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The sebaceous hamartoma of Jadassohn is a congenital skin malformation usually appeared at birth or in early childhood. Many authors support the notion that early complete surgical excision is necessary to prevent the development of malignant neoplasms (especially basal cell carcinoma) after puberty. On the contrary, others in recent large series suggest that it is an histological misdiagnosis: the basal cell carcinoma is in fact a trichoblastoma, basaloi¨d neoplasm, but non-malignant one. We have also asked anatomopathologist for proofreading slide previously described as basal cell carcinoma to research unknown trichoblastoma. During the period, 1982 to 1999, 80 sebaceous hamartoma of Jadassohn were excised and 19 basal cell carcinoma were found. The basal cell carcinoma diagnosis has been confirmed in two cases only. The others were pigmented trichoblastomas. So, trichoblastoma is the most common basaloi¨d tumor developed in sebaceous of hamartoma Jadassohn. Nethertheless, we should recommend surgical excision during the childhood because of best elasticity of tissue, especially on the scalp where it’s mostly localized. [ABSTRACT FROM AUTHOR]

The lower gluteal flap is an autologous microsurgical breast reconstruction procedure using the soft tissue of the region of the gluteal sulcus. The perineal extension increases the volume of the sample. The pedicle with one artery and two large veins extends up the ischial notch and can reach 8 to 12cm. The two operative positions, the relative shortness of the pedicle and the firm tissues transferred are balanced by the discretion of the sequelae of the donor site and the volume which is always enough even in the slim woman. The best indication of this technique is two-sided breast reconstruction but it also provides a solution in case of contraindication of other autologous flaps, especially DIEP., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Calciphylaxis or calcific arteriolopathy is a rare, life-threatening obstructive pathology of the small cutaneous and subcutaneous vessels. It mainly affects patients with chronic renal failure but it also has been described in patients with normal renal function. The principal risks factors apart from renal failure and phosphocalcic metabolism imbalance are: the female sex, obesity, peripheral vascular disease, diabetes and oral anti-coagulation. We present a very rare case of abdominal, mammarian and upper thighs calciphylaxis in a patient with normal renal function. She presented a severe obesity with a recent important loss of weight and had been treated by oral anticoagulants for a long time. She benefited of a multidisciplinary approach with dermatologists, plastic surgeons and anesthesists permitting a recovery in fourteen weeks. Multidisciplinary approach is necessary but the place of the surgery is not well defined. We report a case in which early and wide surgical approach permitted to obtain a favourable evolution of the pathology. Then, we propose a therapeutic strategy after review of the literature., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: To the best of our knowledge, only 52 cases of squamous cell carcinoma (SCC) complicating hidradenitis suppurativa (HS) have been reported since 1958. We describe 13 new cases., Methods: We propose a clinical and histological analysis of our cases. We include these results in a review of previously reported cases to analyze a total of 65 patients. In our series of 13 cases, we also investigate the presence of human papillomavirus (HPV) in tumor samples, by polymerase chain reaction (PCR) on paraffin-embedded material., Results: Malignant transformation affects mainly men with a long-term history of genitoanal HS. Although our cases were 7 well-differentiated carcinomas and 6 verrucous carcinomas, lymphatic and visceral metastasis occurred in 2 and 3 cases, respectively. With PCR, we demonstrated presence of HPV in genitoanal tumoral lesions, principally HPV-16., Conclusion: SCC complicating HS evolves poorly, despite a good histological prognosis. Our results sustain the implication of HPV in the malignant transformation of HS.

Infantile hemangioma appears after the birth as a vascular tumor, which is known for its characteristic evolution in 3 phases: rapid augmentation then stabilization and involution on several years with in the best cases, classical "restitutio ad integrum". Usual surgical attitude is abstention and surgery is proposed only in order to treat sequel. But some particular situations require early surgery for life-threatening lesions or in case of functional impairment. Surgery consists in these cases in a simple volumetric diminution of the tumor with no aim for esthetic improvement. Other kinds of hemangiomas require an early surgical treatment before their complete involution. In some particular locations, deformation or growth delay can occur due to the lesion's development. In some cases, hemangiomas present a delayed involution with minor regression capacity; these are mainly located on the median part of the face and have principally a subcutaneous development. Early surgery can be proposed in order to avoid definitive deformation or growth impairment of adjacent structures. It should be performed before school age and before occurrence of psychological difficulties. Surgery is indicated in a perspective of esthetic improvement. Surgical procedure consists first in modeling excision followed by simple repair technique as linear suture or purse string closure; complex surgical procedures inducing their own sequels are usually inappropriate.

