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The authors summarize in those six pages of drawings the history of breast cancer reconstruction treatment. The focus is on the variety of techniques available for breast reconstruction and on the debates around different indications.

In this document, Pr Guy Magalon presents a reflection on the plastic pediatric surgery drawn from 30 years of surgical practice. His thinking is supported by several examples of plastic surgery results from children reviewed in adulthood. These cases highlight the evolution of surgical practices and the need for continuing education for surgeons to adapt to technical progress. Professor Magalon honors his masters and shares his personal vision of the principles of pediatric plastic surgery.

Revision rhinoplasty can be very challenging especially in cases of thin skin. Autologous fat graft is utilized in numerous applications in plastic surgery; however, its use relative to the nasal region remains uncommon. Adipose tissue, by virtue of its volumetric qualities and its action on skin trophicity, can be considered to be a gold standard implant. From 2006 until 2012, we have treated patients by lipofilling in order to correct sequelae of rhinoplasty. The mean quantity of adipose tissue injected was 2.1cm(3) depending on the importance of the deformity and the area of injection: irregularity of the nasal dorsum, visible lateral osteotomies, saddle nose. Following the course of our practice, we conceived micro-cannulas that allow a much greater accuracy in the placement of the graft and enable to perform interventions under local anesthesia. These non-traumatic micro-cannulas do not cause post-operative ecchymosis and swelling which shorten the recovery time for the patient. On patients who have undergone multiple operations, lipofilling can be a simple and reliable alternative to correct imperfections that may take place after a rhinoplasty.

To evaluate the efficacy of full-field optical coherence tomography to differentiate hypertrophic and keloid scars on ex-vivo tissues.All patients who underwent resection of pathological scar from November 2012 to September 2013 were analyzed. The scars were fixed in formalin and analyzed by conventional histology and full-field optical coherence tomography. The criteria for evaluation were: presence of dermal nodules, presence of cells and hyalinization of collagen.Nineteen pathological scars were analyzed. Histology found 7 keloid scars, 7 mixed and 3 hypertrophic scars. The sensitivity of optical coherence tomography for the detection of dermal nodules was 100%. This technology was not helpful for detection of cells and hyalinized collagen.In the present state of technology, optical coherence tomography did not identify the presence of cells, which makes the differential diagnosis difficult in the case of hypertrophic and keloid scars.

We present in this original article a histological study of surgical skin residues.This study was realized in order to show, in objective way, skin diversity according to sex, age and area, and to illustrate some current surgical practices of our speciality.Two years along, 141 patients was selected, 69 Men and 72 women. Fifty-four biopsies were realized on the upper extremity, 34 on the trunk and 53 on legs and arms. The histological study was based on two steps; the first one was a classic quantitative study, with measurement of each cutaneous layer, and objective evaluation of elastic density in superficial dermis. The second one was a descriptive histological analysis of each cutaneous area.The results coming from the quantitative analysis, allowed us to establish a classification of all the areas, according to each parameter. These results are globally compliant to the literature. The results of the descriptive analysis, lead us to conclude that it exists a lot of different skins with regional specificities. Then the crossover of the two analyses allowed us to define good practices tricks, in order to choose the best reconstruction technique for each area.This study is just a rough draft of a dynamic skin cartography adapted to our surgery. But it allowed us to confirm our basic premise: it doesn't exist only one skin but many skins.

Keloid scar is a proliferative healing dysfunction formed by an excessive build-up of collagen fibers on the dermis. It is responsible of aesthetic and functional disabilities. There is no ideal treatment and recurrence occurs very often. Keloid scars occur only to human, that's why animal model needs to be made to study this pathology and new treatments. Few models have been described using human keloid scars implanted into subcutaneous tissue of nude mice or rat. To allow study of topical and laser treatment we have developed a new animal model using human keloid scar fragment with epidermal and dermal tissue implanted into back of nude mice like a full thickness skin graft. Keloid fragments from five donors have been grafted onto 40 nudes mice. Macroscopic and microscopic studies have been made at day 28, 56, 84 and 112. We observed integration of the fragments in all cases. Hyalinized collagen bundles were observed in all implant biopsies confirming the stability of the keloid architecture within 112 days. This model is easily reproducible and allows the study of topical treatment and laser due to the accessibility of the keloid.

This article describes the concomitant presence of two anomalous muscles on a left forearm in a 40-year-old man. The anconeus epitrochlearis muscle was responsible for a cubital tunnel syndrome and the unusual origin of the flexor digiti minimi brevis muscle was responsible for a compartment syndrome with ulnar nerve compression at the level of Guyon's canal during effort diagnosed by MRI. Resection of these muscles relieved the symptoms and allowed the patient to return to work.

