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Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments. A total of 14 patients with 15 reconstructions (average age = 48 years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35 cm2 (range: 3–150 cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1–4). The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Few studies have been conducted to explore the utility of the IntegraWe retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments.A total of 14 patients with 15 reconstructions (average age = 48 years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35 cmThe 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Resume Introduction En 2015, nous avions relate notre experience a propos de la courbe d’apprentissage en chirurgie de la reassignation genitale et souligne un concept d’apprentissage traditionnel en quatre etapes. Cas clinique Dans cet article, nous presentons notre premiere experience d’aidoiopoiese (vaginoplastie) menee sur modele SIMLIFE®, mannequin humanoide a tres haut degre de realisme utilisant des corps humains issus de don du corps associes a un dispositif de circulation pulsatile et un dispositif de ventilation. Resultats La technique chirurgicale utilisee etait celle de l’inversion penienne, decomposee en 14 etapes distinctes. Le temps chirurgical total fut de 182 minutes. On ne denotait aucune complication intraoperatoire, et il n’y eut aucune lesion de l’uretre ou du rectum. Le saignement intraoperatoire mesure par la perte de liquide operatoire etait de 280 mL. Nous revenons sur les avantages de cette technologie adaptee a la chirurgie de la transsexualite. Conclusion Nous avons demontre la faisabilite d’une aidoiopoiese avec le modele humanoide de simulation SIMLIFE® et l’amelioration de la technique d’apprentissage de ce type de chirurgie avec ce modele. Cette technologie pourrait trouver de nombreuses autres applications chirurgicales. Elle se heurte cependant aux contraintes de cout et de la legislation sur les cadavres.

Assessment of patient satisfaction following an aesthetic surgery has shown an increasing trend over the past years. To date, there is no prospective and comprehensive study evaluating this aspect after surgical facial and neck rejuvenation. The aim of the current work was to address patient satisfaction after face and neck lift surgery using a validated questionnaire.We present a prospective and multicenter study (five regional centers) involving all patients undergoing face and neck lift surgery between April 2015 and April 2017 in several French centers for aesthetic surgery. All subjects assessed the FACE-Q scales before the procedure, and furtherly at 3-month, 6-month and 12-month follow-ups.Thirty-six patients were included with a median age of 58.5 years old [IQR 54.0-66.0]. The FACE-Q outcomes were significantly higher at 3-month follow-up (p 0.001). Seventy-five percent of the patients underwent an additional surgical procedure associated with face and neck lift. Particularly, a combined blepharoplasty led to a significant increase in the score of global facial appearance. The patients considered themselves a mean of 6 years younger in the third month after surgery. These results remained constant at six and twelve postoperative months.A statistically significant improvement of the FACE-Q scores could be highlighted on every scale, with permanent results at 6 and 12 months postsurgery. We hereby present the first study with evidence that appearance and quality of life outcomes can be reliably assessed after rhytidectomy.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 .

Resume Objectif La chirurgie de feminisation faciale fait partie integrante du processus de transformation des patientes transsexuelles male to female. Une evaluation globale de la satisfaction de ces patientes par un questionnaire specifique est fondamentale afin de confirmer le benefice de cette chirurgie et d’optimiser les pratiques cliniques. L’objectif de cette etude est de developper un outil fiable et valide permettant de mesurer la satisfaction de ces patientes. Methodes Une revue de la litterature, l’avis d’une commission d’experts et des entretiens avec des patientes issues de la population cible ont permis de mettre en place le Conceptual Framework du questionnaire. Il regroupe l’ensemble des domaines majeurs du questionnaire et a permis la creation des differents items. Resultats Aucun questionnaire n’existe a ce jour pour mesurer de maniere specifique la satisfaction de ces patientes. Dix experts et 18 patientes ont participe a l’etude. Le Conceptual Framework se compose des domaines suivants : satisfaction concernant l’apparence feminine du visage ; les sequelles postoperatoires ; qualite de vie. Le questionnaire comprend quatorze echelles de Likert independantes entre elles, utilisables en preoperatoire et postoperatoire. La fiabilite du questionnaire est excellente avec un score Alpha de Cronbach moyen de 0,85. La satisfaction mesuree apres chirurgie de feminisation faciale dans cet etude est tres bonne avec une moyenne de 83,7 ± 7,41. Conclusion Le QESFF1 est un questionnaire fiable dont la creation respecte les etapes du patients reported outcomes process. La demonstration de sa validite necessite une etude pluricentrique ulterieure. Il permet aux praticiens de mesurer objectivement l’impact de la chirurgie de feminisation faciale chez les patientes transsexuelles male to female et peut egalement etre utilise en recherche clinique.