Background: Traditionally melanoma has been considered as a radioresistant tumor. However, recent observations regarding radiobiology and clinical response of melanoma have prompted physicians to re-evaluate the role of radiotherapy in the management of melanoma. Indeed, radiotherapy is frequently used in the treatment of metastatic melanoma but the role of this therapeutic approach in the primary tumor management is unclear. We report 4 cases of thick primary melanoma treated by interstitial brachytherapy., Case Reports: Four patients (3 men, 1 woman; age: 73, 74, 79, 84 years), three with lentigo maligna melanoma and one with nodular melanoma, were treated exclusively by interstitial brachytherapy. The thickness of the 4 tumors was more than 3 mm. This treatment was chosen either because of the impossibility of conservative surgery or because of a contraindication for general anesthesia. Median follow-up was 48 months [18 to 65 months] and we did not observe any local tumor relapse. The cosmetic and functional results of this therapy were excellent., Discussion: These four cases illustrate the possibility of obtaining good local control of thick primary melanoma by interstitial brachytherapy where surgery is impossible, although without challenging the standard surgical therapy for primary melanoma. Before our study, this treatment was used only in one study to treat melanoma patients. In this case however, interstitial brachytherapy was accompanied by surgery. Therefore, the findings reported here are the first to demonstrate the efficacy of this treatment when used as the sole treatment for primary melanoma. In conclusion, where surgery is difficult or impossible, interstitial brachytherapy may be used to treat primary melanoma with excellent local tumor control and a good cosmetic outcome.

The lateral brachial flap is a fascio-cutaneus flap. This flap is secured. The functional and cosmetic sequelae are limited. The authors propose in this paper its utilisation as free flap in the reconstruction of facial defects. Thanks to its low morbidity, this free flap may be used in old patients.

Introduction: The dermatofibrosarcoma protuberans (DFSP) is a rare but not exceptional tumour. Surgical treatment should contain a wide excision to avoid local recurrence., Material and Method: We report a retrospective study of 34 cases treated by the same team from 1994 to 1999. In this series, only 4 cases (12%) presented recurrences after previous treatment by the other teams. In all cases, surgical resection was performed with 3 cm lateral margin and a disease free anatomic layer removed with the tumour., Results: The mean of follow up was 60 months. There was no recurrence case in our 34 patients during this period. We compare our results with those, from others teams described in international literature since 1951. Margins and results are similar with some teams who practice the Mohs surgery., Conclusion: These data are in favour of a reduction of the lateral margins in classical surgical procedure of DFSP. They should be consolidated by a follow-up in longer term with a prospective study.

Introduction: Primitive cutaneous neuroendocrine carcinoma (PCNC) is a rare tumor with poor prognosis. Surgery is the treatment of choice, but radiotherapy is taking a larger place in the management of these patients., Methods: The files of 22 patients were studied retrospectively over a period of 14 years., Results: The study included 17 women and 5 men with a mean age of 75.5 years. The localization of the tumor was the cephalic extremity in 12 cases. At the initial stage, the tumor in 3 of the 22 patients was of glandular or visceral localization. Thirteen stage I patients were treated surgically. Adjuvant radiotherapy was performed in 10 of these patients and only one relapsed (incomplete initial exeresis). The other three relapsed. Exclusive radiotherapy led to complete response in 4 patients who could not undergo surgery and in 2 with local relapses. Seven patients exhibited glandular involvement and 6 of them died (median 7 months) after the adenopathy had been discovered., Discussion: Our series illustrates the clinical characteristics of this tumor of the elderly, which is predominantly cephalic and of rapid progression. From a therapeutic point of view, our results underline the benefit of radiotherapy as adjuvant to surgery. When surgery is impossible, and in the case of local relapse, radiotherapy gives good results.