Burn contractures are common after deep burns of the limbs. When rehabilitation fails to restore joint function and normal range of motion, surgical contracture release should be performed. Different plastic surgery techniques can be used, from Z-plasty to skin grafts, artificial dermis and flaps. Surgery can also be used in case of esthetic concerns. Available surgical techniques and indications are presented.

The deep nasolabial fold (NLF) due to age is a frequent complaint from patients in plastic surgery. Various surgical and medical management solutions have been described in literature and are often based on different concepts to justify their interest. We present a new surgical treatment of this region using a temporalis superficialis fascia graft in order to fill the NLF. We also propose a review of the literature about the anatomy and the physiology of this major fold of the face.From 1990 to 2010, we practiced the replenishing of the NLF using a temporalis superficialis fascia graft on 24 female patients. They all were presenting NLF of great or mild importance due to ageing. We also performed on patients with a great importance NLF a lipofilling of the cheek and the lips in order to recover the volumes lost with ageing. The evaluation items were the quality of the filling (importance and symmetry), quality of the scars and complications occurring on the donor and receiving sites.Objective and subjective results were good. Projection of the NLF was in most of cases strongly and durably restored.Filling of the deep nasolabial fold using a temporalis superficialis fascia graft is a simple and reliable technique. Depending on the patients this method can be associated with a lipostructure of the cheek and the lips in order to optimize the facial rejuvenation. According to us this tissular implant allows a long lasting and important correction of the NLF.

The Turner's syndrome encompassed several conditions, of which monosomy X (absence of the entire sex chromosome X) is most common. It is a chromosomal abnormality in which all or part of the sex chromosomes X is absent. Typical females have two X chromosomes, but in Turner's syndrome, one of those sex chromosomes is missing or presents abnormalities. Patients show a shield shaped thorax with thick and bulging chest, breast hypotrophy and widely spaced nipples. The objective of this study was to characterize the breast abnormalities observed in Turnerian.We describe a prospective multicentric study (August 2007-March 2008) on 21 nullipar patients, ranging from 16 to 35 years old. Six were monosomic and 14 were Turner mosaic (in this case the chromosome is missing in some cells but not others), 19 were treated with estrogens and progestatives. This study was achieved through the use of clinical examinations including body, waist, hips (BWH) measurements and photography. The statistical method involved a descriptive analysis, linear correlation calculations and student test.The breast morphology appears to be quite closed to that of the general woman population, but with average thorax volume more bulky mainly in the anteroposterior zone, and with more reduced breast volumes. No specific abnormalities in the chest development were observed. No differences in the hypotrophy, hypertrophy, and normal breast volume repartition were observed between monosomic and mosaic patients. The self-satisfaction index on the breast look is quite low, patients mainly complain about breast hypotrophy. Nevertheless, these results are not representative of the whole turnerians, since this study address only to volunteer patients and we cannot exclude possible distortions.In contrast to common beliefs, we don't have observed any increase of the average of the internipple space; this observation is in good agreement with the most recent published literature works, which report only an apparent increase of this intermamelonary distance versus the thoracic width (in front view), probably caused to an optical distortion effect.

Treatment of obstetrical brachial plexus palsy (OBPP) is always debated, especially for upper plexus palsy. Some authors perform early surgical treatment in case of absence of biceps contraction at the age of 3 months. Others prefer to wait until the age of 6 months before considering a surgical procedure when no suspicion of root avulsion is found. We think that a conservative approach with intensive rehabilitation program can obtain good functional outcome for patients who will recover biceps function spontaneously between 3 and 6 months, and that it is not necessary to perform surgery at 3 months. To argue our choice, we have compared the long-term outcome of two groups of children with upper OBPP conservatively treated regarding the age of biceps recovery (before or after 3 months).Twenty-two patients with non operated upper roots birth palsy, followed in Timone's Hospital of Marseille by a multidisciplinary team, have recovered a biceps contraction between 1 and 8 months and were retrospectively included in this study. All children underwent an intensive rehabilitation program since birth, performed by a specialized physiotherapist. Patients were reviewed, and their shoulder function was assessed using Mallet score. The score was analysed regarding the age of biceps recovery.The mean follow up was 8.2 years. Nine children recovered a biceps contraction at 3 months of age or before; the mean global Mallet score was 4.11. Thirteen children recovered a biceps contraction after 3 months of age (between 3 and 8 months); the mean global Mallet score was 3.92. The difference was not statistically significant.This study shows that global shoulder function is comparable for two groups. The children who did not recover a biceps contraction at 3 months of age had a global shoulder function as good as the one who recovered biceps function earlier. We think our intensive rehabilitation program allowed us to avoid a useless early surgery. Surgical plexus treatment was indicated for children who did not have biceps contraction after 6 months of age.