Summary Introduction Breast reconstruction techniques are multiple and they should be chosen in order to improve women's satisfaction and well-being, thus obtaining a personalized treatment. This report's major purpose was to study, through the Breast-Q questionnaire, how the functional and aesthetic outcomes, as well as the complications, of the main autologous breast reconstruction techniques, can affect patients quality of life and well-being at long-term. The secondary purpose was to analyse, thus to identify, the independent factors characterizing the different reconstructive techniques, which may affect patients’ satisfaction. Methods Women who underwent autologous breast reconstruction through deep inferior epigastric artery perforator or Latissimus dorsi muscle flap from May 2006 to May 2013 were included. The assessment was based on the Breast-Q reconstruction questionnaire. All times of post-mastectomy reconstruction were concerned: immediate, delayed, after previous procedure failure or conversion to another reconstructive technique due to the patient's dissatisfaction. Results A total of 98 patients were included. Concerning patients satisfaction, the breast-Q score is highest in patients who underwent immediate breast reconstruction, while scores after delayed breast reconstruction, previous surgery failure or conversion to another technique are generally equivalent. Higher scores have been observed in patients who underwent reconstruction through autologous Latissimus dorsi compared to Latissimus dorsi with prosthetic implant reconstruction. Conclusion The authors identified factors of higher patients’ satisfaction, like absence of major complication and advanced patient's age, in order to personalize the surgical planning according to the patient's priorities.

The medial head of the triceps brachii muscle (MTB)-free flap is an attractive solution to cover small-to-medium defects of the lower limb. This muscular head has no well-identified function, suggesting minimal impact of its removal on elbow mobility. The aim of this study was to evaluate the safety and reliability of the harvest procedure and the functional and cosmetic morbidity of this donor site. Twenty-four consecutive MTB-free flaps were performed for reconstructive surgery of the lower limb between 2011 and 2015. Patients and their records were retrospectively examined. Functional results were evaluated by assessing elbow extension strength using a dynamometer and with a QuickDASH questionnaire. Cosmetic results were assessed using the POSAS observer and patient scales. Twenty-four patients were followed up postoperatively for an average of 33.9 [min 12–max 59] months. No major complication (in particular, no ulnar or radial nerve injury) occurred during harvest. No patient complained of elbow pain or reduction in strength. Elbow extension was complete in all patients and the mean strength was calculated at 89 [61.1–112.5] % of the opposite arm. The POSAS scale scored an average 8.6 [7–21] for the observer and 10 [7–26] for the patient. Cosmetic results using the POSAS scale were satisfactory in all patients. Objective evaluation of patients who underwent an MTB-free flap for limb reconstruction shows no impact of the harvesting procedure on elbow extension. Patient satisfaction with the donor site was high. From this retrospective study, it appears that this surgery is safe, aesthetically acceptable, and has minimal impact on donor site elbow function.