The authors report a study about 12 cases of partial, total and extensive rhinectomy treated by a median "gingko flower" forehead flap. Technical adaptations are described to resolve the difficult problem of support and lining reconstruction. The authors compare their technique with the various other methods: the classical one (Converse scalping and sea-gull Millard's flaps) or more recent surgical solutions (distal composite flaps and expansion).

Facial burns frequently occur in child. A total of 197 burned patients with facial localisation were seen during the time period (1991-1996) covered by this retrospective study. One hundred and sixteen patients were less than three years old. A quarter of the child were issued from poor social classes with nine cases of child abuse by burning. One hundred and thirteen injuries were performed by hot water or drinks. The total burn area was less than 10% in 63% of the cases. The average facial burned area was 4%. The cheek, the front and the chin were often concerned. Low limbs and trunk were unjured in all cases. 130 patients needed hospitalisation, and stayed in average 17.31 days at hospital. Four patients died from respiratory complications, all after flame injuries. Fifty two child needed skin split grafts. Complete cicatrisation was observed after 21 days of treatment in child without grafts, and after 35.65 days in child with skin grafts. Twenty eight patients needed physiotherapy in center. The scars had a correct cosmetic appearance, without retraction and inflammatory signs in 158 child after two years. Eleven patients needed other surgical treatment. The authors analyse the results and insist on prevention.

Recent evolution of breast reconstruction favorised autologous tissues, without prosthesis. 34 gluteal inferior free flaps have been performed in 30 patients aged from 33 to 72 years for immediate reconstruction (6) or secondary reconstruction (28), unilateral (26) or bilateral (8 flaps); after complete mastectomy (21 included a bilateral one), partial mastectomy (3), sub-cutaneous mastectomy with skin-sparing mastectomy (3 bilateral cases), radical mastectomy with radiolesion (2), non efficient reconstruction using prosthesis (2). The myocutaneous flap vascularized by gluteal inferior artery was anastomosed on thoracodorsal pedicle or on humeral vein. Added procedures have been symmetrizations (21), flap modifications (21), nipple reconstruction (20). Thirty three flaps presented good survey. Cosmetic results were excellent in five cases, good in 21 cases, middle in eight cases. Flap disadvantages were: possible failure of microsurgery with vessel thrombosis and flap necrosis, long operative time (average five hours), variable quality of the skin flap and hypoesthesia of the posterior area of buttock. Flap advantages were: the suffisant volume (300 to 500 g), the simple procedure to raise the flap (after specific training) and discrete scar of the donor site. This flap seems to be a excellent method for autologous mammary versus TRAM flap or latissimus dorsi added fat flap.

Introduction: Venous malformations are usually easy to recognise. We describe one case in which the clinical aspect was suggestive of Maffucci's syndrome., Observation: A 44-year-old male, had numerous angiomatous nodules which could be emptied by pressure since infancy. The progressive increase in volume of these lesions on the arms and forearms led to enormous deformation and major disability. The thoracic area and the right foot were also affected to a lesser degree. Two endobuccal lesions were also found on the clinical examination The cutaneous lesions were tender and occasionally hyperhidrosis was present. The presence of phleboliths on Xray and the presence of venous and capillary cavities with numerous thrombi confirmed the diagnosis of venous malformation. Following the failure of the Ethibloc(R) embolization, eight excisions were made in a two-year-period with a good functional result. Elastic strapping was then applied., Discussion: The diagnosis of venous malformation was based on clinical, radiological and histological findings. The absence of chondroma excluded the diagnosis of Maffucci's syndrome. Spindle cell hemangioendothelioma, "blue rubber bleb nevus" and glomangiomatosis were confirmed by the histological findings. The absence of port-wine stain or bone hypertrophy and the presence of multiple nodules excluded Klippel-Trenaunay syndrome. The presence of multifocal involvement with oral lesions, the severity of the deformation and the relative success of the surgical procedure make this case unusual.