Grace to the creativity of surgeons and the introduction of new technologies, second half of the XXth century opened the era of innovations and decisive progress. At the same time, however, is born the feeling of distrust and claiming which has come with the graving and threatening juridiciarisation. The evolution of complex structures of our society joined the ingenuity researchers unlimited makes formal law and the legal framework constantly to adapt oneself to circumstances. In the field of surgery, it's necessary to make work in integrity the innovation and protection at the patient's and their dignity. The legal framework that governs today innovation in surgery must still to go further and will precise. Dignity, compelling paradigm for all those who seek to better understand and better protect human starred as impassable limit any search and any experimentation. To make this chapter more alive, we have supplemented it and illustrated by the testimony some of the most fruitful French last years innovative in order to enrich our thinking of the fruit of their large and brilliant experience.

Ecthyma gangrenosum is a cutaneous infection, which result from a Pseudomonas aeruginosa septicemia, encountered in most of the case in immunocompromised people. Authors demonstrate the important role of the plastic surgeon in the diagnosis and therapeutic management of the disease in children. An eight-month-old infant has been hospitalized for acute leukaemia. She developed an extensive painful macule in the buttocks and perineal area in a septic context. A multidisciplinary management allowed to set up an adapted antibiotherapy, an early escharrotomy, a protection of the wound by digestive and urine derivation and a reconstruction with wound healing by second intention and split thickness skin graft, which lead to a good quality cure and wound healing at the end of 37 days of evolution. This case demonstrates the importance of the surgical management in the treatment of ecthyma gangrenosum. The wound healing associated with a split thickness skin graft seems to be the less invasive solution in a frail patient and the fastest to re-start the chemotherapy.

Vascular anomalies are a complex pathological group. They are composed of hemangiomas and other vascular tumors and congenital vascular malformations: venous, lymphatic, arteriovenous and capillary malformations. The management of these anomalies is difficult and must involve an interdisciplinary approach. To help patients to understand their pathology, we have made some information documents.

The aim of this study was to review and present our experience with pedicled flap reconstruction of lower limb defects with particular reference to choice of flap, complications and pre-existing health disorders.A retrospective review of lower limb reconstructions by pedicled flaps was carried out by the plastic and reconstructive surgery unit at Marseille's hospitals from January 1st, 1997 to December 31st, 2007. This study evaluated patients satisfaction and complications rate.During 10 years, 152 patients had 157 local flap reconstructions of lower limb defects. General patients satisfaction was 94% with 80% good or very good results and 20% of medium results. There were 16 immediate complications with three total necrosis, four partial necrosis, six hematoma, and three infections. There were nine late complications including wound dehiscence and graft instability. There were 11 functional sequels and 40 aesthetic sequels secondary to flaps.The current study presented our experience with locoregional flap reconstruction of lower limb defects. Lower limb reconstruction used a lot of locoregional flaps which had their own advantages and disadvantages. Their indication depended on the fiability and quality of the donor site.

Several controversial issues concern pectus excavatum (funnel chest), the most common chest wall deformity. The pathogenesis of this deformity is uncertain, and there is no agreement as to its psychological, cardiac and pulmonary effects. An even more debatable point is the choice of surgical treatment among the more or less radical proposals made by different teams. No consensus exists concerning the indications for surgery, the technique to be used, or the suitable age of the patient.This retrospective study concerns 10 patients with funnel chest who underwent reconstruction surgery in our unit between 1989 and 2002. Nine patients received a silicone chest implant made to measure, and one a single breast implant. Each patient was interviewed and examined to obtain information and provide a basis for evaluation. The effects of possible associated abnormalities were evidenced by complementary cardiopulmonary examinations, and the severity of funnel chest was evaluated according to the Haller pectus index.The mean period after surgery was 5 years. The effects of funnel chest deformity were essentially psychological, relating to aesthetic disgrace. Although two-thirds of the deformities were considered severe, cardiopulmonary repercussions were minor. All 10 patients were satisfied with the repair performed, and this judgment was independent of surgical assessment. Acute complications concerned 5 seromas and one minimal scar separation.The indications for surgery and the means of surgical treatment for funnel chest are considered after comparison of our results with those in the literature and a survey of the different existing possibilities for treatment (implant, chondrosternoplasty, fat transplant).