Introduction Some transgender men express the wish to undergo genital gender-affirming surgery. Metoidioplasty and phalloplasty are procedures that are performed to construct a neophallus. Genital gender-affirming surgery contributes to physical well-being, but dissatisfaction with the surgical results may occur. Disadvantages of metoidioplasty are the relatively small neophallus, the inability to have penetrative sex, and often difficulty with voiding while standing. Therefore, some transgender men opt to undergo a secondary phalloplasty after metoidioplasty. Literature on secondary phalloplasty is scarce. Aim Explore the reasons for secondary phalloplasty, describe the surgical techniques, and report on the clinical outcomes. Methods Transgender men who underwent secondary phalloplasty after metoidioplasty were retrospectively identified in 8 gender surgery clinics (Amsterdam, Belgrade, Bordeaux, Austin, Ghent, Helsinki, Miami, and Montreal). Preoperative consultation, patient motivation for secondary phalloplasty, surgical technique, perioperative characteristics, complications, and clinical outcomes were recorded. Main Outcome Measure The main outcome measures were surgical techniques, patient motivation, and outcomes of secondary phalloplasty after metoidioplasty in transgender men. Results Eighty-three patients were identified. The median follow-up was 7.5 years (range 0.8–39). Indicated reasons to undergo secondary phalloplasty were to have a larger phallus (n = 32; 38.6%), to be able to have penetrative sexual intercourse (n = 25; 30.1%), have had metoidioplasty performed as a first step toward phalloplasty (n = 17; 20.5%), and to void while standing (n = 15; 18.1%). Each center had preferential techniques for phalloplasty. A wide variety of surgical techniques were used to perform secondary phalloplasty. Intraoperative complications (revision of microvascular anastomosis) occurred in 3 patients (5.5%) undergoing free flap phalloplasty. Total flap failure occurred in 1 patient (1.2%). Urethral fistulas occurred in 23 patients (30.3%) and strictures in 27 patients (35.6%). Clinical Implications A secondary phalloplasty is a suitable option for patients who previously underwent metoidioplasty. Strengths & Limitations This is the first study to report on secondary phalloplasty in collaboration with 8 specialized gender clinics. The main limitation was the retrospective design. Conclusion In high-volume centers specialized in gender affirming surgery, a secondary phalloplasty in transgender men can be performed after metoidioplasty with complication rates similar to primary phalloplasty.

Introduction Learning a new technique, even for an established surgeon, requires a learning curve; however, in transsexual surgery especially, there is a lack of professional and public tolerance for suboptimal aesthetic and functional results due to a learning curve. Aims In this context, we have tried to build a learning concept for vaginoplasty that includes four steps: (i) formal identification of the surgical steps in order to provide both measure of surgical process and measures of outcomes; (ii) training on cadavers with expert assistance; (iii) performing the live surgery with assistance from expert; and (iv) performing the surgery alone. Herein, we emphasize the second step of our learning concept. Material and Methods Between September 2013 and December 2013, 15 cadavers were operated on by an established surgeon learning vaginoplasty under assistance from two expert practitioners. Mean global time and mean time necessary to perform each step of the operation were recorded by the experts. Intraoperative complications were systematically registered. The final depth and diameter of the neaovaginal cavity were precisely measured. For each cadaver, the aesthetic results were assessed by one of the experts. Results Mean total operating time was 179 ± 34 minutes and decreased from 262 minutes for the first training attempt to 141 minutes for the last one. Intraoperative expert correction included modification of the scrotal triangular flap design and change of position of the urethra: This happened during the first training. No lesion of the urethra or of the anus occurred. The two experts judged the outcomes as excellent in seven cases, very good in four cases, good in two cases, and fair in two cases. Conclusion Despite the numerous reports on vaginoplasty in the literature, there is a real lack of published information on the learning curve of this operation. We make the hypothesis that introducing a learning concept with assistance from expert practitioners at the beginning of the surgeon's experience can optimize both the duration of his learning curve and reduce the risk of major complications.

Background The medial triceps brachii is vascularized by the middle collateral artery and the arterial circle of the elbow. This vascularization allows a distal pedicled use to cover soft tissue defects of the elbow. We report our experience using this flap to cover traumatic and postsurgical wounds. Methods Patients who underwent a pedicled medial triceps brachii flap procedure between 2008 and 2015 were included. Data concerning characteristics of the patients, wound size, surgical technique, and complications were retrospectively reviewed. An independent observer examined patients and assessed outcome of the coverage procedure: wound healing, scar length, range of elbow motion, and patient satisfaction. Results Eight patients were included (70.6 ± 17.7 years old at the time of surgery). All patients had serious comorbidities and risk factors of poor wound healing. Defects were due to postoperative healing complications (5 patients), skin necrosis secondary to an underlying olecranon fracture (1 patient), and direct open fractures (2 patients). Soft tissue defects had a median surface of 17 (14-22) cm2. The olecranon was exposed in 7 cases and the medial humeral epicondyle in 1 case. Mean procedure duration was 83 ± 14 minutes. There was no intraoperative or postoperative complication. All patients healed properly at 3 weeks of follow-up. No wound recurrence or surgery-related complication was reported after a median follow-up of 40.5 (21.5-69.5) months. Conclusion Favorable outcomes in all of our 8 patients make this flap an interesting option to cover small to medium-sized defects of the posterior aspect of the elbow.