Conservative management is usually proposed for common childhood hemangiomas because most lesions resolve spontaneously. The authors report 29 cases of children with hemangiomas treated surgically. Surgical indications were defined at various stages. The study concerned 29 children operated in our pediatric surgery and plastic surgery departments between 1989 and 1995. The average postoperative follow-up was 3 years and 8 months. The average age of the patients was 5 years; two-thirds of children were girls. The hemangioma was a very large lesion, subcutaneous and cutaneous (mixed) in 23 cases, only subcutaneous in 2 cases, only cutaneous in 4 cases, and was located on the face in 19 cases. Six complications (5 ulcerations, 1 Kassabach-Merritt syndrome) were observed.

Gynecomastia is the commonest breast lesion in males. Fifty-two patients (mean age 24 years) operated in our department were reviewed with a mean follow-up of two years and a half. Gynecomastia occurred most frequently during puberty (63%), was bilateral (75%) and idiopathic (65%). The size of the enlargement was evaluated according to Simon's-classification based on breast-volume and skin-redundancy. 18 stage 1, 22 stage 2A, 9 stage 2B, 3 stage 3. Clinical examination and mammography determined the consistency of gynecomastia: adipose or firm. 4 different surgical managements were used: 32 subcutaneous mastectomies, 12 liposuctions, 6 liposuctions assocaited with subcutaneous mastectomy, 1 total mastectomy. One patient had liposuction on one side and subcutaneous mastectomy on the other one. All techniques gave good morphologic results. Nonetheless, the authors recommend the combination "liposuction and subcutaneous mastectomy", as this technique presents many advantages: small intraoperative blood loss, good skin redraping, short hospital stay, complete histologic examination of the material removed.

Background: Surgical treatment of cystic lymphangioma (CL) is so often followed by local and general complications that non invasive treatment must be considered., Population and Methods: Between 1987 and 1993, 20 patients with a superficial macrocystic lymphangioma were treated by percutaneous injection of Ethibloc in order to reduce the volume of the CL, with a minimum follow-up of 1 year. Fourteen CL were cervico-facial and six were located in the upper half of the body. The size of the lesion was determined by echography: three CL were less than 5 cm in diameter, 12 between 5 and 10 cm, five more than 10 cm. Two to 5 mL of Ethibloc were injected during one (15 cases) or several sessions (five cases)., Results: Reduction in volume was excellent in 12 patients after one session and in four patients after several sessions. Four patients had a poor result. All the patients suffered from an important inflammatory reaction for 2 or 3 days followed by exteriorisation of the Ethibloc in seven patients, with a discrete final scar., Conclusion: These fair results suggest that intracystic injection of Ethibloc represents an effective alternative to surgery.

Presuture is a rapid skin expansion technique performed in a 2-stage operation. On the day before the operation, a square of skin sutures is inserted along the lesion to be invaginated, under local anaesthesia. Resection with direct suture can be performed on the following day. Twelve patients presenting with extensive (3 x 3 cm to 7 x 24 cm) lesions of the lower limbs (3 congenital naevi, 7 melanomas, 2 areas of scar tissue) were treated. The scar results were excellent in 2 cases, inter-mediate in 8 cases and poor in 2 cases. The limits of this technique are the risk of malunion due to ischaemia and especially secondary enlargement of the scar.

Thoracolumbar radionecrosis may be difficult to cover. We often use muscular or myocutaneus flaps available in this location, mainly the latissimus dorsi flap. It can be used as a pedicle, free, or especially a "reversed" flap with lumbar pedicles. However in our experience and in the literature this reversed flap is difficult to use because of the morbidity of the flap, transposed without its main pedicle. The authors consider the current methods of cover by flaps in six cases and in the literature. Surgical possibilities are now more numerous. First, a latissimus dorsi muscular flap autonomized by vascular delay, half-free flap, or a flap with the lengthening of its pedicle is possible. Second, we can also use an intercostal island flap for the back and a gluteal thigh flap in the lumbar region.