The aim of this work is to precise the indications to respect and the pitfalls to avoid in prosthesis setting using anatomical cohesive silicone gel implants.135 patients that undergone a reconstructive or cosmetic prosthesis setting were reviewed. Patients satisfaction has been assessed basing on the breast shape, consistency and symmetry. Complications (both usual and specific) were assessed and analysed. The results for mammary reconstruction after expansion or autologous flap and for cosmetic submuscular breast augmentation were good. Complications were unusual as far as the appropriate surgical procedure had been performed rigorously. These implants are an interesting alternative solution to round shape prosthesis in reconstruction indication. In breast augmentation border line indications, a beautiful result may be expected using these implants.

Cutaneous dermatologic lesions of LM, in type of superficial, translucent, localized or diffuse vesicles, are accessible to laser treatment. The useful lasers are essentially laser CO(2), and rarely pulsed dye laser and the Nd: YAG. Treatment by laser allows to obtain the ablation of vesicles by limiting aftereffects (scare) and so to dry up the transcutaneous lymphatic liquid. However laser has no action on the deep constituent of the LM and it's why medium and long term recurrences are inevitable. Finally, the indication of the laser must be retained only as a supplement to the surgery and has to be done by experimented persons.

Lymphatic malformations (LM) are the most frequent vascular malformations. There are three types of lesions involving lymphatic development that must be included in LM: vascular anomalies and knots (truncal malformations [TLM]); cystic anomalies, superficial or deep, uni- or multicystic (extratruncal malformations [ETLM]) and hemolymphatic anomalies which combine venous, arterial, or capillary malformations with LM. ETLM can be ubiquitously distributed but most are located in the cervical or axillary regions. Most ETLM are diagnosed at birth and in 80-90% of the cases before the age of 2. The clinical aspects are extremely variable: superficial ETLM (vesicular) and deep ETLM, localised or diffuse, mono- or multicystic. TLM are generally located on a lower limb with neonatal lymphatic oedema (often in a polymalformation context). All forms of the hemolymphatic combination can be identified. They are generally located on the limbs and are often unilateral. They are usually sporadic but can also be can be found in polymalformation syndromes (Klippel-Trénaunay, Parkes-Weber, Protée, Maffucci). ETLM generally tend to increase in volume and spread with age with stabilisation at puberty. They do not tend to spontaneously regress. Specific local complications can have serious consequences. They are linked to haemorrhaging, infections and compression phenomena. There can also be complications such as skeletal and soft tissue hypertrophy.

Lymphatic malformations remain a therapeutic challenge. Many treatments by the past led to poor success. The wide variety of clinical presentations makes it difficult to outline specific management programs. Often, diagnosis or complication circumstances as infection, bleeding, airway obstruction, or handicap force acting. Thus, a specific follow-up joined to a multidisciplinary analysis are the key of well-planned surgery. Through our experience and a review of literature, we will describe principles of lymphatic malformations surgery and specific technics for specific locations.

MAV surgery remains still today one of most difficult in the surgery of vascular malformations. Embolisation the most selective possible follow-up of a surgical removal carrying the totality of the nidus is the only effective treatment. Usually, MAV of small size, quiescent, should not be operated, the surgery being reserved for the evolutionary or complicated forms. This surgical procedure must allow the complete eradication of the lesion without which the cure is not possible. The incomplete removal causes repetition, sometimes aggravation with, sometimes, life threatening problems.

The understanding of vascular anomalies (vascular tumours and vascular malformations) was obscured, for a long time, by confusion and uncertainties in nosology and terminology. The International Society for the Study of Vascular Anomalies (ISSVA) recently adopted a classification scheme, clearly separating vascular tumours (hemangiomas of different types) which result from active cell proliferation, from vascular malformations, which are inborn defects in vascular morphogenesis. These two types of lesions have different clinical behaviour and require different diagnostic and therapeutic strategies. The most frequent vascular tumour is infantile hemangioma. Its clinical aspects and evolution are well-known. New data have been recently obtained concerning the phenotype of tumour cells and its histogenesis. Of the numerous new vascular tumours, which have been recently described, only the congenital hemangiomas, the vascular tumours associated with the Maffucci syndrome and the tumours that may be complicated by a profound thrombocytopenia (Kasabach and Merritt phenomenon) will be considered. Vascular malformations can be classified according to the vessel(s) types they are composed of. A classification table is presented, separating the malformations of vascular trunks from tissular malformations which are more intimately embedded in the surrounding tissues. The different syndromes associated with vascular anomalies take also place in this table. The clinical, imaging and histological aspects of the most frequent malformations (capillary, venous, lymphatic and arteriovenous) are presented. This classification intend to clarify the nosology and terminology of the complex field of vascular tumours and malformation and to offer a common language to the different physicians and specialists contributing, preferably with a interdisciplinary approach, to the diagnosis and treatment of these difficult lesions.