Resume Un foyer septique peripherique peut etre le mode de revelation d’une fistule aortodigestive chez un patient porteur d’une prothese endovasculaire aortique. Nous avons pris en charge un patient de 69 ans pour un abces de la face anterolaterale de la jambe gauche. Le patient avait beneficie quatre annees auparavant d’un pontage prothetique aortobifemoral secondaire a la cure d’un anevrisme de l’aorte abdominale. Le bilan initial de recherche de fistule aortodigestive justifie par la presence de germes anaerobies retrouves lors du parage et de la mise a plat de l’abces, etait reste negatif. Le traitement de l’abces associait un parage et une mise a plat, un pansement a pression negative et une couverture de la perte de substance cutanee par un substitut dermique et une greffe dermoepidermique. Quelques mois plus tard, devant un retard de cicatrisation inexplique et l’apparition de signes generaux, un nouveau bilan a permis de mettre en evidence une fistule aortodigestive. De plus, les prelevements locaux au niveau de la plaie et les hemocultures retrouvaient tous deux de nombreuses colonies d’ Escherichia Coli . Le changement de la prothese aortobifemorale et la cure de la fistule aortodigestive ont permis la cicatrisation complete de la perte de substance cutanee de la jambe. Les fistules aortodigestives sont des complications des protheses endovasculaires aortiques au pronostic tres defavorable. De diagnostic difficile, leur suspicion clinique doit engager un bilan paraclinique complet. Toutes les plaies septiques chez un patient porteur d’une prothese vasculaire doivent faire evoquer le diagnostic de fistule aortodigestive.

We report our experience with the use of Integra® for the management of severe traumatic wounds of the hand. Fifteen patients were treated with follow-up ranging from 10 to 37 months. Wounds were associated with an osseous and/or joint and/or tendon exposure. Following Integra® placement, patients were managed with dressings and subsequent split-thickness skin grafting an average of 26 days later. Integra® was successful in achieving durable, functional and aesthetic definitive coverage in 13 of 15 applications while allowing a satisfying pollicidigital prehension. Regarding our clinical experience, Integra® is an effective technique to deal with severe wounds of the hand with exposed tendon and/or bone and/or joint, even in the absence of paratenon or periosteum. This can potentially lessen the need for local rotational or free flap coverage and should be taken into consideration as a viable alternative in traumatic reconstruction of the hand.

The prevalence of acellular dermal matrices in reconstructive surgery has increased through the last decade with satisfying outcomes. Long-term follow-up and effectiveness studies could enable appropriate use of these devices and challenge the current gold-standard treatments. This paper presents functional and cosmetic long-term outcomes on the Integra(®) Dermal Regeneration Template (IDRT) for treating traumatic soft-tissue defects of the foot and ankle.All adult patients who underwent severe traumatic foot and ankle reconstruction with Integra(®) since 2004 were retrospectively included. Results were evaluated using standardized outcome instruments.Twenty-one reconstructions were evaluated 4.5 ± 2.5 years after foot and ankle injury. Major complications inducing a second application included 1 hematoma and 1 infection. Seven patients (35%) had good or excellent Foot and Ankle Ability Measures. Subjectively, when asked to compare current function with pre-injury status, the mean response was 66 ± 23%. The Observer Scar Assessment Scale scored 17 ± 5 points (possible range, 5-50), while the Patient Scar Assessment Scale scored 30 ± 11 points (possible range, 6-60).Long-term functional and cosmetic outcomes 4.5 years after severe traumatic foot and ankle wounds treated with IDRTs were rated fair in the great majority of patients. Nevertheless, because complications and surgical revisions were few, potential benefits might be underestimated because of the initial combined injuries and their sequelae. In this way, for appropriately selected patients with severe traumatic foot and ankle soft-tissue defects, including subacute coverage, it appears that this treatment may be a viable first option.

