be found, because all the veins had been ligated previously. One venous thrombosis (2.5 percent) and one arterial thrombosis were experienced. Both were treated by revised anastomoses and did not compromise late results. The circumflex scapular pedicle is a reliable and simple recipient site for breast reconstruction. It allows a unique site of dissection in immediate reconstruction and avoids division of the thoracodorsal pedicle. The technique is now used exclusively at this institution.

The subject of this experimental study is a cylindrical device, with a gauge adjusted to the vessel lumen, which disintegrates in a few minutes. The goal of this device is to increase the reliability of vascular microanastomosis. This study was designed to assess the efficacy and drawbacks of the device. The device is a cylindrical sugar stick, 5 mm long and with a gauge of 1 mm. Ten Wistar rats underwent a standard end-to-end aortic anastomosis with interrupted sutures and ten underwent the same anastomosis with the device placed in the lumen of the proximal and distal vessel. The same surgeon performed all anastomoses. Clamp application time was recorded and anastomotic patency was tested in each case; the vessels were also examined histologically. The clamp application time was significantly lower (p < 0.01), and the patency rate significantly higher (p < 0.01) in the group in which the device was used. There was no histologic sign of intima injury in either group. This very simple device facilitates microanastomosis. It reduces the ischemia time and increases the reliability of the anastomosis, avoiding transfixing sutures. These results suggest that clinical trials are warranted.

Vascular endothelial growth factor (VEGF) is a major angiogenic growth factor. Angiogenesis stimulated by VEGF occurs in several important clinical contexts, including myocardial ischemia, retinal disease, and tumor growth. The level of VEGF is increased in several skin disorders and is stimulated by ischemia. Tissue expansion has been shown to induce angiogenesis and ischemia on the overlying skin. We therefore investigated the hypothesis that VEGF was expressed in expanded tissue. Three samples of skin were obtained from five patients who sustained reconstruction with tissue expansion. One sample was taken on the implantation site of the expander before implantation. Two samples were taken at the time of removal, respectively, one on the nonexpanded skin adjacent to the expanded area and one on the expanded skin on the site of expansion. On these samples we performed immunolocalization of VEGF. Mouse monoclonal antibody was used, recognized with rabbit anti-mouse immunoglobulin alkaline phosphatase-anti-alkaline phosphatase (APAAP) complex conjugated and revealed with naphthol red. Our results showed clearly an increased number of cells that fixated VEGF antibody on the site of expansion. Cell counts revealed that the numbers of cells expressing VEGF were statistically higher in expanded tissue than in nonexpanded tissue. Before expansion skin specimens did not express VEGF. These findings are the first to show the presence of a growth factor in expanded tissue. They open a new field of research on the biological explanation of tissue-expanded angiogenesis.

The main aim of reductive surgery for breast hypertrophy has often been the aesthetic result without considering on the cutaneous sensitivity. This retrospective analysis studied the subjective and objective sensitivity after mammoplasty reduction 44 patients. The preoperative results showed a reduction of sensitivity directly proportional to the ptosis. After surgery the patients described an improvement of the sensibility, especially in the case of moderate resection. This study shows the good restoration of nerve fibers after chronic stretching due to hypertrophy. Nerve fibres were restored when areolar graft was used.

The authors present a case report of a traumatic defect of the scalp involving all layers including galea and periost measuring 10 x 14 cm. The surgical repair of the scalp avulsion was obtained in 3 weeks using Continuous Skin Extension procedure with Kirschner pins threaded through the wound margins, held together with elastic bands. Traction forces were modified twice a week in our patient basis. No undermining was necessary. The authors analyse the benefits of this technic and describe the alternative surgical procedure. This technique is easy to handle, cheap, safe, and requires a single surgical step. Furthermore, it quickly allows the patient to proceed with his work.