Capillary malformations do not demand mostly any therapeutics. For aesthetic reasons, family or child can demand a treatment to ease even to remove the unsightly character of the lesion. In this context, the means employees must be simple and not engender aftereffects more unaesthetic than the lesion. The pulsed dye laser fulfils perfectly this conditions by improving the color of the lesion without touching the texture of the skin. However it's a treatment requiring many sessions over 2-3 years. Surgery keeps an interest for the treatment of capillary malformations resistant to laser (in particular on the limbs) or to treat soft tissues hyperplasia met in certain cervicofacial locations. The surgery uses the whole techniques of plastic surgery classified from the most simple to the most complicated: excision-suture in one time or iterative, excision and coverage by a skin graft, use of skin expansion techniques with local flaps.

Hemangioma (HMG) is a benign tumour of the child generally evolving to spontaneous regression. Sometimes this evolution can become complicated in a more or less serious way according to its localization or of its importance. If local complications are, in the most of cases, without gravity, complications of a general nature like thrombopenia or cardiac failure may compromise the vital prognosis. There are in addition serious forms where, according to its localization or its importance, the HMG can compromise the aesthetic, or functional even vital outcome.

Infantile cutaneous hemangioma is a benign vascular tumour present at 10% of the infants. It forms part of the group of the vascular tumours in the classification of International Society for Vascular Anomalies (ISSVA). Clinical diagnosis is easy in its triphasic typical form with a phase of sometimes brutal postnatal growth, a phase of stabilization and a phase of slow secondary regression. Classically, it is presented in the form of a mass or stains cutaneous red, of a subcutaneous mass or, generally, of a mixed form associating the two aspects.

Nowadays managing a cutaneous malignant melanoma can concern different kind of physicians: dermatologists, general or plastic surgeons The primary surgical procedure is a major step of the treatment. Biopsy must be total to properly determine the thickness of the tumor in case of malignancy. Wide local excision of the scar is often necessary to decrease the local and general recurrence rates. Wide local excision must be performed conforming to its own surgical rules. Managing tumor located on the face or limb extremities is a matter of plastic surgery. Sentinel node biopsy has succeeded to elective lymph node dissection. This procedure allows research of lymphatic spreading of the disease. Practice of sentinel node biopsy must be achieved in a protocolar way. Topography of the lesion can modified achievement and results of this procedure. Prognosis benefit of sentinel biopsy is now clear. Elective lymph node dissection is only performed in case of invaded sentinel node or clinically invaded lymph nodes. Local or locoregional recurrences mainly respond to surgical treatment using wide excision. However, alternative solutions are being evaluated (isolated limb perfusion).

Laboratories propose a large variety of mammary implants, in which the multiplicity makes it difficult for the surgeons to choose. The objective of this work was to analyze the various features of the implants proposed by manufacturers, in particular the characteristics of the shell, the specificities of the filling, and the morphology of the implants. Nine laboratories sell ten brands of mammary implants on the European market. The laboratories are: Arion, Eurosilicone, Inamed Aesthetics, Mentor, Nagor, Perouse Plastie, Poly Implants Protheses, Polytech Silimed and Sebbin. All laboratories propose smooth or textured surfaces on the shell. Only one laboratory uses a surface covered by micropolyurethane foam. The fillings consist of a saline solution or a silicone gel. One laboratory provides a filling with hydrogel containing carboxymethylcellulose. The forms suggested are round or anatomical. The various models propose a variation on the projection for the round implants and a variation on the height for the anatomical implants. Analysis of the different catalogues makes it possible to underline the lack of precision in the terms of usage, in particular for the description of the form and the texture. It is unfortunate to have very little technical information and no clinical or biological information imposed by the European standard EN 12180. This prevents the surgeon from making his choice according to the real quality of the implants.