Male-to-female sex reassignment surgery involves three main procedures, namely, clitoroplasty, new urethral meatoplasty and vaginopoiesis. Herein we describe the key steps of our surgical technique. Male-to-female sex reassignment surgery includes the following 14 key steps which are documented in this article: (1) patient installation and draping, (2) urethral catheter placement, (3) scrotal incision and vaginal cavity formation, (4) bilateral orchidectomy, (5) penile skin inversion, (6) dismembering of the urethra from the corpora, (7) neoclitoris formation, (8) neoclitoris refinement, (9) neovaginalphallic cylinder formation, (10) fixation of the neoclitoris, (11) neovaginalphallic cylinder insertion, (12) contouring of the labia majora and positioning the neoclitoris and urethra, (13) tie-over dressing and (14) compression dressing. The size and position of the neoclitoris, position of the urethra, adequacy of the neovaginal cavity, position and tension on the triangular flap, size of the neo labia minora, size of the labia majora, symmetry and ease of intromission are important factors when considering the immediate results of the surgery. We present our learning process of graduated responsibility for optimisation of these results. We describe our postoperative care and the possible complications. Herein, we have described the 14 steps of the Baudet technique for male-to-female sex reassignment surgery which include clitoroplasty, new urethral meatoplasty and vaginopoiesis. The review of each key stage of the procedure represents the first step of our global teaching process. 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 .

Lipomas are associated with a variety of symptoms including neuropathies, local compression of the surrounding tissues, aesthetic complaints and may be graded as liposarcomas histologically. This study was performed to review our surgical management at the level of the hand. Between 2008 and 2013, 14 patients were referred to our department for suspected adipose tumour of the hand. Preoperative MRI was used to assess tumour and surrounding tissue to plan the surgical therapy. We reviewed the clinical history, MRI findings, surgical approach, and outcomes. Complaints leading to consultation were pain in 11 cases, compression neuropathy in 7 cases, aesthetic concern in 8 cases, and limited wrist range of motion in 2 cases. Magnetic resonance imaging was performed in 13 cases, confirming the diagnosis of adipose tumour in all but two cases. These two cases were diagnosed in one case as a ganglion and the other as an epithelioid sarcoma. An amputation of the fifth digit was performed regarding the latter case and the patient received additional radiotherapy. The mean follow-up period was 32 ± 20 months. There was no recurrence of lipoma or sarcoma. MRI is useful for diagnosing and planning of the surgical intervention performed in the latter case adipose tumours. Rapidly evolving tumours with subfascial localization are absolute surgical indications. Incision biopsy is mandatory for entities of unknown dignity and for malignant tumours. Interdisciplinary tumour board meetings should discuss each patient before surgery is performed. IV.

Satisfaction with breasts, sexual well-being, psychosocial well-being, and physical well-being are essential outcome factors following breast augmentation surgery in male-to-female transsexual patients. The aim of this study was to measure change in patient satisfaction with breasts and sexual, physical, and psychosocial well-being after breast augmentation in male-to-female transsexual patients.All consecutive male-to-female transsexual patients who underwent breast augmentation between 2008 and 2012 were asked to complete the BREAST-Q Augmentation module questionnaire before surgery, at 4 months, and later after surgery. A prospective cohort study was designed and postoperative scores were compared with baseline scores. Satisfaction with breasts and sexual, physical, and psychosocial outcomes assessment was based on the BREAST-Q.Thirty-five male-to-female transsexual patients completed the questionnaires. BREAST-Q subscale median scores (satisfaction with breasts, +59 points; sexual well-being, +34 points; and psychosocial well-being, +48 points) improved significantly (p0.05) at 4 months postoperatively and later. No significant change was observed in physical well-being.In this prospective, noncomparative, cohort study, the current results suggest that the gains in breast satisfaction, psychosocial well-being, and sexual well-being after male-to-female transsexual patients undergo breast augmentation are statistically significant and clinically meaningful to the patient at 4 months after surgery and in the long term.Therapeutic, IV.