Compared to single mother-hood, the twin pregnancy results in important esthetic and functional sequelae of the abdominal wall. The considerable uterine growth involves a musculocutaneous diastasis of both the supra-umbilical and the infra-umbilical area. This study presents the modified abdominoplasty technique with an inverted T scar as the appropriate treatment of supra-umbilical and infra-umbilical musculocutaneous defects.This series reviews a total of 30 female patients of 35 years on average. There was no cases obesity or smoking reported. Surgical treatment consisted in a skin and fat resection following an inverted T scar design and associated to a muscle plication. In 6 patients it has been necessary to repeat the procedure in 6 months time.All 30 patients resolved with an aesthetic and functional improvement. No instances of abdominal diastasis recidivation occurred. There were no complication observed and no impact on the healing process was referred.on of the main differences between single and twin pregnancies is that the second ones are concerned by an abdominal diastasis marked on both a vertical and a transversal direction. The complete surgical treatment sometimes includes a second intervention. Clinical results and luck of complications suggest that the T-type abdominoplasty associated to a muscle re-tightening offers an appropriate surgical treatment of patients concerned.

The methods additional or substitution for the surgery of facial skin ageing are dramatically rising before 40 years. These methods are addressed more to the wrinkles and others signs of aging skin. They can constitute a door of entry in the aesthetic treatments and needs a professional approach. These noninvasive methods (within the meaning of the incision) can present complications this the more so as the tendency is with the vulgarizing and with under considerations of the initial diagnosis and the treatment itself. The devices of thermal effects consist of lasers, pulsed flashlamps and radiofrequency. The objective of this development is to consider the bonds, which link the initial diagnosis and the proposal for a treatment by considering side effects and complications of each method.

In the wake of three consecutive cases of microscopical examination of resection specimens following breast reduction revealing an adenocarcinoma, we wanted to point out the interest of a complete preoperative senological examination including mammography and postoperative anatomopathological examination. A retrospective study concerning 837 patients over a three-year period was conducted. We found seven patients (0.83%) with malignant breast cancer diagnosed on anatomopathological examination, which is comparable to the incidence found in literature. Of these seven cases there were four ductal adenocarcinomas (0.47%), all of them in situ (DCIS), and three lobular adenocarcinomas (0.36%) of which one invasive (ILA), one in situ (LCIS) and one mixed. The majority was aggressive, multifocal and bilateral. Treatment consisted of mastectomy with or without adjuvant therapy with curative intent in five out of seven cases, and this within two months after a esthetic surgery. In our opinion this shows that breast reduction can help in tracking down breast cancer and underlines the need for systematic and meticulous microscopic examination of resection specimens after breast reduction.

The request of care for facial aging has changed. Patients wish more and more a "natural" rejuvenation. The analysis of the different ways of aging shows that it is important to restore the mid-face volumes in order to obtain the fullness of youth. Numerous techniques have been used to increase the central volumes. After an historical study of the different methods, the authors present the new concepts that give a large place to lipostructure as described by Coleman. This technique can be used alone or in association with other techniques (lifting, collagen or other products injections...). The results are motivating; the process is simple and quick. The post-surgical oedemas are often important, but complications are exceptional. All these criteria correspond to current demands linked to aesthetic surgery considering medico-legal pressure. The future is based on the improvement of good grafts defining more precisely the factors of resorption of adipose graft tissues.

Resurfacing laser is one of the alternative treatment for cutaneous facial rejuvenation. Results are mainly good to excellent, but complications do occur with variable frequency.The purpose of this study was to identify and report the complications they occurred during eight years laser resurfacing and to study their possible avoidance. The author experiences are discussed in conjunction with a review of published reports.A retrospective analysis and chart review was performed in 749 patients who underwent cutaneous laser resurfacing with CO2 and Erbium laser by a single operator. Side effects and complications relating to infection, postoperative healing, pigmentary changes, and scarring were tabulated.The most common complication observed was postoperative erythema, which occurred in all patients. Hyperpigmentation was seen in 32% of patients and must be precociously treated. Dermatitis occurred in 10.6% of patients. Hypopigmentation and infections are rare (1%).Although laser resurfacing is a safe and effective method of facial rejuvenation, the cosmetic surgeon must be aware of the various complications that may be encountered. Prompt recognition of complications and appropriate management provide the best opportunity for an acceptable aesthetic outcome.

Split skin graft is frequently needed in the treatment of burned patients. Scalp is often free of burns. Due to its good skin quality and important surface, scalp is a very interesting skin donor site, specially in case of children. A controlled, randomised clinical trial was carried out in 10 French Plastic Surgery or Burns Units. It assessed the efficacy and the acceptability of calcium alginate dressing (Algosteril) versus paraffin gauze dressing (Jelonet) in the treatment of scalp donor sites in children. 67 children (mean age 54 months) entered the study, 34 in the alginate group and 33 in the control group. Follow-up visits were on day 2/d3, d5/d6, Day complete healing, d30 and d60 after surgery. The two groups were comparable on inclusion (demographic characteristics, burn nature and surface, donor site surface and thickness of split skin graft). The mean healing time was 10 and 11 days for Algosteril and Jelonet group respectively (ns). The quality of the newly formed tissue was estimated to permit a sooner skin reharvesting in the Algosteril group than in the control group (p = 0.003). Bleeding through dressing was significantly less important in the Algosteril group (p = 0.02). Changes were considered by investigators less painful with Algosteril on day complete healing (p = 0.0096). Hair growth is homogenous in both groups on day 30 and day 60 (ns). These results showed that scalp is a very interesting skin donor site and that Algosteril is of a real interest in donor site treatment.

The goal of the treatment of patients with cleft lip and/or cleft palate was: obtain a normal appearance, a normal speech and a normal growth without severe pertubations of the quality of life. Millard technique was used to repair the cleft lip in neonatal period. Between 6 and 18 months, the palate cleft was closed by wardill-kilner technique. A gingivoperiostoplasty with osseous graft was performed between 8 and 12 years. The orthodontic treatment began at 7 years. Pharyngoplasty was necessary in several cases. Sequellae and rhinoplasty was performed at the end of the growth. The authors explained their choices.

The main criticism against fat reinjection procedures is related to whether it is possible to graft adipocytes or not. The ideal solution would be to perform biopsies a few months after the operation to check the evolution of the grafted tissue, but such an approach would be difficult to accept for our patients. To overcome this difficulty the authors have compiled all the arguments that plead in favor of adipocyte grafts when Coleman's technique is used. Peer demonstrated in animal studies that it is possible to graft fatty tissue and that more resorption occurs when the fragments are large in size. The histologic studies have shown that the different stages of Coleman's technique do not alter the viability of the adipocytes. A disorganization of the architecture of the lobules is observed, but this does not compromise the theory of adipocyte grafting. An MRI study, performed on ten patients, demonstrated that the reinjected fat cells persist several months after the procedure. These fat cells presented the same characteristics as the patient's native fat in the surrounding area. This impression was confirmed by histological analysis of the reinjected fatty tissue 18 months after the graft. Finally, the clinical results obtained on over 200 patients treated for various indications in plastic and cosmetic surgery lead us to believe that it is possible to perform grafts of fatty tissue.

Based on data from the national advice of the Conseil National de l'Ordre des Médecins (French Medical Board), the author found 654 plastic surgeons in France and classified them into five categories, demonstrating the increasing proportion of females in this specialty.

The indications for skin expansion of the upper limb are now well defined. Based on a series of 56 cases, the authors confirm that a rigorous technique and good management of complications can minimize failures of the method. Technical progress and new biomaterials certainly allow further reduction of these complications and possibly the development of new indications.

Six cases of malignant melanoma were observed in children aged 5-14 years, over a 14-year period: both sexes were equally affected. In three cases, the melanoma was a primary tumor, which indicates that this diagnosis should always be born in mind in children and any suspicious lesion should be biopsied and removed. Three cases had a family history: dysplastic naevus in two cases and malignant melanoma in one case, which confirms the increased risk in some families. Histologically, nodular forms were more frequent than those which spread superficially and the tumors were quite thick when diagnosed (mean thickness: 3.9 mm). Treatment includes wide excision and coverage with skin grafts associated with immuno or chemotherapy in some cases. Mean follow-up was 38 months and no death occurred during this period.

The authors performed a prospective study of 100 consecutive cases of mammary hypertrophy. Sixty were treated by McKissock's technique and forty by Thorek's technique. The patients were reviewed at the second and sixth postoperative months. A general study of the population was performed to specific their demand, which was functional in 90% of cases, and the various symptoms were quantified. 74% of cases presented with psychological problems and a desire for aesthetic improvement was expressed by 67% of cases. Postoperatively, a functional improvement was obtained in 99% of cases, while psychological disorders resolved in 100% of cases. The satisfaction rate was very high: 79% of patients were very satisfied and 20% were satisfied. Some defects observed by the patients or surgical team are analysed. The complications observed, always minor, are reported. Breast reduction provides an unquestionable benefit for patients with mammary hypertrophy. Two simple and perfectly defined techniques were used to treat all these cases with a maximal satisfaction rate and a minimal complication rate.