Introduction Traumatic soft tissue defect is a common issue for the trauma surgeon. The aim of this study was to evaluate the use of a dermal regeneration template (DRT) associated to a split-thickness skin graft (STSG) to cover severe traumatic wounds involving exposure of deep functional structures. Materials and methods Patients with severe traumatic defects, either open fractures or full-thickness skin wounds involving exposure of tendons without paratenon, bones without periosteum or joints without articular capsule, managed in the authors’ trauma centre, were included in a prospective fashion. They were treated by DRT, associated to STSG within a month and followed up to 18 months. The primary outcome was STSG percentage of take at 18 months. The secondary outcomes included complications rate, functional results, scar retraction rate at 18 months and aesthetic results. Results A total of 15 patients were included, with 100% follow-up at 18 months. The mean age was 44.3 years, with nine men. Eighty percent of the wounds were located on the lower limb. After 18 months, the mean STSG take rate was 99.3%. Between the placement of the template and the STSG procedure, the reported complications were template unsticking, seroma, local infection and local oedema. There was no reported haematoma. In terms of functional outcome, percentages of patients undergoing rehabilitation from the time of the skin graft until the end of the follow-up decreased from 80% to 20%. There was 8.7% of retraction in length, and an 8.2% retraction in width. The Vancouver Scar Scale score constantly decreased until 2.5 at 18 months. The final functional and aesthetic subjective scores showed the marks to be located above the ‘Satisfying’ threshold, either by the surgeon or by the patients. Discussion and conclusion Eighteen months’ follow-up demonstrated that DRT reconstruction is a simple, reliable, efficient tool to treat complex traumatic soft tissue defects.

Introduction Les brulures des paumes des mains de l’enfant sont le plus souvent observees entre 10 et 14 mois a la periode de l’apprentissage de la marche. Elles sont causees par un contact prolonge avec une surface chaude, le plus souvent un insert de cheminee ou un poele. La prolongation du contact brulant malgre le stimulus douloureux est en rapport avec l’immaturite des muscles redresseurs du rachis a cet âge. Il en resulte le plus souvent une brulure du 3e degre localisee a la paume de la main et a la face palmaire des doigts. L’excision tangentielle-greffe de peau precoce est actuellement le traitement de choix. Toutefois, aucune etude clinique randomisee et controlee, n’a montre la superiorite de la greffe de peau totale ou de peau fine pour la couverture de ces pertes de substance. L’objectif de notre etude est d’analyser les resultats fonctionnels et esthetiques a long terme de l’utilisation d’une greffe de peau fine dans cette indication afin d’informer les parents de l’evolution envisageable. Materiel et methodes Le service d’information medicale de notre centre hospitalo-universitaire a ete sollicite afin de retrouver au plus anciennement possible l’ensemble des enfants de moins de 3 ans le jour de la brulure ayant beneficie d’une excision-greffe de peau fine precoce pour brulure profonde de la paume de la main. Les patients et/ou leurs parents ont ete convoques pour une consultation chirurgicale au cours de laquelle, apres avoir obtenu leur consentement, les questionnaires POSAS et DASH etaient remplis. Une etude de la sensibilite fine etait egalement realisee. Les sequelles du site donneur etaient analysees. Les dossiers medicaux des patients etaient compulses afin de retracer l’historique chirurgical. Resultats Les donnees informatisees etaient accessibles a partir de 1994 ce qui a permis d’inclure retrospectivement 40 patients dans l’etude. Parmi eux, 20 ont ete vus en consultation. Les resultats des questionnaires etaient satisfaisants et la sensibilite des greffes etait normale. Les sequelles des sites donneurs de greffe etaient considerees comme mineures. Le suivi moyen a long terme etait de 10 ans. Les enfants beneficiaient en moyenne de 1,3 interventions reparatrices dans les suites des greffes de peau. Discussion Les resultats fonctionnels et esthetiques de l’excision-greffe precoce des brulures profondes de la paume des mains de l’enfant sont conditionnes par l’application rigoureuse d’un protocole de reeducation adapte. Malgre cette prise charge optimale, l’evolution a long terme est difficilement previsible car liee a de multiples facteurs comme la croissance, la « compliance » de l’enfant (relations parents/enfants), la localisation des brulures et leur rapidite de cicatrisation. Les resultats de notre etude montrent une acceptation esthetique des cicatrices et surtout une fonction proche de la normale a long terme. Toutefois l’evolution est emaillee par plusieurs interventions reparatrices de brides de la paume et des commissures. L’application clinique immediate des resultats de notre etude permet d’informer les parents sur l’evolution et de les rassurer pendant la periode initiale de prise en charge.

Recto-neovaginal fistulae (RNVF) are the most troublesome complications after the construction of a vagina for a male-to-female (MtF) transsexual. The majority are iatrogenic, most commonly the res...