The authors report a case of carcinoma cuniculatum plantar and review the literature on this rare tumour. The clinical features and course of this tumour. The clinical features and course of this tumour are successively described. Although associated with limited malignancy and almost exclusively local extension, progression of this disease may lead to amputation, which can be avoided by early diagnosis, especially based on precise histological examination of all tumours with a benign recurrent appearance after well conducted treatment.

The history of skin gaining techniques, concerns suture, skin extension and skin expansion. Although, for a very long time, suture and skin extension were intimately related and constitute the basis for current techniques, it was only from the second part of the 20th century that skin expansion was developed and that skin extension was submitted to specific studies.

The repair of defects by skin extension involves various procedures which are thoroughly described by the author. Skin extension is an original concept reflecting the viscoelastic properties of the skin and histological changes. It is based on 3 phenomena: "mechanical creep", "stress relaxation" and mobility of the skin. Although the various skin extension procedures present many advantages concerning the application and removal of the device, the conduct and monitoring of treatment as well as closure of the defect, its disadvantages must not be ignored. They are related to the material and to local conditions. The indications for skin extension are fairly wide. However, its ideal indication consists of closure of skin defects with loss of skin capital.

The indications for skin expansion in the limbs are now well defined. This technique is particularly irreplaceable below the knee, and allows the resection of very large lesions despite a minimal skin capital. More than in other sites, it is a difficult technique which requires rigour and a sound basis in reconstructive surgery. The operative plan must include precise assessment of the tissue gain with selection of prostheses adapted to local conditions. The techniques of insertion, filling and resection must be irreproachable. The functional and aesthetic indications are numerous and the technique often provides a minimal residual scar.

Skin expansion in breast reconstruction presents several specificities related to mastectomy, retromuscular dissection, and the oncological context. In delayed reconstruction (DR), the local clinical examination is essential to select indications and to eliminate high-risk cases (sequelae of radiotherapy, Halsted, etc.). Immediate reconstruction (IR) must be reserved for motivated patients in whom mastectomy represents the last stage of treatment. The patient must be well informed before the operation. The choice of expander depends on the width of the breast to be reconstructed. Precise drawings are made in the standing position. In the case of DR, the prosthesis is inserted retropectorally superiorly and subcutaneously inferiorly. In IR, a complete retromuscular compartment must be created. Inflation begins after healing at a weekly rhythm until the desired volume has been exceeded. Inflation is performed more slowly in the case of previous irradiation. The second stage is performed three months after the end of inflation. After removal of the expander, the periprosthetic capsule of the compartment can be modified when necessary. The choice of the final prosthesis, preferably with an anatomical shape, is critical in order to obtain the correct volume. When necessary, the inframammary sulcus can be reinforced by internal or external procedures. Other reconstructive procedures (symmetrization, areolar reconstruction) can be associated. The most serious complications are infection and exposure. Serous effusion, thoracic deformity, malposition and capsular retractions can affect the result. Apart from breast reconstruction, expansion of the mammary region is useful in congenital malformations (glandular aplasia, Poland syndrome, severe asymmetry) and in acquired developmental abnormalities. Expansion has several indications in cosmetic surgery for certain cases of augmentation mammoplasty, correction of tuberous breasts and revision of certain mammoplasties.

"Vacuum Assisted Closure" (VAC) is a noninvasive negative pressure healing process indicated in the treatment of chronic wounds associated with unfavourable local or systemic factors. It is indicated for the treatment of traumatic and/or surgical skin defects in order to accelerate the healing process. VAC is based on a simple technology of controlled depression of the lesion which healing process. It exerts a mechanical force on the tissues and attracts the wound edges centripetally. It induces an increased peripheral blood flow, improved local oxygenation and promotes angiogenesis and proliferation of good quality granulation tissue. Wound healing in a humid medium is complete or may require secondary surgical management (skin graft, flaps). The preferential indications for Vacuum Assisted Closure include pressure sores, leg ulcer, wounds with skin defects, burns, complications of surgical wounds and delayed healing.

Skin expansion material has progressed and now covers all needs in plastic and reconstructive surgery. Breast reconstruction occupies a special place among expansion techniques and requires specific material. The skin expansion technique was approved by French Social Security in 1995 and is now covered in both the public and private sectors. The skin expansion protocol is rigorous with no room for improvisation. It is only in this way that the quality of the result justifies the use of this technique.

Skin expansion in the lowers limbs has been described for a long time. The authors report their experience in this site. The operating technique is described in such a way as to limit complications to a minimum. The indications for this technique are recalled with particular emphasy on the use of expansion in preparation for a subsequent procedure. Lastly, the most frequent complications are discussed together with the methods of their prevention.